Lots of moms pee when they laugh, sneeze, cough, or jump on a trampoline. And for good reason: the pelvic floor, a sling of muscles, ligaments and tissues that stretch from the public bone to spine, can become weighed down during pregnancy and birth, weakening them. We were lucky enough to do a Q + A with Dana Solomon, a licensed occupational therapist and founder of Functional Wellness in Medford, MA, who demystified the inner workings of the pelvic floor for us: how it functions, common problems, strengthening exercises, and caring for your pelvic floor health in the long-term.
1. What exactly IS the pelvic floor?
The pelvic floor is just like any other muscle in the human body. The key difference is that you can’t see it. You can watch your elbow bend and extend, but it takes awareness to feel your pelvic floor musculature contract and relax. So what exactly is this thing? The pelvic floor is a series of 14-16 muscles weaved within the boundaries of all 4 sides (left, right, front, back) of both hip bones (iliosacral). The two bones come together at the front with a ligament called the pubis symphysis. The back attaches to the lowest part of the spine, the sacrum and tailbone. It's quite literally the floor of the pelvic bowl. The muscles are composed of 3 layers that serve different functions. These layers may play distinct roles, but also work harmoniously as a system. The coordination of all of these muscles enables strength and buoyancy, similar to a trampoline. If the threads of the trampoline don’t work together, it may be that the trampoline is too tight (lacking flexibility) or too loose (lacking strength).
2. Why does my pelvic floor become affected by pregnancy and birth (whether vaginal or C-section)?
Pregnancy causes every system of the body to change, and the pelvic floor is no different. As the baby grows in the uterus, the pelvic floor muscles work overtime to account for increasing pressure. Regardless of delivery method, the pelvic floor muscles become stretched and strained over the course of pregnancy.
It's important to remember a cesarean (c-section), planned or unplanned, is a major surgical procedure requiring an incision through multiple layers of the abdomen. If you had surgery on your knee or your shoulder, you'd go to rehab. Recovery from a c-section should be viewed similarly. C-sections cause a weakened abdominal wall and restrictive tissue mobility, which can make infant care (lifting and carrying your little one or a car seat) difficult. During a vaginal delivery, the pelvic floor muscles undergo more stretching and strain from childbirth. Whether you've had a vaginal or c-section, a healthy pelvic floor contributes to a faster recovery.
3. Why is my pelvic floor so important?
The pelvic floor is sort of like that actor that shows up in every great movie, but never plays the lead. The pelvic floor may not be the sexy heartthrob, and yet, is vital to how the story pans out. It plays an important role in basic human function. Its ability to function properly impacts the body as a whole. The pelvic floor is responsible for 4 main areas.
Elimination: Imagine the sphincter as a clamp in the sink. When tightened, such as while coughing, running, laughing, sneezing, etc., there should be no leakage. When the clamp is relaxed, it should allow you to eliminate with ease. It should contract when you’re not trying to go, and it should release fully without effort.
Sexual Health & Appreciation: Healthy functioning pelvic floor muscles should allow for comfort during intercourse, tampon insertion, and gynecological exams. It also plays a role in pleasure -- both in the mechanics of arousal and orgasm.
Support: The pelvis contains the bladder, rectum, small bowel, and for women, the vagina and uterus. Around each of these organs is connective tissue, called fascia. The pelvic floor and the fascia keep these organs in its proper placement in the body.
Stability: The pelvis is the base of the spinal cord. It holds the weight of the spine, skull, and structures on top of it, and attaches the legs to the rest of the body. The pelvic floor provides stability by absorbing shock absorption and regulating intra abdominal pressure from the impact of everyday movement and activity.
4. How do pelvic floor exercises help me + what are some simple, easy ones I can incorporate into my daily routine?
The pelvic floor muscles are just that...muscles. They need full range of motion. A strong pelvic floor during pregnancy is beneficial for urinary control, pelvic stability, and overall core strength. But when it comes to labor and delivery, those muscles need to get out of the way! They have to be able to release fully.
Simple exercises to contract your pelvic floor:
- Bridges: keep rib cage and hip bones in line the whole time--no pelvic tilts and rolls. This will allow you more into the glutes and pelvic floor
- When picking things up from the floor, unloading the dishwasher or laundry, come up on the EXHALE as you close your openings *Note: you'll never have to do squats at a gym if you do these right!
- Full deep squat (with or without sitting on a yoga block/stacked books)
- Happy baby pose
5. What are some common pelvic floor issues, and what are the remedies?
- Bladder and bowel issues
- Painful sex or an inability to have penetrative sex
- Pelvic Organ Prolapse
- Pain involving the lower back, pubic bone, hips, SI joint, groin, and abdomen
- Pregnancy & postpartum recovery
- Pelvic floor exercises to do at home
- Massage of other parts of the body
- Trigger point massage to release muscle tension
- Stretching and yoga
- Strength-building exercises
- Nutrition and lifestyle considerations
- Postural training and teaching proper body mechanics
- Mindfulness and breathing techniques
- Pain management strategies
6. Is pelvic floor health only for new moms, or is it still important, 5, 10, 15 years after childbirth? How so?
Once postpartum, always postpartum.
Whether you're 2 months, 5, 10, 15, or 20 years after childbirth, your pelvic health remains just as important. Some mind-boggling statistics to consider: 1 in 3 moms reported continued bowel and bladder problems at 2 months postpartum (Childbirth Connection, 2013) 1 in 3 women still pee their pants 12 years after giving birth (BJOG).
There are misconceptions that pain during sex, leakage, and other aches and pains are just "part of motherhood" or "normal." These may all be common issues, but they are not normal. You do not need to live with these symptoms. Most common conditions can be treated successfully through conservative options such as pelvic floor therapy.
This article is for informational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. To the extent that this article features the advice of physicians or medical practitioners, the views expressed are the views of the cited expert and do not necessarily represent the views of Jenny + Evie.