The pelvic floor: that well-known unknown that people have only recently started talking about, but which remains a mystery to many.

The pelvic floor is the internal muscular component of the perineum, the anatomical region at the base of the pelvis bounded at the front by the pubic symphysis, at the back by the coccyx, and on the sides by the ischial tuberosities. It is made up of skin, muscle, fascia and ligament tissue that together close off the lower part of the abdomino-pelvic cavity.

To put it simply, the perineum can be described as the part of our body that rests on a bicycle seat.

The function of the pelvic floor and the muscles that make it up is to surround, support and hold in place the pelvic organs, such as the bladder, uterus and bowel.

This area, which women are not always fully aware of, is essential to every woman's health and wellbeing, since it is involved in important physiological mechanisms such as urinary and fecal continence. It ensures the quality of sexual and reproductive life, supports pregnancy, and helps with the expulsion of the baby during childbirth.

Only recently, since the late 1990s, has medicine also begun to recognize its importance, acknowledging Perineal Rehabilitation as a scientifically established field, deepening the pathophysiological study of dysfunctions and focusing attention on prevention, treatment and rehabilitation.

It is therefore essential for every woman to know and have a correct perception of her own pelvic floor, in order to preserve the integrity of this muscle group which, if not trained, can lose strength and elasticity. Physiological conditions such as pregnancy, childbirth and menopause, or everyday actions that cause increases in abdominal pressure (a sneeze, a cough, constipation or lifting weights), can put the perineum at risk, with repercussions on how it functions.

Among the events in a woman's life that most affect the functioning of the pelvic floor, pregnancy and childbirth are among the main causes of pelvic-perineal dysfunction, although there is a degree of individual variability from woman to woman depending on tissue type (some are more resilient than others), age, and how well the perineum was prepared during pregnancy.

The signs that can indicate weakness in this muscle group, which women may report, involve the genital and sexual sphere: a feeling of heaviness in the lower abdomen, urinary or fecal incontinence, for example when coughing or sneezing, constipation, or difficulty having sexual intercourse.

During pregnancy, the pelvic structures, already loosened and made more yielding by pregnancy hormones, are put under considerable strain, having to support and counteract the weight of the pelvic organs and the uterus, which increases in volume due to the presence of the fetus, amniotic fluid, placenta and related structures.

During pregnancy, prevention is based on adequately preparing the expectant mother, helping her become aware of her own perineum. For this reason, it is useful and recommended to attend antenatal classes with midwives, where women learn not only techniques for the correct use of the pelvic floor but also strategies to reduce the risk of damage during childbirth.

Childbirth is a natural event that is not free from complications affecting the perineal structures. By actively contributing to labor and to the baby's passage through the birth canal, even when the expulsive stage occurs physiologically, internal organs such as the bladder and rectum are compressed and the perineal muscles undergo considerable stretching, sometimes even tearing. It is therefore common for the perineum to sustain injuries that can compromise the normal support of the pelvic organs.

Perineal damage that can occur during childbirth can be prevented not only through adequate preparation during pregnancy, as mentioned above, but also through appropriate obstetric practice in the delivery room, aimed at protecting the perineum and honoring the moment of birth as an act of love. This means providing a welcoming, protected environment that fosters the woman's calm and privacy, reducing the tension that would otherwise make it harder for the baby to be born.

The postpartum period makes it possible to identify women who are at risk of developing a pelvic-perineal dysfunction, or those who already have one, and to refer them to a targeted, personalized treatment path with midwives specialized in pelvic floor rehabilitation. This combines an educational approach with a range of techniques and specific medical aids.

Exercises and the recovery program should be resumed, or started, from the 6th to 8th week after childbirth, gradually, in order to restore muscle contractility, reabsorb swelling and improve local circulation. Generally, these perineal dysfunctions, if short-term, can be recovered within 12 to 18 months.

In the postpartum period, the goal of rehabilitation is the anatomical and functional recovery of the perineum. To this end, it can also help to give new mothers some simple behavioral tips that can reduce or prevent factors that favor the onset or worsening of dysfunctions, such as:

  • practicing good intimate hygiene
  • reducing or avoiding constipation by promoting regular bowel function through proper diet and hydration, and allowing time for physical activity such as a simple walk to stimulate bowel motility
  • emptying the bladder only when the urge is felt, in proportion to the amount of fluids consumed
  • maintaining correct posture while urinating and having a bowel movement, avoiding straining
  • adopting positions during breastfeeding that do not put strain on the perineum
  • avoiding persistent coughing (caused, for example, by cigarette smoke)
  • not lifting excessively heavy loads
  • not doing heavy work without the appropriate aids
  • urinating and practicing good intimate hygiene before and after sexual intercourse
  • avoiding excessive weight gain
  • avoiding intense abdominal training in the first 6 weeks after childbirth; it is in fact recommended to focus first on perineal rehabilitation and only afterward on abdominal exercise, favoring physical activity that does not put excessive strain on the perineal floor

It is important to reiterate that at every stage of a woman's life, it is possible, with the right approach and timing, to support the health of this often little-known and easily forgotten part of the body.