Pelvic Floor “Dysfunction” in Pregnancy and Postpartum and Why You Probably Need a Reboot

This is a post about pelvic floor dysfunction. But we’re a tech family, so indulge me in a little analogy:


I run my computer hard. I keep 20 applications running, 100 tabs open in my browser, at least 2 desktops active, I open and close the lid of my laptop with abandon. Oh, and I really love clicking “Remind me tomorrow” when I get a notification that an update is needed.


At some point, I errors start popping up. I’m out of memory. Photoshop unexpectedly quits. I can’t see the cursor in Word. If it’s really dire, there’s this one pixel that’s always blank.


Every time I go to my tech-genius husband to complain about my poor little laptop, he always asks the very same question, with a slight roll of the eyes. When’s the last time you rebooted?


Duh.


Every time. Problem solved. You’d think I’d learn.


My sophisticated, capable piece of technology is well designed. But it has it’s limits. And sometimes, to keep functioning well, it needs a reboot.


The innermost core of our body (diaphragm, pelvic floor, innermost abdominals and back extensors) works much the same way. It’s this incredibly sophisticated, well-coordinated machine that usually works really well to manage the pressure in our abdomen, stabilize our spine, support our pelvic organs and manage continence (prevent unwanted leaking of pee, poo or gas). But sometimes, it gets overloaded. Through pregnancy. Perhaps through sport. Perhaps it’s just been a while since it had a reboot and it gets a bug in its coordination. It needs a reboot.


When our core is in need of a reboot, we experience things like leaking, abdominal separation, prolapse of our pelvic organs or even just an imbalance in muscle tone (as in the case of too-tight pelvic floor muscles or abdominal gripping). We act like these things are the end of the world, but they’re actually predictable consequences of running the system hard and are often pretty easily managed with a little reboot.


Often, a reboot for the pelvic floor and core looks like breath-reeducation, exploring our body alignment and coordinating our breath to movement and exertion. But before you can address the problem, you need to know what it looks like.

⁠ Here, I am going highlight the more common pelvic floor (and core!) conditions experienced by pregnant and postpartum people. But also note, these conditions are also experienced by people who have never been pregnant (and by people with and without a vagina). Armed with knowledge, you have the power to advocate for the treatment and management of your own pelvic health. If you are experiencing one of these conditions, my goal is to offer hope and provide concrete action items you can implement to begin your healing. Follow the links in each section to find resources and tips that will help you manage the symptoms of each of these common and normal conditions. At the end of this post, I’ll include action items that apply to all of these conditions.


Pelvic Organ Prolapse


Pelvic Organ Prolapse (or, as it’s better known by it’s cute acronym, POP) occurs when the support offered by the pelvic floor (represented by the hammock in this image) is compromised and one or more of the pelvic organs (bladder, uterus or rectum) bulge into the vaginal wall and cause it to droop.⁠ ⁠


For some people, POP can feel like heaviness, bulging or pressure in the vagina or perineum or like something is falling out of the vagina. It can cause pain with sex or queefing (vaginal farts) and even cause involuntary leaking of urine or poop. Most people with POP only experience a few of these symptoms. Some people experience no symptoms.

The degree of pelvic organ descent is described by its “grade” and it’s helpful to note that the severity of symptoms does not correlate to the grade or to the worsening of the grade. Instead, symptoms tend to correlate with things like stress, sleep, time of day, time of the month and management (or not) of intra-abdominal pressure.⁠


Estimates of the prevalence of POP vary widely- so anywhere between 50% to nearly 100% of people who have given birth will experience some degree of POP. It’s very common.

In most cases, POP isn’t “curable” but the symptoms are manageable and sometimes the grade can be corrected a bit. It just takes a bit of effort to find the appropriate help, experiment with strategies and learn what works best for you.


If you suspect you have POP, your best bet is to get evaluated by a pelvic floor physical therapist. In the mean time, there is a lot you can do to manage the symptoms you are experiencing. Start with the general strategies at the end of this post (breath re-education, alignment variability and coordination of breath and movement), and also check out:


7 Ways to Manage Pelvic Organ Prolapse Symptoms During Exercise


Hypertonic Pelvic Floor



POP’s less famous, but no less troublesome, cousin is hypertonic (or overactive) pelvic floor muscles.⁠


A personalized treatment program designed by a pelvic floor physical therapist is the gold standard approach to tackling too-tight pelvic floor muscles (are you starting to see a theme here??). Here are a few self-help tips to explore in the mean time:


How to Chill Out Your Pelvic Floor During a Global Pandemic (or Other Stressful Time)


Leaky bladder



Urinary incontinence (leaking) is the unintentional loss of any amount of urine. It’s a super common symptom experienced by a lot of people (especially those who have given birth).

