What To Expect After Expecting: How Childbirth Changes Your Pelvic Floor

Every expecting parent worries about how pregnancy and childbirth will affect them physically. In a vaginal birth, it’s not unusual for the pelvic muscles and connective tissues to stretch to two or even two-and-a-half times their resting length. And even when the delivery happens via C-section, the layers of muscle, fascia and connective tissue have to give way to make room for the baby. With so much additional stress on the pelvic anatomy and abdominal core, postpartum pelvic floor changes are a common experience for birthing parents. 

“During labor and delivery, your pelvic muscles and tissues, which hold the bladder, uterus and rectum in place, may stretch or tear,” said Kimberly Howell, P.T., D.P.T., O.C.S., a physical therapist at Inspira Medical Center Mullica Hill Rehabilitation Services. “This can lead to pelvic floor muscle weakness or overactivity, which can cause issues like pelvic organ prolapse, pelvic pain conditions and incontinence.” 

Fortunately, there are preventive measures you can take and treatment options for these conditions. Here’s what birthing parents should know about some of the most common postpartum pelvic floor changes. 

Managing postpartum pelvic pain 

Many birthing parents experience postpartum pelvic pain due to musculoskeletal tissue changes and fluctuating hormones. Although it's often mild and manageable, it can be severe and affect your daily activities. 

The first step to managing postpartum pelvic pain is to give your body time to recover. While individual experiences can vary, it usually takes around six to eight weeks for your pelvic organs and tissues to return to their new normal. Take time off from your regular activities, avoid lifting heavy objects and get plenty of rest. 

Another way to manage pelvic pain is by easing into a postpartum exercise routine. “Although it’s important to limit your physical activity for at least six weeks after giving birth unless approved by your doctor, walking and light stretching can help you regain strength and muscle,” said Howell. “Exercising helps you avoid putting additional strain on your pelvic floor and minimize pelvic discomfort.” Remember to listen to your body, stay hydrated and take breaks or rest as needed. 

Checking in with a pelvic floor therapist can be an excellent way to identify the cause of your pelvic pain and come up with a personalized plan to address it. Some common culprits of pelvic pain include overactive muscles, stretching of nerve tissue or sensitive tissue from tearing or surgical incisions. Your therapist can examine you and determine which structures are affected. 

“Often, we find that people are doing Kegel-style squeezes when their pelvic floor is already overactive or uncoordinated,” said Howell. “Contracting those muscles without first assessing their baseline tone can increase tissue sensitivity and make pain worse, which is why a hands-on exam is so important before starting any exercise.”

Talk to your doctor if your postpartum pelvic pain persists or becomes worse. They can recommend treatment options, such as medication or physical therapy, to help alleviate your symptoms. 

Incontinence during pregnancy and childbirth

Many pregnant people experience bladder leakage. “As your baby grows throughout pregnancy, the uterus puts an increasing amount of pressure on the bladder, urethra and pelvic floor, stretching and weakening these muscles and causing them to become less supportive,” said Howell. “As a result, it’s easier for urine to escape from the bladder, especially while laughing, sneezing or exercising.” 

Childbirth can cause tearing or damage to the pelvic floor muscles, which may lead to incontinence issues. As the body heals, many birthing parents experience accidental leakage as the pelvic floor muscles rebuild. 

Pregnancy-related incontinence is common, and it can be managed and treated through pelvic floor muscle training, scheduled bathroom breaks and medications to minimize incontinence symptoms. In severe cases, surgery may be necessary to repair the impacted structures. If you’re experiencing incontinence symptoms, talk to your doctor about your treatment options. 

Pelvic organ prolapse and treatment

Pelvic organ prolapse happens when the uterus, bladder or rectum descends into the vagina due to weakened pelvic floor muscles after childbirth. This condition can cause difficulty with bowel or bladder control. 

People who have experienced multiple pregnancies, vaginal deliveries or a family history of pelvic organ prolapse are at a higher risk of developing this condition. Fortunately, there are treatment options available.

Physical therapy can help strengthen the pelvic floor muscles, improve muscle function and alleviate the symptoms of pelvic organ prolapse. In some cases, a small device called a pessary is temporarily inserted into the vagina to help support the prolapsed organ. 

When the prolapsed organ causes significant discomfort or interferes with daily activities, surgery may be an option. Talking to your doctor about your symptoms can help them develop a treatment plan that addresses your needs.

Learn more about physical therapy and rehabilitation at Inspira.