Pelvic Floor Dysfunction: Don’t Ignore the Signs

Have you ever leaked a little when you coughed, laughed, sneezed, jumped, or worked out? Do you feel you need to run to the bathroom before doing anything high-impact? These symptoms are incredibly common, especially during pregnancy and after having kids. However, common does not mean normal.

These symptoms can be signs of pelvic floor dysfunction (PFD), a core issue that can lead to other complications and negatively impact your quality of life.

The good news is that there are steps you can take to address the issue, heal your pelvic floor, and improve your core strength, confidence, and 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

Quick Answer: Pelvic floor dysfunction happens when the pelvic floor muscles are not functioning well. The two PFD symptoms we tend to see during and after pregnancy are stress incontinence (accidental leakage during sudden movements like coughing, laughing, sneezing, or exercise) and pelvic organ prolapse (when one or more of the pelvic organs descend lower than their normal position). While these symptoms are common during pregnancy and the postpartum period, they are normal, and addressing them can significantly improve core strength, confidence, and overall quality of life. Strategies like neutral alignment, 360° Breathing, avoiding breath-holding, and practicing pelvic floor activations (PFAs) can help reduce pressure and support better pelvic floor function.

Understanding the Anatomy and Function of Your Pelvic Floor

Your pelvic floor is made up of three layers of 14 different muscles that form a sling at the bottom of your core, often referred to as the “floor of the core.” Yes, the pelvic floor muscles are core muscles, even though they are not usually the first thing that comes to mind when people think about the core.

A well-functioning pelvic floor is responsible for:

• Supporting your pelvic organs, including the uterus, bladder, and rectum
• Helping stabilize your spine, pelvis, and hips
• Controlling continence, so you pee when you want to and don’t when you don’t
• Supporting sexual response and satisfaction
• Helping guide the baby out during delivery

What is Pelvic Floor Dysfunction (PFD)?

Pelvic Floor Dysfunction occurs when the pelvic floor muscles are not functioning as well as they should. This can happen in two main ways:

1. Overactive: Too much muscle tone and excessive recruitment
2. 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 can increase the likelihood of developing PFD. The two primary symptoms we tend to see during and after pregnancy are:

1. Stress Incontinence: Accidental leakage (urinary or fecal) during sudden movements like coughing, laughing, sneezing, or exercise.
2. Pelvic Organ Prolapse: When one or more of the pelvic organs, including the bladder, rectum, or uterus, descend lower than their normal position. This can sometimes feel like heaviness, pressure, or a “bowling ball” sensation between the legs.

Potential Causes of Pelvic Floor Dysfunction During Pregnancy

There are four key contributors to the PFD symptoms mentioned above during 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), which happens when the growing belly tips the pelvis forward. The greater the anterior pelvic tilt, the greater the pressure on the pelvic floor muscles, as well as the lower back and abdominal wall.

2. Excess Intra-Abdominal Pressure: During pregnancy, the growing belly increases the pressure in the abdominal cavity, known as 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 technique, known as the Valsalva maneuver, is often used when lifting heavy loads. Holding your breath during a movement increases pressure in the core. This results in greater force production. However, it significantly elevates IAP, increasing pressure on the abdominal wall and pelvic floor. This is why PFD is also common among powerlifters and those lifting very heavy loads. Another example of breath-holding upon exertion is “bearing down” on the toilet during a difficult bowel movement. While this can be an effective strategy if constipated, using it consistently over time may contribute to PFD.
   • “Sucking in” (or chronically engaging your core): Constantly holding your belly in a taut position increases the downward pressure on your pelvic floor muscles. Learn more about the implications of chronic core engagement. 
   • 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. Inadequate pelvic floor muscle support: If the pelvic floor muscles are weak or overwhelmed from the stresses of pregnancy, they aren’t able to support the pelvic organs as well. This can cause the pelvic organs to descend below their normal position, leading to either POP or incontinence.

4. Chronic pelvic floor tension: When the pelvic floor muscles are weak or overwhelmed, they may compensate by overacting to support the pelvic organs or prevent accidental leakage. This excessive recruitment of the PF muscles can lead to tightness. While “tight” pelvic floor muscles may seem like a good thing, a “tight” muscle is not a “strong” muscle.

5. Childbirth: 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 impacts 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 to Mitigate Pelvic Floor Dysfunction During and After Pregnancy

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

1. Get in Neutral: Neutral Alignment is key to alleviating stress on your pelvic floor muscles.
2. Master 360° Breathing: There are many reasons we consider 360° Breathing the most effective core exercise. One reason is that it helps regulate the pressure in your core.
3. Avoid breath-holding upon exertion: If you are someone who traditionally uses the Valsalva maneuver to lift heavy loads, we advise against doing so during the perinatal period, given 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 minimize pressure on your pelvic floor muscles.
4. Avoid chronic core engagement: As mentioned above, keeping your core constantly engaged increases the pressure on your pelvic floor muscles. While it’s perfectly safe and beneficial to engage your core briefly during an exercise, we want to avoid constantly holding it in. Like everything in life, balance is key. 
5. Practice Pelvic Floor Activations (PFAs): These exercises are designed to develop pelvic floor strength and control through a full range of motion. 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.

When performing PFAs, if you are experiencing PFD symptoms, focus primarily on the lengthening portion of the PFA. Why? Because when the pelvic floor muscles are weak, there can be a tendency to keep them chronically contracted in an attempt to prevent leakage. Over time, that excessive recruitment can lead to tightness.

It is very important to note that if you are experiencing symptoms of PFD, the lengthening portion of PFAs is the most important. Why? Recall that when the pelvic floor muscles are weak or overwhelmed, they may compensate by overacting to support the pelvic organs or prevent 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 required to control greater amounts of force, such as that generated by 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.

Just like all other muscles in your body, your pelvic floor muscles need to work through a full range of motion to develop strength, balance, and the ability to respond to different forces and loads.

Pelvic floor symptoms can be frustrating, but they are not something you simply have to accept as a “normal way of life” during and after pregnancy. By understanding what contributes to PFD and learning how to better manage pressure, alignment, breathing, and pelvic floor activation, you can take meaningful steps toward better function, comfort, and confidence.

Additional Support for Pelvic Floor Dysfunction

• 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.
• 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).

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