Many people don’t give the pelvic floor much thought until there’s a problem. And, unfortunately, the risk for pelvic floor issues increases with pregnancy. Nobody wants to deal with pelvic floor issues, especially during pregnancy or when you’re caring for a new baby. So, here are some tips to help maintain pelvic health and prevent issues that can occur during pregnancy and postpartum.
What is the pelvic floor exactly?
The pelvic floor is made up of muscles that attach from the pubic bone to the tailbone and from side to side within the pelvis. The pelvic floor helps support pelvic and abdominal organs, control bladder and bowel function, stabilize the spine and pelvis, aide in sexual function, and help circulate blood and lymph. Those are some very important jobs which are why maintaining pelvic health is essential!
Symptoms of pelvic floor dysfunction
- Urinary incontinence, urgency, or frequency (even a few drops is considered incontinence)
- Stool or gas incontinence
- Painful intercourse
- Pelvic organ prolapse (some people feel a heaviness in the pelvis or have a “falling out feeling”)
- Pelvic pain
- Painful urination
- Inability to empty the bladder completely
These symptoms can occur at any time. Both muscle weakness and tightness can contribute. It’s beneficial to consult a pelvic physical therapist prior to pregnancy if experiencing any of these symptoms as they may worsen during pregnancy.
Pelvic floor changes during pregnancy
- Hormonal changes can result in increased laxity of ligaments which can contribute to issues such as pelvic pain and low back pain.
- There is often more pressure on the bladder due to the growing uterus which can cause more frequent urination
- Increasing pressure in the pelvic floor can also contribute to constipation
- Bones and ligaments shift and stretch to provide space for the baby to travel through the pelvis
- Tearing can occur if the tissues of the perineum are unable to stretch anymore
Preventing pelvic floor issues during pregnancy and postpartum
Being able to not only contract but to relax and lengthen the pelvic floor muscles is essential in preventing pelvic floor dysfunction. Strengthening provides support and stability which can be even more important during pregnancy when there is more pressure on the structures of the pelvis. This also helps in postpartum to regain the strength of these muscles. Lengthening the pelvic floor muscles is helpful to allow these muscles to stretch during labor and childbirth and prevent tearing. It can be difficult to perform these exercises at times and many women do them incorrectly so a visit with a pelvic physical therapist is beneficial to ensure they’re done correctly.
Here are some tips to get started:
Note: Consult your physician before beginning any exercise program.
Pelvic floor muscle contractions (also known as Kegels) help strengthen the pelvic floor muscles.
- Sit in an upright position with feet flat on the floor
- As you gently exhale, slowly tighten the pelvic floor muscles. Some cues that may help you are to imagine you are
- Holding back gas (without clinching the buttocks)
- Pulling the tailbone toward the pubic bone
- Pulling the two sit bones together
- Closing off the vaginal opening, while “lifting and squeezing”
3. Hold this muscle tightening for 5 seconds
- Repeat this 10 times
- Progress to 3 sets each day
- Repeat with brief contractions-holding for 1 second or less
- Repeat this 10 times
- Progress to 2 sets each day
*There should be no movement of the pelvis or spine
Pelvic floor muscle relaxation and lengthening
The pelvic floor muscles relax during inhalation.
- As you inhale, try to gently expand the rib cage in all directions like an umbrella opening. Note the subtle relaxation of the pelvic floor muscles.
- To lengthen the pelvic floor muscles, gently bulge the abdomen as if passing gas. Do not hold your breath. Perform 5 repetitions, once daily during the last 6 weeks of pregnancy for improved awareness and control.
As mentioned above, it’s important to be able to do both exercises for ideal pelvic floor muscle function. Emphasizing lengthening over strengthening is more beneficial towards the end of pregnancy to prepare for childbirth. A pelvic physical therapist can also assess the alignment and mobility of the hips, pelvis, and spine to allow for the necessary movements to occur during labor and childbirth.
In postpartum, a pelvic physical therapist can perform an evaluation to ensure proper healing of the pelvic floor and abdominal muscles. They also assess for spine and tailbone issues and ensure coordination of muscles necessary for increasing core strength.