Tarek Khalife, M.D.
Birthing Centers, Obstetrics & Gynecology (OB-GYN), Prenatal Care
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Pregnancy and childbirth are transformative experiences for a woman's body, affecting it in many ways. One of the areas that may be affected is the pelvic floor, which is the diaphragm of the pelvis. These muscles support the uterus, bladder, large intestine and rectum.
These muscles may be affected by pregnancy and childbirth, altering some of their vital functions. These can include fecal and urinary continence mechanisms, and support of the vaginal walls and uterus. Less support can lead to prolapse. Trauma to the pelvic floor muscles and nerves also may result in pelvic pain symptoms occurring with or without sexual intercourse.
Here are some factors that may affect the pelvic floor during pregnancy and childbirth, and could lead to pelvic floor disorders in the future:
About 50% of pregnant women experience symptoms of pelvic floor disorders even before childbirth. During pregnancy, women tend to gain weight — not just the baby's weight but also weight from the placenta, increased blood volume and an enlarged uterus. The extra weight places increased strain on the pelvic floor muscles, resulting in an increased risk of urinary incontinence.
Constipation is common during pregnancy, especially in the third trimester. The weight of the growing uterus and hormone changes can affect digestion, leading to infrequent or difficult passing of stools. Any related straining and stress can further weaken pelvic floor muscles and nerves.
The body also undergoes significant hormonal changes during pregnancy that affect pelvic floor health. The placenta secretes the hormone relaxin to increase the flexibility of ligaments in the pelvis and soften the cervix. These changes prepare the body for birth. As a result, the connection between the pelvis bones becomes looser, resulting in increased flexibility and instability.
Medical and occupational history
Some women are more susceptible to pelvic floor disorders, and this risk increases with pregnancy. Women with a history of chronic constipation, connective tissue disorders or smoking are at increased risk. Women who are obese or have a history of repeated heavy lifting, either at work or through weight training exercises, also can be at increased risk.
Identifying pelvic floor disorders
Pelvic floor disorders are not easily recognizable, as the symptoms can mimic other conditions. For instance, pelvic pain may be confused for endometriosis, while bladder-related symptoms might mimic some pelvic floor problems. This overlap makes it challenging to pinpoint whether the symptoms are related to pregnancy or pelvic floor disorders.
In addition, the pelvic floor can't be easily seen and examined by a woman or her health care team.
Childbirth and pelvic floor
Labor and delivery are considered risk factors for pelvic floor disorders. Vaginal delivery, in particular, is regarded as the most significant risk factor. During childbirth, the pelvic floor muscles undergo tremendous stress, especially during the second stage of labor when there is active pushing. This risk is increased with operative deliveries using vacuum or forceps.
Labor before a cesarean section delivery also increases risk for pelvic floor disorders.
Some women's pelvic floors are more resilient and able to recover quickly, while others may be more prone to lasting issues. Studies show that the more vaginal deliveries a woman has, the more likely she is to experience pelvic floor dysfunction.
Preventing pelvic floor disorders
Pelvic floor disorders are not a forgone conclusion during pregnancy. Just as pregnant women take prenatal vitamins and avoid alcohol to lower the risks of some congenital conditions, they can take steps to reduce the risk of pelvic floor disorders.
I recommend that patients consider attending birthing classes before childbirth. These often include stretching and breathing exercises to help coordinate the diaphragm and pelvic floor muscles during delivery. Pregnancy yoga and perineal massage can help prepare the pelvic floor by improving the flexibility and stretchability of tissues to limit the risk of perineal injuries at delivery.
When done correctly, Kegel exercises strengthen the pelvic floor muscles. About 40% of people don't perform a Kegel correctly the first time. A physical therapist can help you identify the correct muscles if you are uncertain or have questions.
A childbirth educator, nurse midwife or OB-GYN can recommend stretches and classes to prepare your pelvic floor for childbirth.
Women who experience symptoms of pelvic floor disorders during pregnancy should seek treatment to prevent further complications. In addition, lifestyle modifications, such as regular exercise, a healthy diet and proper management of chronic constipation, can help reduce the risk of pelvic floor disorders.