Pregnancy and postpartum

Your pelvic floor after pregnancy and childbirth

How pregnancy and delivery affect the pelvic floor, how to care for yourself right after birth, and how to rebuild strength.

What is the pelvic floor?

The pelvic floor is a set of muscles that spread across the bottom of the pelvic cavity like a hammock. Three openings run through it: the urethra, the vagina, and the rectum. Its functions include:

• Supporting the pelvic organs, specifically the uterus, the bladder, and the rectum
• Helping provide sphincter control for the bladder and bowel
• Withstanding increases in abdominal pressure such as coughing, sneezing, laughing, straining, and lifting
• Enhancing the sexual response

How does pregnancy affect your pelvic floor?

Pregnancy and childbirth place a lot of stress on your pelvic floor. Some of the ways it can be weakened:

Weight of the uterus

During pregnancy, the pelvic floor muscles may begin to sag and weaken because of the increased weight of your uterus.

Hormones

The relaxing effects of the hormones produced to allow you to deliver your baby can also weaken your pelvic floor.

Extreme stretching

Vaginal delivery extensively stretches the pelvic floor muscles, leaving them weakened.

Episiotomies and tears

Sometimes during vaginal delivery the pelvic floor muscles tear. Occasionally a doctor performs an episiotomy, a cut into the pelvic floor to assist delivery, which may tear further as the baby passes through. Tears and episiotomies weaken the pelvic floor muscles. There are four grades of tears, with higher grades causing more damage: Grade 1, the skin of the perineum is torn. Grade 2, the skin and part of the pelvic floor muscles are torn, equivalent to an episiotomy incision. Grade 3, the skin, the pelvic floor muscles, and part of the external anal sphincter are torn. Grade 4, the skin, the pelvic floor muscles, the entire external anal sphincter, and part of the internal anal sphincter are torn.

Forceps and vacuums

These can damage the pelvic floor and the nerves that supply it, causing further weakness.

Even women who have Cesarean sections can have pelvic floor weakness from the changes in the body during pregnancy.

Coping with discomfort right after birth

The perineum, the area between the vagina and anus, can be very tender after delivery, especially if you have stitches from an episiotomy or tear. You may be bruised and swollen even without tearing. It is important to care for your perineum to avoid infection, relieve discomfort, and promote healing.

• Ice your perineum immediately after delivery and for a few days afterward. A frozen perineal pad, or crushed ice in a frozen wet washcloth wrapped in a thin towel, works well.
• Freeze a perineal pad soaked in witch hazel, which helps relieve pain from a tear, episiotomy, or hemorrhoids.
• Use a peri bottle to pour warm water over your perineum after using the restroom, always front to back to prevent spreading organisms from the rectal area.
• When cleaning yourself, pat rather than wipe to minimize pulling on tender skin, and go from front to back.
• Use a sitz bath to relieve tenderness. Soak the area in warm or cold water for 10 to 20 minutes. Calendula in the water can provide additional relief. Your provider may prescribe other preparations.
• Perform pelvic floor muscle exercises such as Kegels.
• Sit in the way that is most comfortable. Some women prefer a hard surface for support, others a donut or nursing pillow to avoid pressure.
• Lie down as often as you can for the first two weeks, since standing increases swelling of the perineum. Use the time to bond with your baby in bed.
• When having a bowel movement, you may find it more comfortable to support the perineum with your fingers wrapped in toilet paper.
• Do not use tampons or douche until cleared by your doctor or midwife.

What are the consequences of a weak pelvic floor?

Weak pelvic floor muscles can result in pelvic organ prolapse, when a pelvic organ falls out of place. Prolapse can occur to the bladder, urethra, uterus, rectum, intestine, and vagina. Other consequences include involuntary leakage of urine or stool (urinary and fecal incontinence).

How can I strengthen my pelvic floor?

Regular pelvic floor exercise, such as Kegels, improves and maintains strength. See Kegel exercises for how to do them. Kegels also:

• Improve blood circulation in the perineal area, which speeds healing
• Decrease pelvic congestion and the heaviness felt during pregnancy and after childbirth
• Reduce pressure and help heal stitches and tears
• Relieve perineal tenderness
• Decrease the discomfort of swelling and varicose veins in the vulva
• Decrease the discomfort of hemorrhoids
• Decrease menstrual cramps
• Help increase vaginal lubrication
• Make future vaginal deliveries quicker and more comfortable, since strong pelvic floor muscles are less likely to tear and recover more quickly
• Improve sexual response for you and your partner

It is safe to begin Kegel exercises immediately after delivery. When you first try a pelvic floor contraction, you may feel as though nothing happened. The muscles have been traumatized and lose some sensation after delivery. Do not be discouraged. Be patient and take the time to focus. As the muscles recover, you will feel more sensation of tightening and relaxing. Continue Kegels even after the postpartum period. A strong pelvic floor throughout life can prevent future problems and should remain part of your regular exercise routine.

What else can I do?

During the postpartum period and while breastfeeding, the pelvic floor is in a weakened state, which decreases support for the pelvic organs and increases the chance of prolapse. To lower that chance:

• Avoid heavy straining during bowel movements
• Increase your daily fiber and fluid to prevent constipation
• Think about contracting your pelvic floor before you sneeze or cough
• If a long coughing spell is coming on, try sitting on a hard surface or an exercise ball for pelvic floor support
• Avoid repetitive heavy lifting