Signs of a Weak Pelvic Floor During Pregnancy
Are you pregnant and wondering about the status of your pelvic floor? Think you might have a weak pelvic floor during pregnancy? You’ve come to the right place! Keep reading to learn all things pelvic health during pregnancy.
Pelvic Floor Health During Pregnancy
Common signs of a weak pelvic floor during pregnancy
The pelvic floor is a really, really important group of muscles for anyone, but especially important for a pregnant woman. The pelvic floor muscles sit deep within the pelvis and function to support the pelvic organs, maintain continence (urinary and fecal), and play a vital role in core strength.
Because of where the pelvic floor muscles sit within the pelvis there are several signs and symptoms of a weak/uncoordinated pelvic floor including but not limited to:
Urinary leakage
Pelvic heaviness
Fecal incontinence
Pelvic organ prolapse
And while pelvic floor weakness is common, pelvic floor tension is even more common. You know how women carry their tension in areas like the jaw and upper traps? The pelvic floor muscles also carry a good amount of tension. Signs and symptoms of a tense pelvic floor include:
Pelvic pain
Urinary urgency and frequency
Pelvic heaviness
Pain with intercourse
Constipation
Urinary leakage
Causes of pelvic floor weakness in pregnant women
While pelvic floor weakness can occur, what I typically find more often is pelvic floor coordination issues.
Your pelvic floor works in coordination with various other muscles in the core including the transverse abdominus (TA). The TA is the deepest core muscle and looks like a weight lifting belt. This muscle works with the pelvic floor along with the multifidi, a group of muscles that run up and down the spine and function to brace the spine when engaged.
These muscles work in a feedforward fashion, meaning they should fire before they are needed.
How pregnancy impacts pelvic floor strength
Two major changes happen within the body during pregnancy that inhibit the physiology listed above.
Stretching of all of these muscles - without continuously challenging them at their new length
Changes in center of mass - leading to balance issues and challenging the pelvic floor as the pelvic floor plays a vital role in balance
Other challenges include:
Weight gain sitting directly on top of the pelvic floor
An increase in musculoskeletal aches/pains which can inhibit muscle function
Decreased thoracic range of motion
Changes in the lower ribs as they expand laterally to make room for the growing uterus
Symptoms and Conditions
Bladder leakage during pregnancy: Is it normal?
Despite likely being told it is normal, urinary leakage during pregnancy is common, but not normal.
In fact, studies show those who leak during pregnancy will leak postpartum.
One piece of advice: address it during pregnancy. There are likely other symptoms in addition to leakage that can be resolved during pregnancy, plus you’ll be tuned into your pelvic health and connected to your pelvic floor which will work wonders postpartum.
Pelvic pain and discomfort: Signs of weakness or tension?
There are several very important nerves that course through all of the pelvic floor muscles, which are often contributing factors if not the source of pelvic pain.
Imagine your muscles being tense, and “strangling” the nerves that course through them – not allowing the nerves to get adequate blood flow, oxygen and nutrients, thus causing pain.
Because the nerves aren’t able to properly communicate with the muscles, there can also be signs and symptoms of weakness (leakage, etc).
Typically, the root of most pelvic pain is most likely pelvic floor muscle tension rather than pelvic floor muscle weakness.
Pelvic organ prolapse: Symptoms and prevention
Pelvic organ prolapse is the descent of one or more pelvic organs into the vaginal canal. This can occur with the bladder (cystocele), uterus (uterine prolapse), or rectum (rectocele).
Signs and symptoms of prolapse include pelvic heaviness or feeling like something is going to fall out, low back pain, urinary retention, and/or constipation. Sometimes patients are able to see a bulge with higher stages of prolapse. Prolapse is graded 1-4 with stage 1 prolapse being the least extreme and stage 4 being most severe.
Prevention strategies of prolapse include:
Minimizing breath holding
Managing constipation
Remaining active
Core strengthening
You can read a lot more on prolapse in these blogs:
Strengthening and Prevention
Exercises to strengthen the pelvic floor during pregnancy
My favorite strategies to strengthen the pelvic floor during pregnancy revolve around tapping into the co-contractors of the pelvic floor including the adductors, TA, multifidi, and diaphragm.
Try these 5 exercises:
Diaphragmatic breathing
Ball squeeze between your knees - begin by lying on your back with your knees bent and feet flat on the ground - when you exhale, squeeze the ball / when you inhale relax
Bridge + ball squeeze
Side plank
Banded side steps
These exercises will get several different muscle groups firing including the diaphragm, adductors, glutes, obliques, and TA.
Note: if any of these exercises hurt or increase pelvic floor symptoms, consider modifying them or skipping them altogether.
Lifestyle changes for a healthy pelvic floor
Three lifestyle changes I recommend to benefit overall pelvic include:
Managing constipation - a full rectum is a weight sitting on top of your pelvic floor, so managing this takes a load off (literally) of your pelvic floor
Staying hydrated: hydration is beneficial for all of your pelvic organs - we recommend 60-80 ounces/day unless you are breastfeeding or sweating excessively, then consider increasing by 20 oz.
Use a squatty potty: you know how babies poop? They go off in a corner and squat super low because this is the natural pooping position. In America we have these super tall toilets because of hip replacements and knee replacements, so adding a stool under your feet creates this natural pooping position.
How to prevent pelvic floor weakness before and after pregnancy
In an ideal world, working on pelvic health prior to pregnancy would be beneficial for optimizing pelvic floor function and connecting to your pelvic floor.
Working with a pelvic floor specialist is ideal during pregnancy to prevent pelvic floor weakness.
Additionally, continuing to move through pregnancy in a way that feels good is so key for preventing pelvic floor weakness after pregnancy. A few types of movement I am partial to during pregnancy include:
Strength training
Pilates
Walking
Professional Help and Recovery
When to see a pelvic floor therapist during pregnancy
This is not always possible, so beginning pelvic floor PT as early as possible during pregnancy is ideal. We like to start seeing our patients on a monthly basis beginning in the first trimester, as long as they are symptom free. If they present with pelvic floor symptoms, we might recommend a higher frequency.
We walk alongside our patients during pregnancy to manage any symptoms they experience AND prepare them for birth (both vaginal and cesarean) and the postpartum period.
We like to begin seeing our patients at about 2-4 weeks to begin working on core strengthening, thoracic mobility, and any aches/pains and then begin addressing the pelvic floor at 6 weeks.
Treatments for pelvic floor dysfunction in pregnant women
The world of women’s health research, specifically prenatal, is interesting because it’s considered unethical to research anything on a pregnant woman that could be harmful.
Therefore, the treatments I use during pregnancy is very conservative:
Exercise
Manual therapy (hands on treatment to joints, muscles, and ligaments)
Dry needling
Postpartum pelvic floor recovery tips
Resting early on is key, but it is important to move in a way that does not provoke signs of a weak pelvic floor like urinary incontinence and pelvic heaviness.
Gentle core reengagement is safe and effective beginning at 2 weeks. I recommend things like:
Diaphragmatic breathing
Adductor squeezes
TA contractions
If any of these are symptoms you are experiencing – good news! We are currently taking new patients with prolapse in Rockwall, Canton, and Sulphur Springs. If you are interested in scheduling an appointment, please request an appointment here and someone from our team will reach out to you to get you scheduled.
