Pregnancy and the Pelvic Floor: Understanding Impact and Managing Change
The pelvic floor is one of the most impacted muscle groups during pregnancy and after. But why and is there anything you can do to reduce this impact?
The pelvic floor is a group of muscles and connective tissue that closes off the bottom ring of the pelvis. There are three holes running through the muscles as exit or entry point to the bladder, vagina and rectum/colon.
The pelvic floor connects to the bony structure of the pelvis in the front, back and sides, but the middle of the pelvic floor is all soft tissue that holds up everything above it. This includes the pelvic organs, bladder, uterus, and colon. But also the abdominal contents like your intestines, stomach and liver.
The main roles of the pelvic floor are
to keep pee, poop and baby in until ready to let them out
organ & joint support
sexual function and
movement of fluid from the legs to the heart & lymph system
During pregnancy these roles can be stressed by the physical and hormonal changes that occur. Let’s take a look at how and what you can do to reduce the stress on the pelvic floor.
Hormonal Changes
One of the most significant changes that occur is the influx of hormones including relaxin. One of the main purposes of relaxin is the soften the joints to make room for baby’s growth and birth, especially the pelvis. With the decrease in connective tissue support surrounding the joints, the muscles take over more of that role. When there is an imbalance in muscle strength, an increase in tension can occur.
This is is particularly noticeable in the pelvic floor. Since the pelvic floor works with surrounding muscles to provide support to the hips, pelvis and spine, it relies on these other muscles to find balance. In particular the abdominals, adductors (inner thighs) and glutes. If these other muscles aren’t pulling their weight to support; which is tremendously hard for the abdominals to do when they are stretching out; the pelvic floor does more work, thus getting stressed out and likely tensing up.
What you can do about it!
There is nothing you can do about the hormone changes, however there is a lot you can do to address the muscular imbalances that may occur. Performing safe for pregnancy exercises that target the glutes, abdominals and adductors in various positions and planes can help you manage the joint stability necessary to reduce stressing out the pelvic floor that can cause pelvic pain or other issues.
Pressure Changes
As baby grows and moves upward, eventually taking up the majority of the abdominal cavity, this prevents the respiratory diaphragm from pulling down as optimally or as far when you are breathing. In general this can force you into more of a shallow breathing pattern, which changes the intraabdominal pressure. Leading to more of a sucking in pattern of the pelvic floor on inhale and a pushing out or pressure downward on exhale.
This is a significant change on the pelvic floor since increased downward pressure can lead to incontinence and pelvic organ prolapse. A change the pelvic floor will try to withstand a long as possible by contracting more, again overworking it, without meaning to.
What you can do about it!
Working on your breathing and maintaining a downward inhale and upward exhale for as long as possible can reduce the impact of pressures changes in pregnancy. This includes doing thoracic mobility exercises to reduce stiffness in the ribs and mid back strengthening exercises which help your ribs expand through the back and sides. Performing breathing centered exercises in multiple positions will also help you clue into patterns that aren’t serving you, like ballooning the belly out on exhale or sucking in on inhale.
Posture Changes
During pregnancy your center of gravity changes and so will your posture. The most common posture change due to this is a anteriorly tipped pelvis with an increased spine curve and pushed forward ribs. Unfortunately, this can strain your joints, especially if your muscles can’t provide the support necessary. You may find yourself trying to correct this by going in the [almost] complete opposite direction, which may be leading to tense muscles rather than relief.
This forward posture puts a lot of pressure downward into the pelvic floor which can increase pubic symphysis pain, bladder control issues, and pelvic pressure. And if you try to correct it inadvertently using the incorrect muscles you can increase tightness in the back of the pelvic floor making pooping more challenging and SIjoint-lowback/hip pain.
What you can do about it!
Building strength in postural muscles like your glutes, abdominals, hamstrings, adductors and upper-mid back, while maintaining proper pelvic and rib alignment. Including isometric exercises where you focus on just engaging the muscles in good form as well as movement based or functional exercises. You can also do muscle release work with a ball or foam roller to let go of tension prior to strengthening, allowing for better range of motion through the exercise and teaching the muscles how to lengthen.
You will also want to pay more attention to how you are sitting and standing through out the day can really help reduce this impact. You don’t have to sit perfectly 24/7, however being in a position that strains your joints for longer than 30 minutes may cause you pain. So consider sitting in different positions and practicing using your posture muscles in those positions, which will be easier if you are stacked in your ribs and pelvis.
This will help prevent excessive muscle tightness, stabilize joints during movement, reduce pressure on the pelvic floor and support your growing belly.
There you have it, 3 major changes that occur in pregnancy and how they impact the pelvic floor. You can see these changes have nothing to do with the birth. Which is why you may have pelvic floor problems even if you had a cesarean birth or uneventful vaginal birth. The good news is you can influence these changes by being mindful and proactive.
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