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Praise the pelvic floor

Reviewed by: Maureen Christian, PT, WCS, CLT
Written by: Lauryn Feil

Ladies. Let’s address the post-baby-sneeze-and-pee phenomenon. If you’re a mom, first-of-all, go you – you rockstar – for creating, nurturing and birthing an actual human-being into this world and then dealing with all the drama once it’s actually left your body. Seriously, major kudos to you. We can talk all day long about how beautiful motherhood is, but if you’re experiencing the not so beautiful “I laughed so hard I peed a little” situation, or have had some, ahem, accidents, where you just didn’t quite make it to the ladies room in time, you should know, you really don’t have to just live with it. Urinary incontinence is a common symptom of pelvic floor dysfunction, which can often occur after childbirth. But, as far as we are concerned, it is not a sacrifice you have to make as a mom. We’ve got a fix for it, which can make motherhood, womanhood, and life in general that much better.

So what’s the deal with the pelvic floor – what exactly is it, how can pregnancy and childbirth affect it, and what can you do about it? We talked with expert pelvic floor physical therapist, Maureen Christian, at UT Health Austin’s Women’s Health Institute, to pick her brain about it. Below are her answers to questions about pelvic floor health during and after pregnancy and how you can get it back into tip-top shape.

1. What is the pelvic floor, and how is it stressed during pregnancy?

The pelvic floor is a multi-layered group of hammock shaped muscles along with other ligamentous and connective tissue structures, which span from the pubic bone anteriorly to the sacrum/coccyx posteriorly, and between the “sits” bones bilaterally. These structures help to support the pelvic organs and as pregnancy progresses, the added weight pressing down on these structures can cause compression and prolonged stretching, possibly making the muscle tissue weaker and more challenging to contract. This, combined with added pressure directly on the urinary bladder, can cause urinary leakage with surge pressures from coughing, sneezing, laughing, position changes, etc.

2. How may childbirth cause damage to or weaken the pelvic floor?

The degree to which the pelvic floor structures are stressed during childbirth is dependent on many factors, some of which include fetal weight and head size, length of stage II labor, and labor to birth positioning. The soft tissue structures, which include peripheral nerves, may experience prolonged compression and stretching during childbirth, rendering them less functional and less supportive, and in the case of muscle tissue, less able to perform optimal contraction. Some studies have suggested that a great deal of these changes may occur more in the latter stages of pregnancy, whereby, cesarean section may not always contribute to preventing pelvic floor injury.

3. What are the symptoms of pelvic floor dysfunction?

Symptoms that are possibly related to pelvic floor dysfunction can manifest in many ways, including urinary incontinence, fecal incontinence, and pain with sexual intercourse or other sexual complaints or dysfunction. The truth is, childbirth does change things and puts a woman at greater risk for pelvic floor dysfunction. However, given time, the body heals, recovers, and returns to its pre-partum state. However, when the pelvic floor is not functioning optimally, there are several interventions a trained pelvic floor physical therapist can educate the patient on in order to reduce and, ideally, eliminate the symptoms. In short, don’t assume it’s normal to leak urine or have pain or other sexual dysfunction following childbirth. Seek the assistance of a pelvic floor therapist should you have persisting symptoms after 6-8 weeks postpartum.

4. Can pelvic floor dysfunction lead to other more serious issues, like pelvic organ prolapse?

The most common risk factor for pelvic organ prolapse (when one or more of the pelvic organs drops or presses into or out of the vagina) is vaginal childbirth. However, there are other risk factors as well, including obesity, chronic constipation, and long term respiratory conditions, including incessant coughing. All of the conditions mentioned may affect the pelvic floor negatively, creating dysfunctional muscle activity. It is important in the presence of pelvic organ prolapse, to have a thorough pelvic floor assessment and learn interventions to help prevent the progression of the prolapse and increase the integrity and function of the support structures such as the pelvic floor muscles. In severe cases, however, surgical intervention is warranted. Following recovery from surgical intervention, pelvic floor dysfunction should be addressed in order to assist in facilitating an optimal outcome.

5. Is there anything recommended to minimize pelvic floor problems prior to giving birth?

Becoming well informed about your pelvic floor prior to pregnancy is ideal, and a visit to a pelvic floor physical therapist is a great place to start. During an uncomplicated pregnancy, it is important to remain generally active and maintain a low impact exercise routine such as walking, swimming or yoga, for instance. Utilizing safe body mechanics, being mindful of engaging abdominal muscles and a balanced routine of pelvic floor muscle engagement and relaxation is helpful. In the latter stages of pregnancy (post 37 weeks), I recommend having an experienced therapist begin manual perineal stretching treatment and instructing proper self perineal stretching techniques. This can help to prepare the tissue for the extensive stretching it will encounter during the birth process. Also, it’s important to learn as much as you can about ideal labor and birth positions, which can aid in optimizing the process and potentially reducing risk of soft tissue injury.

6. What can you do to restore pelvic floor health after giving birth?

First of all, give your body time to recover prior to returning to high impact activity such as running. While childbirth is a wonderfully natural process, there are demands that the body requires time to heal and repair. As your pregnancy progressed, your center of gravity shifted, and your core musculature was profoundly affected. It’s very important to regain optimal postpartum core stability prior to engaging in high impact activities which place significant demands on those structures. It’s advisable to see a physical therapist who is well versed in how best to initiate a postpartum core stability and pelvic floor function program.

So there you have it, ladies. While treatment for pelvic floor dysfunction might be slightly more involved than this article can get into, the bottom line is, there is treatment, and you don’t have to settle for peeing your pants every time you cough just because you had a baby. With therapy and guidance from experts, many women are able to strengthen their pelvic floor muscles, regain control and live without incontinence or other issues.

If you are experiencing any of the symptoms mentioned or may be concerned about your pelvic floor health, talk to your doctor, or make an appointment with experts at UT Health Austin’s Women’s Health Institute by visiting online here or calling 1-833-882-2737.

About UT Health Austin

UT Health Austin, the group practice designed and managed by the faculty and staff of the Dell Medical School, focuses the expertise of a team of experienced medical professionals to deliver personalized, whole-person care of uncompromising quality. Our experienced healthcare professionals treat each patient as an individual, with unique circumstances, priorities and beliefs. Working with you, your care team creates an individualized care plan to help you reach the goals that matter most to you — in the care room, and beyond. For more information, call us at 1-833-UT-CARES or request an appointment here.