What are normal pelvic floor changes during pregnancy?
Our body experience many changes during pregnancy. Just because a symptom is common does not mean that it is normal. What is normal and what is not?
What is the pelvic floor and what is pelvic floor dysfunction?
The pelvic floor is a group of muscles that sits in the bottom of the pelvis. During pregnancy, these muscles support our core and growing baby. Pelvic floor dysfunction is when there is an issue with these muscles, giving rise to urinary, bowel sexual symptoms and/or orthopedic pain.
A common myth is that pelvic floor dysfunction occurring during pregnancy will go away once you are not pregnant. Unfortunately this is not true and leads many patients feeling like their symptoms are “par for the course” after having a baby
Urinary changes during pregnancy
Urinary frequency
Why does this happen? Increased cardiac output and blood volume contributes to increased frequency and urgency.
When do you know if urinary urgency is a problem? If you are urinating more than 1 time per hour or needing to get up more than 1 time per night you would likely benefit from pelvic floor physical therapy
Stress Incontinence or leakage
Why does this happen? Increased weight from the baby and increased thinning of the abdominal musculature decreases support through the pelvic floor.
When do you know if urinary leakage is a problem? While stress incontinence is common during pregnancy, it is never normal (even if it’s just a little with coughing/sneezing!) While our core muscles are thinning as the baby grows, they should absolutely still be able to support you and keep you continent.
Bowel changes during pregnancy
Constipation
Why does this happen? Your body is taking all of the nutrients from your food and giving it to your growing baby, which contributes to drier, harder stool.
When to know if this is a problem? If you are finding that you are straining, having to sit for longer than 2 minutes on the toilet, or are experience symptoms of hemorrhoids and/or fissures, you should definitely seek out help from a pelvic floor physical therapist.
Orthopedic concerns during pregnancy
Lower back pain
Why does this happen? An increase in the hormone relaxin helps to stretch out the pelvis and places more stress on the surrounding joints and muscles.
When to know if this is a problem? While pain is common, it is never normal. Our bodies are built to be able to accommodate the changes during pregnancy and if there is pain, it is a sign that too much stress is getting put on surrounding tissues.
Pelvic girdle pain
Why does this happen? An increase in the hormone relaxin helps to stretch out the pelvis and places more stress on the pelvic joints including the sacroiliac (SI) joint and pubic symphysis (giving rise to pubic symphysis dysfunction)
When to know if this is a problem? While pain is common, it is never normal. The pelvic girdle should be able to stretch in order to accommodate delivery of the baby, without pain and pain is your body’s way of telling you that something isn’t doing it’s job.
Other pelvic related symptoms:
Pelvic pressure
Why does this happen? Increased stretching of the ligaments and downward pressure on the pelvic floor muscles creates more pressure on our pelvic floor and pelvis which can create the sensation of pelvic pressure
When to know if this is a problem? Pressure can be relatively expected, especially with increased activity and with subsequent pregnancies. However, pelvic pressure should not keep you from being able to do your normal everyday activities.
Pain with intercourse
Why does this happen? Increased pelvic pressure and stress through the pelvic floor muscles creates tension through the pelvic floor and can give rise to pain
When to know if this is a problem? While decreased libido is expected, intercourse should never be painful, even during pregnancy.
Diastasis Recti
Why does this happen? Increased stretching of the abdominal muscles and ligaments in the abdominal wall creates thinning to the linea alba, which creates coning and doming when placing a lot of stress through the core.
When to know if this is a problem? Diastasis is 100% normal at the end of pregnancy and research shows that 100% of women have a diastasis recti at 35 weeks pregnant. We want to ensure that the core doesn’t have too much pressure placed directly on the front of the core and exercises should be modified as pregnancy progresses.
“I had never even considered the vital role pelvic floor would play in my birth preparation and from my initial meeting, they immediately gave me confidence that they could get me through the rest of my pregnancy. They listened to my concerns, tried various exercises and positioning to alleviate pain and prepare me for labor. Vivid Health gave me the confidence I needed to achieve my birth plan!”
— A Vivid Patient