Your body goes through many changes during pregnancy, ranging from pressure on your bladder to belly expansion to hormonal shifts that can leave you feeling moody, achy, bloated, or nauseated. 

As your baby grows inside you, you may spend a lot of time thinking about and discussing the mode of delivery and immediate complications of childbirth, from pain and the risk of bleeding to the return to normal activities. Yet you may be unaware of some of the leading postpartum complications. These challenges include pelvic-floor disorders such as urinary and fecal incontinence, pelvic-organ prolapse, and sexual dysfunction. 

Pelvic-floor conditions may take decades to develop and are impacted by other factors such as body mass index, diet, constipation, smoking, and high-impact activities. Being aware of these potential long-term delivery impacts, as well as their risk factors, can help you manage them more effectively.

How your body changes during pregnancy

During your pregnancy, your uterus expands to accommodate your growing baby, and with this change comes a change in your center of gravity.

“To help keep you from tipping forward, your posture adjusts,” explains Ashley Rawlins, a Dallas-based pelvic-floor therapist at Origin Physical Therapy. “At the same time, the muscles in the back have to work harder, and the muscles in the front (your abs) are further elongated and weakened.”

Hormonal changes contribute to pelvic ligaments and joints being looser and stretchier, all of which can contribute to weakening of the pelvic floor, notes Jenny Archer, a pelvic-floor therapist.

Impact of delivery on the pelvic floor 

During a typical birth, your baby’s head comes down into the pelvis and presses against the muscles that line it. As you push, the baby’s head presses against the muscles with such great force that the normal blood flow to these muscles is temporarily cut off. Between each push, fresh blood comes in, and the muscles have time to recover. However, with prolonged pushing, these muscles and nerves can become more stressed, leading to short- and long-term damage. 

Two nerves, the pudendal and pelvic nerves, lie on either side of the birth canal and are especially vulnerable to the pressures of labor. The pudendal and pelvic nerves carry the signals from the brain to the muscles that hold the bladder and rectum in place¹. If these nerves are injured, the signals meant for the muscles around the bladder, vagina, and rectum may not be properly transmitted, which can result in a weakening of the pelvic floor.

Furthermore, research has shown that certain factors, such as a large baby, prolonged labor, a baby being in a challenging birthing position (such as “sunny-side up” or “breech”) during labor, or vaginal delivery assisted by a medical device such as forceps or a vacuum, all increase the risk of pelvic-floor disorders down the road².

Because planned C-sections avoid the stretching and tearing of the muscles and nerves that occurs as the baby's head comes through the pelvis, it is not surprising that women who have a C-section have a lower risk of a pelvic-floor disorder, such as urinary incontinence, anal incontinence, or prolapse³.

That said, a C-section doesn’t eliminate these risks, as many pelvic-floor disorders are related to pregnancy rather than labor.

“Not all women with vaginal deliveries have pelvic-floor issues, and cesarean section does come with its own set of risks,” says Dr. Michele Torosis, an obstetrician-gynecologist. “I am certainly not suggesting electing for a cesarean section with the sole intention of avoiding risk for pelvic-floor disorders.”

What happens to the pelvic floor after birth?

How your pelvic floor is affected by birth often depends on the circumstances of your pregnancy, labor, and delivery. Studies have shown that nearly 24 percent of women in the United States have at least one pelvic-floor disorder⁴. A woman’s lifetime risk for surgery for a pelvic-floor disorder is 20 percent⁵. These common conditions are seldom discussed in the postpartum period because most disorders present many years after childbirth or are brushed off as a normal part of recovery.

Three out of four women experience vaginal-bulge symptoms at eight weeks postpartum, and the bulge symptoms typically resolve within a year⁶. Issues with incontinence are more likely to manifest in the first five years after childbirth, while pelvic-organ prolapse typically takes 10 or more years after delivery to become an issue. 

Postpartum pelvic-floor recovery

Once your baby arrives, it takes a minimum of six weeks to heal from the experiences of childbirth. It can take the pelvic floor, organs, and pelvic joints as long as a full year to return to a pre-pregnancy state. 

“Depending on how the baby was born, most patients feel ‘back to normal’ within three to four months, with continued healing for up to a year postpartum,” Archer says. “Rest and nutrition play a big role here, with improved healing rates in people who are able to get more rest and eat more nutritious foods postpartum.” 

Pelvic-floor exercises can also help facilitate your pelvic and abdominal recovery, regardless of how challenging your pregnancy or birthing experiences may have been.

Pelvic-floor exercises, which include stretches and breathing methods, can help support improved bladder, bowel, and sexual functions.

"When restoring a happy and healthy pelvic floor, we should focus on so much more than just strength; we want balance,” Rawlins says. 

“To best support bowel, bladder, and sexual function—as well as all of your normal daily activities—we need muscles that have appropriate endurance, coordination, flexibility, and even speed (think: the quick reaction that is needed for those unexpected sneezes!),” Rawlins adds. “This is especially true in the postpartum period, when your body and your muscles have been put through the ultimate test.”

Risk factors and mitigators for postpartum incontinence

Vaginal deliveries—particularly with a first child—are largely unpredictable and uncontrollable. No two moms have the exact same experience, and physicians may deem certain procedures necessary in certain childbirth situations. That said, certain childbirth events have a reputation for increasing your risk of developing postpartum incontinence, and there are certain things that can minimize these particular risks when in labor. These events (and mitigators):

What to do about a weak pelvic floor

If you’re experiencing any of these symptoms, or just don’t feel right in your pelvic region, contact your health care provider, or bring your symptoms up during one of your postpartum visits. There are many solutions to remedy a weak pelvic floor, including Kegels, or pelvic-floor muscle resistance training, as well as working with a pelvic-floor physical therapist who can create a specific plan for you. 

How to find a pelvic-floor physical therapist

Finding a pelvic-floor therapist might not be as easy as it seems, especially if you live in a rural part of the country. Your doctor might recommend one that is affiliated with your hospital or medical network, or you can work with a PT at Origin, which has five physical locations in Los Angeles and also offers virtual visits that you can do from the comfort of your home (something that definitely comes in handy during those first few years with a little one).