Pelvic floor before and after pregnancy

The pelvic floor before and after birth

What is the pelvic floor?

The pelvic floor is a diamond-shaped area made of a group of muscles located at the base of the trunk or core whose functions are to support the abdominal organs and to provide constrictor mechanism to the three openings: the urethra sphincter, the vagina and the anus.[1]

The female pelvic floor is made up of three layers of muscle attached to the pelvic bones (the “hammock” of muscles). This diamond-shaped area can be divided into two urogenital triangles, superior and inferior.

The first and deepest layer of muscles is formed by the pelvic diaphragm conformed by the Levator Ani muscles and the Coccygeus muscle and has a cupula shape. This is the lower urogenital triangle and it is the stronger part in the female.

The second layer, the deep transverse perineal layer is a thin muscle that covers the upper urogenital triangle and has an opening for the urethra and the vagina. The urethral sphincter surrounds this opening and controls the exit of urine.

The third layer is the perineum, and eight-shaped muscle that connects the front and the back of the pelvis and surrounds the three pelvic floor openings.

The pelvic floor during pregnancy

According to perinatal yoga expert and author Uma Dinsmore-Tuli “during pregnancy, these muscles come under additional strain from supporting the weight of the contents of the womb, including the placenta, the amniotic fluids and the growing baby”.[2]
While it is fundamental to train these muscles to gain tone and strength, it is also important to learn how to voluntarily relax them in order to facilitate birth.

Choose exercises that aim at increasing elasticity by alternating strengthening and releasing practices combined with breath and the awareness of the connection between the three diaphragms: thoracic, vocal and pelvic diaphragm. Indeed, keeping the lower jaw relaxed is key to avoid tension in the vocal diaphragm which would affect the pelvic floor muscles by restricting their mobility.

Pelvic floor strengthening and relaxation exercise:

This practice facilitates birth and creates a foundation for optimal pelvic tone after birth.
Start sitting on a bolster or birthing ball, or in a semi-inverted position (similar to Puppy pose) resting the forehead on to a pillow. If you suffer from high or low blood pressure or heartburn, keep the head higher than the hips resting the forehead on to the seat of a chair for example.

  1. Bring your attention to the base of your spine. Inhale, squeeze the ring of muscles around your anus shutting it tight. Exhale, release the muscles fully. Repeat a few times extending the exhalation, keep buttock muscles relaxed.
  2. Next, shift your awareness from the back of the pelvic floor to the area under the pubic bone at the front. With rapid short movements, squeeze and release in turns the small muscles that control your urethra sphincter. Imagine you’re at the doctor’s office and you need to handle a urine sample, stopping and starting the flow of urine. Do not hold your breath nor the squeezing action. Repeat a few times extending the exhalation.
  3. Last, turn your attention to the birth passage, inhale, draw in or lift the muscular walls of the vagina, exhale and release. Do not hold the lift and do not hold the breath. Repeat a few times extending the exhale time.

A heightened perception of the pelvic floor will allow first-time mothers to relax the muscles when needed and direct pressure accurately during labour and facilitate birth. A relaxed pelvic floor will lessen the chances of tearing and/or need for episiotomy.[3]

Contrarily, pelvis floor dysfunction (too weak or­ too tight) has been also associated to lower back pain.[4]
Awareness of the different pelvic floor areas will help to gain elasticity and enhance or restore the healthy functions of each of the three openings. It will also make easier to regain strength after birth.[5]

The pelvic floor postnatally

Right after birth and whether you had a vaginal birth or C-section the pelvic floor muscles have the consistency of a wet paper bag full of groceries – as one of my mentors would put it. Muscles and connective tissue have been largely stretched. Additionally, the perineum may have been cut (episiotomy) or torn, an even received stitches, so experiencing perineal soreness or discomfort during the first few weeks after birth is not uncommon.

A weak pelvic floor can lead to urine or faecal incontinence (the unwanted release of urine or faeces) and pelvic organ prolapse, a condition in which the organs descend, fall out of place or protrude externally.

Decompressing breath:

In order to relieve the pelvic floor muscles and the organs of the lesser pelvis organs try the following breathwork developed by Blandine Calais-Germaine:[6]

  1. Lie on your mat in a supine position (back on the floor) with knees bent and soles of the feet flat.
  2. Take a few deep breaths noticing the expansion of the ribcage as you inhale and how the ribs fall back together as you exhale.
  3. Inhale deeply and allow the ribs to expand. With the next exhalation try to keep that expansion in the ribcage and feel the abdomen being pulled up towards the thorax. This action creates a vacuum that decompresses the lower organs – bladder, uterus and rectum.

If you experience any type of incontinence while sneezing, coughing, laughing or jumping, pelvic girdle pain, pain during intercourse (dyspareunia) or a bulging sensation in the vagina or rectum beyond the 12 weeks postpartum, consult with a physiotherapist specialized in pelvic health.

[1] Pelvic Floor Anatomy and Applied Physiology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2617789/

[2] Dinsmore-Tuli, Uma. 2017. Yoga for Pregnancy and Birth. Improve your wellbeing throughout pregnancy and beyond. London: Teach Yourself, p. 155

[3] Anaya, Patricia A. 2016. Bumps in Motion. Pregancy Yoga Sequences from Around the World. Redondo Beach, California: Serenity Birth, p. 10

[4] https://www.lifemark.ca/blog-post/low-back-pain-and-pelvic-floor-dysfunction

[5] Anaya, Patricia A. 2016: p. 9

[6] Calais-Germain, Blandine. 2003. The Female Pelvis. Anatomy and Exercises. Seattle, WA: Eastland Press, Inc.