Guest Spot: The Truth About Your Pelvic Floor During Pregnancy and Beyond
It is common knowledge that the changes a women experiences during pregnancy, birth and postpartum are incredible. The ability of the female body to go through so many changes in a relatively short amount of time is nothing short of miraculous, but does not always feel physically good. As a pelvic floor physical therapist, I am especially interested in helping moms through these changes both during pregnancy and postpartum and I have additional training in treatment of the pelvic floor muscles to be able to do this. I am often helping my patients understand how to use their pelvic floor, abdominals and diaphragm to create balance in their body.
Your pelvic floor is a group of muscles that forms a funnel-like support system connecting from pubic bone to tailbone. They are literally the floor of your body. They do some amazing things like:
Preventing leaking of urine and feces
Holding up internal organs
Pumping fluid from lower body for circulation
Supporting the joints of the pelvis
Allowing sexual function and enjoyment.
During pregnancy, the combination of the pelvic floor muscles supporting weight from baby and hormone changes that make joints looser can cause the tissues in the pelvis to become strained and stretched. This can lead to leaking of urine during pregnancy, which we know happens to about 40% of pregnant women. In addition to urinary leaking, a pregnant mom could experience low back pain, pain in the front of the pelvis, perineal pain or excessive vaginal heaviness.
During the birth process, women who have vaginal deliveries experience a stretch to their pelvic floor muscles, connective tissues and nerves that is 3-4x the resting length of these tissues. Research tells us that 10-30% of vaginal births cause significant trauma to pelvic floor tissues. This trauma and tearing can often go deeper than the outside skin into the muscles of the pelvic floor. Women who have a C-section experience trauma to connective tissue and muscle in the abdomen which can lead to problems as well.
Knowing all of this, can we be surprised that women don’t feel “good to go” after their 6-week check in with their OB? Or that even 6-12 months after birth they continue to experience problems? Symptoms that could present postpartum are back pain, pubic pain, urinary incontinence and pain with sex (see the statistics below). Other symptoms could include vaginal heaviness/pressure and excessive abdominal muscle separation known as diastasis recti.
Here are the biggest myths I hear about these symptoms during pregnancy and postpartum and the truths that I wish women knew!
Myth 1: Symptoms like leaking and pain are a normal part of the birth process, no need to make a big deal out it. Wrong! While these symptoms are typical, they are not normal and should not be accepted as the “new norm.”
Myth 2: After your 6-week check with your doctor you are cleared to go back to ALL activity (boot camp, running, weight lifting). This timeline should not be a one-size fits all idea. Most women have residual weakness or pain they are dealing with at 6 weeks and need to ease back into exercise with awareness of their changed body.
Myth 3: If you do Kegels your symptoms will get better. Kegels can be an important part of recovery postpartum, but they are not appropriate for everybody. A tight muscle is also a weak muscle and sometimes pelvic floor muscles need to be stretched and relaxed before starting a Kegel program to avoid causing pain or making symptoms worse.
Myth 4: Pain or leaking urine during pregnancy and postpartum will get better with time. Maybe...I don’t know about you, but I wouldn’t want to wait 12 months to not leak urine or be able to have non-painful sex. “Getting through it” is not good enough, we can give women better care than that! Working on these symptoms sooner rather than later (even while pregnant!) decreases the impact on a women’s well-being and allows her to move through her healing process in a safe and informed way.
As a pelvic physical therapist, I want help women figure out how to best give their body the care and support needed to continue their healing journey and do what they love.
Here is what I may do with a patient depending on their symptoms.
Strengthen what is weak
Lengthen what is painful
Support joints that are irritated
Coordinate their pelvic floor to work with and not against abdominals and diaphragm
Understand the role changing hormones play in recovery
Get back to exercise in a safe way
Take care of their own body while caring for baby
Have a better understanding of a body that often feels unfamiliar after childbirth
My goal is always to empower new moms with the truth of what is going on in their body and the hope that they can get better and feel stronger. I am passionate about women receiving pelvic floor rehab postpartum even if they feel like they are doing well. We may only need one or two visits, but it is a great time to practice preventative care and learn about changes in your pelvis and abdomen after birth.
I hope for all my patients that the skills they learn in rehab will help them throughout their lives.
You are not alone, mama! There are plenty of therapists like me and the awesome practitioners on the Rise team who want to support you in your recovery journey. Reach out, ask us questions, come meet us! We would love to know you!
Cora is a physical therapist who has over 180 hours of continuing education specifically devoted to the treatment of those with pelvic dysfunction and low back pain. She works for Athletico Physical Therapy (Knapp’s Corner location). She offers free 30 minute assessments to patients interested in how physical therapy could help them. For more information contact Athletico Physical Therapy at 616-818-0586 or click the link to request an appointment! https://www.athletico.com/patients/request-appointment/?location=grand-rapids-knapps-corner
*At one year postpartum, 77% of moms will have low back pain, 49% some type of urinary incontinence and 40% will have both.
*The American College of Obstetricians (ACOG) reports that 18% of vaginal deliveries will result in muscle damage to the anal sphincter leading to 13-25% of women having difficulty controlling gas or bowels.
*ACOG reports that perineal pain occurs for 10% of women a year after vaginal delivery. 30% women have pain with sex 3 months after delivery and 17% 6 months after delivery.
1. American College of Obstetricians and Gynecologists. Accidental bowel leakage. ACOG FAQ 139. Washington, DC: American College of Obstetricians and Gynecologists; 2014. Available at: https://www.acog.org/Patients/ FAQs/Accidental-Bowel-Leakage.
2. American College of Obstetricians and Gynecologists. Pelvic support problems. ACOG FAQ 012. Washington, DC: American College of Obstetricians and Gynecologists; 2017. Available at: https://www.acog.org/Patients/ FAQs/Pelvic-Support-Problems.
3. American College of Obstetricians and Gynecologists. Urinary incontinence. ACOG FAQ 081. Washington, DC: American College of Obstetricians and Gynecologists; 2016. Available at: https://www.acog.org/Patients/FAQs/ Urinary-Incontinence.
4. Dietz, H.P. (2013), Pelvic floor trauma in childbirth. Aust N Z J Obstet Gynaecol, 53: 220-230. doi:10.1111/ajo.12059
5. Haddow G, Watts R, Robertson J. Effectiveness of a pelvic floor muscle exercise program on urinary incontinence following childbirth. Int J Evid Based Healthcare. 2005;3(5):103–46. 10.1111/j.1479-6988.2005.00023.
6. Sangsawang, B., & Sangsawang, N. (2013). Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. International urogynecology journal, 24(6), 901–912. https://doi.org/10.1007/s00192-013-2061-7