Pregnancy is a period that brings significant physiological and anatomical changes to a woman’s body. According to the American College of Obstetricians and Gynecologists (ACOG), these changes affect:
- The respiratory and cardiovascular systems
- Metabolism
- Temperature regulation
- The musculoskeletal system and the body’s biomechanics
Some of these changes are visible, while others are not. Pelvic floor muscle dysfunction, with possible symptoms of incontinence, falls under the musculoskeletal changes and, although extremely important, is not visible!
Your body adapts to the new demands with the help of the hormone relaxin. This hormone “softens” the tissues to allow the body to “expand and widen” during pregnancy and to stretch the pelvic floor during childbirth.
In the pelvic floor, this “softening” of the muscles due to relaxin and the increasing weight of the baby puts great pressure on the area. During childbirth, as the baby passes through the birth canal, it stretches the nerves and muscles of the pelvic floor that help keep the urethra closed. It is rare for the bladder itself to be injured, but the pelvic floor and nerves are stretched to their limits! The pelvic floor muscles lose part of their strength and cannot keep the urethra closed to retain urine in the bladder.
The result? You may lose urine when sneezing, coughing, laughing, lifting weight, exercising, or feel a strong and frequent urge to urinate. If you develop symptoms of incontinence, be aware that they won’t go away if ignored. A muscle re-education program with Kegel exercises will be essential to regain continence!
Pregnancy is a time when you definitely need a strong pelvic floor!
A weak pelvic floor:
- Increases the chances of incontinence symptoms during pregnancy
- Increases the risk of perineal injury, episiotomy, and incontinence symptoms during delivery
- Increases the risk of pelvic organ prolapse and sexual dysfunction, and the worsening of incontinence symptoms after childbirth
For all these important reasons, if you are pregnant and haven’t started pelvic floor exercises (Kegel’s) yet — start now and learn to do them correctly!
Which women are at greater risk?
Women at higher risk include those with:
- Multiple pregnancies
- Assisted vaginal births (e.g., with forceps)
- Prolonged pushing (more than 1 hour in the second stage of labor)
- Large episiotomy
- Babies with high birth weight (over 4 kg)
And in case you’re wondering whether opting for a cesarean section could “protect” you from pelvic floor dysfunction, research shows that:
“A difficult vaginal birth may increase the chances of pelvic floor dysfunction, but cesarean delivery does not guarantee avoidance of dysfunction.”
In fact, incontinence in women is linked to many other causes. Women who haven’t given birth can also experience incontinence if they have chronic coughing or constipation, are elite athletes (e.g., weightlifting or high-impact sports), lift heavy loads at work, or have joint hypermobility.
And don’t forget: According to the International Continence Society (I.C.S.):
“Women during pregnancy and after childbirth should be encouraged to do pelvic floor exercises both for the prevention and treatment of incontinence.”
A recent study in Australia showed that 1 in 3 women who have had even one childbirth experience incontinence symptoms and are advised to do Kegel exercises!
Remember! Before starting, speak with your gynecologist and ask a pelvic floor physical therapist to guide you through proper technique and design a strengthening program tailored to your individual needs. Pregnancy is a special time in a woman’s life — anything new you decide to start during this period should ensure the safety of both you and your baby.
Foteini Lagari, M.A., P.T.
New York University
Physiotherapist – www.ptpraxis.gr
Scientific Collaborator SCA (TENA) Hellas
Article: http://www.tenasynseola.gr
