Postpartum Pelvic Floor: Navigating Changes and Healing in the 4th Trimester
After having a baby your body has changed in many ways, especially around the pelvis. The soft tissue and muscles of the pelvis supported the weight of your baby for 9 months, lengthening and adjusting to accommodate.
These changes can have a profound impact on how the muscles work after birth and can be scary when you don’t expect it.
It can be helpful to understand what is normal for pelvic floor healing in the 4th trimester. Then you can ask for help if you notice signs outside of the normal range.
First, let’s look at the pelvic floor’s 5 functions or roles:
support - of the pelvic organs
sphincter - opening and closing of the urethra and anus
stability - of the pelvic joints & transfer of forces through the pelvis
sex - arousal and orgasm
sump pump - to move lymph and blood up through the pelvis from the legs
These functions can be altered during pregnancy, if you think about pelvic girdle pain and swelling as just two examples.
So what is normal to expect from the pelvic floor after giving birth?
Support
The pelvic floor muscle and ligament integrity can be compromised from pregnancy and birth, which may result in loss of or reduced support of the pelvic organs. Immediately after birth you may feel more vaginal pressure and difficulty accessing these muscles to support your organs. This is normal in the first few weeks.
However, by 6 weeks you shouldn’t feel any downward pressure in the pelvis on a regular basis. This may feel like heaviness or bulging in the bottom of the pelvis, either in the vagina or perineum. Or difficulty peeing or pooping.
Since the pelvic floor does not work in isolate, you may still experience some pressure when loading your body beyond your whole system can handle. What I mean by this is, if your core system no longer responds automatically when you cough or sneeze, if you breath in a reversed way so you bear down when you exhale, or you lift beyond your muscles tolerance, the intraabdominal pressure or forces places on the body will go to the place of least resistance, meaning the pelvis.
Sphincter
Similar to support the sphincter muscles within the pelvic floor may have lost some integrity or coordination. After giving birth your bladder and bowels may have difficulty emptying initially do to the overall discomfort in the area as well as the change in physical space. This should not continue past the first few days, unless you had a pelvic floor injury, which can prolong healing.
You may also notice difficulty holding urine, gas, or stool in the first few weeks, but again this should not last beyond 6 weeks postpartum. For those with a tear or episiotomy, depending on the degree you may experience prolonged control difficulty. If you experience leakage of any kind beyond 12 weeks, your body needs extra support to resume normal function.
Stability
Your body will continue to have some ligament laxity in postpartum as your pelvis shrinks and your joints shift. This continues to put more responsibility on your stabilizing muscles, like the pelvic floor & the core system to stabilize your movement.
Other than vaginal or abdominal soreness or some soreness from extra sitting or lying down, you should not experience any other pain during regular movement. This pain may be in the pubic (front) joint, sacral (back) joints, tailbone, hips or low back. Common movements that result in pain is single leg standing when getting dressed, rolling in bed, sit to stand, getting in and out of the car, walking up or down the stairs.
This is usually the result of the muscles inability to stabilize the joints in proper alignment while they move. But even if you are able to move without pain, the core system is still healing and needs time to progress to more complex movements that place more forces and loads on the muscles & joints. Again, since the pelvic floor does not work in isolation, ensuring the whole core system and accessory muscles are functioning optimally, will ensure that pelvic floor is not stressed from doing too much work or doing too little. By 6 weeks, there should be no soreness, discomfort or pain on a regular basis.
Sex
Sex can be impacted by more than just the pelvic floor, but we will focus on this more physical aspect. Once you are cleared and you feel ready the biggest take away around sex and the pelvic floor is, there should be no pain. That being said you will most likely be dry, which can be uncomfortable. So if you continue to have pain while using lubricant, this is not normal.
On the other hand, you may not experience pain, but lack of or low desire. Again, many factors play a role in this including hormones, sleep deprivation, feeling touched out. However, the clitoris is part of the pelvic floor and a strong and responsive pelvic floor can help with desire. This timeline is different for everyone based on all the other factors.
Sump Pump
Immediately after birth you will likely experience some amount of vulva swelling, that does not last beyond 6 weeks. Most women will see a difference even before 6 weeks, unless there was tearing or another injury.
Since your pelvic floor helps your body pump the lymph and blood through the pelvis, if the pelvic floor is tense or inflexible, meaning it doesn’t move, fluids may become stuck in the area. Then you will noticing lingering swelling (any where from pelvis down), heaviness, blood pooling, hemorrhoids or varicosities.
The restoration of each pelvic floor function may have a different healing timeline for everyone, however with regular daily activity you should not experience any incontinence, pain, swelling, hemorrhoids, difficulty going to the bathroom, pressure, heaviness beyond 6 weeks postpartum.
If you do higher impact or complex activity too soon you may notice issues and that is your body telling you it’s too soon. For most people, if symptoms are still around by 12 weeks postpartum, they are likely not to get better without assistance and pelvic Physical Therapy is highly recommended. If any of the above information resonated with you, then I invite you to set up a consult call to discuss pelvic PT and your options.