Many women are concerned about the appearance and the function of their bodies after having children. Our bodies go through incredible changes in order to grow and birth our babies, so its normal to worry about recovering from your pregnancy and delivery. After all, you just spent 9 months growing a life inside of you. After pregnancy, muscles inside the pelvis and abdomen that help support your baby during pregnancy might weaken. These muscles include the abdominal muscles, and the muscles in a tissue system known as the “pelvic floor muscles.”
When these muscles weaken, women might develop uncomfortable symptoms that affect their urinary and sexual function.
How does pregnancy affect the abdominal muscles?
The “six-pack” muscles on the front of the abdomen make up part of the abdominal wall. The right and left sides of this muscle are separated by a ligament that runs down the middle. During pregnancy, this ligament has to stretch and thin to accommodate the growing baby. The abdominal muscles can separate (called a diastasis recti) when this ligament stretches past a certain point.
If this ligament doesn’t bring the abdominal muscles back together after the baby is born, a woman might have difficulty generating the same amount of strength in her midsection as before. If the baby was born via a Caesarean section, healing the abdominal wall muscles can sometimes be difficult.
What are the “Pelvic Floor Muscles” and how are they affected in pregnancy?
The pelvic floor is a group of muscles that sits at the bottom of the pelvis. Their role is to close off the holes where urine and stool come out. They also support the weight of the pelvic organs from below, kind of like a sling or a hammock.
These muscles work very hard during pregnancy to support the weight of the baby. The can also be injured during vaginal birth if there is tearing. Even if a woman has a Caesarean birth, the pelvic floor is still affected by carrying the pregnancy for 9 months.
What are the symptoms of a weak pelvic floor?
It is very common for women after pregnancy and childbirth to experience problems with their pelvic floor muscles. Symptoms can include accidentally leaking urine, gas or stool, feeling pressure or heaviness in the vagina, and/or experiencing pain with intercourse. Approximately one in four women is struggling with at least one of these issues.
Leaking urine is called “urinary incontinence”. The most common types are leaking with activities such as coughing, sneezing, or exercise (called stress incontinence) and leaking on the way to the bathroom (called urge incontinence, or overactive bladder).
Feeling heaviness in the pelvic floor is often a sign of pelvic organ prolapse. This is when the bladder, uterus, or rectum start moving down towards the vaginal opening. This can be made worse by things like standing for long periods of time, excessively bearing down while going to the bathroom, and heavy lifting.
Returning to sexual intercourse after having a baby can be challenging in many ways. From a physical standpoint, the pelvic floor muscles have to recover from birth enough to be able to accept penetration and friction. If there is muscle spasm or scar tissue at the level of the pelvic floor, couples may struggle with returning to intercourse due to the woman’s pelvic pain.
There are two main barriers to women getting treatment for pelvic floor dysfunctions. Firstly, there is a stigma associated with them and women may not feel comfortable talking about these problems, even with their Doctors. Secondly, many women believe that pelvic floor dysfunctions are a normal part of pregnancy and childbirth. Although they are common, it is not normal to leak urine, gas or stool, to feel heaviness in the pelvic floor, or to have pain with sex. There are treatment options to help with these issues and studies have shown that a full recovery is possible with Pelvic Physiotherapy and pelvic floor muscle training.
This post was authored by Jillian Palmer is a Pelvic Physiotherapist and a Mom of four wonderful children. She is passionate about improving the quality of care for women in pregnancy and postpartum. Her Pelvic Physiotherapy practice in Edmonton, Alberta, serves women throughout the lifespan struggling with pelvic dysfunction. You can find her @yeg_pelvicphysio and @pine_health_yeg
Nygard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of Symptomatic Pelvic Floor Disorders in US Women. JAMA. 2008 Sep 17; 300(11):1311-6.