Signs of Weakened Pelvic Floor | Oh Mama Matrona

A weakened pelvic floor can lead to urinary incontinence, a feeling of heaviness, discomfort during exercise, or a slower postpartum recovery.

However, many women normalize these signs or fail to identify them in time, due to the fact that the pelvic floor has been largely forgotten for centuries, both during pregnancy and postpartum.

Fortunately, in recent decades, something has changed. Today we better understand the changes that a woman's body undergoes during pregnancy and also the importance of caring for certain areas, such as the pelvic floor (PF).

One of the parts of the body that can suffer the most during gestation is precisely the pelvic floor. That is, the set of muscles, ligaments, and tissues that support organs such as the uterus, bladder, and rectum.

During pregnancy, this area bears a progressive increase in pressure and weight, which can weaken the musculature and hinder postpartum recovery.

Therefore, recognizing the signs of a weakened pelvic floor in time can help you prevent more significant problems.

Table of Contents

• How Pregnancy Affects the Pelvic Floor
• Why Many Women Do Not Detect Pelvic Floor Problems
• Signs That Your Pelvic Floor May Be Weakened
• What Factors Can Weaken the Pelvic Floor
• How to Recover the Pelvic Floor
• Frequently Asked Questions About the Pelvic Floor

How Pregnancy Affects the Pelvic Floor

Caring for the pelvic floor during pregnancy is essential to support the increase in uterine weight, prevent urinary and fecal incontinence, and facilitate childbirth.

Did you know, for example, that during pregnancy your uterus multiplies in size by up to 500 times? To give you an idea: it goes from being the size of a small pear to a watermelon, measuring around 30 cm and weighing more than 1 kg.

With this drastic growth —which allows fetal development— it is not surprising that our pelvic floor suffers as the pressure exerted by this vital organ increases considerably.

The direct consequence is that the perineal musculature weakens (with the help of our hormonal friends) and, therefore, conditions such as urinary and/or fecal incontinence may appear, or the recovery process after childbirth may take longer.

To ensure a good recovery after the birth of your baby and also to prevent ailments such as incontinence, it is advisable to carry out specific care as well as perform certain exercises to strengthen the pelvic floor or perineal massage.

Why Many Women Do Not Detect Pelvic Floor Problems

After giving birth, women are focused on caring for their newborn.

In the first 6-8 weeks, a woman's body gradually returns to its essence, slowly regaining its usual state. The uterus contracts to its original size, the organs return to their usual place… a process that often takes months.

With the hormonal changes and the changes in our body that we experience from the moment we become pregnant and during the first months of postpartum, it is normal that we do not always know how to detect problems that arise in our own body.

If we add to this the fact that this specific muscular area (the PF) is very complex and invisible, it becomes even harder to recognize if there is any dysfunction.

The lack of anatomical education I mentioned can also lead to cultural misconceptions that everything is normal and inevitable… And if the taboo, shame, guilt, or emotional burden associated with postpartum comes into play, it can be helpful to seek professional support such as a perinatal psychologist.

Pelvic floor problems often generate a certain shame (gas, urinary and/or fecal incontinence)… Hence, many prefer to hide it rather than seek help.

Did you know that more than half of women experience some dysfunction after childbirth? The problem is that the vast majority either do not know how to detect it, ignore it, or postpone it for too long. The symptoms often present as mild at first but can become debilitating. That is, leaking urine when laughing, coughing, or jumping.

I must tell you, my friend, that NO, it is not normal to have urinary leakage, feel heaviness, or even pain… and it doesn’t matter if you are in the midst of recent motherhood or menopause.

Signs That Your Pelvic Floor May Be Weakened

As you can see, a deficient or weakened PF affects women's lives: problems during childbirth, urinary leakage, and even discomfort or pain during sexual intercourse.

But what signs does our body give us to warn us that our pelvic floor is not in shape?

1. Small Leaks of Urine When Laughing, Coughing, or Exercising

We refer to stress incontinence when urine leaks during coughing, high-impact exercises, and/or sneezing. But you can also have small leaks when you laugh out loud.

Difficulty controlling gas and urgency when defecating are also indicative of a weakened pelvic area that is losing functionality.

2. Feeling of Weight or Pressure in the Pelvis

A feeling of heaviness or pressure in the vaginal area is another common symptom indicating pelvic floor dysfunction or problems with pelvic organs (uterus, bladder, rectum). It can manifest as chronic constipation, incontinence, and also pain in the lower back.

3. Pelvic or Lumbar Pain

The pelvic floor, the base of the trunk, plays a crucial role in stabilizing the core. When this area weakens, poor posture and chronic pain may appear.

