Pelvic floor health in pregnancy

Pregnancy puts special strains on the pelvic floor, and physical therapy while pregnant or postpartum can help arrest and reverse problems without any need for surgery.

As many as one in four women has some sort of pelvic floor disorder, according to the National Institutes of Health, so it’s no wonder we’re seeing a lot of women experiencing uncomfortable issues such as urinary incontinence, fecal incontinence and pelvic organ prolapse.

The risk of pelvic floor conditions increases due to factors such as a woman’s age and the number of pregnancies she’s had. But while pelvic floor dysfunction is common – and certainly nothing to be embarrassed about – it’s not normal.

Fortunately, there are ways to heal the pelvic floor that don’t involve invasive procedures like surgery.

At our Los Altos physical therapy clinic, pelvic floor issues are some of the most common reasons that pregnant and postpartum women come for help. And while men can struggle with pelvic floor issues, too, I’d like to discuss this common health concern in the context of new and expectant moms.

Meet the pelvic floor

The pelvic floor is a group of muscles that literally form the “floor” of the pelvic cavity. These muscles are suspended across the pelvis – attached to the front, sides and back of the pelvic ring – like a sling or hammock. Their job is to help hold the pelvic organs in place, including the uterus, bladder and bowels, as well as to provide stabilizing support for the spine.

During pregnancy, the growing weight of the baby increases strain on the pelvic floor muscles. This, along with normal hormonal changes in the body that promote tissue laxity, can cause the muscles to stretch out. Vaginal and cesarean deliveries can impact pelvic floor muscle function, too, causing the pelvic floor and other core muscles to become weak, uncoordinated, or both.

The pelvic floor muscles don’t always bounce back on their own and return to their normal, pre-pregnancy state over time – especially if you have a pre-existing pelvic floor dysfunction.

That’s where physical therapy comes in.

PT benefits

If you’re a mom with any of the following signs and symptoms of pelvic floor dysfunction, you could benefit from consulting with a pelvic floor physical therapist.

• Urinary incontinence (for example, leaking a little urine when you sneeze, laugh or pick something up)

• Fecal incontinence or constipation

• Pelvic organ prolapse (this can look or feel like something bulging into your vagina)

• Abdominal separation (diastasis recti)

• Pain during sex or while inserting a tampon

• Persistent lower back pain, vaginal pain, vulvar pain or pelvic pain

Research shows that pelvic health physical therapy can alleviate these symptoms and help you build better control and confidence in your health. Pelvic health physical therapy is part of the standard of care for postpartum moms in places like France.

My bottom line: If you’re pregnant, postpartum or beyond, a physical therapist who specializes in pelvic health can help you uncover pelvic floor dysfunction and minimize or even avoid future problems.

Avoiding dysfunction

In addition to working with a specialized pelvic floor physical therapist, there are several things you can do to optimize pelvic floor health and avoid dysfunction after pregnancy. Here are my top tips:

• Learn good body mechanics. Poor posture and inefficient movement patterns can put extra strain on your pelvic floor.

• Learn how to breathe properly. Your breath and core muscles (including the pelvic floor) are intricately connected. Breathing exercises can improve pelvic floor muscle coordination and strength.

• Stay active. Healing your pelvic floor goes beyond Kegel exercises. Staying active helps avoid back pain, maintain a healthy weight, reduce stress, boost mood, promote sleep and improve overall wellness. A pelvic health PT can help you figure out how to safely resume physical activity after your baby arrives.

Kim Gladfelter is owner, physical therapist and Pilates instructor at PhysioFit Physical Therapy & Wellness, 1000 Fremont Ave., Suite 108, Los Altos. For more information, call (650) 887-6046 or visit