Caitlin Goodwin MSN, CNM is a Certified Nurse-Midwife with nearly ten years of experience caring for pregnant and postpartum women.
Pelvic Floor Problems in Pregnancy
If you're here, it's because you're either experiencing pelvic floor issues or you are anticipating suffering from them soon. There are a number of changes that can affect our pelvic floor- pregnancy, childbirth, obesity, and aging are just a few.
Follow along as we identify the potential causes and how to correct them.
What is the Pelvic Floor?
You can locate your pelvic floor muscles between your pelvic organs and your perineum (the tissue between your bottom and your vaginal opening). This muscle layer stretches from your tailbone to the pubic bone.
There are nerves, ligaments, and connective tissue that make up your pelvic floor-- these include your uterus, bladder, and even your rectum!
The pelvic floor supports the pelvic organs just like a hammock. However, the more stress that the occupant (baby) applies to the hammock, the more it moves down towards the ground.
If the pelvic floor muscles begin to weaken and drop, this is called a pelvic floor disorder.
What Does My Pelvic Floor Do?
Your pelvic floor supports your pelvic organs, particularly when the pelvic floor contracts. The pelvic muscles are so supportive that very little can pass through even when relaxed. The muscles allow passage of bodily fluids through the openings of the vagina, urethra (urine), and rectum. Having strong pelvic floor muscles gives you control over your bladder and bowel!
Pelvic floor disorders occur when the muscles in the pelvic floor muscles fail to contract properly. A weakened pelvic floor means that your organs are not fully supported and left untreated can cause problems like leaking urine and pelvic organ prolapse. This type of prolapse occurs when the bladder or uterus drops from up inside your body into your vagina.
Even if you don’t experience pelvic organ prolapse, you may have difficulty with incontinence-- trouble controlling your urine, feces, or gas. Pelvic floor weakness may cause you to have problems with bowel movements or to urinate when you sneeze.
Incontinence is not a normal part of aging and should not affect postpartum women for life. It is essential to strengthen your pelvic floor to prevent these symptoms from occurring.
How does Pregnancy Affect the Pelvic Floor?
Pregnancy puts increased pressure on the pelvic floor during pregnancy. As the weight of the baby increases so does the pressure on your pelvic floor.
In preparation for childbirth, your body secretes a hormone of pregnancy called Relaxin. This critical hormone that causes the ligaments and pelvic muscles to relax so that your baby’s head can begin to descend. It also softens and opens the cervix to allow for the passage of your baby. Finally, childbirth can stretch and damage the pelvic floor muscles
While this is a win for the childbirth process, this softening leads to decreased pelvic floor tone. While pregnancy is a risk factor, you may be able to avoid pelvic floor disorder if you commit to health, exercise, and a few essential exercises.
Risk Factors during Pregnancy
- Avoiding lifting heavy weights (particularly over 35 pounds)
- Repetitive high impact exercise.
- Chronic coughing
- Straining on the toilet.
The risk factors like obesity and age are hard to modify at this stage in the game. However, gaining a healthy amount of weight in pregnancy will help prevent additional stress on your pelvic floor. Maintaining your physical fitness is important, but do not lift heavy weights or do repetitive high impact exercise routines.
In pregnancy, there are a few safe ways to resolve a cough. These include cough drops, Robitussin and Robitussin DM cough syrup, and gargling with salt water. If you are having issues with a constant cough, seek out care from your physician to keep both your lungs and pelvic floor healthy.
Constipation is a fairly common pregnancy complaint. However, there are many methods to avoid toilet troubles. Carry a water bottle with you at all times, sip water constantly, and aim to drink at least two liters each day. Increase your intake of fiber-rich foods like vegetables, fruits, legumes, and whole grains.
If you find that you are regularly constipated, try a medication called Colace (docusate sodium) daily. If you are backed up, try Milk of Magnesia, Miralax, or psyllium husk powder. As a last resort, you can always try glycerin suppositories. It’s important to focus on drinking enough water and eating enough fiber every day to keep your pelvic floor healthy!
Why Should I Strengthen My Pelvic Floor?
Women with a pelvic floor disorder experience uncomfortable symptoms like the leaking of urine, lower back pain, and inability to control gas. However, women with strong pelvic floor muscles are able to adequately support the extra weight of pregnancy, improved healing in your perineum after birth, and a satisfying sex life.
