And why should I care?
The pelvic floor is a group of muscles that play a very important role in both the man and woman’s body. Because of the tremendous amount of anatomical and physiologic changes the pelvic region goes through during pregnancy, labor, and delivery, they are especially important to be aware of as a mother.
Where is it?
The pelvic floor is located at the base, or bottom, of your pelvis. It is a network of muscles and other connective tissues. The pelvis is where your hip bones connect to your tail bone at the center of your body. The muscles of the pelvic floor are directly integrated in to your core.
The pelvic floor muscles have two main functions. First, there are sphincter (circular) muscles that work to close openings by squeezing shut. The urethral sphincters contract to stop the flow of urine, and the anal sphincter contracts to stop the escape of gas. Second, there are the levator ani muscles that act as a hammock. They function to lift or support all of the pelvic organs by being the foundation for what holds them in place. The pelvic organs include your bladder, small bowels, uterus, vagina, and rectum.
Consider a wicker basket. The bottom of the basket could be compared to your pelvic floor. The interlocking weaves and strands tie directly into the sides of the basket, which could be compared to your hip bones. They work together to house all of your pelvic organs.
If you’re still having a hard time understanding where your pelvic floor is and what it does, check out this short video.
Pelvic floor muscle dysfunction can occur due to many factors including age, the number of vaginal deliveries, BMI (body mass index) and intense physical exertion. (1) It includes but is not limited to bowel or bladder incontinence, urge frequency, painful intercourse, or pelvic organ prolapse.
Your pelvic floor is put under incredible stress due to your growing uterus as your baby develops. The extra weight of baby and placenta, as well as the extra vascularity, lead to a chronic increase in pressure on your pelvic floor for up to nine months or the length of time you carry. With constant pushing down from the extra weight, the muscles can begin to stretch. As muscles stretch, they tend to lengthen. Because muscles inherently work best at a certain length, they can become ineffective and lead to pelvic floor muscle dysfunction. This is why many women who have caesarean sections may still experience incontinence. Even though the pelvic floor muscles aren’t at direct risk for injury during the delivery process, they can be compromised throughout pregnancy.
During Labor and Delivery
The muscles must adapt further yet, with the help of hormonal changes, to stretch even more to allow for the baby to pass and deliver. An extended second phase of labor may increase the chance of pelvic floor dysfunction secondary to the powerful forces generated by uterine contractions. This causes a significant increase in intrauterine pressure which can push downward on the pelvic floor. An extended pushing phase also puts the pelvic floor at further risk.
Additionally, there’s a possibility that the muscles may tear. Depending on what degree of the tear, there may be pelvic floor muscles involved. Therefore, it’s vital that you allow yourself time to heal. Just like “pulling a hamstring” would prompt you to sit out of track until you’re healed, injuring a pelvic floor muscle should also be a sign that you should prioritize rest and recovery. This is where the doctor’s recommendations of pelvic rest, or abstaining from intercourse and any physical exercise until six to eight weeks after delivery, plays in. Similar to a dedicated track sprinter who tears a hamstring running a 100 meter race, some form of therapy will be necessary for full return to optimal function.
It is my personal bias that every new mom should be assessed by a pelvic floor physical therapist before returning to exercise postpartum. Even if you aren’t experiencing any of the “3 P’s”: pain, prolapse, or peeing (incontinence) that Jessie Mundell discusses, these problems could develop if proper rehab isn’t performed prior to returning to your previous activity level or higher level exercise.
Ultimately, the pelvic floor is a very important group of muscles, especially in mothers. It needs to be recognized and thus treated following pregnancy, labor, and delivery. According to the American College of Obstetricians and Gynecologists, “The interpregnancy period is an opportunity for women’s health care providers to address complications and medical issues that develop during pregnancy, assess a woman’s mental and physical well-being, and optimize her health along her life course.”
Find a women’s health physical therapist near you today!
1. D. D. Chmielewska, M. Piecha, K. Kwa´sna, E. Błaszczak, J. Taradaj, and V. Skrzypulec-Plinta, “Urinary incontinence: a problem of the modern woman,” Menopause Review, vol. 17, no. 5, pp. 378–384, 2013.
2.) H Memon and V Handa. “Vaginal childbirth and pelvic floor disorders,” Womens Health (Lond Engl), 9 (3): 10.2217/whe.13.17, 2013.