What Happens to Your Pelvic Floor After Pregnancy and Giving Birth

What Happens to Your Pelvic Floor After Pregnancy and Giving Birth

When I was pregnant, my biggest fear about postpartum life was a baby who wouldn’t sleep. Imagine my surprise, then, when I found myself six weeks postpartum, wide awake in the middle of the night, furiously Googling “what does vagina look like after birth?” while my newborn daughter slept peacefully in her bassinet.

Earlier that evening, I’d finally worked up the courage to look down there. In the weeks since I gave birth, I’d been feeling a heaviness in my pelvic area. Sometimes it felt like there was something “in there,” like a tampon or trapped air bubble. Other times it felt like if I didn’t find a place to sit down RIGHT NOW my insides could very well slide out. 

At first, I didn’t worry too much about these pelvic floor symptoms — after 17 hours of labor and a second-degree perineal tear, they made sense. But as the days turned to weeks, and I inched ever closer to my postpartum checkup, I started to feel anxious. I’d been told countless times that six weeks was the typical “recovery period” after giving birth, yet I felt nowhere near recovered. 

It didn’t help that things looked and felt … different down there. It wasn’t necessarily “bad” but I did feel confused about the symptoms and how long they’d stuck around.

When I texted my doula the next morning, she assured me that pelvic heaviness and weakness were normal. Normal?, I thought. How could this be normal?

When it came to postpartum recovery, I’d known to expect leaking boobs and fatigue, but no one had prepared me for changes to my pelvic floor.

What is the pelvic floor, and what happens to it during pregnancy and birth?

An all-important group of muscles and connective tissue, the pelvic floor sits somewhat like a hammock in your pelvis and holds organs like the uterus, bladder and rectum in place. It helps with urinary continence, bowel control and even sexual arousal. 

During pregnancy, these layers of muscles have to support your changing body and growing baby. This extra pressure can weaken the muscles, and some women may start experiencing pelvic floor dysfunction (PFD) during pregnancy as a result.[1]

Then comes the big day. Generally, vaginal birth stresses the pelvic floor in a different way than a C-section does. But because pregnancy itself weakens the pelvic floor — not to mention, many women have C-sections after laboring first — both types of deliveries challenge the pelvic floor muscles, says Sabina Busby, D.P.T., a women’s health physical therapist in Sharon, Connecticut. 

During a vaginal birth, your pelvic floor muscles need to stretch up to three times their normal length.[2] Many people think of the pelvic floor as pushing a baby out, but that’s a misconception, says Mae Hughes, D.P.T., a Nashville-based pelvic floor physical therapist. “They need to stretch and get out of the way,” she explains. “They part like the Red Sea.”

Muscle strain, bruising and swelling are common after giving birth. In many cases (including after my own 17-hour labor), all this stretching can lead to tearing of the perineum, the most superficial layer of the pelvic floor. Perineal tears occur in around 80 percent of births, research suggests, with first-time moms more likely to be affected.[3]

The result of all this, even after the most straightforward of labors, is the need for plenty of recovery time. 

How long does it take for postpartum pelvic floor symptoms to go away?

Too few new moms are prepared for the myriad of pelvic floor discomforts that are possible in the postpartum period, whether it’s incontinence, painful sex long after the six-week mark, vaginal pressure or signs of pelvic organ prolapse, such as heaviness or bulging.

Roughly half of pregnant and postpartum women will experience some form of pelvic floor dysfunction.[4] Despite the commonality of these issues, a survey found that upwards of 50 percent of OB/GYNs don’t discuss symptoms of postpartum pelvic floor dysfunction at all during routine prenatal care.[5]

Looking back, it seems ridiculous that I actually thought that my body would somehow return to business as usual so quickly after 40 weeks of pregnancy, not to mention childbirth. But perhaps it’s not so ridiculous when you consider how much emphasis is placed on the six-week mark, which is historically when the initial postpartum checkup takes place. (The American College of Obstetricians and Gynecologists (ACOG) recommends ongoing follow-up care between three and 12 weeks postpartum, but practices vary widely.)[6] 

It’s easy to assume you’ll “bounce back” after six weeks, especially since we live in a country where many women are forced to go back to work well before that, Dr. Propst says.

And it does take about six weeks for your cervix to close, your uterus to shrink and stitches to dissolve. But some experts also believe it takes six months (or more) for your pelvic floor to really heal.[7]

“Experiences are varied, so it’s difficult to say where someone should be at a given time,” explains Katie Propst, M.D., a urogynecologist in Tampa, Florida, and member of the What to Expect Medical Review Board. “Within six weeks, there will likely be significant improvements. But you can continue to feel changes in sensation and muscle function for up to six months or even longer.”

“What I tell people is that you’re pregnant for nine to 10 months, so expect that amount of recovery time on the backend,” says Dr. Hughes.

How to support pelvic floor recovery

While symptoms of pelvic floor dysfunction — whether that’s pelvic pressure, pain or incontinence — are common, they shouldn’t be accepted as “normal.”

If you’re feeling not quite right after you make it to your six-week mark, you should know that you are definitely not alone, Dr. Propst says. 

“Most women feel like [their pelvic floor] is not as ‘well supported’ after a vaginal delivery,” she notes. “It may feel like their muscles aren’t working as well or maybe there’s just more pressure or a heaviness. These are things that are hard to describe, and may be difficult to find as a problem on a physical exam — but they’re very real.”

At my six-week appointment, I fully expected my OB/GYN to diagnose me with prolapse, or at least tell me I needed to wait to have sex. But after a thorough exam, he assured me that he didn’t see anything to be concerned about. Thankfully, once I explained how I was really feeling — heaviness, weakness — he referred me for physical therapy. 

It’s really important to speak up about your symptoms and ask for help, adds Dr. Propst. “If you feel like your provider is telling you everything is fine but you don’t feel fine, you can ask specifically for a referral to physical therapy.”

Pelvic floor physical therapy has been shown to help all kinds of pelvic floor disorders. Physical therapists can provide an accurate diagnosis of your pelvic floor issues and suggest exercises or other treatment options to improve your symptoms.

At my first session, my PT examined me and had me perform some pelvic floor contractions. It turned out that what I was experiencing was a combination of weakness and poor coordination between my pelvic floor muscles. At that first session, I learned how to practice fully contracting and fully releasing my pelvic floor, and I was given a program for doing exercises at home.

As I practiced, I realized that I actually had trouble fully releasing my pelvic floor, which surprised me since one of my main symptoms (heaviness) felt to me like weakness, almost like I couldn’t hold things together down there. So, in follow-up sessions, we focused just on the relaxation aspect, which is harder than it sounds! 

In the end, it all paid off. By 12 weeks postpartum, the most frustrating of my symptoms had pretty much disappeared. By 4 months postpartum, I started gentle workouts again, following my PT’s advice to move slowly and rest as much as I needed. Now that I’m about 7 months postpartum, I’ve started running — something that, at 6 weeks postpartum, I couldn’t even imagine given how much heaviness and bulging I was feeling. 

Am I as strong as I was before I had a baby? Not yet, but now I have much more realistic expectations. I understand and respect what my body went through. Pelvic floor recovery takes time and effort, but your symptoms can improve — and I hope that more women will learn that and get the help they deserve.