Here’s Why You Need to Take Better Care of Your Pelvic Floor
Your pelvic floor is an all-important group of muscles, tissues, and ligaments that works extra hard during pregnancy. Here's why you need to show your pelvic floor some love, and how to go about it.
What is the pelvic floor?
The pelvic floor is located at the base of the female urogenital system. It’s designed to support the vagina, rectum, uterus, and bladder, helping to maintain urinary and fecal continence, and enabling strong, orgasmic response.
“Think of the pelvic floor like a hammock, it keeps everything in, and where it should be,” says Heather Bartos, MD, an OB-GYN in Cross Roads, Texas. “It’s a very complex body of muscles. When it fails, (think too much tension like a neck sprain) or, becomes too lax, pelvic floor dysfunction can cause painful sex, or hernias.”
What happens to the pelvic floor during pregnancy?
The female body is designed to withstand the demands of pregnancy, but that doesn’t mean it snaps back effortlessly. Pregnancy, and delivery, both take a toll on the pelvic floor. “During pregnancy, you have a growing uterus, and everything gets displaced. The pelvic floor muscles become stretched, and challenged,” says Lauren Streicher, MD and author of Sex Rx: Hormones, Heath, and Your Best Sex Ever. “Pushing, and labor, does much of the damage, but it’s a misconception that the pelvic floor is only affected by vaginal delivery. Even a pregnancy without labor, such as a scheduled Cesarean section, can cause problems.” Dr. Streicher says that pelvic floor weakness, while not painful, can cause rectal, or uterine prolapse, and incontinence of urine, and stool. It can also diminish orgasmic response, which relies on pelvic floor contractions, to feel powerful and, in extreme cases, can make sex painful.
What you can do before you get pregnant
Just in case you need another reason to stop smoking before trying to conceive, think about this: smoking cigarettes increases your risk for stress urinary incontinence, due to pelvic floor damage caused by smoker’s cough. Current, and former smokers both have risk, but stopping smoking helps tip the scales in yours (and your baby’s) favor. This is also the time to lose some weight, if your body mass index is higher than it should be. “Women who weigh more to start with, or who gain a lot of weight during pregnancy, are more likely to have issues with pelvic floor weakness, due to the increased pressure,” explains Dr. Streicher.
What you can do during pregnancy
It’s never too early to start strengthening your pelvic floor. Dr. Streicher recommends taking a proactive approach, and learning how to do pelvic floor exercises, (also called Kegel exercises), during pregnancy. The trick, however, is to make sure you’re doing them correctly. “Women are told to do Kegels, but it doesn’t always work for them. That’s because most women aren’t taught how to do them properly, or consistently. You need to do both things,” she explains. In many European countries, pelvic floor health is stressed extensively, both during, and after, pregnancy.
What you can do post-pregnancy
It’s important to get onto a Kegel schedule as soon as you can after delivery. As well as other exercises we’ll get to in a minute. Yes, this is a chaotic time, and it’s a given you won’t be getting enough sleep, but Kegels can help you to regain confidence, and control, plus help you to resume your daily activities sooner. Post-delivery urinary incontinence is common, and may resolve on its own, over time. That doesn’t mean you shouldn’t take proactive steps to hasten the process. Keep in mind that the typical pelvic exam your ob-gyn does, will not show pelvic floor muscle issues. If you’re having pain upon intercourse, or urinary or fecal incontinence, talk to your doctor. “Let them know you’re concerned that you are having a pelvic floor issue, and ask them to give you a referral for pelvic floor physical therapy. Seeing the right professional can help you to resolve your issues, so that you can enjoy your new life with your baby, and your sex life, sooner,” says Dr. Streicher.
Additional moves to try
If you’re a yoga studio denizen or Pilates enthusiast, talk to your instructor about exercises which positively impact upon the pelvic floor. In general, anything that strengthens the abdominals, will also be beneficial to this area. There are other exercises which can help, as well. Katy Bowman, author of Diastasis Recti: The Whole-Body Solution to Abdominal Weakness and Separation, recommends taking a whole-body approach to pelvic floor health. She suggests trying a strap stretch, in addition to Kegels: Lie on your back with the hamstring of the left leg resting on the ground (if your hamstring doesn’t touch, bolster your torso on pillows until it does), lift your right leg, and wrap a strap (or belt) around one foot, pulling the foot down, to create a 90° ankle angle. Fully extend your knee. Keeping your pelvis level, slowly bring the leg across the body until you feel the load in the lateral hip. Repeat on other side.
There are a number of other-the-counter pelvic floor exerciser tools you can try at home. They include insertable, biofeedback devices which rely on your smartphone, that let you know if you are doing Kegels correctly. These devices, such as PeriCoach, rely on visual feedback, to track your progress, on an ongoing basis. Other similar, biofeed back devices include Elvie and InTone. When buying an over-the-counter pelvic floor exerciser, always look for one that is FDA-approved.
Do not put up with painful sex
It may not be the subject of casual conversation, but post-pregnancy, painful sex is all-too-common. Doing Kegels, and other forms of pelvic floor physical therapy may help. If it’s not enough, you (and your partner) deserve to get additional support. Painful intercourse can happen postpartum, especially if you are nursing your baby. Breastfeeding interferes with estrogen production, which can lead to vaginal dryness. This can make already-existing issues with pelvic floor dysfunction even harder to handle, or cause high-tone issues to occur.
“Women with vaginal dryness may grin and bear it through painful intercourse. They keep having sex, even though it is painful, creating spasms, and high-tone, tense muscle, pelvic floor problems. Sex gets more painful over time, instead of easier. If the pelvic pain is continuing, see a doctor, or physical therapist. The pain may go, but the muscle memory may remain. When this happens, you need to work with a pro. It also helps to use a vaginal dryness cream before the secondary muscle stuff kicks in,” says Dr. Streicher.
- Heather Bartos, MD, FACOG, in Cross Roads, Texas
- Lauren Streicher, MD and author of Sex Rx: Hormones, Heath, and Your Best Sex Ever
- Katy Bowman, author of Diastasis Recti: The Whole-Body Solution to Abdominal Weakness and Separation