The impact of pregnancy on the pelvic floor

Alleviating pelvic floor dysfunction to restore wellness 

You’re expecting a baby, or just had a baby, and there’s a million different emotions you’re feeling.

Anxiousness.

Anticipation.

Joy and wonderment.

A sense of, “I’m not sure what to expect."

These strong emotions are all valid.

Pregnancy and the postpartum period, often called the fourth trimester, can be a wonderful journey filled with excitement and new experiences, but it will bring significant changes in a woman’s body, including the pelvic floor.

Pelvic floor dysfunction is a common issue that many pregnant and postpartum women face, yet it often remains undiscussed and overlooked.

There’s generally little to no education given to women about what to expect about their changing bodies or how to prepare their bodies for birth, which can lead to a big wake-call up call for many.

Before and after pregnancy

During pregnancy, the body is changing – a lot. There’s weight gain, hormones and a plethora of other changes, internal and external.

Among these substantial changes is the effect on the pelvic floor.

The pelvic floor is a mix of muscles, ligaments and connective tissue that fit together to form and support various organs in the body. One might say the uterus and pelvic floor have a “love/hate” relationship with each other during and after pregnancy.

Read on to find out why below.

As a woman gets further along in her pregnancy, the width of the hips increase as the uterus expands to accommodate the growing baby. This exerts pressure on the pelvic floor muscles.

This constant pressure can lead to stretching and weakening of these muscles over time.

Many women don’t realize that the pelvic outlet (the opening of the pelvis) can come in different shapes, and the amount of pressure on the pelvic outlet can vary.

There are women with:

• Narrow outlets (making a vaginal birth more difficult)
• Triangle outlets (causing the baby’s shoulders to get stuck during delivery)
• Oval shapes (ideal, making childbirth easier and putting less pressure on the pelvic floor)

Sometimes, vaginal birth can become too difficult, straining the body and necessitating a C-section. This additional strain on the pelvic floor muscles can lead to pelvic floor dysfunction.

This strain on the muscles makes them weak and can cause a feeling of “letting go.” This feeling follows into the fourth trimester, or postpartum time.

Common symptoms of pelvic floor dysfunction

Symptoms of pelvic floor dysfunction, in particular the constant feeling of “letting go,” are uncomfortable topics because they are highly personable, but honest conversation can bring important issues to light.

Some symptoms include:

1. Urinary/fecal leakage – peeing/pooping within your pants
2. Pelvic organ prolapse – occurs when pelvic organs, such as the bladder, uterus or rectum, descend into the vaginal canal due to weakened pelvic floor support. This can cause pain during sexual intercourse or a feeling of “something coming out.” Pregnancy and vaginal childbirth are significant risk factors for pelvic organ prolapse due to the stretching and weakening of pelvic floor tissues.
3. Feeling of pressure/heaviness in the pelvis – this pressure may manifest as a dull ache, sharp sensation or persistent discomfort in the pelvic region.
4. Ligament pain – this is pain often felt in the abdomen, hips or groin.
5. Pubic bone pain
6. Back pain

Recognizing the symptoms of pelvic floor disorders, for pregnant and postpartum women, is the first step toward seeking appropriate care and support.

Preparing the body in advance

As we already covered, during pregnancy, childbirth and postpartum, a woman’s body goes through many changes to support the growing baby.

The diaphragm pushes up, the ribs spread out, the abdominal wall is stretched and there is an increase in pressure on the pelvic floor muscles, bowel and bladder.

These changes can lead to pelvic pain, weakness and dysfunction postpartum. While these changes may be common, they are not normal.

Preparing the pelvic floor can contribute to a smoother pregnancy, easier labor and less complications with the pelvic muscles – meaning, you won’t need to worry about peeing your pants without your control.

If you want to get ahead of the game and not have to worry about developing symptoms of pelvic floor dysfunction, a pelvic health specialist can help.

Let’s go over the process:

1. Early pregnancy – Women can typically start to see a pelvic health specialist about halfway through their pregnancy, or 20 weeks. During this time, they will be educated on basic exercises to help alleviate pressure in the pelvic region, build core strength, what postpartum might look like and how to further prepare the body.
2. Close to giving birth – Around 36 weeks, a pelvic health specialist will help instruct the expectant mother how to push and use the pelvic muscles during contractions. They will optimize pelvic floor motor control and breathing techniques to aid in a successful labor and delivery. Also, they will provide instruction on how to do a perineal massage to reduce perineal injuries, such as tearing during childbirth.
3. Postpartum – Every woman will have a different postpartum experience, but pelvic health specialists can help guide them through the physical and emotional changes that come with postpartum, especially pelvic floor dysfunction symptoms. Frequently, postpartum women experience urgency/hesitancy/leaking with peeing or pooping as their pelvic muscles are disjointed. They might also experience constipation, painful sex, scar tissue discomfort, pelvic organ prolapses, pelvic congestion, back pain and public pain.

