Pelvic Floor 101: Pregnancy and Postpartum

November 18, 2024

Pelvic floor therapy has gained more attention recently. There’s a growing understanding of its importance in women’s health, particularly around pregnancy, childbirth, and aging. Historically, issues like incontinence or pelvic pain were underreported and under diagnosed. But with advances in medical research and honest conversations taking away the stigma of pelvic floor issues, we now have options and education to keep this vital area healthy! Pelvic Floor 101 has everything you need to know, and features the expert advice of our friends at Pelvic Pride in Baltimore, MD.

Remember that in seeking counsel, a pelvic floor therapist is a highly trained professional with the clinical designation of Doctor of Physical Therapy (DPT) or Occupational Therapist specializing in the pelvic floor. This is a doctoral degree involving extensive training in anatomy, physiology, and rehabilitation techniques. DPT’s have also completed clinical rotations in women’s health, orthopedics and more.

What is the Pelvic Floor?

The pelvic floor is not just 1 thing- it is actually 26 muscles that work together. This team of muscles surround the urethra, vagina and anus that acts as a “hammock” of support for the bladder, uterus and rectum. (The prostate is also supported, but for this lesson we’re concentrating on women and people who don’t have a prostate). Like with all of our body parts, a strong properly functioning pelvic floor is important for overall well-being. The main reasons to keep a strong pelvic floor are:

1. to maintain good bladder and bowel control; your pelvic floor muscles help your bladder and anus open and close.
2. support your internal organs; the pelvic floor is the structural support of all the organs in the lower abdomen: bladder, intestines and reproductive organs
3. improved sexual function; a strong pelvic floor alleviates pain/discomfort during sex, increases blood
   flow and allows for better orgasm control.

How can I help ensure a well functioning and healthy pelvic floor?

Pregnancy, labor and delivery and aging in general can affect the strength of the pelvic floor. Anyone can do pelvic floor exercises! But in the area of maternal health, there are specific exercises that are appropriate during pregnancy, and specific exercises during postpartum.  

Your pelvic floor therapist and your own comfort can help you decide which exercises you’d like to do.

Pelvic Floor 101 During Pregnancy – 3 Exercises to Consider

• Kegel Exercises – Perhaps the most well-known pelvic floor exercise is the Kegel Exercise or “Kegels.” Kegels involve tightening and then releasing the muscles in the pelvic floor to strengthen them. You can assure that you’re doing the exercise correctly by practicing a few during urination. Kegels use the same group of muscles we use to stop and start the flow of urine. Kegels can be done before, during and post pregnancy. They can be done in a seated position and when tolerated, can also done in bridge pose.

However! It’s important to know that while they’re well known, the success of Kegels depends on your personal physiology. As Joy Noble, Doctor of Physical Therapy says, It may be worth noting that Kegels are not for everyone as they can contribute to a tight pelvic floor, this is where it is ideal to see a pelvic therapist to assess the state of your pelvic floor.

• Diaphragmatic Breathing – This deep breathing method engages the core muscles, including the pelvic floor, improves posture and core stability. Here’s how:

1. Sit or lie down in a comfortable position
2. Breathe in slowly through your nose, focusing on expanding your abdomen rather than your chest.
3. Exhale slowly and fully through your mouth, using your abdominal muscles to push the air out.
4. Repeat for several breaths

• Pelvic Tilts: Tilting the pelvis forward (anterior tilt) and backward (posterior tilt) while lying on your back, sitting, or standing. The focus is on isolating the movement of the pelvis without involving the rest of the spine.

Beyond the Basics

There are specific therapies for the postpartum phase as well. One well-tolerated exercise is called 360 Canister Breathing and engages your core while helping the pelvic floor. In addition to self-guided exercise, it’s recommended to include professional visits to a pelvic floor therapist. Here you can expect a specialized program based on your needs that may include Manual Therapy, where a physical therapist actually helps release tension and improve muscle function with you.