What You Need to Know About Pregnancy and Your Pelvic Floor

Even if you haven’t done them yourself, odds are you’ve heard of Kegel exercises — especially if you’re pregnant or have been pregnant in the past. Kegels help strengthen the pelvic floor muscles, which are the little-talked-about but uber-important support system of vital organs in the pelvic region, including the uterus, bladder and rectum. Essentially, the pelvic floor muscles hold all these organs in and help them function as they should, says Christopher Simons, DO, an obstetrician and gynecologist with Atlantic Health System.

That’s why it makes sense that if something impacts the pelvic floor, it can not only cause a lot of discomfort, but can also affect your sex life and your ability to go to the bathroom normally.

Enter pregnancy, when a whole lot more is asked of the pelvic floor muscles, such as supporting extra weight, stretching to prepare for a vaginal delivery and simply staying strong during the act of childbirth itself.

“It can be hard to gauge what’s normal during this time because it’s relative and typically varies from person to person,” Dr. Simons says. “The pelvic floor can only carry so much weight, though, and if you put a lot more weight on top of it, it might get weaker and you might have occasional related symptoms.”

Pelvic floor disorders

When the muscles or connective tissues of the pelvic area weaken or are injured, it can lead to a pelvic floor disorder, according to the National Institutes of Health. The most common of these include:

• Bladder problems, such as:
  • Leaking urine by accident (known as urinary incontinence)
  • Feeling a frequent, sudden urge to urinate (known as overactive bladder)
  • Feeling the urge to urinate but being unable to release more than a small amount (known as urinary retention)
• Fecal incontinence, which is leaking from the rectum
• Pelvic organ prolapse, which occurs when the pelvic floor can no longer support one or more of the pelvic organs and they drop or press into the vagina

Weakened or injured pelvic floor muscles also can cause pain during sex.

“If you experience one or several of these symptoms occasionally during pregnancy, like accidentally leaking urine during exercise, we might say, ‘Yeah, this is something that’s probably related to pregnancy and may be normal,’” Dr. Simons says. “But if you’re having constant or severe pain, or severe urinary or fecal incontinence, that’s not normal in pregnancy, and you should talk to your provider.”

The good news is that after you’re no longer pregnant, pelvic floor issues may go away or improve on their own. If they don’t, though, your ob/gyn can help.

Managing pelvic floor dysfunction

“I usually tell my patients that a good rule of thumb for evaluating whether everything is back to baseline is checking in after pregnancy, once they’re back down to their pre-pregnancy weight,” Dr. Simons says.

For some women, that might be three months. For others, it might be six months or more. If at that time pelvic floor issues persist but are improving, conservative management, like physical therapy, may be the best course of action.

Pelvic floor physical therapy

Like other physical therapy regimens, pelvic floor physical therapy is a series of exercises designed to strengthen the pelvic floor muscles. That may include Kegels or other movements that contract the pelvic floor muscles in certain ways and at certain intervals.

“I often refer patients to pelvic floor physical therapy as a first step because they get instruction on the right way to do helpful exercises, and who can’t benefit from a coach?” Dr. Simons says.

If pelvic floor physical therapy doesn’t resolve the issue or a pelvic floor disorder is severe, surgical management may be an option.

“The bottom line is pelvic floor dysfunction is something women should feel comfortable talking about with their doctor,” Dr. Simons says. “We have a lot of tools at our disposal to help treat these issues.”