Pregnancy and Your Pelvic Floor: Why exercise and pelvic floor therapy matter

Your pelvic floor probably doesn’t come up in routine conversations with friends and family. However, if you’re pregnant or have had a baby, you’ve probably either thought about it or felt the impacts post-partum, even years after childbirth. The topic is one that women should become more comfortable talking about because your pelvic floor matters. We turn to Dr. Andrea Higgins Yarbrough, an orthopedic/pelvic floor specialist, to get the conversation started.

Meet the Expert: Dr. Andrea Higgins Yarbrough, is an orthopedic/pelvic floor specialist at The Hope Doctors.

TBPM: What exactly is the function of the pelvic floor and why should I care?

AH: The pelvic floor muscles are located between our sitz bones from a side-to-side manner and pubic bone to tailbone from a front-to-back manner. Imagine them as a sling or a hammock that is supporting the weight of our pelvic organs (bladder, urethra, vagina, uterus, bowel, rectum and anus). Their main jobs are to keep us dry when we are not trying to go to the bathroom or allow us to pee or poop when we are ready to go. They aid in sexual function and pleasure.

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You should really care about your pelvic floor muscles because we pee, poop and/or procreate on a daily basis and these muscles control all three of those.

TBPM: How does pregnancy impact the pelvic floor?

AH: Pregnancy will impact the pelvic floor from a physical standpoint. During pregnancy, women gain weight from the growing uterus, increased blood volume, and the placenta. This all puts more downward pressure through our pelvic floor muscles. This can lead to an increased risk of hemorrhoids, pelvic organ prolapse, incontinence, pubic pain, lower back pain, and SIJ pain.

TBPM: Are there therapies or classes I can take to strengthen my pelvic floor before delivery? What are the benefits?

AH: Pelvic Floor Therapy (PFT) is the gold standard to get a full body evaluation and get a baseline of how your pelvic floor muscles are functioning. Spoiler alert: They’re probably too tight, which can greatly impact the ability to lengthen the pelvic floor muscles during a vaginal delivery. Often, a big reason for any lack of progression of labor and delivery is simply [that] the pelvic floor muscles cannot relax and allow your baby to come through the pelvis.

You also want to seek out PFT to strengthen the surrounding muscles around your pelvis (glutes, hamstrings, adductors, core, feet, etc.) so that your pelvic floor muscles aren’t having to compensate for the weaknesses surrounding them. Another benefit for PFT is to feel strong and to not have pain. Having pain throughout pregnancy is a HUGE myth and PFT can help with that.

TBPM: What happens during a pelvic floor therapy session?

AH: A pelvic floor therapy session involves examining your muscles for coordination (balance), strength (what muscles are firing appropriately or not), mobility at the joints (is one hip tighter than the other), flexibility (how well a muscle can lengthen), and motor control (how well can you contract your abdominals, while breathing out, while engaging your glutes, for example).

This is for the pelvic floor muscles and the rest of the muscles surrounding the pelvic floor. Your posture is examined and corrected. Diastis Recti is examined and treated. Once everything is evaluated, a specific plan of care is created for you.

TBPM: Does it matter if I have a natural delivery or C-section?

AH: NOT AT ALL! Both scenarios require you to carry a growing uterus on top of those pelvic floor muscles for approximately 10 months. Each soon-to-be-mama encounters the postural and hormonal changes. Postpartum will look a little different based off of if you had perineal tearing and stitching or a cesarean with stitching. They will both require an individualized approach to recovery and either scenario should seek out a pelvic floor therapist!

It’s been years since I’ve had babies. Is there anything I can do to prevent or treat urinary incontinence?

AH: If you are leaking urine, first schedule an evaluation with a PFT. We have to figure out WHY you’re leaking. Is it coming from your breathing patterns (do you have tightness in your jaw, neck or shoulders?). Is it coming from your foot posture and your arches or lack thereof? Is it coming from the fluid you’re intaking or NOT intaking throughout the day?

Make sure you’re consuming half of your body weight in fluid ounces of water per day (if you’re 100 pounds, you need to be taking in at least 50 ounces of pure water). Are you having regular BMs? If not, this can greatly impact your ability to stay leak-free. Are you active or sedentary? All of these factors play a huge role in staying dry!

Pelvic floor therapy is popular overseas in Europe. Why hasn’t it picked up here in the United States?

AH: It starts in our education system. We aren’t educated as young females on what our pelvic floor muscles are. We aren’t educated on normal versus abnormal periods. We are taught that it is a taboo topic. As we further our education, healthcare providers are not given this information in school. So who is supposed to discuss these topics when a woman goes to her doctor’s office and asks why she is having pain with sex or leaking while running?

So doctors aren’t referring out nearly enough because they aren’t educated on pelvic floor therapy. Women, advocate for yourselves! Seek out a pelvic floor therapist. You do NOT need a referral from a doctor to see one!

Feature Photo by Kimberly Romano – The HOPE DOCS Pelvic Floor Therapists from left to right: Dr. Andrea Higgins, DPT, Dr. Kate Smith, DPT, Dr. Kaylee Simmerman, DPT (Founder of The HOPE DOCS), Dr. Jalisa Lowe, DPT, Dr. Katie Ihlenfeldt, DPT

Originally published in the October 2023 Issue