Women with a solid fitness routine have a decreased incidence of incontinence, hernia, back pain, and pelvic floor disorders. Increasing your core and pelvic strength promotes pelvic floor health.
Exercises to Promote Pelvic Floor Strength
Start doing pelvic floor exercises as soon as possible in pregnancy. You can begin Kegel exercises at any time in the postpartum period, as long as you are not experiencing pain.
Kegel exercises strengthen your pelvic floor muscles. Squeezing your pelvic muscles should feel like you are holding a tampon inside of your muscles. You should not lay flat on your back in the second trimester of pregnancy and beyond
- Sit cross-legged, with your knees bent and contracted your pelvic muscles.
- Hold the pelvic muscle contraction for at least ten seconds.
- Once you can easily hold for ten seconds, attempt the exercise in various positions multiple times per day (side-lying, standing, kneeling).
Figuring out where to direct your energy may be difficult at first. The first time you attempt this, sit quietly and place one end at the top of your bump, and the other on your shoulders. Breathe peacefully for about thirty seconds. If you feel that your breathing is relaxed, your bump should move more than the hand on your shoulder. If this is not happening, try to further relax your breathing by focusing on taking long breaths in and out.
When you notice this relaxed breathing, pull your pelvic floor up and in as you exhale. Continue focus on your breath until you can coordinate exhalation with contracting your pelvic floor. Make sure you are not tightening your abdomen, where you are touching. If you notice that you are tightening your stomach, go back to focusing on your peaceful breathing.
Eventually work up to being able to perform ten at a time, at least three times per day. An easy way to remember to do your Kegel exercises is to complete ten every time you are at a red light. It triggers a reminder every day for you to do them. It’s the perfect location; you are a captive audience while waiting for the light to change and you can do Kegel exercises anywhere!
How can I tell that my Kegels are working?
There are some ways to check to make sure your Kegel exercises are working. Perform a Kegel exercise during intercourse and get feedback from your sex partner regarding your vaginal tone during the contraction of the pelvic floor. You can also take a warm bath, and put your fingers inside your vaginal opening. Practice a Kegel exercise and see if you can feel a tightening around your fingers.
There are other exercises that you can do to strengthen your pelvic floor by engaging the largest muscles in the body. Moves like tabletops and squats activate the pelvic floor muscles in the process.
- Stand upright with your feet somewhat wider than shoulder-width apart and toes pointed out. If you can use proper form, consider using a barbell. It should rest behind your neck on your trapezius muscles.
- Bend your knees and push your hips back as if you’re going to sit in a chair. Tuck your chin and keep your spine neutral.
- Keeping your weight in your heels, and your toes pointed slightly outward, drop down until your thighs are parallel to the ground.
- Straighten your legs. Stand upright.
- Complete 15 reps.
- Lie on the floor and knees bent so your thighs are perpendicular to the floor and your shins are parallel to the floor.
- Brace your abs and activate your inner thighs, legs touching.
- Slowly split your legs, so each knee falls outward, reaching a comfortable position.
- Slowly rise back to the start.
Complete 10 to 15 reps and three sets.
Pelvic Floor Specialists
In a perfect world, every postpartum mom would receive free pelvic floor physiotherapy. Given that it is costly and not always covered by insurance, most women opt to perform the above exercises at home before calling in the specialists. Studies have shown that physiotherapy is a safe alternative to surgery.
If you perform these exercises for three months without improvement, it's time to call in the specialists. A pelvic floor physical therapist is specially trained too evaluate your pelvic floor and develop a therapy routine to improve the issues.
A physical therapist will evaluate your pelvic floor by one of two methods. Biofeedback is electronic monitoring that assesses the strength and tone of your exercises and to monitor improvement. Physical exams involve a gloved hand in the vagina or rectum to evaluate pelvic floor strength. If you are uncomfortable with the physical exam, you can often request an alternative form of evaluation.
Pelvic Floor Health
You grew and gave birth to a beautiful baby, and now your waking time is devoted to helping them flourish. As a mother, it’s important to take care of yourself and to take charge of your health.
Challenge yourself to three months of committing to a pelvic health routine. Improving the strength in your pelvic floor will enhance your sex life, your quality of life, and help you to feel your best!
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2018 Caitlin Goodwin