Pelvic floor and pregnancy: What to know before, during and after

Nothing in this article is or should be construed as medical advice; for any medical questions, consult your healthcare professional.

Have you ever sneezed, laughed a little too hard, or jumped and peed your pants just a little? You’re totally not alone. Pregnancy, along with age, genes and many other factors, can do a number on your pelvic floor. Here we share how to care for your pelvic floor before, during and after pregnancy.

First, a little pelvic floor 101

The pelvic floor is a thin, sling-like sheet of muscle fibers and connective tissue that holds the pelvic organs in place.^1,2 Pelvic organs include the vagina, uterus, cervix, bladder, urethra, rectum and intestines.² The role of your pelvic floor is to support, protect and control.

• Supports: Your pelvic floor holds your pelvic organs in the correct position and supports your abdominal organs.¹
• Protects: Your pelvic floor protects your pelvic organs.¹
• Controls: When you sneeze, cough or strain, the muscles in a strong pelvic floor contract, which helps prevent urine leakage.¹ Also, when you pee, poop or pass gas, your pelvic floor helps control these functions.¹

Your pelvic floor also plays an important role during sex: If you’re better able to relax your pelvic floor and contract it, it’s more likely that vaginal sex will be pain-free, you’ll see an increase in vaginal lubrication and you may experience better orgasms, thanks to increased blood flow.³

Pelvic floor dysfunction: Pregnancy may not be the only cause

Varying risk factors for pelvic floor disorders (PFDs) are currently being studied. It’s a good idea to be aware of the many different things that can increase your PFD risk before, during and after pregnancy. Here’s a quick rundown of them.

• Pregnancy and childbirth: Risks may include a vaginal delivery versus a cesarean, having more than one child, or having a baby vaginally with the aid of instruments (like forceps) or devices (like a vacuum).⁴
• Pressure: If you’re frequently constipated and often strain when using the bathroom, this can increase pressure on your pelvic floor.⁴ Diet can contribute to that pressure — too little fiber or water can lead to hard or irregular bowel movements, while too many processed foods in your diet can lead to constipation.⁵ Increased pressure can also come from heavy lifting, chronic coughing or obesity.⁵
• Age: Your pelvic floor muscles can weaken as you get older, especially during perimenopause.⁵
• Genes: Some people simply have weaker muscles, bones and connective tissues than others.⁵ If you have a condition that affects your connective tissue strength, this will affect the strength of your pelvic floor as well.⁴
• Surgery or injury: If you’ve had surgery to correct pelvic organ prolapse (a condition where at least one pelvic organ drops from the normal position⁶) in the past, you are at a higher risk for future PFDs. You’re also at a higher risk if your pelvic floor is injured during a fall or in an accident.⁵ If you had (or plan to have) a hysterectomy, that can increase your risk as well.⁵

Pelvic floor pain in pregnancy

You may experience pelvic floor pain during and after pregnancy. According to the International Urogynecological Association (IUGA), damage to the pelvic floor’s muscles, tissues or nerves during or after pregnancy can result in a condition healthcare professionals call “maternal pelvic floor trauma.”⁷ IUGA defines three types of injuries that can happen:

• Mechanical injury: often involves the head of the fetus interfering with the pelvic floor, or forceps being used during delivery.⁷
• Nerve injury: often involves compression or damage to the main nerve to the pelvic floor, generally caused by the fetus’s head, the size of a large baby, prolonged second-stage labor or the use of forceps during delivery.⁷
• Indirect injury: can involve hormonal changes during pregnancy.⁷

Maternal pelvic floor trauma, which you can experience during pregnancy, after pregnancy or even years later, can result in urinary, bowel and sexual problems, and symptoms of prolapse.⁷ If you’re concerned about being at risk for pelvic floor dysfunction, talk to your healthcare professional before pregnancy, if possible. They can help you understand your pelvic floor health and address your concerns.

Pelvic floor dysfunction symptoms

Talk to a healthcare professional if you’re experiencing any of the following problems:

• Having to go to the bathroom often
• Issues with urination including having to start and stop frequently when trying to pee, experiencing pain when peeing and urinary incontinence
• Issues with bowel movements including constipation, straining to poop, having to change your position in order to be able to poop, and fecal incontinence
• Lower back pain
• Pelvic pain⁸

How to tell if your pelvic floor is tight or weak

While the above symptoms may indicate a weak pelvic floor, it’s important to visit a healthcare professional who can test its strength. These tests may include a physical exam, which may also include a pelvic exam and/or a rectal exam.⁸ Additional tests can measure how well your pelvic floor performs while peeing or pooping.⁸

How to strengthen your pelvic floor before pregnancy

The National Association for Continence offers four types of exercises to help strengthen your pelvic floor before you get pregnant here. Some simple lifestyle changes can help reduce your risk of pelvic floor dysfunction as well. These include sticking to a healthy diet, exercising regularly and managing constipation.⁹

The importance of pelvic floor exercises during pregnancy

According to Mayo Clinic, about half of people who are pregnant experience pelvic floor dysfunction symptoms.⁹ Taking a birthing class can teach you breathing and stretching techniques that can help you better control your pelvic floor muscles during delivery.⁹ Kegel exercises can help strengthen your pelvic floor.⁹ Talk to your healthcare professional, who may recommend a physical therapist to ensure you’re doing them correctly.

When to start pelvic floor therapy during pregnancy

Your healthcare professional can advise you if and when you need to start pelvic floor therapy during pregnancy. Pelvic floor therapy goes beyond Kegel exercises and involves a physical therapist who can help pinpoint too-tense pelvic floor muscles and share specific exercises with you to help stretch them.⁸

Postpartum pelvic floor exercises

Kegels are a great way to exercise your pelvic floor postpartum. You can learn how to do Kegel exercises here. The American Urogynecologic Society provides more information on how to do Kegels and bladder training here.

When to start pelvic floor therapy after birth

If you are experiencing symptoms of pelvic floor dysfunction after birth, talk to your healthcare professional. They may recommend pelvic floor therapy and can provide guidance on next steps.

Just like you care for other parts of your body, it's necessary to be mindful of your pelvic floor. Taking care to include plenty of fiber in your diet and staying hydrated — and doing a few simple exercises — can go a long way toward saving you trouble down the road. And if you're worried something's amiss, don't be shy about talking to your healthcare professional, especially if you think you’re doomed to pee a little every time you sneeze. There are possible solutions! Don’t be afraid to ask.

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