Congratulations, you’re pregnant! You may have already heard your mom’s, aunt’s or friend’s stories about their morning (ahem, all day) sickness, superhero sense of smell, or bizarre cravings, and be wondering which recipe of symptoms you’ll experience. But wait, there’s one more thing to consider, something that doesn’t always come up. What do you need to know about your pelvic health during pregnancy? This is an important topic that is not talked about enough, yet is part of most women’s stories, so let’s dive in.
Summary of this article:
Influence of pregnancy on the pelvic floor: In pregnancy, the pelvic floor muscles are put under more strain, which may result in overactive, tight pelvic floor muscles
5 common pelvic health symptoms seen in pregnancy: more frequent trips to the bathroom, urinary leakage, painful intercourse, low back, hip and pelvic pain, and diastasis rectus abdominis
Prenatal Pelvic Physiotherapy helps optimize a woman’s connection to her pelvic floor and adjacent muscles to help mitigate these symptoms, and prepare for labor and delivery.
The Pelvic Floor
The pelvic floor is a group of muscles found in the pelvis that attaches to the pubic bone, tailbone and sacrum, and sitting bones. When these muscles are contracted (squeezed), they work to lift the internal organs of the pelvis, and tighten the openings of the urethra, vagina, and anus. Relaxing the pelvic floor allows for the relaxation and opening of these orifices. In addition, the pelvic floor functions include sexual health, circulation, and core strength.
The influences of pregnancy on the pelvic floor
As a pregnancy progresses, there is a natural increase in demand placed on the pelvic floor. This occurs due to the following reasons:
1. Pregnancy-related anatomical and physiological changes:
Weight of your baby
Blood volume increase (anywhere from a 20-100% increase, but usually close to 45%)
Extracellular fluid (fluid outside of your cells) volume increase
Enlargement of the uterus
Growing placenta
Amniotic fluid
Enlargement of the mammary glands and breast tissue, a growing placenta
Stored adipose tissue (fat) and muscle development
Due to the pelvic floor’s location, which is beneath these anatomical and physiological changes, the pelvic floor is one of the key muscle groups that help support this increasing load. Given that typical weight gain is between 15-40lbs, depending on the pregnancy and individual circumstances, the pelvic floor must work hard to accommodate for this increased weight.
2. Decreased activity from adjacent core muscles
The core is made up of the transverse abdominis, diaphragm, pelvic floor muscles, and multifidus. As the uterus expands, it impact the ability of some of these muscles to effectively contract, mainly the transverse abdominis and diaphragm. This results in the pelvic floor becomes the main core muscle group supporting you in your day to day activities (time to shine, pelvic floor!)
Take home: In pregnancy, the pelvic floor is recruited more in terms of amount and frequency. Essentially, it’s working harder. Due to this, some women may experience a hypertonic, or tight pelvic floor, as the muscles are being used more than usual (think of if you started carrying a 20lbs weight around all the time. The muscles in your arms would get tight over time, as they would not have a chance to rest).
5 common pelvic health symptoms during pregnancy
1. More frequent trips to the washroom
This occurs for a number of reasons. During the first trimester, many women notice an increase in the frequency that they need to urinate. This occurs due to the rise in hormones (progesterone and human chorionic gonadotropin), and elevated level in body fluids, which make the kidneys work harder (REF). The increased need to urinate may subside in the second trimester, as the body becomes acclimatized to these changes. The frequency and urgency to urinate may pick up again in the third trimester, as baby’s growing size means more pressure on the bladder. Other urinary symptoms during this stage include incomplete emptying and slow stream (Fonti et al. 2009).
2. Urinary leakage with laughing, coughing, sneezing, or exercising
This is called stress incontinence, and is a very common occurrence in the prenatal world. In fact, 46% of women will experience urinary incontinence during their first pregnancy, 66.6% of women will experience it they are on a subsequent pregnancy (Wesnes et al 2007). During pregnancy, the pelvic floor not only has to account for the usual weight of the bladder and the liquid that it holds, but also for the weight coming from baby, placenta, and the amniotic fluid in the uterus. This growing demand results in more activity required from the pelvic floor in terms of amount and frequency to effectively contract around the urethra and prevent urinary leakage throughout the day. Due to this, it is common for the pelvic floor to become tired, making it less efficient in this role when an increase in intra-abdominal pressure occurs, such as when we laugh, sneeze, cough, or exercise, and for some urine to make it through the urethra. It is important to address this, as urinary incontinence during pregnancy is predictive of incontinence later on (Abrams et al 2013), and while this is a common symptoms, it is not normal, and does not have to be part of a woman’s pregnancy journey.
3. Back, pelvis, or hips discomfort/pain
This is more common in the third trimester. In fact, 76% of Canadian women pregnant will experience pelvic girdle pain during pregnancy (Weis et al 2018). This is due to the increased weight that the body is carrying while pregnant, resulting in new body mechanics and pressures throughout the body. Additionally, the abdominal musculature becomes lengthened, making it more difficult for a woman to activate her deep core throughout the day.
4.Sexual intercourse might be uncomfortable, or even painful
As mentioned above, as a pregnancy progresses, and woman’s pelvic floor is placed on increased demand, which may result in this muscle group being overworked, and tight. Given that it is important for pelvic muscles to be able to relax for comfortable intercourse, some women may notice some challenges in this area. In fact, some research suggests that 22-30% of women experience pain with intercourse in their second trimester ( Tennfjord, 2014, Kennedy, 2009). This could occur before, during, or after intercourse, may increase or decrease in intensity as intercourse progresses, and may change in quality (burning, cramping, pressure).
5. Diastasis Recti Abdominis (DRA)
Diastasis recti abdominis (DRA) is defined as a separation of 2 muscle bellies of the rectus abdominis (our 6 pack muscles). In pregnancy, this occurs when the linea alba, which is a connective tissue that runs down center of the abdomen and connects the rectus abdominis, expands against the pressure of growing bump, creating more space between the muscles, and more space of baby to grow. It is important to know that some degree of DRA is found in 100% of women at 35 weeks of pregnancy (Mota et al 2014), and that it is one of the many ways that a woman’s body adapts to the growing baby. While a DRA is a normal occurrence in pregnancy, there are many strategies to consider during this time that will help optimize core function to help support the linea alba, and help mitigate dysfunctions postpartum.
Prenatal Pelvic Health Physiotherapy
Pelvic Health Physiotherapists are highly specialized and passionate in helping women optimize their pelvic health during pregnancy, labour and delivery, and the postnatal stage. There are many strategies that help to manage, treat, and even prevent pelvic health symptoms, and to improve a pregnant woman’s connection to her pelvic floor and adjacent muscles to help prepare for labor.
If you are unsure of whether Pelvic Floor Physiotherapy will help with your symptoms and condition, we highly encourage you to contact us for a 15 minute Free Phone Consultation. One of our specialised Pelvic Floor Physiotherapists will discuss your concerns with you, and help you determine whether this is the best course of treatment for you.