When it comes to pregnancy and childbirth, it’s easy to focus on your uterus, cervix, and vaginal canal…but your pelvic floor deserves just as much attention. Your pelvic floor is involved in issues such as bladder leaks, constipation, back pain, and hemorrhoids (yes, even hemorrhoids!). Without the right care, these are all common symptoms during pregnancy that can follow you for years after birth. Pelvic floor physical therapy like the care provided at Origin can help you manage these symptoms, support your body through pregnancy and birth, and build a stronger foundation for postpartum recovery.
What exactly is the pelvic floor? (And why it matters now)
Your pelvic floor is a group of muscles, tendons, ligaments, and connective tissues at the base of your pelvis. They attach front-to-back (from your pubic bone to your tailbone) and left-to-right (between your sit bones), creating a “hammock” that supports your bladder, rectum, and reproductive organs. That means that when you’re pregnant, they support your baby, too!
While it’s easy to overlook these muscles, your pelvic floor has five major functions that are critical to your overall well-being, especially during and after pregnancy. Your pelvic floor functions are:
- Support: A strong pelvic floor cradles everything in your pelvis, helping to keep your uterus, bladder, bowels, and organs supported.
- Stability: The pelvic floor muscles are a part of your core, stabilizing your low back, hips and pelvis as you move. They support your joints as ligaments loosen to prepare for birth and accommodate your body’s changing weight distribution and balance.
- Bladder and bowel control: Strong pelvic floor muscles help you stay leak-free, but it’s a balancing act; these muscles also need to relax and coordinate to allow for strain-free bowel movements.
- Reproductive and sexual function: Your pelvic floor muscles may need to stretch to over three times their normal length during vaginal childbirth. They’re also a critical piece of your sex life: they must be able to both contract and relax for comfortable penetrative intercourse and to experience orgasm.
- Circulation: These muscles help circulate blood and lymph fluid through your pelvis and abdomen, working to decrease swelling and bloating and protect you from infections.
Pregnancy and childbirth put a lot of pressure and stress on your pelvic floor, and nearly half of all pregnant and postpartum people experience symptoms of pelvic floor dysfunction (PFD). However, your pelvic floor is nothing if not resilient! Caring for your pelvic floor can help you prepare your body for pregnancy, manage PFD symptoms if/when they happen, and build a foundation for pelvic floor postpartum recovery.
Why is pelvic floor important for pregnancy and childbirth?
Pregnancy and childbirth ask a lot of your pelvic floor. Your growing uterus and baby add weight and increase downward pressure on the muscles and connective tissues.
Your pelvic floor muscles work hard to stabilize your pelvis as your body changes: the natural curvatures of your spine increase, your joints and ligaments become more mobile, and your pelvic joints widen to make space for your growing baby. These changes happen regardless of how you birth: your pelvic floor needs TLC before and after both a vaginal or cesarean birth, too!
During labor, your vaginal tissues and levator ani muscles (one group of your pelvic floor muscles) experience a huge amount of stretch. This stretching and straining can cause muscle injuries such as tearing or avulsion (when the muscle and tendon come away from the bone).
Childbirth can overstretch the nerves in your pelvic floor, which can impact long-term pelvic floor function. PFD is common during pregnancy and postpartum, especially after vaginal birth. That said, postpartum pelvic floor therapy and the right treatments can help you manage and improve your PFD symptoms.
Common pelvic floor symptoms during pregnancy
Pregnancy and childbirth are major causes of pelvic floor dysfunction (PFD) symptoms. PFD happens when your pelvic floor muscles are too weak, too tense, resistant to stretch, or poorly coordinated…or a combination of these. Common PFD symptoms during pregnancy and postpartum include:
- Urinary or fecal leakage
- Chronic constipation, which can lead to hemorrhoids and anal fissures
- Painful sex
- Low back, hip, or pelvic pain
- Heaviness in the pelvis often coinciding with pelvic organ prolapse
You may experience some, all, or none of these symptoms (good for you!). Regardless, monitoring your pelvic health throughout pregnancy can help you stay ahead of new problems and keep present ones from getting worse.
Anorectal issues
While the uterus and vaginal canal often get all the attention, your rectum and anus feel the effects of pregnancy and birth, too. Constipation is common during pregnant and postpartum, as are hemorrhoids and anal fissures, and they all relate to your pelvic floor. Here’s how:
- Constipation: To poop comfortably, your pelvic floor muscles need to relax and lengthen. Pregnancy can make this more difficult: these muscles are constantly working to sustain an increased load, your hormones can plug you up, and your expanding uterus compresses into your colon and rectum.
- Hemorrhoids: Pregnancy and hemorrhoids go hand-in-hand because of increased abdominal pressure. Constipation, straining, and overactive pelvic floor muscles can contribute to the development of hemorrhoids and make them worse.
