By Dr. Monica Frydach, PT, DPT, CMTPT
Pregnancy can be both incredibly beautiful and incredibly challenging. During pregnancy the body undergoes significant change. Your belly grows, your pelvis widens, and perhaps even your feet get slightly bigger. What a joy!
And as your baby grows the muscles of your body are placed under significant stress. The muscles have to work extra hard to keep up with the added weight and postural changes pregnancy can bring. Additionally, fluctuations in your hormone levels can contribute to ligament laxity placing the muscles of the core, back, hips, and pelvic floor under even more pressure.
All of these changes can lead to things like back pain, pelvic pain, and even accidental leaking of urine during pregnancy or in the postpartum period. The accidental leaking of urine is called urinary incontinence and is a sign of pelvic floor muscle dysfunction. Activities like coughing, sneezing, laughing, and jumping are all common times a woman might experience an accidental leaking of urine.
Incontinence and pelvic floor dysfunction is not only experienced by those who had a vaginal delivery. Any pregnant person, regardless of delivery method, is susceptible to pelvic floor muscle dysfunction.
So why does this happen? Is it just a normal part of pregnancy and postpartum? And what can be done? Well, let’s back up a bit to discuss some basic anatomy and learn about the pelvic floor muscles.
What is the pelvic floor?
Your pelvic floor is a group of muscles located in your pelvis. These muscles are like a bowl between your hips and run from your pubic bone to your tailbone. They support your bladder, bowel, and uterus (if you have one). This group of pelvic floor muscles make up the base of your core. Along with the low back muscles, abdominal muscles, and diaphragm these muscles aid in stabilizing your spine and help regulate your internal pressure system.
Just like any other muscle you should be able to contract and relax your pelvic floor muscles. Many of us have probably heard the word Kegel. A Kegel is the name for a pelvic floor muscle contraction and involves a squeeze and lift of the muscles within the pelvic floor.
However, it’s equally important to be able to relax the pelvic floor muscles. Sometimes the muscles of the pelvic floor can become too tight. A tight muscle can not function properly and can lead to a variety of problems including pain, leaking, or prolapse. That is why both strength and length are important for a well balanced body and pelvic floor.
Finally, the pelvic floor muscles do not act alone. They are very closely connected to the muscles of the abdomen, the back, the gluteals, and the diaphragm. When we are assessing pelvic floor function we always need to also address these “best friend muscles” of the pelvic floor.
What happens to our pelvic floor during pregnancy and postpartum?
So now let’s think about pregnancy. For months you grow a baby in your uterus that sits on the pelvic floor. And the combined weight of the baby, the placenta, and extra fluid places quite a bit of extra weight on these pelvic floor muscles. This can cause the pelvic floor to stretch out and the muscles that close the urethra (where the pee comes out) to become weak.
Additionally, during childbirth the pelvic floor muscles may undergo trauma including tearing. This trauma to the pelvic floor can result in pelvic floor muscle rebound tightness or weakness.
Finally, let’s think of some of those other important muscle groups mentioned above. During pregnancy the muscles of the abdomen tend to be stretched out and weakened. The low back muscles tend to become tight, tense, and lack sufficient mobility. Often a pregnant woman’s posture changes resulting in weakness and tightness of the muscles of the glutes and hips. In addition, as the growing baby takes up more and more space within the abdominal cavity we often no longer are able to take full deep breaths. This leads to restriction of the diaphragms movement and function which can largely impact how the pelvic floor muscles are functioning.
Why do we leak?
For some women these musculoskeletal changes resolve themselves after the baby is born, but what happens if they don’t? As many as 1 in 3 women experience a form of pelvic floor dysfunction in their life. Changes in strength, flexibility, bladder habits, body mechanics, and ability to manage pressure within our body all contribute to pelvic floor dysfunction including incontinence during or after pregnancy.
What can be done?
So what can be done? This is where pelvic floor physical therapy can help. Postpartum Pelvic Floor Rehabilitation Physical Therapy is a special type of physical therapy that focuses on the muscles and ligaments in the pelvic floor most affected by pregnancy and birth. It involves exercises that encourage improved function of the muscles of the core and lower pelvis.
A specially trained pelvic floor physical therapist can help restore balance to the body and eliminate symptoms including urinary issues, pelvic organ prolapse, diastasis recti, bowel issues, pelvic pain, pain with intercourse, and more.
Are Kegels the answer?
Simply put, no. Kegels can be helpful to address a weak pelvic floor, but many people are not doing Kegels correctly. Positioning can be wrong, quantity or the number of Kegels may be too much or too little, and not identifying the proper muscles while doing Kegels can cause more damage. Also if your pelvic floor muscles are too tight Kegels might actually be making your problem worse.
What is pelvic floor therapy?
In pelvic floor physical therapy we address your whole body and the core canister system. Not only do we want to see what your pelvic floor muscles are doing but also how are you breathing, what your posture looks like, your core muscle function, your hip strength, and much more. Be proactive about your pelvic health and meet with a pelvic floor therapist during pregnancy to help prevent pelvic floor dysfunction. Additionally, we often limit the postpartum period to 1 year after giving birth to a baby. However, postpartum is forever and it’s never too late to address your pelvic health.
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