The Pelvic Floor During Pregnancy and Following Childbirth

"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.

Why Do You Need To Strengthen Your Pelvic Floor Before and During Pregnancy?

Your pelvic floor is made up of muscles, ligaments, and tissues, that stretch from the base of your spine to your pubic bone. It's main role within the body is to support the function of your bladder, bowel, and uterus. This is made more difficult during pregnancy as the muscles are under extra stress from the weight of your growing baby. During pregnancy, the muscles can become exhausted and weaken, which can lead to a pelvic floor disorder.

Pelvic floor muscles are also important for:

• Sexual function - In women, the squeezing of the pelvic floor muscles is responsible for sexual sensation and arousal.
• Posture and support - The pelvic floor muscles help to support and stabilise the spine, alongside the core muscles of the abdomen and back.
• Continence - The muscles support the function of the bladder and bowel. Weakened pelvic muscles can allow your bladder and rectum to drop and prolapse (bulge) into the vagina. This can cause urinary and sometimes faecal incontinence where you lose control of these functions.
• Bowel movement - Constipation can occur when your rectum or small bowel (small intestine) loses its support from the pelvic floor muscles.

How Can You Strengthen Your Pelvic Floor?

Kegel exercises are the main method for strengthening your pelvic floor during pregnancy. Completing these pelvic floor exercises regularly will act as a preventative measure towards pelvic floor disorders that can arise in later pregnancy, as well as treating any existing weak areas.

You can use an electronic pelvic toner before pregnancy to strengthen your pelvic floor to hold the weight of your baby, and after childbirth to repair any damage or pelvic floor disorders such as incontinence or prolapse.

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:

• Stress urinary incontinence - You are at 21% risk of developing urinary incontinence after having your first vaginal birth, rising to 36% if forceps are used. If you developed the incontinence during your pregnancy, you are more likely to continue to have it after delivery.
• 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.
• 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 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.

Stress Incontinence After Childbirth

Stress incontinence is common amongst mothers, with 45% still suffering from urinary incontinence 7 years after giving birth. Regardless of its prevalence, it will always be embarrassing when you are unable to prevent urine leaks when you cough, sneeze, laugh, or lift objects. The good news is that it is easily reversible. Ensure you perform your daily pelvic floor exercises to regain control of your bladder.

If you suffer with stress incontinence, follow these tips to help prevent bladder weakness:

• Drain the tank - When you go to the toilet, ensure that your bladder is completely emptied. Conversely, avoid making a trip to the toilet 'just because', as this will train your bladder to empty more often than usual.
• Kegel! - Before you begin to sneeze, cough, laugh, or lift an object, try squeezing and holding your pelvic floor muscles to reduce the chance any accidents.
• Relax - Avoid high impact exercises, or lifting heavy loads as these can worsen any pelvic floor weakness. 
• Fuel your system - Make sure you drink plenty of fluids, and eat fibre-rich food to avoid constipation.
• Perfect your position - When you make a trip to the toilet for a number two, ensure that you lean forward, straightening your back, whilst you are sat. For optimal release, your knees should be in a slightly higher position than your hips (a toilet stool may be helpful in this process). It's important that you avoid pushing to reduce strain, and relax your pelvic floor.

Pelvic Organ Prolapses After Childbirth

It is fairly common for a pelvic organ prolapse to follow a complicated vaginal delivery. Prolapses are also more common following multiple pregnancies, as your pelvic floor becomes severely weakened. Prolapse occurs when your pelvic organs are not supported properly. Your organs can push down or descend into your vagina, resulting in a heavy, dragging sensation. However, it's not as daunting as it sounds as the prolapse can be reversible.

Mild and moderate prolapse can be treated through pelvic floor exercises (although it's best to avoid heavy lifting or exercise during this process). However, further action may need to be taken for women who suffer with severe pelvic organ prolapse.

