Pelvic Floor Weakness: What to Know Before and After Having a Baby

Firm, flexible, and thick, your pelvic floor muscles provide support to your pelvic organs.

Growing and having a baby changes so many aspects of a woman’s body, and a significant one is the effect that pregnancy and childbirth have on your pelvic floor. A woman’s pelvic floor consists of a few major muscles that support the pelvic organs of the bladder, uterus, and rectum. Pregnancy and childbirth can weaken pelvic floor muscles, leading to annoying and embarrassing symptoms like leaking urine and passing uncontrolled gas, and painful, serious issues like pelvic organ prolapse. Here’s what to know about pelvic floor weakness and what you can do about it.

What is the Pelvic Floor?

Pelvic floor muscles run like a hammock from your pubic bone to your tailbone and spanning the width between your hips. Firm, flexible, and thick, they provide support to your pelvic organs and are able to be contracted (raised) and relaxed (lowered), similar to a trampoline. Within the pelvic floor muscles are several holes for urethra, anus, and vagina to pass through, and the pelvic floor muscles usually wrap snugly around these elements to help keep them closed. Encircling the anus and urethra are circular muscles called sphincters. 

What Do Pelvic Floor Muscles Do?

The pelvic floor muscles help hold the uterus, bladder and rectum in place. They play an important role in bladder and bowel control, sexual health, and in childbirth.

When the pelvic floor muscles like the sphincters are contracted, they prevent urine and feces from being released. Strong pelvic floor muscles allow us to contract and control our bathroom functions and delay emptying our bladder and bowels until it’s convenient to do so. We relax the pelvic floor muscles when we want to go to the bathroom or pass gas.

When pelvic floor muscles are weak, inconvenient, embarrassing, and sometimes painful symptoms can appear. You might find yourself peeing a little when you laugh, or difficulty in making it to the bathroom on time. You may also experience pelvic organ prolapse, when any one of the pelvic organs sag, possibly herniating or bulging into the vagina.

What Causes Weak Pelvic Floor Muscles?

Weak pelvic floor muscles in women are often a side effect of pregnancy and childbirth. The pregnancy weight puts added pressure and stress on the pelvic floor muscles, diminishing their strength. They’re also stretched out of shape during labor. Other causes of weak pelvic floor muscles are age, menopause, obesity, and recurrent straining/constipation. 

Signs of Weak Pelvic Floor Muscles

Weak pelvic floor muscles are very common, with at least one-third of women experiencing symptoms of pelvic floor weakness. When you have a weak pelvic floor, your ability to tighten and relax your pelvic muscles is not as great as it should be. This weakness means you have less control and can present as any/all of these symptoms:

  • Urinary incontinence (leaking urine when you do things like laugh, sneeze, and walk, not making it to the bathroom in time) 
  • Fecal incontinence (leaking feces) 
  • Passing gas when bending or lifting
  • Tampons becoming displaced and/or falling out
  • Unexplained lower back pain
  • Feeling of heaviness in vagina
  • Distinct bulge at vagina if prolapse has occurred
  • Pain with sex
Kegels are one way to improve your pelvic floor strength.
It’s important for all women to exercise their pelvic floor muscles, and it’s especially essential for women who’ve been pregnant and delivered vaginally. 

How to Strengthen Your Pelvic Floor

It’s important for all women to exercise their pelvic floor muscles, and it’s especially essential for women who’ve been pregnant and delivered vaginally. Here are some ways to improve the strength of your pelvic floor.

Maintain a healthy weight: This helps alleviate the muscle strain caused by supporting extra weight.

Eat a fiber-rich diet: Help your body out by making bowel movements easier and strain-free.

Biofeedback: Biofeedback treatment for pelvic floor disorders involves working with a physical therapist and using sensors and video to monitor pelvic floor muscles as you attempt to contract and relax them. More than 75% of women experiencing pelvic floor dysfunction see improvement from biofeedback treatment, according to the Cleveland Clinic. 

Surgery: If you’ve experienced a pelvic organ prolapse, you’re probably in discussions with your doctor about the best course of action, including a hysterectomy in the case of a prolapsed uterus.

Kegels: Even if you’re not experiencing any of the symptoms of a weak pelvic floor, you should almost certainly* be doing kegel exercises for a few minutes every day for prevention. Kegel exercises involve contracting and relaxing your pelvic floor muscles to keep them strong and functioning as they should.

To identify what muscles you should be working when doing kegels, imagine you need to pee but aren’t near a restroom so you are holding it. Then relax those muscles. Another way to identify your pelvic floor muscles is to place two fingers inside your vagina and tighten around them, then relax.

Once you have identified your pelvic floor muscles and how you can control them, aim to do 10 reps three times a day. Here’s a kegel exercise to try, alone or part of this postpartum Pilates workout:

“Imagine your vaginal opening wrapping around a straw, then, gather the muscles inward, lifting up as though your vagina were sipping from the straw. Just as important as it is to engage and lift, we must gently lower and fully release the pelvic floor. Contracting these muscles alone will not work. For muscles to be functional, healthy, and strong they must lengthen and relax as well as engage.”

You might find doing kegels easier and even fun by employing kegel balls or a pelvic floor exerciser. These devices sync with an app featuring monitoring and games to help you track your kegels.

*It’s important to consult a physical therapist who specialize in pelvic floor disorders before beginning to do kegels, and here’s why: According to the National Institute for Continence, some women suffer from their pelvic floor being in an overactive, rather than weakened, state. Performing kegels with an overactive pelvic floor can cause more harm than good. It can be hard to know if you have a weak pelvic floor or an overactive one without a diagnosis from a physical therapist. 

Remember that pelvic floor weakness and disorders are very common and nothing to be embarrassed about. Get in touch with your doctor if you have any concerns or are in need of treatment advice and support.