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Dear Dr. Myrtle,
I've heard rumors about women losing vaginal tone and becoming loose after childbirth. Is that true?
 Some skin and pelvic floor tone is lost through pregnancy and childbirth because the weight of the pregnancy and the compression of internal organs stretches out the pelvic floor. If the woman does not have good pelvic floor strength before becoming pregnant, the process of pregnancy is more likely to stretch weaker muscles.
This strength loss is also made more difficult if the woman stands all day long during her pregnancy (think hairdresser, for example). The steady pressure downwards puts a constant strain on the muscles and ligaments of the pelvic floor, and leaves her with a whopper backache, besides.
The good news: it is possible to gain most or all of the pelvic floor strength back. - Breastfeeding releases a hormone called “oxytocin”, which naturally restores some of the tone of the pelvic floor muscles and ligaments.
- Pelvic floor exercises (Kegels) will specifically strengthen the muscles.
- Always begin practicing your pelvic floor exercises while lying on your back. These muscles are weaker now, and taking the abdominal pressure off helps to feel them again.
- Concentrate on regaining the conscious contraction of your pelvic floor muscles, and make sure that you contract the muscles in the front (near your urethra), as well as the muscles deep in your vaginal space, all the way back to your tail bone. I like to think of zipping up a zipper, slowly from front to back, holding for 2 secs then relaxing the entire zipper, followed by a deep breath.
- Focus on long, slow contractions of about 10-12 seconds total. Fast isn't good here: strength of the pelvic floor is much more about your ability to hold strong, long contractions, than tightening your muscle groups quickly. (Keep the quickie idea for some other activity.)
- Gradually work up to 20 long-strong contractions in the morning, and another 20 at night, but don't push too fast. You want to think of strengthening the muscles, not fatiguing them by feeling the burn. Go to the number that you can complete fully, with strength. If you can do that for 2 days in a row, then add one more contraction/relaxation.
- Remember, you aren't pushing out, you're pulling in. If you find yourself pushing/bearing down and/or holding your breath, you might benefit from a biofeedback tool to help you exercise these muscles correctly.
- Also, consider that orgasmic contractions of the pelvic floor are revitalizing! Because the floor muscles naturally stretch while carrying a pregnancy, your early postpartum orgasms may feel less intense. When you’re ready, regular orgasms are one of the best ways to increase the strength and flexibility of your pelvic floor muscles.
If you're losing any urine with coughing, laughing, etc, this is related to the weakness of your pelvic floor, and will lessen as your muscles strengthen. Remember to empty your bladder more often than you used to, and always empty your bladder before practicing your Kegel exercises. The pressure of urine won't help you to contract your pelvic floor muscles.
With focused attention, you can significantly strengthen your pelvic floor again. If you need some biofeedback tools, consider the Exercise Egg or the Energie Exerciser. Both of these products give you more information about exactly which muscles you're working on, making it easier and more effective to regain strength.
Take Care.
Dr. Myrtle
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