Pelvic Floor Dysfunction: Don't Ignore the Signs

Updated December 20, 2024

Have you ever leaked a little pee when you coughed, laughed, or sneezed?

Do you feel you need to run to the bathroom before jumping jacks or any sort of high-impact activity?

Often these symptoms are viewed as a “normal” (albeit annoying) way of life — especially after having kids.

Let us make one thing clear:

Just because it’s common, does not mean it’s NORMAL.

The symptoms described above are signs of pelvic floor dysfunction (PFD). PFD is a core issue that, if not addressed, may lead to other complications and can negatively impact your quality of life.

Read on to learn:

The anatomy and key functions of your pelvic floor
What Pelvic Floor Dysfunction (PFD) is, and the key symptoms
Potential causes of PFD
Tips for mitigating PFD
Pelvic Floor recovery exercises
Additional resources to support recovery

Understanding Your Pelvic Floor

Your pelvic floor is comprised of three layers of 14 different muscles that form a sling at the bottom of your core (or the “floor of the core”). Yes, the pelvic floor muscles are critical core muscles, even though they are often not what comes to mind when we think of the core.

A well-functioning pelvic floor is responsible for:

Supporting your pelvic organs: uterus, bladder, rectum
Helping to stabilize your spine and pelvic-hip region
Controlling continence (making sure you pee when you want to, and don’t when you don’t want to)
Aiding in sexual response and satisfaction
Assisting in guiding the baby out during delivery

Understanding Pelvic Floor Dysfunction(PFD)

There are two types of Pelvic Floor Dysfunction (PFD):

Overactive: Too much muscle tone and excessive recruitment
Underactive: Too little muscle tone and inadequate recruitment

While there are a variety of reasons why an individual could have PFD, the increased stress on the pelvic floor muscles during pregnancy and childbirth can increase the likelihood of developing PFD. The two primary symptoms we tend to see during and after pregnancy are:

Stress Incontinence: Accidental leakage (urinary or fecal) during sudden movements like coughing, laughing, sneezing, or during exercise.
Pelvic Organ Prolapse: When one or more of the pelvic organs (bladder, rectum, or uterus) descends lower than its normal position. It can sometimes manifest as a heavy “bowling ball” feeling or pressure between the legs

Potential Causes of Pelvic Floor Dysfunction

There are three primary contributors to the PFD symptoms mentioned above during and after pregnancy:

1. Alignment Shifts: Pregnancy tends to pull the body out of neutral alignment. One of the key shifts is the anterior pelvic tilt (shown below) from the growing belly tipping the pelvis forward. The greater the anterior pelvic tilt, the greater the pressure on the pelvic floor muscles (and low back and abdominal wall as well).

2. Excess Intra-Abdominal Pressure: During pregnancy, the growing belly increases the pressure in the abdominal cavity, or intra-abdominal pressure (IAP). This leads to some degree of Diastasis Recti and also increases the pressure on the pelvic floor. The following factors further increase this pressure, which could lead to PFD:

1. Breath-holding upon exertion. This is otherwise known as the Valsalva maneuver, and is often used by those lifting very heavy loads. NOTE: This is why PFD is an issue that can affect anyone, like powerlifters, bodybuilders, and athletes. Holding your breath during a movement does increase the force production. However, it has the side effect of increasing the pressure on your abdominal wall and pelvic floor. Another example of breath-holding upon exertion is “bearing down” on the toilet.
2. “Sucking in” (or chronically engaging your core): Constantly holding your belly in a taut position increases the downward pressure onto your pelvic floor muscles. Learn more about the implications of chronically engaging your core.
3. Weak or overwhelmed deep core muscles: Your deep core muscles are responsible for regulating the pressure within your core (among many other things). If these muscles are weak, or simply overwhelmed from the stresses of pregnancy, they cannot regulate pressure as well.

3. Childbirth: Obviously, a vaginal birth increases the stress on the pelvic floor muscles — especially if breath-holding is used as the primary pushing strategy over an extended period of time. A C-section also traumatizes the pelvic floor muscles because the procedure involves moving the abdominal muscles, which are intricately connected to the pelvic floor.

While all these factors may make it seem like PFD is inevitable during pregnancy, that is not true. PFD can be prevented by focusing on the strategies outlined in the section below.

Tips for Mitigating PFD

Now that you better understand the causes of PFD, the strategies to prevent or mitigate it should make more sense.

Get in Neutral: Neutral Alignment is key to alleviating stress on your pelvic floor muscles.
Master 360° Breathing: There are many reasons why we refer to 360˚ Breathing as the #1 most effective core exercise. One reason is that it helps regulate the pressure in your core.
Avoid breath-holding upon exertion: If you are someone who traditionally uses the Valsalva maneuver to lift heavy loads, we advise not doing this during the perinatal period given the elevated IAP during pregnancy, and weaker core tissues in the early postpartum period. Instead, focus on exhaling on the effort to generate force in a safer way. In addition, try to limit “bearing down” on the toilet. We appreciate that this can be easier said than done since constipation is a common side effect during pregnancy. For help with this, see these 10 Tips to Reduce Pregnancy Constipation. Finally, if you are pregnant, practice this pushing strategy to work on pushing in a manner that minimizes the pressure on your pelvic floor muscles.
Avoid “Sucking in”: As mentioned above, “sucking in” or chronically “engaging your core” increases the pressure on your pelvic floor muscles While it’s perfectly fine (and beneficial) to engage your core for a brief period to perform an exercise, we want to avoid constantly holding it in. Like everything in life, balance is key.

Pelvic Floor Recovery Exercises: “PFAs”

In addition to taking the steps above to reduce the excess pressure in your core, you can also practice some targeted pelvic floor exercises. We call this pelvic floor work PFAs (Pelvic Floor Activations).

Watch the video to learn how to perform these exercises. It takes you through a 4-step process to help you first find your pelvic floor muscles, then learn how to perform the two PFA variations: PFAs-Slow and PFAs-Fast.

It is very important to note that if you are experiencing symptoms of PFD, the lengthening portion of PFAs is the most important. Why? Because when the pelvic floor muscles are weak, there is a tendency to keep the muscles in a chronically contracted state (to avoid accidental leakage). This excessive recruitment of the PF muscles can lead to tightness. When muscles are held in a chronically tight state, they are not able to respond when needing to control larger amounts of force like that generated from coughing, sneezing, or jumping. To illustrate this, think of how a trampoline responds when you jump on it. It lengthens in response to the force, then contracts. This is what we need the pelvic floor muscles to do.

So, just like all other muscles in your body, it’s important to work your pelvic floor muscles through a full range of motion to develop strong, well-balanced muscles that can respond to various forces and loads.

Additional Support

The best way to heal PFD is to work with a pelvic floor physical therapist. You can use this physical therapist locator provided by APTA (American Physical Therapy Association) Pelvic Health to find a qualified women’s health physical therapist near you.
For a great self-guided option, explore our 8-Week Core Recovery Program.
If you have painful symptoms, consider wearing a compression garment. We love the range from SRC Health, which offers high-quality garments to wear under and over your bump (use code PRONATAL10 for 10% off).

Are you a Health & Fitness Professional?

Are you interested in training pre & postnatal clients or supporting them better in your current line of work? Explore our ProNatal Professional Education & Certification to find courses, resources, and community to help you build your pre & postnatal fitness expertise.