Simple Tips to Keep your Pelvic Floor Strong During Pregnancy

Written by Laura Coventry - Founder and Women's Health Physiotherapist PhysioFemina

Pregnancy is a time of huge change. One day, you are feeling on top of the world; the next, you need help to tie your shoelaces. Your body constantly evolves as you prepare to bring your baby into the world. Whilst all this change can feel overwhelming at times, there are some changes that have the ability to impact the rest of your life. Your pelvic floor is one of them.

In this post, I want to help you to understand the changes that are occurring to your pelvic floor so that you can build a strong and connected pelvic floor that is prepared for birth and postpartum. 

How does the pelvic floor change during pregnancy?

During pregnancy, there is an increased load on your pelvic floor as this group of muscles works overtime to support the growing weight of your uterus, baby, blood volume and body mass. The effects of pregnancy hormones also work to soften and lengthen the pelvic floor.

Postural and biomechanical changes can negatively impact the pelvic floor and prevent it from functioning optimally. Bladder capacity can significantly reduce in the third trimester, and you might begin to experience symptoms that may not have been present before pregnancy. Because it is out of sight, it can easy to ignore these changes to your pelvic floor.  

Some of the common pelvic floor-related symptoms that you may experience during pregnancy include: 

• Bladder leakage: As your baby grows, the pressure on your pelvic floor muscles increases. Your pelvic floor must work overtime to meet this increased downward pressure. During pregnancy, your pelvic floor muscles also start to thin and stretch as they prepare for birth. The combination of increased downward pressure on a weakened pelvic floor can result in bladder leakage with activities like coughing, sneezing, exercise, and vomiting.
• Prolapse: Prolapse is the downward displacement of pelvic organs from their original position in the pelvis. Prolapse can cause feelings of vaginal heaviness, pressure or bulging and can be very distressing. The EMP has written an incredibly informative post about prolapse in pregnancy here if you would like to read more about treating this condition in pregnancy. 
• Pain with Sex: A swollen vulva, changes in lubrication and changes in hormones all affect your sexual arousal and experience with intercourse. It is common for women to experience discomfort or pain with intercourse in during pregnancy as a result. Although it is common, we suggest you speak to your Women's Health Physio or Healthcare provider as it may indicate a yeast imbalance, an infection, a pelvic floor dysfunction or other issue that would benefit from further investigation.

Changes to Your Vulva

During pregnancy, you might notice several changes to your vulva. Some women can feel embarrassed to discuss these changes. However, they are often a normal part of pregnancy and are primarily due to increased blood flow and hormonal fluctuations: 

• Increased Blood Flow: Your blood vessels dilate throughout your pregnancy. Combined with increasing oestrogen levels, blood flow to the pelvic region is increased. This can result in swelling and a bluish tint to your vulva. This is entirely normal. As a result, you may also experience significant discomfort with prolonged periods of standing and/or discomfort when haveing sex. In the postpartum period, the blood flow to your pelvic region returns to normal, and swelling and associated symptoms are generally reduced. 
• Varicose Veins: Just like you can get varicose veins in your legs, some women develop varicose veins in the vulva. This is due to the increased pressure from your growing uterus and hormonal changes dilating the blood vessels. These veins can cause severe discomfort and a feeling of heaviness in the vagina. Prolonged standing may worsen this feeling, especially if you have an active job.
• Pigmentation: Hormonal changes can cause the skin on your vulva to darken and change colour. This often fades after pregnancy. 

As I mentioned above, changes to your vulva can be concerning or cause feelings of embarrassment. If you are concerned, please talk to your healthcare provider. Many women find it reassuring to know that vulva changes are only temporary and do not continue into the postpartum period (once the initial swelling after birth has healed, of course!) 

How can you build a strong connection with your pelvic floor?

Learning how to engage and connect to your pelvic floor during pregnancy is one of the most important things you can do for your long-term pelvic health.

A strong pelvic floor isn’t just important for pregnancy and birth. Being able to contract and fully release your pelvic floor during pregnancy is one of the best ways you can begin to prepare for your postpartum recovery.

