Those problems can include struggling with incontinence (i.e. peeing yourself), holding back gas, and, in more severe cases, dealing with a health condition called uterine prolapse, which is where the uterus actually slips down into the vagina or protrudes out it, explains Cora Biese, DPT, PRPC, a physical therapist at Corewell Health who’s certified in pelvic floor rehab.
- Ashley Rawlins, DPT, doctor of physical therapy specializing in women’s health
- Cora Biese, DPT, PRPC, physical therapist at Corewell Health who’s certified in pelvic floor rehab
- Lauren Streicher, MD, OB/GYN and author of Sex Rx-Hormones, Health, and Your Best Sex Ever
- Lisa Hickman, MD, an OB/GYN at The Ohio State University Wexner Medical Center
Despite all that, pelvic floor health information isn’t something that’s regularly discussed, even at your doctor's office. “Most women don’t even know that they have a pelvic floor, let alone if it's working for them,” says Lisa Hickman, MD, an OB/GYN at The Ohio State University Wexner Medical Center. “It’s often not even on their radar until it's a problem.”
If you’re pregnant or thinking about trying to become pregnant in the near future, it’s understandable to have questions about what actually happens to your pelvic floor during this time of massive change in the body. Here, OB/GYNs and pelvic floor physical therapists break it down.
How can you tell if your pelvic floor is weak?
It can be tricky to tell if you’re lacking strength down below. “Sometimes you don’t know if your pelvic floor has problems,” says Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine. "There are people that don’t have a perfectly healthy pelvic floor but don’t have noticeable issues.”
The best way to truly understand your pelvic floor status is to see a pelvic floor physical therapist for an evaluation, says Ashley Rawlins, DPT, pelvic physical therapist and clinical specialist at Origin. But there are certain symptoms that can clue you in that your pelvic floor isn’t as strong as it could be. According to Dr. Rawlins, those include:
- Bladder leakage
- Bowel leakage
- Having trouble holding back gas
- Feeling like you’re falling out down there
- Low back or pelvic pain
- Decreased sensation or trouble orgasming during sex
How does pregnancy and childbirth impact your pelvic floor?
“Pregnancy is at the top of the list for risk factors for pelvic floor problems,” Dr. Streicher says. “Pregnancy is a big stress test for the pelvic floor.” According to the Mayo Clinic, around 50 percent of pregnant people struggle with symptoms of pelvic floor disorders.
Your entire body changes and adjusts during pregnancy to help you grow and give birth to a baby, Dr. Rawlins points out, noting that elements like posture adjustments, softening joints, and a wider pelvis can all impact your pelvic floor health. “Research shows that your pelvic floor can soften and change shape during pregnancy, which can impact the integrity and performance of the tissues, leaving you at risk for pelvic floor muscle injury,” Dr. Rawlins says.
The extra weight of the fetus and placenta add stress on the pelvic floor muscles, according to the Mayo Clinic, and straining from constipation (which is all too common in pregnancy, particularly the third trimester) can also weaken the pelvic floor muscles and nerves. Meanwhile, the hormone relaxin, which is secreted to help the pelvis open up enough to pass a baby, also leads to additional instability in the pelvic floor.
Childbirth also puts stress on your pelvic floor muscles, whether you have a vaginal or C-section delivery, Rawlins says. “During a vaginal delivery, the pelvic floor muscles have to stretch several times their natural length in order to accommodate the baby’s head, and it has been shown that up to 85 percent of birthing people experience some sort of perineal injury during vaginal child birth as a result of the forces and strain placed on it during delivery,” Dr. Rawlins says. That can have an impact on your pelvic floor strength, she says. Studies show that those who have had more than one vaginal delivery are at greater risk for pelvic floor dysfunction.
“Cesarean sections aren’t protective for developing pelvic floor dysfunction either,” Dr. Rawlins says. “While weakness is less likely, research has shown that muscle pain and dyspareunia (pain during sex) are more common for those in the first year after a cesarean.”
How to prepare your pelvic floor for pregnancy and childbirth
Hickman says it’s important for anyone with a vagina to work on strengthening their pelvic floor. “The most simple way is to do Kegel squeezes, like you're trying to pick up a marble with the vaginal muscles,” she says. This is even something you can do after you become pregnant, Hickman adds.
If you’re already going into pregnancy with signs of a weak pelvic floor, Rawlins recommends doing pelvic floor muscle training (PFMT). “This has been shown to reduce the chances of developing incontinence in pregnancy and in the postpartum [period],” she says. (Note: This is something you’ll need to consult a pelvic floor physical therapist about to make sure you’re doing correctly.)
“You also want to make sure that, in addition to strengthening your pelvic floor, you want to work on its flexibility as your due date approaches,” Dr. Rawlins says. “Flexibility is not only important for optimal strength—a tight pelvic floor can also be weak, as tightness can inhibit a muscle’s ability to transmit force—but flexibility is imperative in minimizing pelvic floor birth injuries as well.”
Signs to consider seeing a pelvic floor therapist after giving birth
“In a perfect world, everyone would see a pelvic floor therapist routinely after giving birth,” Dr. Streicher says. “But that's not realistic and it isn’t going to happen.” Still, there is a laundry list of more urgent reasons to see a pelvic floor therapist after delivery. Dr. Biese breaks it down:
- Leaking pee
- Bowel leakage
- Pelvic pain (internal or external)
- Constipation or pain when you try to poop
- Trouble returning to normal activity after you give birth
- Pain in your back, pubic area, tailbone, or hips
- Vaginal heaviness and pressure
If you’re experiencing any of this, Dr. Biese recommends contacting your OB/GYN to ask for a referral to a pelvic floor physical therapist or simply contacting one directly. She also notes that you don’t need to wait six weeks to see a physical therapist after giving birth, even though that’s sometimes thought of as the typical timeline. “There is no one-size-fits-all for postpartum recovery,” Dr. Biese says.
Dr. Rawlins agrees. “Pelvic physical therapy is safe to start as soon as you are able to be home to recover,” she says. “It is never too early or too late to see a pelvic physical therapist to improve your pelvic floor health.”
- Routzong, Megan R et al. “Pelvic floor shape variations during pregnancy and after vaginal delivery.” Computer methods and programs in biomedicine vol. 194 (2020): 105516. doi:10.1016/j.cmpb.2020.105516
- Kettle, Chris, and Susan Tohill. “Perineal care.” BMJ clinical evidence vol. 2008 1401. 24 Sep. 2008
- Memon, Hafsa U, and Victoria L Handa. “Vaginal childbirth and pelvic floor disorders.” Women’s health (London, England) vol. 9,3 (2013): 265-77; quiz 276-7. doi:10.2217/whe.13.17
- McDonald, E A et al. “Dyspareunia and childbirth: a prospective cohort study.” BJOG : an international journal of obstetrics and gynaecology vol. 122,5 (2015): 672-9. doi:10.1111/1471-0528.13263
- Woodley SJ et al. “Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women.” Cochrane Database of Systematic Reviews Issue 5 (2020): CD007471. doi:10.1002/14651858.CD007471.pub4.
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