How To Do Pelvic Floor Exercises After Childbirth

You have to keep your pelvic floor muscles working well not only after childbirth, but for the rest of your life. When you first give birth, you may be sore, however as soon as is comfortable, complete a set of 5 slow and 5 quick squeezes. Once this can be completed comfortably, follow these steps:

1. Lay or sit comfortably with your back straight.
2. Tighten your pelvic floor muscles, starting at your anus, then vagina and urethra. This will feel as if you're trying not to pass wind, or urine.
3. Squeeze these areas, and lift! Think of the lift part as a suck up towards your belly button; though be careful not to tense your abdomen as this will reduce effectiveness.
4. Hold the squeeze and count to 5 (or longer if possible) to strengthen your slow twitch muscles. For your fast twitch muscles, only hold the squeeze for a second.
5. Relax your muscles for a few seconds following each squeeze. This is just as important as squeezing in the pelvic floor toning process.
6. Repeat the process 6-10 times per day for a strong pelvic floor.

From your 4-week midwife appointment, you should get the all clear to begin using your Kegel8 Electronic Pelvic Toner again. Speak to your midwife if you have any queries.

Sources

Continence Foundation of Australia (Updated 2024) Incontinence Prevention [online] Continence Foundation of Australia [viewed 12/12/2024]. Available from https://www.continence.org.au/continence-health/prevention

Hay-Smith, E.J.,Dumoulin, C. (2010). Pelvic floor muscle training versus no treatment, or inactive control treatments for urinary incontinence in women. Cochrane Database of Systematic Reviews. 25(1). [Viewed 12/12/2024].

Hilde G, Stær-Jensen J, Siafarikas F, et al. (2013) Impact of childbirth and mode of delivery on vaginal resting pressure and on pelvic floor muscle strength and endurance. American Journal of Obstetrics and Gynecology. 208(1). [Viewed 12/12/2024]. Abstract available at: https://pubmed.ncbi.nlm.nih.gov/23103345/

Morkved, S., Bo, K. (2000). Effect of postpartum pelvic floor muscle training in prevention and treatment of urinary incontinence: a one-year follow-up. International Journal of Obstetrics and Gynaecology. 107(8), pp. 1022-1028. [Viewed 12/12/2024]. Abstract available at: https://pubmed.ncbi.nlm.nih.gov/10955436/

Morkved, S., Bo, K. (2014). Effect of pelvic floor muscle training during pregnancy and after childbirth on the prevention and treatment of urinary incontinence: a systematic review. British Journal of Sports Medicine. 48(4), pp. 299-310. [Viewed 12/12/2024]. Abstract available at: https://pubmed.ncbi.nlm.nih.gov/23365417/

NHS (Reviewed 2023) Your Body After Childbirth [online] NHS 2023 [viewed 12/12/2024]. Available from https://www.nhs.uk/conditions/baby/support-and-services/your-post-pregnancy-body/

Pelaez, M. et al. (2013). Pelvic Floor Muscle Training included in a pregnancy exercise programme is effective in the primary prevention of urinary incontinence: A randomized controlled trial. Neurology and Urodynamics. 33(1), pp. 67-71. [Viewed 12/12/2024]. Abstract available at: https://pubmed.ncbi.nlm.nih.gov/23389863/

Wilson et al (2002). Obstetric Practice and Urinary Incontinence 5-7 Years After Deliver. Neurourology and Urodynamics. 21, pp. 289-291. [Viewed 12/12/2024]. Available at: https://www.researchgate.net/publication/286914854_Obstetric_practice_and_urinary_incontinence_5-7_years_after_delivery

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 12/12/2024]. Available from: https://link.springer.com/article/10.1007/s00192-013-2133-8

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 12/12/2024]. Available from: https://www.sciencedirect.com/science/article/pii/S1028455914001697

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 12/12/2024]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3279110/

Chitra, T. V. Panicker, S. (2012). Journal of Obstetrics and Gynecology of India. Child Birth, Pregnancy and Pelvic Floor Dysfunction. [online] 61(6), p 635-637. [viewed 12/12/2024]. Available from: https://pmc.ncbi.nlm.nih.gov/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 12/12/2024]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3877300/

National Childbirth Trust. (2014). Pelvic floor exercises how-to guide: Pregnancy & beyond. [online] National Childbirth Trust, 2014. [viewed 12/12/2024]. Available from: https://www.nct.org.uk/information/pregnancy/body-pregnancy/pelvic-floor-and-stomach-exercises-pregnancy

(Reviewed 2021) Pelvic organ prolapse [online] National Health Service, 2021 [viewed 12/12/2024]. 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 12/12/2024]. Available from: https://www.nice.org.uk/guidance/cg171