The Pelvic Floor During Pregnancy and Following Childbirth

Don't believe what you hear! It is common to develop a Pelvic Floor Disorder (PFD) after having children, but the damage caused to your pelvic floor by pregnancy and childbirth can be minimised and often reversed.

"You're having a baby, it's too late for your pelvic floor!"

"Expect to leak when you laugh, its inevitable!"

Don't believe what you hear! It is common to develop a Pelvic Floor Disorder (PFD) after having children, but the damage caused to your pelvic floor by pregnancy and childbirth can be minimised and often reversed. You don't have to accept urinary incontinence and other pelvic floor disorders as part of becoming a mother.

Even if you had your last child many years ago, there are steps you can take to reverse the pelvic issues you may have developed. They may indeed only become present several weeks or even months, after your child is born.


What Happens to Your Pelvic Floor During Pregnancy?

As your baby grows, its weight is added to your pelvic floor, along with any extra weight you gain. Add that to the effects of the hormonal changes that you will experience, and you will likely become aware that your pelvic floor has weakened and is pushing down in your pelvis. You may feel some discomfort, and may even experience a pelvic floor disorder, such as urinary incontinence, during the later stages of your pregnancy. In some cases this incontinence stops after your child's delivery, as the pelvic floor is able to better support the bladder once it has less weight on it. The axis of your spine will also improve following delivery, providing further support. However, it is not uncommon to experience some nerve damage during pregnancy, which may result in you being unable to contract your pelvic muscles as you were able to before your pregnancy. Again, this is reversible!

If you become a mum in your late 30's or older, you are at an increased risk of developing a pelvic floor disorder during pregnancy, as your pelvic floor is already weakened by the drop in your oestrogen levels.


What Happens to Your Pelvic Floor Following Childbirth?

The changes that happen during pregnancy mean that 43% of women that undergo a cesarean delivery will experience a degree of one or more pelvic floor disorders. As expected, your risk of developing a pelvic floor disorder is significantly higher if you have a complicated or traumatic vaginal birth - where instruments such as forceps or vacuums are used, your baby is large, or delivery was prolonged. But even uncomplicated vaginal deliveries come with a degree of damage to your pelvic floor and the associated vaginal tissue and nerves.

It is therefore likely that you will experience one or more of the following pelvic floor disorders:

  • Overactive bladder - Any damage to your bladder or the pelvic floor may mean you feel the need to frequently empty your bladder of small amounts of urine. This may be as a result of your pelvic floor being unable to contract and support the bladder sufficiently.
  • Faecal incontinence - If you experienced a perineal tear, you are at a greater risk of developing faecal incontinence (aka anal incontinence). Faecal incontinence can occur alongside urinary incontinence.
  • Pelvic organ prolapse (POP) - Around 50% of women who have carried a baby to full term will experience a degree of vaginal prolapse. The weight of the baby on the pelvic floor weakens it, and pregnancy hormones can encourage it to stretch beyond its limit. A prolapse is most common in women who had a vaginal delivery. To learn more about the types of vaginal prolapses that can occur, visit our Prolapse Hub.
  • Sexual dysfunction - Often as a result of urinary incontinence or damage from a vaginal delivery, you may notice changes in your enjoyment of sex following your pregnancy. If you undergo surgery to resolve any of the disorders above, you are at an increased risk of further dysfunction.

Your risk of developing any of the pelvic floor disorders listed above increases with each birth and your age. But don't let that put you off having children - you can minimise your risk and reverse the damage caused during pregnancy by following the steps below.


Can I Reduce My Risk or Reverse the Damage to My Pelvic Floor?

You will be encouraged to begin pelvic exercises as early as your 1st trimester (from day one!). Ideally they will already be a part of your routine giving you a great start at protecting yourself against developing a pelvic floor disorder.

Having a strong pelvic floor before and during your pregnancy, reduces your risk of developing urinary incontinence during your pregnancy. Your pelvic muscles will hold the weight of the baby off your bladder and be able to support the uterus more effectively. A strong pelvic floor will also protect your pelvic organs from being damaged from the growing baby.

Here are our tips to reducing your risk of developing a pelvic floor disorder, and how to reverse any damage that you have:

  • Do your Kegels! - Strengthen your pelvic floor through Kegel / pelvic floor exercises to support your pelvic organs. Electronic pelvic toners, such as the Kegel8 Mother Nurture Electronic Pelvic Toner & Labour TENS Machine, have specific programmes to help strengthen the pelvic floor most efficiently before conception and after childbirth. Throughout your pregnancy you will be encouraged to follow manual routines.
  • Shake that baby weight - Extra weight adds extra pressure to your pelvic floor. The National Institute for Heath and Care Excellence (NICE) recommend maintaining a healthy weight with a BMI of less than 30 to remove excess weight from your pelvic floor whilst you strengthen it through routine Kegel exercises.
  • Avoid picking up older, heavier children - As well as being bad for your back, picking up heavy weights puts unnecessary strain on your pelvic floor. Learn how to lift correctly to avoid causing damage when you need to pick up a heavy weight.
  • Avoid constipation - Eat a high fibre diet to keep your bowel movements regular. Having constipation will cause you to strain, which puts unnecessary pressure on your pelvic floor.
  • Use a toilet stool - Toilet stools are designed to put you in the perfect position to fully empty your bowel. With your knees high forcing you to squat. It may seem daft but trust us, once you try it out you will never go back!
  • Stop smoking and treat any persistent coughs - Every time you cough you add pressure to your pelvic floor. If it is unable to contract sufficiently you will likely leak a small amount of urine. Train yourself to contract your pelvic floor when you need to cough, and treat any coughs that can be avoided.
  • Avoid strenuous activity and high impact exercise - High impact exercises weaken your pelvic floor as you land heavily on your feet, sending pressure up your legs to your pelvis. Swap running for swimming and cross fit for cycling. Yoga and Pilates are excellent exercises to break a sweat but avoid this unnecessary pressure. They can even be modified to balance any pressure more evenly.

