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The pelvic floor will undergo intense challenges in pregnancy, during birth, and in the postnatal period. Preparing the pelvic floor for those challenges can make a huge difference in pelvic floor health for the years to follow.
The pelvic floor must be able to support the weight of the mother and the growing baby.
Maintaining a strong and reactive pelvic floor in pregnancy would seem to limit excessive connective tissue and ligament stretching of the attachment structures of the uterus and thus reduce pelvic organ prolapse though this is an example of factors that may be too difficult to safely assess to validate in the research.
Research has shown that pelvic floor muscle training does reduce the risk of incontinence after delivery and reduces the risk of 3rd and 4th degrees tears during delivery. Further research needs to be done on the ability of pelvic and core muscle training to reduce the occurrence and severity of pelvic organ prolapse in pregnancy, during delivery and postnatally.
The risk for prolapse would increase during a lengthy pushing stage of labor especially in the presence of a tight protective pelvic floor, with excessive constipation/straining in the postpartum period and if a return to sport is pursued too soon before the pelvic floor can adequately support the pelvic organs. As a result, pelvic floor therapy in the pregnant and the postpartum client should include very specific education on safe and effective pushing and constipation prevention and a return to sport assessment should be performed with a tailored treatment program according to which sport is chosen.
For some women, the body intuitively knows how to relax the pelvic floor for birth. For others, there can be a tendency towards contracting the pelvic floor instead of relaxing the pelvic floor during pushing. Constipation from childhood could be one red flag indicator that the pelvic floor may have trouble relaxing. Another red flag indicator would be if there is known pelvic floor tension. A short pelvic floor will not lengthen well. In either of these cases, being screened by a pelvic floor PT in pregnancy would help identify possible issues, and the pelvic PT can help develop a program to correct the coordination pattern so that muscle lengthening can more easily occur during vaginal delivery.
Core and pelvic floor training can also help prevent musculoskeletal pain in pregnancy, in postpartum, and beyond. The childrearing years come with a lot of joy and stress. Many moms will forsake their health during this time. The stress and changes through the sacroiliac joint alone can set these moms up for consistent or sporadic back pain. In addition, difficulty transferring loads across the pelvis for some may initiate a steady, slow reduction of activity which would lead to more muscle weakness and lack of joint support over time.
In addition to treating any pelvic muscle dysfunction, pelvic floor therapy in pregnancy should include a nice foundation of core strength, lower body, and upper body strength with education to continue strength development during child-rearing years to prevent aches and pains and to build a healthy strength bank for the golden years.
*Blog content is for informational purposes only and is not considered medical advice.
