Top 3 pelvic floor issues with childbirth

The pelvic floor has to stretch up to 25-245% its size during vaginal childbirth! (Svabik, Shek & Dietz, 2009) It’s not hard to imagine that people come out with some pelvic floor issues. The pelvic floor is not spared, even if the baby is delivered via cesarean section because the baby still spent a significant amount of time putting pressure down on the pelvic floor during the pregnancy.

The pelvic floor is a group of muscles that acts like a hammock, holding up the pelvic organs (bladder, uterus, and rectum). As the baby comes down through the pelvis, it can shift these organs in various directions, which can then cause symptoms. There can also be trauma to the tissues of the vaginal wall as the baby descends. So let’s look at the most common symptoms we see following delivery.

The top 3 issues we see after childbirth are leaking, pelvic organ prolapse, and pain with intercourse.

Thirty-three percent of women will experience urinary incontinence of some kind during the first 3 months postpartum (Thom, D. & Rortveit G., 2010).

Leaking

There are several types of incontinence, including stress urinary incontinence, urge urinary incontinence, overflow incontinence, functional incontinence, and mixed urinary incontinence. The two most common types we see are stress urinary incontinence and urge urinary incontinence.

Stress urinary incontinence (SUI) occurs when sneezing, laughing, coughing, jumping, etc. This is due to a pressure change in the abdomen that causes the leak. Urge urinary incontinence (UUI) presents a strong urge to urinate with a subsequent leak if the bladder is not emptied right away. UUI can be caused by a trigger, such as the garage door opening, putting keys in the door, or hearing the faucet running. These triggers have become linked in the brain and tell the body it needs to eliminate the urine right away.

Leaking can also be aggravated by poor habits, such as dehydration, eating foods or drinking beverages that irritate the bladder, and “just in case” peeing.

Pelvic Organ Prolapse

Pelvic organ prolapse is the second issue we see following childbirth. Vaginal delivery is the highest known risk factor for developing pelvic organ prolapse (Gyhagen, 2013). As mentioned above, the bladder, uterus, or rectum rest on top of the pelvic floor, and each of these can descend down into the vaginal canal to cause prolapse. The severity is graded from 1 to 4, with 1 being mild, and 4 being severe.

Pelvic organ prolapse can be caused from pushing during labor, but it often develops after birth in the following weeks and months from cumulative small traumas that add up over time. Constipation is a huge factor and is often overlooked! Constipation is very common in the weeks following delivery, especially if pain meds, anesthesia, or an epidural were involved. If chronic straining occurs due to the constipation, it puts a lot of increased pressure down through the pelvis and can cause the organs to prolapse.

Symptoms of pelvic organ prolapse are: heaviness, pressure, bulging, feeling like something is coming out of the vagina, feeling like a tampon is falling out, or feeling like you are sitting on a ball. Pelvic organ prolapse can be associated with leaking but not always.

Dyspareunia (pain with sex)

Pain during intercourse, also known as dyspareunia, is the third pelvic floor issue that often occurs after childbirth. Sometimes the pain is new following delivery, but sometimes the pain was present before, but it is now worse.

The pain can worsen for a variety of reasons. There is a steep drop in estrogen following delivery, and breastfeeding perpetuates this low level of estrogen. Estrogen helps increase the production of natural lubrication, so a drop in this hormone can cause vaginal dryness, which can in turn cause pain. As mentioned before, the pelvic floor and the vagina have to stretch significantly during a vaginal delivery. There can be tissue injuries similar to bruising that occurs which can lead to pain, and any assisted birth techniques such as forceps or vacuums can increase these injuries. Perineal tears or episiotomies can also cause pain, especially if the laceration extends into the muscular layer of the pelvic floor (grade 2 or higher).

A traumatic birth experience can also cause pain with intercourse because the body elicits a fear response which often leads to pain. Trauma can occur at any point in the birth experience. Trauma may be from the labor not going as desired, not pushing out the baby in the desired position, being transferred from initial birth location to a hospital, having an unplanned c-section, unwanted interventions, or not getting consent for certain interventions.  No matter the type or the cause for the trauma, physical pain can occur.

Don’t let this be your new normal

If you are dealing with leaking, pelvic organ prolapse, or pain with intercourse following childbirth, reach out to a local pelvic floor physical therapist. There are many types of treatments they can offer to help you with these symptoms. Don’t suffer any longer! This does not have to be how you feel forever.