- Anal fissures: Small tears in your anal tissue can cause major pain, making your anal sphincter spasm and tense up. This muscle tension makes it harder to poop and easier to reopen the tears.
Anorectal issues are incredibly common, especially during pregnancy and after birth. While it can seem benign, something as simple (and annoying!) as chronic constipation can increase your risk of pelvic organ prolapse and urinary and fecal incontinence.
The good news here is treatment can help! Pelvic floor physical therapy and prescription hemorrhoid and anal fissure creams can help you work through anorectal symptoms, no matter how long you’ve dealt with them!
What is pelvic floor physical therapy?
Pelvic floor physical therapy (PFPT) is what it sounds like: therapy that focuses on the muscles that support your bladder, bowels, and reproductive organs. However, it doesn’t work the way you probably think! (Spoiler: no stirrups or speculums, and wayyy more specific than just Kegels.)
PFPT is highly individualized to your body and your needs. Your pelvic floor physical therapist can assess how your pelvic floor muscles function and where they need support. Pregnancy and childbirth can exacerbate existing pelvic floor issues or cause new ones, making PFPT a necessary support. However, even if you don’t receive PFPT during pregnancy or immediately postpartum, it’s still worth seeking out later on: it’s never too late to start helping your pelvic floor with PFPT.
Can I do pelvic floor therapy from home?
Absolutely. Origin offers virtual care nationwide! In a virtual session, you meet one-on-one with a credentialed physical therapist via a secure, HIPAA-compliant Zoom meeting. Your provider will assess your symptoms, walk you through a self-check (to do then with your camera off, or later on your own), and provide you with tailored care and pelvic floor exercises for pregnancy or postpartum.
When to start pelvic floor exercises and therapy
Wondering when to start pelvic floor exercises during pregnancy? While it’s never too early to start, it’s also never too late! Pelvic floor physical therapy (PFPT) can help you stay symptom-free throughout pregnancy and prepare you for birth.
| Timing | What PFPT can help with |
| Trying to conceive & 1st trimester | Diaphragmatic breathing, pelvic floor muscle strengthening and lengthening (relaxing), and minimizing pain so you can stay active |
| 2nd & 3rd trimester | Exercises to build pelvic floor strength and flexibility, guidance on birthing positions and individualized pushing methods, perineal massage to reduce risk of tears |
| 4th trimester & later postpartum | Heal from childbirth, prevent pain through movement education, rebuild your abs & pelvic floor, and help with conditions such as constipation, prolapse and return to sex |
Do I need pelvic floor therapy if I don’t have symptoms?
If you have a pelvic floor, you can benefit from PFPT! If you don’t have symptoms, getting a check-up to establish your pelvic floor baseline will help you understand your “normal.” That way, if symptoms ever do start, you know what baseline you’re aiming to return to.
This is especially true if you’re trying to conceive, pregnant, or postpartum. Your pelvic floor muscles are undeniably involved in pregnancy and birth, and can use as much support as they can get. Symptoms are more common than you’d think, and can sneak up without much warning. Research shows that pelvic floor training during pregnancy can help prevent symptoms from developing in the first place, and reduce the likelihood of more serious perineal complications during birth. Pelvic floor physical therapy can help you stay on top of your pelvic health and work to keep you symptom-free.
Frequently asked questions (FAQs)
Can virtual pelvic floor therapy actually help with postpartum hemorrhoids?
Yes, it can. For many birthing people, hemorrhoids improve within a few weeks of birth. For some, though, they stick around and become chronic. A pelvic floor physical therapist can recommend personalized habit changes to reduce hemorrhoids and help you address pelvic floor muscle issues that may influence your hemorrhoids.
Do I need pelvic floor therapy if I had a C-section?
Yes, your pelvic floor can still benefit from pelvic floor physical therapy after a cesarean birth. Your body goes through all of the same changes while pregnant as someone who gives birth vaginally: your pelvic floor is under added weight and pressure, your muscles and ligaments become looser, and you may experience symptoms of pelvic floor dysfunction. PFPT is holistic; it also works to restore abdominal and core function, which is critical after a major surgery to the abdominal wall.
How do I know if my pelvic pain is normal pregnancy aching or a pelvic floor issue?
The best way to know if your pelvic pain is “normal for pregnancy” is to talk with a pelvic floor physical therapist. Pregnancy puts incredible demand on your body. While your body is incredibly resilient and capable of managing these challenges, PFPT can help you minimize pain, condition your pelvic floor, and prepare physically for birth.
Is it too late to restore my pelvic floor years postpartum?
It’s never too late to care for your pelvic floor! The benefits of pelvic floor physical therapy (PFPT) don’t have an expiration date, and postpartum pelvic floor symptoms often don’t either. pelvic floor physical therapy at Origin can help improve symptoms, such as hemorrhoids, urinary incontinence, pelvic organ prolapse, and painful sex, no matter how long you’ve experienced them.
Sources
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