Plus, if you had a tear in your vagina or perineum during delivery or forceps were used, your pelvic floor muscles may take longer to heal. That’s why it’s a good idea to be patient with your recovery and talk to your healthcare provider about what’s normal or not, especially if it’s affecting your quality of life.  

When to seek more help

If you’re still experiencing symptoms three to six months after childbirth, you may want to consider seeing a urogynecologist—also known as a pelvic floor specialist. Urogynecologists have training in both urology and gynecology, making them uniquely qualified to treat pelvic floor issues. 

Urogynecologists specialize in pelvic reconstructive medicine, which can involve a range of treatments and services, including:

• Medications for stress incontinence (urine that leaks when you cough, sneeze, or jump)
• Bladder surgery or injections for stress incontinence 
• Pelvic floor muscle training
• Referrals to pelvic floor physical therapy 
• Surgical vaginal wall repairs
• Vaginal pessary fittings for stress incontinence or pelvic organ prolapse

When it comes to surgical interventions, your urogynecologist may recommend waiting until you’re done having children, depending on the exact surgery, and exploring non-invasive treatment options such as biofeedback—which uses low-grade electrical currents—or pelvic floor physical therapy first. 

What is pelvic floor physical therapy?

A pelvic floor physical therapist will start by assessing your muscle strength, tone, and coordination during an internal exam. Based on the findings, they can teach you techniques and exercises to strengthen or relax your pelvic floor muscles, depending on what is needed. 

Factoring in your health condition and goals, your physical therapy plan may involve:

• Behavior modifications (e.g., bladder habits, fluid intake, and diet)
• Body awareness, posture, and movement training
• Exercises to strengthen, relax, or massage muscles
• Exercises to help with urine leakage (AKA Kegels)
• Using biofeedback to stimulate and coordinate muscles
• Diaphragmatic belly or chest breathing techniques

Reviewed by the Ovia Health Clinical Team

Sources:

• American College of Obstetricians and Gynecologists Staff. (ACOG) “Pelvis Support Problems.” ACOG. Accessed August 2024. https://www.acog.org/womens-health/faqs/pelvic-support-problems
• Hill AJ et al. Trajectories of pelvic floor symptoms and support following vaginal delivery in primiparas between third trimester and 1 year postpartum. Female Pelvic Med Reconstr Surg. 2021 Aug 1; 27(8): 507–513. doi: 10.1097/SPV.0000000000001068

It’s no wonder, then, that both pregnancy and childbirth can take a toll on your pelvic floor. During a vaginal delivery, your pelvic floor muscles stretch up to three times their usual length to allow your baby to pass through the birth canal. Afterward, your muscles may not function in the same way. 

A common postpartum complication

Roughly 24 percent of women in the U.S. are affected by pelvic floor dysfunction (PFD), which occurs when your pelvic floor muscles aren’t functioning correctly. This often happens because they’ve become stretched, weakened, or damaged by pregnancy and childbirth. 

Up to 50% of childbearing women have some signs of PFD, with symptoms that can begin during pregnancy or up to one year after giving birth. Other contributing factors that may increase your risk of PFD include chronic constipation, lower back injuries, obesity, endometriosis, IBS, and interstitial cystitis.  

Signs and symptoms of pelvic floor issues

Some women with PFD may have only one symptom. Others experience multiple symptoms. Here are some of the most common ones to look out for:

• Pelvic pain, including muscle spasms
• Urine that leaks when you sneeze, cough, laugh, or jump (aka stress incontinence)
• Feeling vaginal heaviness or a bulge from your vagina (aka pelvic organ prolapse)
• Sex that’s painful either during or after intercourse
• Difficulty fully emptying your bladder
• Feeling like you need to urinate all the time
• Lower back pain
• Perineum pain
• Constipation

Not sure what to do?

While PFD can feel embarrassing and isolating, it’s important to know that you’re not alone—and that there are several treatments available that can help, from medication to biofeedback to physical therapy. Your symptoms may also improve naturally as you heal and recover from childbirth.    

If you think you may be experiencing PFD, discuss your options with your healthcare provider. You can also read our article on when to consider seeing a pelvic floor specialist to learn more about various PFD treatments. 

Reviewed by the Ovia Health Clinical Team

Sources:

• University of Utah Health. “When to see a pelvic floor specialist after birth.” Accessed July 25, 2024. https://healthcare.utah.edu/womens-health/postpartum/pelvic-floor-disorders/when-to-see-specialist.
• Hallock JL and Handa VL. The epidemiology of pelvic floor disorders and childbirth: an update. Obstet Gynecol Clin North Am. 2016 Mar; 43(1): 1–13.  doi: 10.1016/j.ogc.2015.10.008.Accessed July 25, 2024.