In the Empowered Motherhood Pregnancy Program, Titled Pelvic Health Physio, Lyz Evans shares incredible education and pelvic floor-focused workouts to help you understand how your pelvic floor changes during pregnancy and what you can do to protect it and prepare it for birth.

This includes: 

1. Pelvic Floor Awareness: If you have never given your pelvic floor a moment of consideration before falling pregnant, you are definitely not alone. The first step in pelvic floor health is simply to become aware of your pelvic floor and how it functions. Start to pay attention to how your pelvic floor feels during different activities, such as standing, sitting, passing bowel movements, lifting, and exercising.
2. Pelvic Floor Exercises: Learning how to engage your pelvic floor in the postpartum period (when it is weakened and stretched) can be incredibly difficult. The EMP includes pelvic floor workouts for each trimester combined with pilates and strength classes designed to help you engage your pelvic floor in a functional way while maintaining full-body strength. The EMP also uses examples of pelvic floor contractions under real-time ultrasound to see what a good pelvic floor contraction looks like.  If you are still unsure of how to do a pelvic floor contraction, I recommend seeing a Women’s Health Physio.
3. Birth Preparation: The EMP includes a complete birth preparation program to help you to prepare your pelvic floor muscles for birth. During a vaginal birth, your pelvic floor needs to stretch up to 3 times its normal length, so it needs to be prepared for this. It is incredibly important that you start to release and open your pelvic floor preparing for birth from around 34 weeks gestation. Understanding pelvic floor safe birthing positions and the correct way to push will also help to support your long term pelvic health and birth outcomes.
4. Breathing: Your pelvic floor is connected to your diagram through a complex web of fascia. Learning how your breath impacts your pelvic floor can help you engage and lift your pelvic floor during exercise and open and release your pelvic floor during birth.

Simple tips for pelvic health during pregnancy  

• Do your Pelvic Floor Exercises In the Empowered Motherhood Program, you will find a range of different tools, cues, visuals, and workouts to help you engage and strengthen your pelvic floor properly. It is important to take your pelvic floor through the full range of motion, including a complete release and relaxation of your pelvic floor between contractions. 
• Use Compression Garments: Compression tights are designed to provide graduated compression, meaning they are tighter at the ankles and gradually become less tight towards the top. This helps push blood upwards, preventing it from pooling in your legs and pelvic area. They help reduce the pressure in the veins, which can alleviate the swelling and discomfort. 
• Reducing Time on Your Feet: Spending time off your feet may help to reduce varicose vein symptoms and also alleviate pelvic organ prolapse symptoms of heaviness. 
• Reducing Constipation and Straining Limiting straining on the toilet is important. Repetitive straining contributes to haemorrhoids and pelvic heaviness. Some tips to support bowel movements are: 
• Use a foot stool to elevate your knees whilst defecating. 
• Lean forwards
• Aim for full relaxation and try not to rush (we know this is hard if you have a toddler running riot)
• Aim to keep your fluid intake up.
• Adding a fibre supplement may help your regularity with bowel movements and make it a bit easier to go. 
• Reducing pain during intercourse: Using a lubricant may provide some relief for painful sex - you could try a silicone or a water-based lubricant to see which option works best for you. Trialling different positions during intercourse will change the angle of the vagina, providing some relief if you're experiencing pain with penetration.
• Pessary Usage: Unfortunately, the increased pressure on your pelvic floor during pregnancy tends to increase prolapse symptoms. The use of a silicone pessary can help relieve symptoms of vaginal heaviness, pressure and bulging. If you would like to use a pessary during your pregnancy, please discuss with your Obstetrician or Women' Health Physio whether this is a safe option for you.

About the Author 

Laura Coventry is a physiotherapist specialising in women’s health and the founder of Physiofemina. Laura works with women experiencing pelvic floor concerns throughout any stage of their life. She helps them nurture their pelvic health and return to exercise transformed.

Physiofemina is based on the Central Coast of NSW. Physiofemina’s goal is to create meaningful lifestyle changes through women's health physiotherapy. We provide health and wellness support to women throughout every life stage - from puberty, pregnancy, postpartum to menopause. We aspire to teach, educate and arm women with knowledge about their bodies, their pelvic health, and how to create proactive change for their future.

Learn more about Laura and Physiofemina here https://physiofemina.com.au/