May 26, 2020

By Carolyn Yates, PT, DPT

During pregnancy, you may hear the term pelvic floor from your doctor or midwife, or even a yoga instructor. But it’s possible that no one has taken the time to explain to you what it is and why you should care. You deserve to know because your pelvic floor is very important both during and after pregnancy. So here’s a quick dive into Pelvic Floor 101.

What is your pelvic floor?

The pelvic floor is the “hammock” or “sling” support system for our pelvic organs; the bladder, rectum, and uterus. In addition to being a support system for the organs, it is also a passageway for the vagina, urethra, and rectum so we can pass bowels, release urine, and have sexual and reproductive function.

The image above will help you visualize the pelvic floor. To help you understand this image better, the pelvis in this picture has been cut in half right down the middle of the body. You are looking at the pelvis from the side. The left side of the picture is the front of your body and the right side is the back. You can see that the pelvic floor muscles run from the pubic bone in the front of the body, to the tailbone in the back of the body.

The pelvic floor is made up of layers of muscles and fascia in order to perform this support and allow for passage. The muscles contract and close off the passageways for the urethra and rectum in order to maintain urinary and fecal continence when we are not “ready” to use the bathroom and then relax (open up) to allow for their passage once we are. The muscles of the pelvic floor also contribute to the orgasm in both the female and male and can enhance the experience if the muscles are strong and mobile.

What happens to your pelvic floor during and after pregnancy?

The pelvic floor muscles play a key role in pregnancy, delivery, and postpartum. During pregnancy, they continue to play their “supportive” and “sphincteric” roles by helping to hold the pelvic organs up, support the increasing weight of the growing baby, and maintain continence.

Related: How to prepare your pelvic floor for labor and delivery

The important role of the pelvic floor muscles during delivery is often misunderstood. It may be surprising to learn that these muscles should actually be relaxing during delivery. Just like when you are urinating or passing bowels and your pelvic floor muscles are relaxing in order to allow for that passage, your pelvic floor muscles are relaxing and allowing the vaginal passage to expand so that your baby can enter this world. Remember, when the pelvic floor muscles contract, they constrict the passageways in order to help you hold your pee and poop in until you are ready to use the restroom. This is the same concept with delivery of your baby; you want the pelvic floor muscles to be relaxed in order to make the delivery process easier.

In the immediate postpartum time (especially after a vaginal delivery), the pelvic floor muscles have been stretched, and possibly torn. They will be very sore and may not function properly (i.e. you may experience urinary and/or fecal incontinence for a few days). Just like if you overstretched or tore your hamstring, you need time immediately following the injury to be restful and focused on gentle mobility to aid in healing and recovery of function. The same concepts of muscular injury rehabilitation should be used when thinking about the pelvic floor muscles after labor and delivery. The muscles have gone through a form of trauma and need to recover and rehabilitate in order to regain full functionality (i.e. no pain with intercourse, full urinary and fecal continence). Gentle belly breathing with focused attention on slow and controlled pelvic floor contract/relax is a great place to start (see the following video for further details).

Many women who have had children experience some form of pelvic floor dysfunction (see below) due to not properly rehabilitating their pelvic floor muscles. It might start within the first 6 months postpartum or 5 years later, but overall almost 1 in 4 US women have symptoms of dysfunction. Implementation of a simple but effective rehabilitation protocol immediately postpartum can greatly reduce the likelihood of experiencing these disorders.

What is pelvic floor dysfunction?

A pelvic floor dysfunction is a condition in which you are unable to correctly and efficiently contract and/or relax your pelvic floor muscles in order to produce the desired effect. Whether that be to hold urine or feces in in a conscious manner, maintain your pelvic floor muscle tone throughout the day to help prevent prolapse of your pelvic floor organs, or experience pain-free penetrative intercourse, to name a few. These dysfunctions can be the result of various different factors; labor and delivery being the most common factor to produce these dysfunctions.

Related: What to do about painful sex after childbirth

How to get help

It is highly recommended that all women who are considering pregnancy or are currently pregnant see a pelvic floor PT. Understanding what your pelvic floor is, where it is, and how to properly contract and relax it is the important first step to preventing dysfunction. Consulting with a pelvic floor PT postpartum to get on a simple but effective rehabilitation program to help prevent dysfunction is also very important and highly recommended. If you had a vaginal delivery with tearing and/or an episiotomy, or if you had a c-section, seeing a pelvic floor PT in person at 6 weeks postpartum will help reduce scar tissue formation and greatly improve your recovery of function and reduce the likelihood of future dysfunction.

If seeing a pelvic floor PT in person is not possible for you, due to safety concerns, restrictions, or lack of access, an online pelvic floor rehabilitation program is a great option. Check out our partner offerings to find something that works for you.

Sources:

Nygaard, I.E., Barber, M.D., Burgio, K.L., Kenton, K.S., Meikle, S., Schaffer, J., Spino, C., Whitehead, W.E., Wu, J.P., & Brody, D.J. (2008). Prevalence of symptomatic pelvic floor disorders in US women. JAMA, 300 11, 1311-6 . Retrieved from https://www.semanticscholar.org/paper/Prevalence-of-symptomatic-pelvic-floor-disorders-in-Nygaard-Barber/2a28b7316d66cd06d8933b0b83d3517c3a84a641

Carolyn Yates, PT, DPT is a Colorado State licensed Physical Therapist with a pelvic floor rehabilitation specialty. She received a Doctorate of Physical Therapy (DPT) from Belmont University School of Physical Therapy and is the owner and head physical therapist of Verity Physical Therapy & Wellness in Boulder, CO.