Don’t Ignore Your Pelvic Floor

This content is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. For concerns related to your baby’s health, development, or sleep, or your own physical or mental wellbeing, always consult a qualified healthcare provider.

During vaginal delivery, pelvic floor muscles undergo extraordinary strain. Computer modeling and MRI studies show that the levator ani muscle may be stretched to more than three times its resting length as the baby’s head descends, and the pudendal nerve, which supplies sensation and motor control to the pelvic floor, can experience strain of up to 35%, well beyond the threshold known to cause nerve damage.^1,2

Pregnancy itself also places demands on the pelvic floor. Research shows that even first pregnancy is associated with changes such as bladder neck lowering, increased pelvic organ mobility, and decreased levator ani muscle strength.³ However, the risk of long-term pelvic floor disorders is substantially higher after vaginal delivery than after cesarean delivery. A large cohort study found that compared with spontaneous vaginal delivery, cesarean delivery was associated with roughly half the risk of stress urinary incontinence and overactive bladder, and less than one-third the risk of pelvic organ prolapse.⁴

Regardless of how you delivered, symptoms like leaking when you cough, sneeze, or laugh; pelvic pressure or heaviness; pain during intimacy; or difficulty with bowel movements are common but not something you simply have to live with.

Pelvic floor muscle training is recommended as a first-line treatment for urinary incontinence by the American College of Obstetricians and Gynecologists.⁵ A systematic review and meta-analysis found that postpartum pelvic floor muscle training reduced the odds of urinary incontinence by 37% and pelvic organ prolapse by 56%.⁶ A randomized controlled trial found that individualized, physical therapist-guided pelvic floor muscle training starting around 9 weeks postpartum significantly reduced urinary incontinence and related bother at 6 months, and improved pelvic floor muscle strength and endurance.⁷

Working with a pelvic floor physical therapist, when you feel ready after delivery, is one of the most valuable investments you can make in your long-term health. It is not just about Kegels. A skilled therapist will assess whether your muscles need strengthening, relaxing, or both, and may use techniques including biofeedback, manual therapy, and behavioral education to build a plan specific to you.⁸

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This content is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. For concerns related to your or your baby’s health, development, or sleep, or your own physical or mental wellbeing, always consult a qualified healthcare provider.

References

1. Lien KC, Mooney B, DeLancey JO, Ashton-Miller JA. Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol. 2004;103(1):31-40.
2. Lien KC, Morgan DM, DeLancey JO, Ashton-Miller JA. Pudendal nerve stretch during vaginal birth: a 3D computer simulation. Am J Obstet Gynecol. 2005;192(5):1669-1676.
3. Van Geelen H, Ostergard D, Sand P. A review of the impact of pregnancy and childbirth on pelvic floor function as assessed by objective measurement techniques. Int Urogynecol J. 2018;29(3):327-338.
4. Blomquist JL, Muñoz A, Carroll M, Handa VL. Association of delivery mode with pelvic floor disorders after childbirth. JAMA. 2018;320(23):2438-2447.
5. American College of Obstetricians and Gynecologists. Urinary incontinence in women. Practice Bulletin No. 155. Obstet Gynecol. 2015;126(5):e66-e81.
6. Beamish NF, Davenport MH, Ali MU, et al. Impact of postpartum exercise on pelvic floor disorders and diastasis recti abdominis: a systematic review and meta-analysis. Br J Sports Med. 2025;59(8):562-575.
7. Sigurdardottir T, Steingrimsdottir T, Geirsson RT, et al. Can postpartum pelvic floor muscle training reduce urinary and anal incontinence? An assessor-blinded randomized controlled trial. Am J Obstet Gynecol. 2020;222(3):247.e1-247.e8.
8. Department of Veterans Affairs/Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Pregnancy. 2023.