Exercises to support the pelvic floor

While it’s natural for mothers to prioritize the health of their growing baby, maintaining their own fitness can be equally important.

In recent years, there has been a shift in understanding the benefits of exercise during and after pregnancy, with many health care professionals advocating for safe physical activity throughout all trimesters, even postpartum.

Pregnant and postpartum women can see a pelvic health therapist to learn how to safely exercise and improve function of the pelvic floor muscles.

Exercises during pregnancy

Below are some basic exercises, but the most recommended one is to walk for about 30 minutes a day at an easy pace, focusing on calm breathing. If, prior to pregnancy, you were used to weightlifting or intense workouts, a pelvic health specialist can also help with modified positions for basic weightlifting and aerobic exercises.

Common exercises conducted during pregnancy:

1. Four-point kneeling – strengthens and tones the abdominal muscles
2. Seated leg raises – strengthens abdominal muscles and helps with balance/stability
3. Seated overhead triceps extension – strengthens the triceps and chest muscles, while also working the abdominal and hip muscles
4. Ball wall squat – strengthens the buttocks and muscles of the legs
5. Ball shoulder stretch – strengthens the upper back, arms and shoulders
6. Seated side stretch – eases tension on either side of the body and stretches the hip muscles
7. Kneeling heel touch – tones muscles of the upper and lower back and abdomen
8. Standing back bend – helps counteract the forward slouch that happens during pregnancy as the uterus expands

Regular, safe exercise during pregnancy can improve posture and decrease common discomforts such as backaches, constipation, bloating, swelling and fatigue. By strengthening your pelvic floor muscles, you can develop the ability to relax and control these muscles in preparation for labor and postpartum.

Postpartum care

Postpartum is a time of major adjustment and wanting that “back to normal” feeling.

The journey of pregnancy and childbirth, no matter which mode of delivery, can take a toll on a woman’s body, leaving her with various physical challenges in the postpartum period.

From weakened pelvic floor muscles to abdominal separation (diastasis recti), these changes can impact a woman’s overall well-being and quality of life. These physical changes, if left unaddressed, can persist well after childbirth, affecting a woman’s ability to perform daily activities comfortably.

This is why seeing a pelvic health specialist is crucial for recovery and getting back to feeling like yourself. 

Postpartum physical therapy is focused on strengthening the abdominal wall and pelvic floor, but a pelvic health therapist can also help improve mood and well-being. A pelvic therapist will provide a personalized program to help address your needs and goals.

First, they’ll listen to your concerns and assess the status of your abdominal wall and pelvic floor. Then, they will explain their findings and set a plan of care to help you achieve your goals.

A pelvic health specialist may include these exercises and techniques in a rehabilitation program:

1. Diaphragmatic breathing – a specialist can help teach you how to breathe in a way that engages the core muscles. This will improve core stability and help repair diastasis recti.
2. Pelvic floor exercises – Kegels. Tighten your pelvic floor muscles (the ones used to stop the flow of urine) and hold for 10 seconds. Repeat.
3. Swiss ball bird dog holds – this exercise helps with posture, stability and reduces lower back pain because of pelvic floor dysfunction. This exercise is conducted on a stability or exercise ball.
4. Cat-cow in tabletop – this is typically a yoga stretch, but this move supports the lower back muscles, strengthens the core and promotes mobility in the spine.
5. Swiss ball glute bridge – this exercise is good for core stabilization and the pelvic floor. It targets the abdominal muscles, glutes, quadriceps and hamstrings.

Remember, postpartum, or the fourth trimester, is a time to focus on what your body needs and how to ease back into normal.

If you want to get ahead of the game and get your body prepared, seeing a pelvic health specialist will help guide you in the direction of taking back your physical and emotional health.

Don’t ignore that sudden pain or bulge in your pubic area.

Don’t ignore that feeling of peeing your pants when you laugh or sneeze.

Don’t ignore that feeling if something feels “off” in your body.

Be kind to your body and take care of you.

You and your baby deserve this type of specialized care.