Pelvic floor changes in childbirth

Q: I’m pregnant with my first child, and I’ve heard a lot about pelvic floor changes during pregnancy and childbirth. I’m worried about what to expect. Can you explain these changes and offer advice on preparing for a healthy pelvic floor after pregnancy? A:

Pregnancy and childbirth are transformative experiences for a woman’s body. One of the areas that may be affected is the pelvic floor, which is the diaphragm of the pelvis. These muscles support the uterus, bladder, large intestine and rectum.

Such muscles are affected by pregnancy and childbirth, altering many functions. These can include fecal and urinary continence mechanisms and support of the vaginal walls and uterus. Less support can lead to prolapse, which is when organs shift within the pelvis. Trauma to the pelvic floor and nerves also may result in pelvic pain symptoms with or without sexual intercourse.

Here are some factors that can affect your pelvic floor during pregnancy and how they can lead to pelvic floor disorders:

Physical changes: About 50% of pregnant women experience symptoms of pelvic floor disorders even before childbirth. During pregnancy, women tend to gain not just the baby’s weight, but also weight from the placenta, increased blood volume and an enlarged uterus. The extra weight increases strain on the pelvic floor, increasing risk of urinary incontinence. Constipation is common during pregnancy, especially in the third trimester. The weight of the growing uterus and hormone changes can affect digestion, leading to infrequent or difficult passing of stools.

Hormonal changes:

The body also undergoes hormonal changes during pregnancy that affect pelvic floor health. The placenta secretes the hormone relaxin to increase the flexibility of ligaments in the pelvis and soften the cervix. These changes help prepare the body for birth. But this can also loosen the connection between the pelvis bones and lead to increased instability.

Medical and occupational history:

Some women are more susceptible to pelvic floor disorders. This risk increases with pregnancy. Women with a history of chronic constipation, connective tissue disorders or smoking are at risk. Women who are obese or have a history of repeated heavy lifting also can be at risk.

Vaginal delivery is regarded as the most significant risk factor. During childbirth, the pelvic floor muscles undergo tremendous stress. This risk rises with operative deliveries using vacuum or forceps. Labor before a C-section delivery also increases risk for pelvic floor disorders.

Some women’s pelvic floors are able to recover, while others may be more prone to lasting issues. Studies show that the more vaginal deliveries a woman has, the more likely she is to experience pelvic floor dysfunction.

Just as pregnant women take prenatal vitamins and avoid alcohol to lower the risks of some congenital conditions, they can take steps to reduce the risk of pelvic floor disorders.

Regular exercise and a healthy diet benefit the baby and your pelvic floor. Try birthing classes, too. These include stretching and breathing exercises to coordinate the diaphragm and pelvic floor muscles during delivery. Prenatal yoga and perineal massage can improve the flexibility of pelvic tissues to limit your risk of perineal injuries at delivery.

When done correctly, Kegel exercises strengthen the pelvic floor muscles. About 40% of people incorrectly perform Kegels the first time. A physical therapist can help you with the exercise.

Finally, talk with your OB-GYN. They can recommend stretches and classes to prepare your pelvic floor for childbirth.

DREAMSTIME Prenatal yoga can strengthen the pelvic floor.