Many of us wander through our lives, ignoring the pelvic floor and pelvic organs if we have no specific concerns. We were taught as children to use non-anatomical names for things, not talk about sex or continence, and largely are unaware of the daily functioning of our pelvic floor until something like pregnancy or postpartum symptoms arise. 

However, the pelvic floor works all day to ensure stability in the pelvis. Plus, it controls the bowel, bladder, and reproductive functions. It also allows for sexual appreciation, controls the sphincters for urination and bowel release, and works in tandem with the diaphragm during breathing – much like a pistoning system – to control the core and abdominal pressure. 

Understanding your pelvic floor muscle function and its importance is critical across the lifespan, regardless of parenthood status, gender, age, or sexuality. The pelvic floor muscles (PFM) are composed of three layers of muscles. Much like other muscle groups, they contract and relax- some of which is voluntary (under your control), and some involuntary (like breathing, it works without you thinking about it.) We’ve covered the pelvic floor in greater detail in this blog post.

Anatomy and Changes During Pregnancy

During pregnancy, many changes begin occurring in the pelvic floor muscles to adapt to a change in your center of gravity (the baby and placenta brings your center of gravity more forward as the belly expands), the decreased space in the abdomen making room for the fetus and placenta, and preparing the body to birth. 

Among many critical hormonal changes—including but not limited to a surge in the hormone relaxin, which allows tendons and ligaments to stretch and aids in the widening of the pelvic bones to prepare for birth—there is also a significant increase in blood and fluid flow to the pelvis, a rise in estrogen, and countless other physiological changes to the body (right down to your DNA!). 

Unfortunately, sometimes the body is too good at adapting to these changes and gets nice and loosey-goosey with the aid of relaxin. This can cause your lumbopelvic alignment to get out of balance, leading to something like symphysis pubis dysfunction (SPD), SI joint pain, low back pain, and hip flexor pain. With the weight of the placenta, in addition to the increase in fluids and decrease in space, many people have to urinate more frequently. 

Some people with pelvic floor muscles that are weak (or too tight, in many cases) can experience incontinence, bowel changes like constipation, and hemorrhoids. Others may begin (also with the aid of relaxin and the growing belly) to experience some mild diastasis recti aka abdominal separation. 

All of these details and more about all of the physiological changes that occur during each stage of pregnancy, the hows and whys, and various dysfunctions, what to expect and how to treat them are all found in my book, Pelvic Prep School: A Guide to Preparing Your Pelvis for Each Stage of Pregnancy, Birth & Beyond

The magic of many of these symptoms is that they are not forever—many resolves after birth (but not all). 

Working with a Pelvic Therapist

During pregnancy, a pelvic floor physical therapist will evaluate your breath, core strength, lumbopelvic alignment, pelvic floor strength and coordination, and assess your posture and movement. 

They will look for signs of diastasis recti, and ask you a whole host of questions regarding your bowel and bladder habits, what you enjoy doing for movement or exercise, your role in your daily life, your goals, and how to work together to keep you feeling and moving your best during pregnancy. 

A large part of pelvic floor physical therapy during pregnancy is education and aiding in preparing you for birth and recovery postpartum regardless of how or where you are having your baby. 

Following cues from your baseline, current strength, your progression into pregnancy, and much more, pelvic PTs will guide you through various exercises, stretches, self-care, posturing, education, breathwork, birthing positions to optimize mechanics, discuss prevention of tears, and many, many other things…and lead your forward towards your birth feeling prepared (and maybe less anxious!) 

Common Pregnancy-related Issues:

Let’s break some of these symptoms or dysfunctions down in simple forms:

Diastasis recti: Diastasis means separation, and recti refers to the rectus abdominus muscle. The left and right rectus abdominal muscles attach in the middle at a thick, tendinous sheath called the linea alba. 

When the hormones hit, particularly relaxin, it allows tendons and ligaments to stretch.  In some individuals, these muscles separate (but not sever) further apart, causing a gap, or bulge, in the center.  

We want to monitor this during pregnancy to ensure that the pregnant person is not doing activities that make it worse (e.g., some exercises, sitting straight up out of bed, holding breath, and lifting without the correct mechanics). 

Beyond education, movement pattern training, and therapeutic exercise, pelvic physical therapists may use other tools or resources such as taping, support bands, and soft tissue release or myofascial release to facilitate control of diastasis recti. Some diastasis recti is normal, so don’t panic! 

Symphysis pubis dysfunction (SPD): SPD can be super painful, particularly when you are swinging a leg out to the side (like getting into a car or onto a stationary bike), standing on one leg to put on pants, rolling over in bed, or climbing stairs.  

In particular, shooting, sharp pain at the groin or pelvis occurs when these movements occur where the two pubic bones meet, under the mons pubis or under where your pubic hair would be. Again, relaxin and the increasing size of the baby and placenta can cause your alignment where these bones meet to go askew.  

Management and Treatment Options:

My personal pet peeve is people telling pregnant persons that this is normal. It is common but not normal, and very treatable and manageable with pelvic floor physical therapy. 

In addition to alignment correction, engaging the appropriate muscles, therapeutic exercise, and manual therapy (e.g., muscle release, fascial work), pelvic floor PTs may also recommend certain SIJ belts to stabilize and teach you how to wear them correctly. 

However, one month, let alone nine, is a long time to manage intractable pain, muscle spasms, and other symptoms that have often been so normalized by society. These dysfunctions and symptoms are common but very treatable and or/manageable with pelvic physical therapy. We believe every person should be pain-free and enjoy activity, movement, and leisure during their pregnancy. 

In a perfect world, this would be before you are pregnant! Let’s prep your body, gain strength, release what is too tight (sometimes the pelvic floor, believe it or not), and provide a load of education. After all, you don’t know what you don’t know!  

I love the idea of people seeing a pelvic floor PT throughout their lifespan at various life-change intervals, for example, prenatal, postpartum, perimenopause, menopause, and so forth. 

Seeing a pelvic floor PT during pregnancy allows us to help you develop your postpartum team.  Pelvic PTs are enormous supporters of doulas, mental health professionals, lactation consultants, and many other professionals. Plus, we can be a source of referrals, connections, and education beyond what we do personally.  

Many pelvic floor PTs, like our team at Indigo, are experts in preparing for birth. However, if you can’t access a PT where you are based, Pelvic Prep School covers birth preparation, positioning, breathing, how to use your pelvic floor, and when to see a pelvic PT.

Wondering if one of our experts in prepping for birth is right for you or if a PT can help you with something else? We offer free same-day 15-minute phone consultations with our doctors of physical therapy. Just call 1-888-803-4244 and you’ll be put in touch for a no-strings attached conversation. 

Dr. Sam DuFlo