Pregnancy / Postpartum and the Pelvic Floor


Most women have heard that they should do “kegels” during and after pregnancy. A kegel is a contraction of the pelvic floor muscles. These muscles get a lot of press related to pregnancy because of the important role they play in supporting the pelvic girdle through all the hormonal and mechanical changes that occur in the body during this season!

Positioned like a hammock from pubic bone in the front to tailbone in the back, the pelvic floor is a group of muscles that supports the internal organs including the bladder and uterus. Also included are the sphincter muscles, which close and open the urethral and anal openings — relaxing to let urine and stool void when at the toilet. As the posture/weight distribution changes in the pregnant body, these support muscles must work harder in a “gravity dependent” position like standing and walking. For example, holding back urine may be easier when coughing/sneezing if you are lying down, but more difficult when upright. Urinary leakage can be one sign that the pressure system made up by your deep abdominal, pelvic floor, and other muscles isn’t working properly. Although this is a common issue for women who have experienced pregnancy and childbirth, it is not normal

Learning how to identify and contract and relax the pelvic muscles can be challenging. It’s hard to figure out if you’re engaging a muscle you can’t see, unlike a bicep muscle, which you can look at and know whether it’s flexed or not. A pelvic health physical therapist can objectively assess the muscle strength, coordination and endurance to give women feedback on where they’re at, utilizing internal and/or external biofeedback units and analyzing the information they gather.

After determining your pelvic floor muscle coordination, strength and endurance, a pelvic health PT can develop a specific plan, tailored to address what your muscles need most for you to reach your individual goals. Even during the journey toward conception, there is a preventative aspect of PT that focuses on helping prepare the body for pregnancy. The individualized plan of care can then continue throughout your pregnancy, with appropriate adjustments made to the therapeutic exercise program based on pregnancy stage.

Woman receives physical therapy treatment

As baby’s due date nears, the focus shifts from keeping the pelvic floor muscles strong to stabilize the pelvis, to training them how to relax and bear down as the pregnant body gets ready for birth.  A pelvic health PT can assist with labor/birth preparation, helping women learn how to lengthen the pelvic floor as well as testing which body positions facilitate the best relaxation of the pelvic floor, which can help to speed up labor as well as reduce the risk of perineal tearing. Every woman, even those who have no pain or leakage can still benefit from labor, birth preparation and position training.

Whether baby is born vaginally or via cesarean section, there is muscle recovery and often scar tissue management involved after birth. Problems such as constipation/hemorrhoids, urinary leakage, pressure/heaviness/bulging from the vagina, and painful intercourse are all frequently experienced issues that can improve drastically with pelvic floor muscle and breath training for improved pressure management in the core.

Working with a pelvic health specialist before, during and after pregnancy can help you return to your optimal function and ensure your focus is on the joy of motherhood.

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