What Happens to the Pelvic Floor During Pregnancy?
During pregnancy, the pelvic floor muscles support the increasing weight of the baby and uterus, causing them to stretch and sometimes weaken. Delivery further strains these tissues, whether you have a vaginal birth or a C-section.
The pelvic floor is a 'hammock' of muscles and ligaments that stretches from the pubic bone to the tailbone. Throughout nine months of pregnancy, this hammock carries a heavy load. Hormones like relaxin further loosen these tissues to prepare for birth. By the time you deliver, the pelvic floor has undergone significant physiological stress.
At Viva Eve, we often see patients who believe that a C-section 'protects' the pelvic floor. While it avoids the direct stretching of the vaginal canal, the pregnancy itself still impacts the muscles. Additionally, abdominal surgery disrupts the core 'pressure system,' which can affect how the pelvic floor functions. In short, every postpartum mother can benefit from pelvic floor attention.
Common signs of pelvic floor dysfunction include 'stress incontinence' (leaking when you cough, sneeze, or jump), 'urgency' (a sudden, overwhelming need to go), or a feeling of heaviness in the pelvis. These are common, but they are not 'normal' long-term. You do not have to live with these symptoms as an inevitable part of motherhood.
What is Diastasis Recti and How Do You Heal It?
Diastasis recti (DRA) is the separation of the large abdominal muscles (rectus abdominis) during pregnancy. Healing involves specialized core exercises that focus on the deep transverse abdominis muscles rather than traditional crunches.
As your belly grows, the connective tissue (linea alba) between your 'six-pack' muscles thins and stretches. This separation is present in nearly all women by the end of the third trimester. For many, it closes naturally in the weeks after birth, but for some, the gap remains, leading to a 'pooch' that doesn't go away or lower back pain.
The goal is not just to 'close the gap,' but to restore the tension and function of the connective tissue. Traditional abdominal exercises like crunches or sit-ups can actually make DRA worse by pushing the abdominal contents against the weakened tissue. Instead, we focus on deep core activation and breath work.
You can check for DRA by lying on your back with knees bent and gently lifting your head while feeling the area around your belly button. If you feel a gap of more than two finger-widths or a 'softness' in the tissue, you may have DRA. A pelvic floor physical therapist is the gold standard for creating a customized healing plan.
To protect your core and pelvic floor in the early weeks, avoid 'sitting straight up' from bed. Instead, roll onto your side and use your arms to push yourself up. This prevents excessive intra-abdominal pressure on your healing tissues.
How Do You Perform a Proper Kegel Exercise?
A proper Kegel involves lifting and squeezing the pelvic floor muscles as if you are trying to stop the flow of urine or prevent passing gas. The key is to lift 'up and in' while keeping your breath steady.
Many women perform Kegels incorrectly by squeezing their glutes, inner thighs, or holding their breath. A true Kegel is an isolated internal contraction. Imagine you are using your vagina to pick up a blueberry and pull it up toward your belly button. Hold for three to five seconds, and then—critically—completely relax for five seconds.
Relaxation is just as important as the contraction. A pelvic floor that is 'always on' (hypertonic) can lead to pain during intercourse or difficulty emptying the bladder. Think of it like a bicep curl: you need the full range of motion for the muscle to be strong and functional.
We recommend doing 10 to 15 repetitions, three times a day. You can do them while brushing your teeth, sitting at a red light, or nursing your baby. However, if you find that Kegels are not improving your symptoms, or if they cause pain, it's a sign that you need a more detailed evaluation from a specialist.
When Should You See a Pelvic Floor Physical Therapist?
We recommend a pelvic floor physical therapy (PFPT) evaluation for almost all postpartum mothers. PFPT is especially important if you have persistent incontinence, pain during sex, or signs of pelvic organ prolapse.
In many countries, such as France, pelvic floor rehab is a standard part of postpartum care. At Viva Eve, we are working to make it a standard here in NYC as well. A pelvic floor PT does a full assessment of your posture, breathing, core strength, and the internal health of the pelvic muscles.
Pelvic organ prolapse (POP) is when the bladder, uterus, or rectum drops from its normal position and pushes against the vaginal walls. This can feel like 'heaviness' or as if something is falling out of your vagina. While the word 'prolapse' sounds scary, most cases are mild and can be successfully managed with PT and lifestyle adjustments.
PT is not just about exercises; it’s about 'functional movement.' Your therapist will help you learn how to lift your baby, push a stroller, and return to your favorite workouts without damaging your pelvic floor. It is an investment in your long-term health and quality of life.
How Do You Safely Return to High-Impact Exercise?
Returning to high-impact exercise (running, jumping, heavy lifting) should be a gradual process. We typically recommend waiting at least 12 weeks for high-impact activities to allow for full tissue remodeling.
The '6-week clearance' you get at your postpartum checkup means that your uterus has returned to its normal size and your major incisions are closed. It does *not* mean your pelvic floor and core are ready for a marathon or a CrossFit class. Connective tissue takes about 12 to 16 weeks to regain its full strength.
Start with walking and low-impact core work. Gradually increase intensity, paying close attention to your body's signals. If you experience leaking, pressure, or pain during or after a workout, it means you have exceeded your 'load capacity.' It’s a sign to scale back and focus on foundational strength.
Think of this period as 'training for the sport of motherhood.' Picking up a growing baby, carrying a car seat, and managing a diaper bag all require core stability. By prioritizing your recovery now, you are building a strong foundation for the years of active parenting ahead.
What About Sexual Health and Pain After Childbirth?
Sexual health often changes postpartum due to hormonal shifts (especially while breastfeeding) and physical healing. Pain during intercourse (dyspareunia) is common but treatable through lubrication, PT, and patience.
The drop in estrogen after birth, particularly if you are breastfeeding, can cause vaginal dryness and thinning of the vaginal walls (atrophy). This can make sex feel uncomfortable or even painful. Using a high-quality, water-based or silicone-based lubricant is often a simple but effective first step.
There is also the emotional side of 're-connecting.' You may feel 'touched out' or self-conscious about your postpartum body. Communication with your partner is essential. If pain persists even with lubrication and a relaxed environment, it could be due to pelvic floor tension or scar tissue from a tear.
At Viva Eve, we take sexual health seriously. It is a vital component of your overall well-being. If you are struggling with pain or low libido, please bring it up during your visits. We have a range of options, from localized estrogen creams to pelvic floor referrals, to help you feel like yourself again.
