Fast facts:
As you move through the journey of pregnancy and childbirth, just about every part of the body changes. Some are discussed more often than others — hormone and breast changes, for starters — but others get less attention, including a handful of postpartum pelvic floor issues.
A female pelvic floor is a group of muscles, ligaments, and tissues at the bottom of your torso that supports your pelvic organs: the bladder, bowels, and uterus. Additionally, the urethra, vagina, and anus pass through the pelvic floor. The pelvic floor plays a crucial role in many aspects of your overall health and wellness including bladder control, sexual function, and even the comfort of your lower back.
The physical aspects of pregnancy and childbirth, including hormonal changes, can weaken your pelvic floor muscles, leading to problems with bladder and bowel control, urethral function, and the positioning of your pelvic organs, among others.
And while these postpartum pelvic floor issues may be a natural effect of growing a baby and giving birth, that doesn’t mean you should learn to live with these discomforts.
Whether these symptoms gradually fade as your body recovers from childbirth — which is the case for some women — or last beyond your first postpartum weeks and months, pelvic floor physical therapy can help you strengthen these muscles and heal your pelvic floor. (At Ruth Health, we make it simple to fit pelvic floor therapy into postpartum life, with personalized 30-minute virtual pelvic floor recovery sessions.)
Here are some of the most common pelvic floor issues that can arise during pregnancy and postpartum and how to treat them.
Accidentally leaking urine after sneezing, exercising, and laughing is a symptom of stress urinary incontinence (UI), which often develops as the result of a weakened pelvic floor. Stress UI often happens during pregnancy as your growing uterus compresses your bladder, which limits your ability to hold it in — literally — when you have to pee. Additional stretching and weakening of your pelvic floor muscles during childbirth can also contribute to urinary incontinence.
This type of urinary incontinence often lingers for a few weeks after giving birth. In some cases, it may last longer due to a variety of factors, including how the uterus compresses the bladder as it shrinks back to its normal size and the extent to which your pelvic muscles changed during childbirth. If urinary incontinence persists beyond six weeks, it’s time to visit the doctor. Small changes can help, including:
Fecal incontinence — the accidental leakage of stool — is another common postpartum pelvic floor issue. It happens for a few different reasons. First, the perineum, the tissue between the vagina and anus, can tear during childbirth, either involuntarily or in an episiotomy.
In addition, childbirth can strain the anal sphincter, which is the ring of muscle that opens and closes the anus. About 40% of women experience some type of injury to the anal sphincter during childbirth.
These issues are more common if you had a long or complicated delivery or if forceps were used during childbirth, both of which can put significant pressure on the pelvic floor muscles.
Here are some ways to improve postpartum fecal incontinence.
At the other end of the spectrum, weakening of the pelvic floor muscles during childbirth can delay the emptying of your colon and cause constipation. In addition to practicing pelvic floor physical therapy exercises that strengthen your pelvic floor muscles, you may also benefit from increasing your water and fiber intake or taking laxatives under your doctor’s guidance.
One of the pelvic floor’s main functions is to hold your pelvic organs in the right place. A weakened pelvic floor can cause the uterus, bladder, or rectum to prolapse, falling into your vagina. If you’re experiencing pelvic organ prolapse, you may have a feeling of pressure or discomfort in your pelvic region that worsens when you stand or cough, or a sensation of something coming down into your vagina.
In addition to exercises that help heal pelvic organ prolapse, doing strengthening exercises before or during pregnancy can prevent issues postpartum.
Up to 80% of women may experience some degree of postpartum sexual dysfunction. While a weak pelvic floor can lead to painful sex, there are other factors involved in sex-related issues after giving birth. Stress, anxiety, postpartum hormones, sleep deprivation, and any changes to how you feel about your body can lower your sex drive.
Physical therapy can help with any sexual dysfunction that stems from weak pelvic floor function. It can also focus on helping increase circulation to your pelvic floor, which can not only help with healing but increasing sex drive as well, if that’s a priority for you. Working one-on-one with a pelvic floor therapist also gives you the opportunity to discuss these issues before your first postpartum visit with your OB/GYN, which is usually at six weeks.
When you’re experiencing postpartum pelvic floor issues, it’s easy to wonder if things will ever be the same again. Pelvic floor dysfunction is treatable. Some birthing people find that the pelvic floor muscles naturally strengthen as the body heals. In other cases, pelvic floor physical therapy may be necessary.
Healing is a gradual process, and it may take several months of physical therapy before symptoms get better, but sticking with it is the key to improvement.
Postpartum pelvic floor exercises are safe to perform as soon as you’re comfortable and have spoken with a healthcare professional or physical therapist. You also don’t have to wait for postpartum pelvic floor issues to arise to begin strengthening your pelvic core — working with a pelvic floor physical therapist during pregnancy may help you avoid some of these issues altogether.
No two bodies are built the same, and at Ruth Health, we take an individualized approach to pelvic floor training and recovery. Our 30-minute virtual sessions blend physical therapy with fitness to deliver the pelvic floor TLC that your body needs.
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