Laura was 38 when she had her first child, and was thrilled to become a mother. She sailed through pregnancy mostly unscathed, and couldn’t wait to hold her little one in her arms.

But when she finally did give birth, she found that she had horrible back pain, and couldn’t control her bladder. It was painful to even rise to standing, and lifting her baby was a challenge. Still, it was her first baby and she assumed these symptoms were normal and would eventually go away.

Three weeks after her baby was born, a friend came to visit, also having just given birth. She seemed shocked that Laura was in so much pain, and claimed she hadn’t experienced any pain or leakage at all.  “I still felt like I had been run over by a truck and she said she was already starting to feel like her old self. It was then that I knew something was wrong. This wasn’t normal at all.”

Pregnancy is a wonderful time in a woman’s life. But many new moms are unaware of the potential challenges that pregnancy and childbirth can have on the body – particularly the pelvic floor, which helps control everything from sexual function to bladder control. When these muscles become damaged, it can create many problems for a new mom, many of which they weren’t prepared for.

Let’s start with a quick primer on what the pelvic floor is.

What is the pelvic floor?

The Pelvic Floor Muscles (PFM) are a broad sling of muscles that attach from your pubic bone at the front of your body to the base of your spine at the back, and from side to side. These muscles act similar to a trampoline, in that they are able to move up and down. The pelvic floor muscles support the bladder, uterus and rectum and help control opening and closure for the urethra, vagina, and anus. This set of muscles has 5 main functions:

• Supports the abdominal organs

• Sexual intercourse function

• Helps with sphincteric control of the bladder and bowel, which helps prevent leakage

• Stabilize Spine & Pelvic Girdle, providing support

• Acts as a “sump pump”, to maintain good circulation from the lower half of our bodies

What happens to the pelvic floor during pregnancy?

During pregnancy, our bodies experience many hormonal changes. These can sometimes cause problems, such as weakened ligaments (which can lead to instability in the hips and pelvis), frequent urination (due to your growing uterus pushing on your bladder), and even constipation. The pelvic floor muscles are also under a lot of pressure, which can cause problems like incontinence or bladder leaks during pregnancy.

What happens to the pelvic floor during childbirth?

During childbirth, the muscles at the top of your uterus contract which pushes your baby’s head toward your cervix. As the baby travels to the vagina, your bones and ligaments move and stretch to accommodate him. Your cervix dilates so that your baby can travel through it. After birth, your uterus continues to contract in order to deliver the placenta.

Potential complications from pregnancy and childbirth

Pregnancy and childbirth put a tremendous amount of pressure on the pelvic floor, which can sometimes result in a weakened PF, or in some cases create extra tension, each leading to different symptoms.  Different symptoms might include a weakened pelvic floor, as well as a pelvic floor that is too tight. Both of these scenarios can cause problems.

Symptoms of a weakened pelvic floor can include:

• Urinary incontinence, urgency, or increased frequency

• Stool and gas incontinence

• Pelvic organ prolapse, or the dropping of your organs through your vagina

• Sexual dysfunction

Symptoms of pelvic floor tension:

• Constipation

• Painful intercourse

• Pelvic pain

• Inability to empty your bladder completely

• Painful urination

Orthopedic pain

You may also experience orthopedic problems after giving birth.  Things like low back pain, pelvic girdle pain (pain in the pubic or groin region), or wrist and hip pain are not uncommon after having a baby.

Why you need to pay attention to bladder leaks

Just because things may be common, it doesn’t mean they are normal.  Any type of pain or discomfort should be looked into after childbirth. And, even if they go away, many issues, such as bladder leakage or prolapse, may come back later in life as your muscles get weaker, if they are not addressed early on. Additionally, your bladder leakage may be a symptom of another problem, like a pelvic organ prolapse or a diastasis recti.  Addressing these problems now can help prevent more issues with your pelvic floor down the road.  Here is a look at several common (but not normal!) issues that women may face after having a baby, why they’re issues, and why it’s important to get them checked out.

Leaking

Why It Happens: The pressure of carrying a growing baby around for 9 months, and then giving birth can cause some urine leakage in many women after childbirth. While it’s common for this to occur for a short time  immediately after birth (about 3 months), it’s not normal for leakage to continue.

Why It’s A Problem: Longer-term leakage may be due to a problem with the pelvic floor muscles or support system.

Why It’s Important To Get It Checked Out: Even if you are experiencing only mild, occasional leaking in the months after childbirth, it could signify a problem. And since our muscles weaken as we age, the issue may get worse as you get older. See a PT to get checked out and learn what you can do to make the leaks stop.

Pain With Intercourse

Why It Happens: Your body has changed a lot after giving birth, and you are still experiencing fluctuating hormones that can cause things like vaginal dryness. Additionally, breastfeeding mothers produce less estrogen. Sometimes this can cause tissues in the vaginal area to become thinner, which can contribute to pain with intercourse.

