Pregnancy is a time of so much change in a woman’s life and body! As well as thinking about all of the new demands needed to nourish your growing baby, caring for and preparing your body for delivery is an important aspect of pregnancy. 

As your baby and belly are growing, your pelvic floor is changing, too.

What happens to the pelvic floor during pregnancy?

The pelvic floor and its muscles have an increased workload during pregnancy: they are required to support the weight of the growing baby, while also softening and stretching to be ready to allow the baby to pass through at birth. 

Whether giving birth vaginally or by cesarean, your pelvic floor muscles will be impacted by the hormonal changes and the weight of the growing fetus. During a vaginal birth, the pelvic floor muscles undergo considerable stretching and strain. During a cesarean, surgery through multiple muscle layers can lead to a slower recovery generally and a weakened abdominal wall.

What are some signs of a weak or injured pelvic floor?

A pelvic floor that is not functioning well can lead to urinary and faecal incontinence (leaking), or feeling that you cannot hold as well as you should. Pelvic organ prolapse can also occur (which happens when the pelvic organs bulge into the walls of the vagina and give a feeling of ‘heaviness’. A weak pelvic floor can also contribute to pelvic girdle pain and lower back pain.

There are a number of risk factors that can increase the chance of having a perineal injury during birth: 

  • High birth weight baby 
  • Instrument assisted delivery 
  • Primiparity (first baby) 
  • Labour induction 
  • Baby positioned posteriorly
  • Episiotomy (A surgical incision in the perineum - making a small, controlled injury that reduces risk of larger tears during delivery).

Your obstetric team will work closely with you to reduce the risk of having a birth injury. And even those who do experience perineal injury can work with their medical providers and Physiotherapist to regain strength and function of their pelvic floor. 

What can I do to support my pelvic floor during pregnancy?

Pelvic floor Training - Relax Phase 

During pregnancy, pelvic floor training is important to prepare and protect your pelvic floor. A pelvic floor physiotherapist can modify an individual program of safe pelvic floor exercises as the pregnancy progresses. Just as having a strong pelvic floor is important to be able to hold the weight of a baby and prevent incontinence, being able to relax the pelvic floor and allow it to open and expand for delivery is equally important. 

Pelvic Floor Training - Strength Phase 

The benefits of a healthy pelvic floor are numerous. Exercising these muscles before and during pregnancy can decrease weakening of the muscles caused by the strain of carrying a growing baby, decrease the risk of injury during a vaginal birth and speed up recovery afterwards. A strong pelvic floor can also increase sexual pleasure for a woman and her partner, and has even been shown to reduce the length of time spent in active labour!

Since pelvic floor trainers have not been tested on pregnant women for ethical reasons, we do not recommend using this method during pregnancy to train your pelvic floor. Alternative ways to strengthen the pelvic floor during this time are recommended, such as manual Kegels, pre-natal yoga or pilates.

Perineal Massage 

There have been some studies done showing the potential benefit of perineal massage to help reduce the risk of perineal tears during a vaginal delivery. Starting at week 34 or 35 of pregnancy, a woman (or her partner) can start massaging the perineum 1–2 times per week, with each session lasting for a maximum of 5 minutes.

There are several different techniques of perineal massage. All generally involve the insertion of one or two lubricated fingers approximately 5 cm into the vagina and applying gentle pressure downward (toward the anus) and to the side of the vagina until a very slight tingling or burning sensation is felt. The stretch is held for about 2 minutes and then the fingers are repositioned (Royal Australian College of General Practitioners).

Maintaining healthy bowels

Another important way to care for your pelvic floor during pregnancy is to avoid becoming constipated or straining to pass a bowel motion. The hormonal changes of pregnancy naturally slow down the movements of the gut lining, and mean that it is common for pregnant women to become constipated. Bearing down or straining on the toilet puts stress on the pelvic floor, and can lead to problems such as hemorrhoids. Maintaining adequate fluid intake, eating plenty of fiber and gentle exercise are good ways to help keep bowels moving and protect the pelvic floor.

What if I have an ‘overactive’ or ‘tight’ pelvic floor?

Some women may experience overactivity or “tightness” of their pelvic floor muscles. This means that the pelvic floor muscles have difficulty relaxing and therefore are constantly held in a slightly contracted state. While this may sound like a good thing, it actually isn’t optimal, and doesn’t necessarily mean the pelvic floor is healthy and strong! 

If you have been told you have an overactive pelvic floor before pregnancy, or experience pelvic or sexual pain, difficulty emptying your bladder or chronic UTIs, then the relaxation phase of pelvic floor training is very important. Evidence suggests that increased pelvic floor resting tone in pregnancy may be linked to a longer “pushing” phase of labour, though isn’t associated with increased risk of complications of delivery. 

Talk to your Women’s Health Physiotherapist about the best ways to exercise and relax your pelvic floor during pregnancy if you think you may have an overactive pelvic floor. 

Article written by
Laura Justin
Qualified and Registered Australian Physiotherapist
Women's and Children's Health

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