Signs of Weak Pelvic Floor After Childbirth: Understanding the Impact and Recovery
Childbirth is an empowering experience, but it does come with physical challenges.
One of the most significant changes a woman experiences in her body after childbirth is the condition of her pelvic floor musculature.The pelvic floor is a group of muscles and connective tissue that support the organs in the lower abdomen, including the bladder, uterus, and rectum.
During pregnancy and childbirth, these muscles stretch and lengthen to about 3 times their length, and in some cases, may become weakened or strained. Over the past decade, significant research has been conducted on the signs of weak pelvic floor after childbirth, shedding light on this often overlooked issue.
What is Pelvic Floor Weakness?
Pelvic floor weakness refers to a condition where the muscles and tissues that support the pelvic organs become less tolerable to endurance and are not able to perform their job appropriately.
This can occur due to the physical stress of pregnancy and labor, particularly during vaginal delivery.
The pelvic floor muscles can lose recoil, endurance, and coordination, leading to symptoms such as urinary incontinence, pelvic organ prolapse, and sexual dysfunction. The pelvic floor is a crucial part of the body’s core strength and plays a key role in maintaining bladder and bowel control, as well as supporting the uterus.
Signs and Symptoms of Pelvic Floor Weakness
So what are the signs of weak pelvic floor after childbirth?
Pelvic floor weakness manifests in various ways, and its signs can often be subtle, making it difficult for new mothers to recognize.
Research conducted in the past decade has identified several key symptoms that may indicate pelvic floor weakness:
Urinary incontinence
Pelvic organ prolapse
Sexual dysfunction
Chronic pelvic pain
Bowel incontinence
Lower back and pelvis girdle pain
Urinary Incontinence
One of the most common signs of weak pelvic floor after childbirth is urinary incontinence, particularly stress incontinence, which occurs when pressure is applied on the bladder.
This can happen when sneezing, coughing, laughing, or lifting something heavy. A 2014 study in Obstetrics & Gynecology found that approximately 30-40% of women experience postpartum urinary incontinence, with the prevalence being higher in women who had a vaginal delivery.
A 2020 meta-analysis published in JAMA Surgery showed that 6 months after childbirth, about 10% of women reported persistent urinary incontinence. This was more common in women who had larger babies, long second stages of labor, or required interventions like forceps or episiotomies.
Pelvic Organ Prolapse
One of the other common signs of weak pelvic floor after childbirth is pelvic organ prolapse.
Pelvic organ prolapse occurs when one or more of the pelvic organs (bladder, uterus, or rectum) descend from their normal position due to pelvic floor muscle and tissue dysfunction. Symptoms of prolapse may include a sensation of fullness or pressure in the vagina, a feeling of something "falling out" of the vagina, or difficulty with bowel movements.
Recent research published in The Lancet (2022) suggests that pelvic organ prolapse is more common in women who had vaginal deliveries, particularly if there were long labors, or if force was applied during delivery. The study also showed that prolapse symptoms tend to appear months to years after childbirth, with nearly 1 in 3 women reporting mild to moderate symptoms postpartum.
Sexual Dysfunction
Pelvic floor dysfunction can also impact a woman’s sexual health and is a less commonly known sign of weak pelvic floor after childbirth, but many women report pain during intercourse or reduced sensation due to weakened pelvic muscles.
A study in The Journal of Sexual Medicine (2017) noted that 40% of women who had given birth experienced sexual dysfunction, which is often linked to pelvic floor weakness. This can be caused by the physical changes to the pelvic region, trauma during childbirth, or emotional factors.
Chronic Pelvic Pain
Chronic pelvic pain is another sign of weak pelvic floor after childbirth that may arise.
A study published in The European Journal of Obstetrics & Gynecology and Reproductive Biology (2015) found that up to 15% of women experienced persistent pelvic pain after childbirth. This pain can be attributed to a range of factors, including nerve injury, muscle tension, perineal tears, or pelvic organ prolapse.
Bowel Incontinence
Another lesser-known but significant symptom of pelvic floor weakness is bowel incontinence, or the inability to control bowel movements.