Most mild and moderate damage can be reversed through Kegel / pelvic floor exercises alone. Speak to your doctor about which routine is right for you. If you had an uncomplicated delivery, you may be able to begin exercising your pelvic floor immediately after your child is born.


Sources

Bø, K. Hilde G. Engh, M. E. Siafarikas. F. Stær-Jensen, J. (2013). Obstetrics Gynecology. Ultrasonographic evaluation of pelvic organ support during pregnancy.[online] 122(2), p 329-336. [viewed 04/04/2018]. Available from: https://insights.ovid.com/pubmed?pmid=23969802

Bø, K. Hilde G. Jensen. J. S. Siafarikas. F. Engh. M. E. (2013). International Urogynecology Journal. Too tight to give birth? Assessment of pelvic floor muscle function in 277 nulliparous pregnant women. [online] 24(12), p 2065-2070. [viewed 04/04/2018]. Available from: https://link.springer.com/article/10.1007%2Fs00192-013-2133-8

Boyle, R. Cody, J. D. Hay-Smith, E. J. Mørkved, S. (2017). Cochrane Database of Systematic Reviews. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. [online] Cochrane Library, 2017. [viewed 04/04/2018]. Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD007471.pub3/full

Bozkurt, M. Sahin, L. Yumru, A. E. (2014). Taiwanese Journal of Obstetrics & Gynecology. Pelvic floor dysnfunction, and effects pregnancy and mode of delivery on pelvic floor. [online] 53(4), p 452-458. [viewed 05/04/2018]. Available from: http://www.tjog-online.com/article/S1028-4559(14)00169-7/pdf

Cacciatore, A. Fonti, Y. Giordano, R. La Rosa, B. Romano, M. (2009). Journal of Prenatal Medicine. Post partum pelvic floor changes. [online] Journal of Prenatal Medicine, 2009. [viewed 03/04/2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279110/

Chitra, T. V. Panicker, S. (2011). Journal of Obstetrics and Gynecology of India. Child Birth, Pregnancy and Pelvic Floor Dysfunction. [online] 61(6), p 635-637. [viewed 05/04/2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3307929/

Handa, V. L. Memon, H. U. (2013). Women's Health. Vaginal childbirth and pelvic floor disorders. [online] 9(3), p 265-277. [viewed 04/04/2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877300/

Mørkved, S. Bø, K. (2000). BJOG: An International Journal of Obstetrics & Gynaecology.Effect of postpartum pelvic floor muscle training in prevention and treatment of urinary incontinence: a one‐year follow up. [online] 107(8), p1022-1028. [viewed 16/04/18]. Available from: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-0528.2000.tb10407.x

National Childbirth Trust. (2014). Pelvic floor exercises how-to guide: Pregnancy & beyond. [online] National Childbirth Trust, 2014. [viewed 03/04/2018]. Available from: https://www.nct.org.uk/pregnancy/pelvic-floor-exercises-during-and-after-pregnancy

NHS. (2016) Safe lifting tips [online] National Health Service, 2016 [viewed 20/03/2018]. Available from: https://www.nhs.uk/livewell/workplacehealth/pages/safe-lifting-tips.aspxNHS. (2018) Pelvic organ prolapse [online] National Health Service, 2018 [viewed 14/03/2018]. Available from: https://www.nhs.uk/conditions/pelvic-organ-prolapse/

NICE. (2015). Urinary incontinence in women: management, 1 Recommendations [online] National Institute for Health and Care Excellence, 2015 [viewed 14/03/2018]. Available from: https://www.nice.org.uk/guidance/cg171/chapter/1-Recommendations#physical-therapies

van Veelen, G. A. Schweitzer, K. J. van der Vaart, C. H. (2014). Ultrasound in Obstetrics & Gynecology. Ultrasound imaging of the pelvic floor: changes in anatomy during and after first pregnancy. [online] 44(4), p 476-480. [viewed 04/04/2018]. Available from: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/uog.13301

Women's Health Concern. (2015). Prolapse: Uterine and vaginal [online] Women's Health Concern, 2015 [viewed 04/04/2018]. Available from: https://www.womens-health-concern.org/help-and-advice/factsheets/prolapse-uterine-vaginal