Your pelvic floor is probably the most important muscle group you never think about. While you’re working out your biceps or your quads, your pelvic floor muscles are also working, without acknowledgment, to hold up many of your organs. It’s a big job, and it gets bigger during pregnancy. Today we will scratch the surface of the pelvic floor, but I want to start with two big takeaways.
First: if you want to know more about the pelvic floor outside of pregnancy, pick up the book Floored by Sara Reardon. The book has far more detail than we can go into here.
Second: my top-line advice here is that everyone should, if possible, see a pelvic floor therapist, ideally starting during pregnancy but certainly after. You can find one in your area here.
What is the pelvic floor?
The pelvic floor is a group of muscles that span the bottom of the pelvis, a bit like a hammock. They support the bladder, bowels, and uterus.
The pelvic floor muscles are important for the functioning of the pelvic organs. They are what make it possible for you to pee and poop, and they hold your organs where they are supposed to be. When the pelvic floor muscles do not function properly, it can lead to an enormous number of different symptoms. These include (but are not limited to) bladder and bowel dysfunction (releasing pee or poop when you do not want to, or being unable to urinate easily), pain during urination or bowel movements, and pain or discomfort during sex.
What does the pelvic floor do during pregnancy?
One of the organs supported by the pelvic floor is your uterus. During pregnancy, that job gets a lot harder. As the uterus gets heavier, the pelvic floor muscles have to do more work and are more likely to falter, especially under stress. For example, if you’re a runner, you may find that leaking urine is more common during pregnancy than it was before. The muscles are just not quite up to holding everything in.
Your pelvic floor muscles also play a role in labor and delivery. In particular, being able to relax your pelvic floor muscles can make things move more smoothly.
An important note: While it’s true that the pelvic floor gets a lot of work during pregnancy, and pregnancy and birth are a risk factor for pelvic floor issues, your pelvic floor works for you all the time — in and out of pregnancy. We would do better to take care of it in general! But pregnancy is an opportunity to start.
What is pelvic floor dysfunction?
Issues with the pelvic floor can take a number of forms. A very common one, both during and after pregnancy, is urinary incontinence. Generally, this means urinary leakage. This can happen anytime, but commonly during activities that stress the pelvic floor (exercise, laughing, sneezing). On the other hand, pelvic floor issues can also make it more difficult to urinate, especially to start urination.
The pelvic floor also plays a role in bowel movements — the muscles work on both pushing poop out and keeping it in. This means that constipation and, on the other side, fecal incontinence are both possible symptoms. Hemorrhoids can be associated with pelvic floor issues, because straining to poop can cause them to arise.
Third: Pelvic floor issues also affect sex — pain during sex is a common symptom, or difficulty with penetration.
Finally: prolapse. Pelvic organ prolapse is a condition in which the pelvic organs fall into, or push into, the vagina. This can happen with the uterus, bladder, or other organs. In some cases, you can feel the organ in your vagina (as in uterine prolapse) or feel a bulge in the vagina.
It should be said that although many of these issues are little talked about, they can have enormous impacts on quality of life. Leaking urine during everyday activities can make people less likely to do those activities — less likely to exercise, or see friends, or do other things they enjoy. Work and income may be affected. Just because these injuries are not seen does not mean they are not felt.
How to take care of your pelvic floor
If we acknowledge that the pelvic floor is important (it is!) and that pregnancy is a stressor on these muscles (also true), the obvious follow-up question is what you can do to take care of your pelvic floor, especially during and after pregnancy.
One thing you have probably heard of is kegels. Kegels are an exercise that involves repeatedly tightening and releasing your pelvic floor muscles. They have been shown to reduce symptoms of urinary incontinence in particular.
Despite what many people think, kegels are not the only pelvic floor exercises — not by a long shot — and depending on the issues you’re facing, they may not even be the best ones. Other exercises focus more on muscle relaxation or other strengthening techniques. The best approach for an individual will depend on the symptoms they are experiencing.
This is why, if at all possible, you should consider visiting a pelvic floor physical therapist either during or after pregnancy. They can evaluate you physically and discuss any symptoms you are experiencing. You can work together to figure out what kind of exercises will help you. Pelvic floor physical therapy has been shown to affect prolapse, urinary incontinence, and fecal incontinence, among more general effects on pelvic pain. Summary reports simply say that it is the definite first-line approach for any pelvic issues. If you can access it, it is a good idea.
The bottom line
- The pelvic floor is a group of muscles that is vital for urination, bowel movements, and sexual function.
- During pregnancy, the pelvic floor muscles work harder and may experience stress, leading to symptoms like urinary leakage.
- Pelvic floor dysfunction can manifest as urinary or fecal incontinence, constipation, pain during sex, or even pelvic organ prolapse — all of which can significantly impact quality of life if untreated.
- Visit a pelvic floor physical therapist during and/or after pregnancy to figure out what your body needs.
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