You may also have experienced tearing during childbirth, which can lead to scar tissue. Or, you may have pain related to muscles and nerves affected by pregnancy and labor.

Why It’s A Problem: Pain can be caused by a number of underlying issues: vaginal dryness, scarring, muscle or nerve damage or injury to the pelvic floor. These should never be ignored.

Why It’s Important To Get It Checked Out: Sex is an important part of a relationship and you owe it to yourself, and your partner, to get checked out if it’s feeling painful.

Urinary Issues:

Why It Happens: Urinary issues are common after pregnancy, but if they persist past a few weeks, they are in no way normal. Weakened muscles can be largely to blame, but other issues during childbirth may have been a factor as well.

Why It’s A Problem: Urinary issues may include more than just leakage. The inability to control your bladder, an urgent need to empty your bladder, bladder pain or infection, or the inability to empty your bladder can all occur after pregnancy and may be symptoms of other more serious conditions, such as pelvic organ prolapse.

Why It’s Important To Get It Checked Out: Urinary issues can greatly affect a woman’s quality of life. But there are many treatment options that can help alleviate these conditions. Women need to speak up and get the treatment they need. These conditions are not normal and it’s not something anyone should have to live with.

Bowel Issues

Why It Happens: Again, your weakened muscles, and changing hormones, are to blame. Bowel issues after childbirth can range from constipation, to increased flatulence, to fecal incontinence. Bowel movements immediately after delivery may be harder due to the side effects of pain medications you may have received during or after labor.

Why It’s A Problem: Fecal incontinence and/or the inability to control gas is an embarrassing problem, and can greatly limit your life. On the other end of the spectrum, constipation can cause all sorts of problems too, like anal fissures, impactions, or even pelvic organ prolapse.

Why It’s Important To Get It Checked Out: Leaking fecal matter can have a huge effect on your quality of life, and constipation is no picnic either. There are treatment options for both and it’s important to treat them before they cause further issues.

Pelvic Organ Prolapse

Why It Happens: Pelvic Organ Prolapse (POP) is when the muscles or tissues that support the uterus, rectum and bladder become weak or loose, resulting in one of more of the organs to press into or through the vagina.

Why It’s A Problem: A POP can cause a feeling of pressure, or bulge in the vagina and can cause achiness or discomfort in the pelvis. POP can cause other side effects too, such as pain, constipation, urine leakage, or the ability to empty your bladder or bowel.

Why It’s Important To Get It Checked Out: Left untreated, Pelvic Organ Prolapse may worsen over time. Luckily, there are treatments available – no one should have to live with these symptoms. Things like physical therapy, biofeedback, or even surgery are options for fixing a POP.

Diastasis Recti

What It Happens:  Diastasis Recti Abdominis, or DRA, is a condition in which the large muscles of the abdomen separate during pregnancy and don’t come back to midline after delivery. While the condition can occur in anybody, it’s very common in mothers.

Why It’s A Problem:  Apart from making your stomach still look and feel like you’re pregnant, DRA can have many undesirable side effects, including a weakened core, lower back pain, constipation, and urine leakage.

Why It’s Important To Get It Checked Out:  Everyone has a small gap between their abdominal muscles, but a larger gap can cause additional pelvic floor problems, like lower back pain, constipation, or leakage. Proper exercise moves can help you decrease this gap, providing your core with more stability.

Some tips if you have a diastasis recti abdominis:

• Talk with a PT for a proper diagnosis and to learn exercises that can help.

• Be careful with the types of exercises you do. Certain moves can put increased pressure on your abdominal wall, making the condition worse.

• Avoid constipation. Straining to use the toilet can worsen the condition.

• Avoid lifting heavy things.

• Be mindful of your posture.

Why Seeing Physical Therapist Is Important After Childbirth

Ok, so we’ve covered many of the things that can happen to your pelvic floor after pregnancy and childbirth. If you experience any of these issues, a first course of action should be to visit a pelvic floor physical therapist. A pelvic floor PT can give you a full examination and tell you if your pelvic floor muscles have been weakened or are too tense. They’ll measure your ability to contract and release your pelvic floor, and will show you specific exercises to help you fix whatever problem you may be having.  In many cases, regularly seeing a PT can help alleviate your pelvic floor issues, without a need for medication or surgery.  (Read: Physical Therapy After Childbirth)

Not all women experience a leaky bladder or other symptoms after having a baby. But, even if you don’t, it’s still a good idea to see a physical therapist and get an examination. Sometimes, potential issues may not be immediately apparent, but may appear over time – even many years later – as your pelvic floor continues to weaken with age. Many women live for years with a slight prolapse and don’t notice any symptoms until they get older. By taking control of your pelvic floor when you’re younger, you’ll be able to stabilize it early on, and may prevent other symptoms – like bladder leakage, prolapse, or back pain –  from occurring down the road.