Many postpartum symptoms can leave almost as quickly as they came, while others can linger. The latter is the case with pelvic-floor dysfunction, but certain exercises with a pelvic-floor physical therapist can help you regain control over these muscles.

What it is

Your pelvic floor is a web of muscles between your tailbone and your pubic bone that helps support your bowel, bladder, uterus, and vagina. During pregnancy and delivery, your pelvic floor is stressed and stretched more than it has been at any other time in your life. This can result in weakening and impaired coordination of these muscles, known as pelvic-floor dysfunction, which can impair the release of fluids and bowels from your body and result in constipation, straining, frequent urination, involuntary leakage of urine or stool, pelvic pain, and pain with intercourse.

How it can impact you

Pelvic-floor dysfunction can manifest—and affect your daily activities—in a number of ways.

Hypertonic pelvic floor

A tight, or “hypertonic,” pelvic floor is the result of pelvic-floor muscles becoming tense and difficult to relax. Symptoms can include a slow urine stream, constipation, and pain during bowel movements, intercourse, or when inserting a tampon.

Anal incontinence

Anal incontinence is the involuntary loss of stool or gas from the rectum. It can show up immediately following delivery or several years down the road.

If you had a vaginal delivery, you are at an increased risk for this condition. And you are at a particularly high risk for this condition, if you’ve had more than three vaginal deliveries, undergone an operative vaginal delivery (involving a vacuum or forceps), or had a fourth-degree tear. Evaluation by your obstetrician or gynecologist is key in understanding the driving cause, and initial management can include bulking stools, pelvic-floor physical therapy, and biofeedback.

Urinary incontinence

Urinary incontinence is the involuntary loss of urine from your bladder. Most commonly seen after vaginal delivery, leakage occurs because of stretching of the muscles and ligaments that normally support the urethra and bladder. This is called stress incontinence and can result in loss of urine during activities like coughing, jumping, and running.

This condition generally improves during the first six months following delivery. If the problem persists, or it is at any point impacting your life negatively, speak to your obstetric provider, or ask to be referred to a urogynecologist for further evaluation.

Prolapse

Pelvic organ prolapse is the loss of support of the vagina, uterus, rectum, or bowel, resulting in a dropping of these organs within your pelvis. Prolapse typically presents with a feeling of pelvic pressure or a bulge at the vaginal opening. You may notice a new bulge with wiping or a rubbing sensation on your underwear. In some cases, prolapse causes pain during intercourse.

Prolapse may be more noticeable immediately following delivery, with improvement in symptoms over the 12 postpartum months. Prolapse is not typically addressed with surgery until you are done with childbearing. Until then, you can manage symptoms with pelvic-floor muscle exercises or a vaginal insert called a pessary.

Why it happens

There are many causes of pelvic-floor dysfunction. One of the most common causes is childbirth. Pregnancy naturally stretches out your pelvic region as your uterus grows, and that sometimes weakens the pelvic floor and disrupts the nerves.

When it happens

A growing fetus can put pressure on the organs in the pelvic floor, including the bladder and the rectum, causing them to weaken. This can persist beyond pregnancy.

What to do about it

If you’re experiencing any of the symptoms associated with a weak pelvic floor, consider reaching out to your health care provider. Your physician will likely perform a vaginal and/or rectal exam to determine the strength of your pelvic-floor muscle. Your provider may suggest that you seek the help of a pelvic-floor physical therapist, who can help you regain control over these muscles through the use of exercises and stretching.

When to seek help

The above conditions can all impact your quality of life. If you feel like the symptoms of pelvic-floor dysfunction are negatively impacting your day-to-day living, speak to your obstetrician or gynecologist. If you don’t get the answers you need, ask to be referred to a pelvic-floor specialist.