It turns out that leaking can be caused by an underactive OR an overactive pelvic floor, POP and even other non-pelvic floor related things (like your brain!) and so it’s extremely valuable to get evaluated by a pelvic floor physical therapist. They can determine which end of the pelvic floor tension spectrum you live on and give you a custom treatment plan that will address your issues.


If you’re dealing with pesky leaks in the mean time, try a few of these reliable strategies for managing leaks when coughing, sneezing or laughing:


5 Ways to Support Your Pelvic Floor When You Have a Cold or Chronic Cough


Abdominal Separation (Diastasis Recti)


Abdominal separation (diastasis recti) is the most VISIBLE of the common pregnancy and postpartum core conditions and so it often gets the most attention. In order to make space for baby, your body is designed to stretch. The line of connective tissue that runs down the midline of your abs stretches and thins giving the appearance that the 6-pack muscles are moving away from one another. Imagine what it looks like to stretch a pair of pantyhose. It’s very common, very normal and happens to nearly every pregnant person [reference].


If you have a wider diastasis that does not generate tension, your core might not feel very strong. If your core isn’t able to generate tension it won’t be able to do a good job creating the central stability you need to complete everyday tasks or exercise (making all those things much more difficult). If this is the case, you will use other parts of your body to compensate and this might lead to secondary aches and pains elsewhere in your body. Most of the time, the abdominal separation resolves by 6-8 weeks postpartum. When considering whether or not the diastasis has “healed” or not, we look at whether or not a person can generate tension through the connective tissue. The ability to generate tension is much more important than the absolute size of the gap between the muscles. The gap will not return to zero, but it probably didn’t start at zero either. At 8 weeks if you still have a gap significantly greater than 2 finger widths apart or one that is very squishy, make an appointment with a pelvic floor PT and see if you can find a postnatal fitness specialist to work with in the mean time.


For more information on diastasis recti, check out:


The Real Deal With Diastasis Recti: What It Is, Why It's a Problem and What You Can Do About It


Action Items: The Reboot


No matter which flavor of pelvic floor consideration you are confronting, the first line approach to managing it is likely to be remarkably similar.

1. Practice breathing. Breathing diaphragmatically puts your pelvic floor through its full range of motion ((← essential to balancing a hypertonic pelvic floor). It works to lengthen and strengthen those muscles as well as encourage better coordination with the whole inner core unit and response to changes in demand (← necessary to control leaking, coning or doming of the abdominal midline, and descent of pelvic organs). 2. Bring awareness to your alignment. Do you spend a lot of time in a butt-tucked-under position? With ribs super flared or shoulders super hunched? There’s no perfect posture, but there are postures that might make it easier for your pelvic floor work well. Try spending more time untucking your butt, relaxing your rib cage down, or getting your rib cage stacked over your pelvis.

3. Experiment with coordinating your breath with your movements in order to maximize the support offered by your core and pelvic floor. A good starting point is to exhale during the hard parts of a movement or exercise. If that doesn’t work for you, I can offer you a variety of alternatives to try. Practicing your breathing strategies during exercise will train your pelvic floor to work automatically and reflexively during your activities of daily living.


If you’re looking for guidance in navigating your pelvic health symptoms or returning to sport after a pelvic floor diagnosis, I offer 1:1 coaching and consultations. Please send me an email to set up a free Meet and Greet to discuss your goals and how I can help you achieve them!


Further Reading:


An Introduction to Your Pelvic Floor


Breathing Strategies in Pregnancy and Postpartum: the Connection Breath


5 Things You Should Know About Your Remarkable, Resilient Postpartum Body


Learn how to dial in your breathing strategy to harness control of your pelvic floor and manage symptoms of pelvic floor dysfunction. Download a copy of The No B.S. Guide to Breathing for a STRONG Pregnancy and Postpartum.



My mission is to make sure that having a baby is not a reason why you can’t do all the things.

Contact me if you have questions about exercise or pelvic health pertaining to pregnancy or postpartum. I work with people locally (Seattle's Eastside: Redmond, Bellevue, Kirkland and surrounding areas) and online to develop personalized pregnancy and postpartum personal training plans. I also offer labor support (doula services) within the greater Seattle-Metro Area.

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