4. Discomfort During Sexual Intercourse

Perhaps some women were not aware that discomfort during sexual intercourse and/or loss of sensitivity can be associated with a weakened or tense pelvic floor. Hypertonicity, muscle weakness, and scars from childbirth can feel like pinching or heaviness.

5. Difficulty Recovering the Abdomen After Childbirth

To recover your abdominal area after pregnancy and childbirth, it is necessary to strengthen the pelvic floor.

If you didn’t know, during pregnancy, the abdominal rectus muscles physiologically separate to make room for the uterus (diastasis recti). This separation, caused by the pressure of the baby, affects about half of pregnant women. Although it usually reduces after giving birth, it sometimes requires physical therapy.

The recovery of the abdominal area after pregnancy and childbirth is usually a long process that requires a specific type of training in the form of very specific postpartum classes. Breathing exercises, Kegel exercises, and supervised hypopressive abdominal exercises will help improve your abdominal area.

6. Frequent or Urgent Need to Urinate

Both urinary urgency and the constant need to go to the bathroom are signals your body sends you that your pelvic floor is not functioning as it should.

7. Discomfort or Instability When Exercising

Having a weakened pelvic floor can also cause discomfort or a feeling of instability when performing certain exercises.

This is because your body cannot manage abdominal pressure properly when exerting effort.

What Factors Can Weaken the Pelvic Floor

The most common causes of a weakened pelvic floor are:

• Pregnancy and postpartum.
• Pelvic organ prolapse (POP): descent of the uterus, bladder, or rectum.
• Tension in the pelvic muscles (myalgia) or inability to relax them.
• Hormonal changes and aging (menopause).
• Chronic constipation, chronic cough.
• Obesity or being overweight.
• Gynecological problems such as endometriosis, fibroids, or cysts.
• Engaging in high-intensity or impact sports.

As you can see, pregnancy is not the only overload for the pelvic floor. Therefore, it is advisable to work on it routinely to avoid short- and long-term problems.

How to Recover the Pelvic Floor

The positive aspect is that the pelvic floor can often be recovered. In other words, it is rehabilitatable.

In general terms, good posture (especially when sitting), avoiding unnecessary loads, better management of breathing, and temporarily avoiding impact activities can greatly aid in your recovery.

But this is usually not enough. You will need a routine of guided special exercises for women with low-impact sports that help you strengthen both the deep abdominal girdle and the pelvic floor, such as swimming, yoga…

In some cases, it will also be necessary to consult a physiotherapist specialized in the pelvic floor.

When to Consult a Specialized Pelvic Floor Physiotherapist

When exercises are not sufficient, it is necessary to visit a physiotherapist specializing in the pelvic floor. After a comprehensive assessment, they will prescribe a specific exercise routine according to your needs. The goal will be to ensure functional recovery beyond aesthetics.

To prevent greater issues, this initial assessment should be done 6-8 weeks after childbirth.

However, there are certain reasons why it is especially important to see a professional as soon as possible:

• Stress incontinence: urinary leakage when jumping, running, coughing, or lifting weights. This occurs when the muscles in the area are unable to support the bladder under any pressure.
• Urinary and/or fecal incontinence.
• Chronic constipation.
• Sexual dysfunction or pain during sex.
• Pelvic organ prolapse (POP): the muscles also do not properly support the pelvic organs, resulting in a feeling of pressure or a “lump” descending.
• Muscle overload causing lower back pain, fatigue, or spasms because the PF has to work twice as hard to be “functional.”
• Pelvic instability, which also causes heaviness or discomfort in the vaginal area.

It is ideal to consult a specialized pelvic floor physiotherapist upon the appearance of any of the symptoms described above to start receiving the most personalized treatment possible and prevent the issue from worsening.

Frequently Asked Questions About the Pelvic Floor

Here are some questions we receive during pelvic floor recovery sessions.

What symptoms does a weakened pelvic floor have?

Symptoms of a weakened pelvic floor include urinary leakage from effort, heaviness in the vaginal area, difficulty holding gas and/or stool, lower back pain, or discomfort during sex.

Is it normal to have urinary leakage after childbirth or as we age?

Although it is common, it is not normal to have urinary leakage. This condition has functional treatment and a high success rate (between 50% and 70%).

Can only women have a weakened pelvic floor?

No, men can also have pelvic floor issues and may suffer from incontinence, for example.

How to care for your pelvic floor at home?

Avoid carrying excessive weights, do not voluntarily stop urinating, do not exert excessive effort when evacuating, and follow the guidelines we have provided throughout the article.

What does a pelvic floor assessment involve?

It is a specialized examination conducted by a midwife and/or physiotherapist where they will evaluate the musculature and structures of the pelvis, as well as an internal assessment (scars) and a physical postural examination.

What should I expect from the pelvic floor assessment?

It should be a completely personalized evaluation with the...