Women may experience this symptom as a result of childbirth-related trauma to the pelvic floor muscles or nerves.
Bowel incontinence can manifest as accidental leakage of feces or an urgent need to use the bathroom.
A 2019 study in Neurogastroenterology & Motility found that postpartum bowel incontinence was common, especially in women who had multiple vaginal deliveries or who had undergone an episiotomy or forceps-assisted delivery.
Lower Back and Pelvic Girdle Pain
Lower back pain, pelvic girdle pain, or a feeling of pelvic “heaviness” are other signs of pelvic floor weakness that are commonly overlooked due to their seeming more orthopedic in nature.
The pelvic floor muscles play a significant role in stabilizing the pelvis and spine. When they weaken, the body may compensate by placing more stress on the back and pelvic joints, resulting in discomfort.
Research in Spine (2020) indicated that postpartum women who experienced pelvic floor dysfunction were more likely to report lower back pain.
Factors Contributing to Pelvic Floor Weakness
Several factors increase the likelihood of developing pelvic floor weakness after childbirth. These include:
Mode of Delivery: Women who undergo vaginal deliveries are more likely to experience pelvic floor dysfunction than those who have cesarean sections. However, a C-section does not completely eliminate the risk, as it can still be influenced by the pressure of pregnancy on the pelvic floor.
Multiple Pregnancies: Women who have had multiple children are at a higher risk of pelvic floor weakness. The more pregnancies a woman has, the more strain is placed on the pelvic muscles and connective tissue.
Prolonged Labor: A long labor or difficult delivery can contribute to pelvic floor damage. Research has shown that women with prolonged labor or who require the use of forceps or a vacuum during delivery are at a higher risk of pelvic floor injuries.
Large Baby Size: Delivering a baby who weighs more than 8 pounds, 13 ounces (4,000 grams) can put additional stress on the pelvic floor and increase the risk of injury.
Age: Older women (35 y/o +) may be more likely to experience pelvic floor weakness after childbirth. The natural aging process can contribute to a loss of muscle tone, making recovery more challenging after childbirth.
Prevention and Recovery
Fortunately, there are ways to address and prevent pelvic floor weakness. Strengthening the pelvic floor muscles through pelvic floor muscle training can significantly improve muscle tone and prevent incontinence and prolapse.
A 2018 study in The Cochrane Database of Systematic Reviews found that pelvic floor muscle training is effective in reducing postpartum incontinence and improving pelvic organ support.
Recovery, including pelvic floor physical therapy, can help restore balance in the pelvic muscles so that the trunk stabilization system is working at its best. Postpartum women may also benefit from lifestyle modifications, such as postural education and modifications to reduce aggravating factors.
In cases of severe pelvic floor dysfunction (POP), surgical intervention may be necessary, particularly for women with prolapse or persistent incontinence. Minimally invasive procedures and pelvic reconstructive surgery have become more advanced over the years, providing women with more effective and less invasive treatment options.
Conclusion
Pelvic floor weakness after childbirth is a significant issue that affects a large number of women, yet it is often under-recognized and undertreated.
The past decade of research has shed light on the prevalence of pelvic floor dysfunction and its impact on women’s health.
Understanding the signs of pelvic floor weakness after childbirth is crucial for new mothers, as early intervention can lead to better recovery and improved quality of life. By prioritizing pelvic health and seeking appropriate care, women can reclaim their pelvic strength and continue to thrive post-birth.
Looking for pelvic floor physical therapy in Jacksonville Beach, FL?
If you’re looking for personalized, one-on-one sessions to address your pelvic floor concerns, we provide pelvic health physical therapy services to women in the Jacksonville Beach area.
If you’re looking for providers who will listen to you and help you get to the root cause of your pelvic concerns, we’ve got you. We’re here to help you if you’re experiencing pain, heaviness, leaking, or are pregnant/postpartum and want to continue safely working out/running/lifting during your pregnancy and get back to your sport after birth.
Get started today by booking a discovery call.
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