More than a kegel: pregnancy and the pelvic floor

Pregnancy can be one of the most exhilarating times in a woman’s life, full of anticipation and joy. It can also be physically and mentally taxing, placing significant stresses on our bodies, causing us to experience aches and general discomfort.

Due to pregnancy’s considerable anatomical changes, many pre and post-natal women face physical challenges that may affect them long after delivery.

One of the most commonly and drastically-affected areas during pregnancy is the pelvic floor. The pelvic floor is a system of ligaments and smooth muscle tissue that acts as a sturdy and ingenious hammock supporting, among other things the uterus, bladder, urethra, and bowel. It is connected to the rectum and the vagina, stretching from the pubic bone to the tail bone and from one hip to the other. This creates what we call the fourth wall, or the ’floor’ of the torso.

Due to its unique position, the pelvic floor has to be strong enough to carry the additional load of the fetus as well as sufficiently elastic to expand during delivery. During labor the pelvic floor guides the baby's head down the birth canal. Even more than labor, pregnancy substantially affects the strength and resilience of the pelvic floor. Even women who had cesarean delivery are still susceptible to pelvic floor dysfunction. One consequence of that is incontinence. It is reported that during pregnancy, 64% of women develop some level of incontinence.

During pregnancy, functionality of the pelvic floor lessens due to the demands of the body’s growth and the increase in fascial and ligament flexibility. The systematic overstretching of ligaments and laxness of joints create an inherent vulnerability in the face of the load. That weakness leads to lack of communication between the brain and the muscles, resulting in dysfunction. The consequences of this reality often fall under the umbrella of ’pelvic floor dysfunction’ which includes pelvic pain, urinary incontinence, pelvic-organ prolapse, anal incontinence, and changes in sexual function. It is reported that 15% of women in the United States experience pelvic pain.

In addition to pregnancy and child birth, other factors can also weaken the pelvic floor muscles, including surgery, aging, excessive straining (from coughing or constipation), and being overweight. Pelvic floor weakness can also lead to pain around the hip, low and upper back pain, knee pain, ankle sprains and ACL vulnerabilities. In spite of the vast implications of pelvic floor dysfunction, many women are only partially informed, believing Kegel exercises to be the only solution. However, contrary to popular belief, “Kegeling” or holding the pelvic floor artificially is not the most effective method. Although Kegels have their place in rehabilitation and conditioning protocols, recent studies show that pelvic floor dysfunction is addressed best by functional movements like squats and gentle full body exercises such as in Pilates. That is because nerves and muscles communicate most efficiently while performing full range motions that are similar to the body’s everyday actions. Moreover, health professionals are still uncertain about the number of individuals who can actually engage the pelvic floor muscles correctly and evenly, if at all. It is troubling to think that as of today, the most prominent academic contribution to pelvic floor dysfunction dates back to studies by Dr. Kegel in 1952.

Too many women’s health issues are silent morbidities, lacking the exposure and discussion they deserve. Although countless women are affected in some way from pelvic floor dysfunction, many neglect to report their symptoms and even less would be diagnosed and treated. Still, women do not have to suffer silently. Most physicians are now educated enough to recommend further tests or refer appropriate patients to pelvic physiotherapists who specialize in women’s health. Pilates or similar exercise that is guided and purposeful has been proven to be beneficial to pelvic floor health. A strong pelvic floor will support an active life style and help sustain appropriate body mechanics so women can thrive in every aspect of life.

Note: Please seek the advice of your physician prior to resuming or commencing any physical activity regimen.