Your Pelvic Floor After Birth

A cesarean doesn’t take it off the list

My pelvic floor never came up the first time. What it does, what to watch for and why a pelvic floor physical therapist is on my care team now.

Key points

About 15% of women have urinary incontinence three months after a cesarean, and about 30% after a vaginal birth. Ask for a pelvic floor assessment however you deliver.
In a Cochrane review (a summary of the research) of 46 trials and 10,832 women, pelvic floor muscle training during pregnancy lowered the risk of incontinence by 62% in late pregnancy and by 29% three to six months after birth, for women who started out continent (not leaking). Ask whether to start during pregnancy, and with whom.
Kegels, squeezing exercises for the pelvic floor, can make some problems worse when the muscles are already too tight. Get assessed before you start exercises.

Not on the plan

In my first pregnancy, I labored through an induction that didn’t progress, then had a cesarean. After the birth, my follow-up care covered my incision and my blood pressure, and I was working through feeding my baby. My pelvic floor never came up: not before the birth, not at my postpartum visits and not from me, because I didn’t know to ask.

My six-week visit note covers physical activity and returning to sex. It doesn’t mention my pelvic floor.

After a C-section, it’s easy to assume the pelvic floor is a vaginal-birth concern. It isn’t. Pregnancy puts months of load on those muscles, and labor before a cesarean adds more.

In this pregnancy, a trainer gave me a late-pregnancy movement and breathing plan. It made me realize how little I’d thought about this the first time, and how much I wanted a specialist to weigh in on what my body needs.

What the pelvic floor does

It supports and controls. These muscles support the bladder, bowel and uterus and help control continence. Pregnancy and childbirth can affect them however you deliver.

It has to relax as well as contract. Some people need strengthening. Some need to learn to relax muscles that are too tight. Many need better coordination. That’s why an assessment comes before exercises (NIDDK).

Symptoms to raise rather than work around:

Leaking urine or stool
Constipation or straining
Heaviness, pressure or a bulge in the vagina
Pelvic pain
Pain with sex

These are common, and they’re treatable.

What I’m doing this time

Getting a referral before birth to a pelvic health physical therapist with pregnancy and postpartum experience, and checking what my insurance covers.
Asking whether I need strengthening, relaxation, coordination or all three.
Asking how breathing, lifting and getting out of bed fit my recovery, especially after a cesarean.
Bringing my trainer’s plan to my clinicians and asking what to change for my history.

Finding a therapist. The APTA Pelvic Health PT Locator, a directory of pelvic health physical therapists, lets you filter by insurance. Ask your plan whether you need a referral and how many visits it covers.

Take this back

To discuss with your care team:

Can you refer me to a pelvic health physical therapist now, during pregnancy?
Should I start pelvic floor training before birth, or wait for an assessment?
When can I start or resume exercise after birth, and what symptoms mean I should stop?

To discuss with the people in your life: In the first weeks after the birth, can you do the lifting so I don’t have to?

Next in the series: “Nine Months Later, I Was Still Asking What Happened in My Surgery”