How And Why To Take Care of Your Pelvic Floor While Pregnant & Postpartum

November 09, 2020

There is a LOT to think about when you’re pregnant. So it’s understandable that something like your pelvic floor, which is invisible and many people don’t know much about anyway, might not be front of mind. But you’re doing yourself a disservice if that is the case. Despite what the world may sometimes seem to be telling you and other pregnant women, everything is not just about your baby! You, your body and your health are just as important. 
 
But too often, women don’t receive the information they should about how they can prepare their bodies for a healthy pregnancy and birthing process. The pelvic floor and pelvic health more generally is a key part of that and so today, we’re going to try tackling that information gap with some helpful tips for taking care of your pelvic floor during pregnancy and beyond.

Why should I care about my pelvic floor while I'm pregnant?

Let’s start with pregnancy. Your pelvic floor is basically a hammock of muscles and ligaments at the base of your pelvis / abdomen. It has two key jobs that are particularly relevant for this discussion. 

First, it supports all the organs, muscles and other anatomy that are above it in your abdomen. And guess what? There is going to be something else (actually someone else, to be more precise) in your abdomen that it will also need to support soon… a growing baby that is going to be getting heavier by the week, particularly in the second and third trimesters. A strong pelvic floor will be able to do a good job providing the core strength and support the rest of your body needs to thrive through pregnancy.

The second job has to do with bladder control and continence. Multiple muscles that are part of the pelvic floor play a key role in controlling the urethra and rectum and help prevent the flow of urine or solid waste when you’re not on the toilet. The extra stress placed on your pelvic floor during pregnancy can stretch and weaken it so that it can’t do its job (especially when you cough, sneeze, or exercise; i.e. stress incontinence). This is why studies have found that the prevalence of urinary incontinence during pregnancy is 42%. 

A strong, flexible pelvic floor can fulfill both of those key functions even as your pregnancy progresses and the demands on it become higher. And according to the University of Colorado Urogynecology department, the right kind of pelvic floor exercise regimen during pregnancy can lead to:

• Improved ability to relax the muscles while the baby’s head is crowning
• Easier healing of the perineum after birth (with or without episiotomy)
• Reduction or absence of overactive bladder symptoms
• Increased chances of achieving an orgasm during sex, both while pregnant and postpartum

Why should I care about my pelvic floor for childbirth?

Speaking generally, healthy pelvic floor muscles will maximize the chances of a smooth delivery (and recovery). But there’s an important distinction here. “Healthy” does not mean “as strong as possible”. During delivery, your core and pelvic floor muscles should basically get out of the way and let the rockstar uterus do its job to push the baby out. For the pelvic floor, you should be thinking about words like ‘relaxing’ and ‘opening’. Words like ‘tense’ or ‘squeezing’: not so much.

So, while pelvic floor muscle strengthening exercises (aka Kegels) have a place, they are not the be-all, end-all and particularly as you prepare for delivery, you should also focus on making sure your pelvic floor is limber and flexible. 

Why should I care about my pelvic floor after giving birth?

It is unfortunately common (although it should certainly not be seen as inevitable) for the pelvic floor to be one of the body parts that has the most recuperation to do in the postnatal stage (regardless of whether you had a vaginal birth or c-section). This dysfunction can manifest as issues such as continence problems, pelvic pain, pelvic organ prolapse or strange sensations. In fact, that same study mentioned above found that 38% of women are experiencing urinary incontinence at 8 weeks postpartum, and other pelvic floor problems are common as well.

More specifically, the demands of pregnancy and delivery have a tendency to stretch and weaken your pelvic floor muscles. When this is the case, those weakened muscles sometimes struggle to stop your bladder from leaking urine. Again, this happens most frequently when you cough, sneeze, try to lift something, or exercise, but it can and does happen at many other times as well. It is also common to have difficulty waiting when you notice you need to pee.

Tips for maintaining pelvic floor health during and after pregnancy 

OK, so there’s all the reason in the world to care about your pelvic floor health during and after pregnancy. But what should you actually do to keep it as strong and flexible as you can? Glad you asked! Here are a few tips:

1. Pelvic floor muscle exercise, making sure to focus not just on strengthening / Kegel exercises but also on down-training (practicing relaxation of your muscles). Note that it's a good idea to ask your obstetrician, pelvic floor physiotherapist or other healthcare professional about the right timing to start pelvic floor muscle training after delivery, especially if you will use an exercise device (in that case, a good rule of thumb is to wait at least 6 weeks, although exercise without a device can begin sooner)
2. Include plenty of fiber and water in your diet, as this keeps your bladder and bowels health and helps to avoid constipation
3. Be a little more conscientious than normal about your toilet usage and routine. Try to make sure you empty your bladder completely when you use the restroom and try to avoid using the toilet “just in case”, since this can build bad habits for your bladder. Lastly, try to keep your back straight, your pelvic floor relaxed and avoid pushing 
4. If in doubt (or even if not), check in with a pelvic floor physical therapist and see what they think is the ideal physical therapy routine for your individual body, based on your unique pregnancy, delivery and recovery trajectory 

The Takeaway