Andrew Siegel MD 5/21/16
Pregnancy, labor and delivery are amazing experiences culminating in the birth of a precious human being. However, the process can be traumatic with possible untoward pelvic consequences. Today’s entry addresses some of the aftermaths and repercussions of the process of childbirth.
“The thought was delivered just after my newborn’s placenta: A sneaking suspicion that things were not quite the same down there, and they might never be again…my daughter had finished using my vagina as a giant elastic waterslide. Alissa Walker, Gizmodo.com, April 2, 2015
The pelvic floor muscles (PFM) take a genuine beating from pregnancy, labor and vaginal delivery. Pregnancy incurs maternal weight gain, a change in body posture, pregnancy-related hormonal changes and the pressure of a growing uterus and fetal weight, all of which may reduce the supportive and sphincter (urinary and bowel control) functions of the PFM.
Labor is called so for a genuine reason! The hours you spend pushing and straining are often very unkind to the PFM. Elective Caesarian section avoids labor and affords protection to the PFM, but prolonged labor resulting in an emergency C-section is equally as potentially damaging to the PFM as is vaginal delivery.
Vaginal delivery is the ultimate traumatic event to the PFM. The soft tissues of the pelvis (including the PFM) get crushed in the “vise” between your baby’s bony skull and your own bony pelvis and are simply no match for the hardness and inflexibility of these bones. The PFM and connective tissues are frequently stretched, if not torn, from their attachments to the pubic bone and pelvic sidewalls, and the nerves to the pelvic floor are often affected as well. The undesirable consequences of obstetric “trauma” include altered PFM anatomy with loss of vaginal tone and function, a.k.a. birth-related laxity (looseness). This can give rise to a variety of pelvic floor dysfunctions including pelvic organ prolapse (pooching of one or more of the pelvic organs into the space of the vagina and in more severe cases, outside the vaginal opening), urinary and bowel control issues and sexual dysfunction.
Studies measuring PFM strength before and after first delivery show a decrease in PFM strength in about 50% of women. Not surprisingly, following delivery, the larger the measured diameter of the vaginal opening, the weaker the vaginal strength.
Who Knew? After a vaginal delivery, things “down there” are often just not the same. The vagina becomes looser and more open, the vaginal lining becomes dryer and hormonal-related pigmentation changes often cause a darker appearance of the vulva.
Since birth trauma to the pelvic floor often gives rise to urinary, bowel, gynecological and sexual consequences, why not consider starting pelvic floor muscle training (PFMT) well before pregnancy? This runs counter to our repair-based medical culture that is not preventive-oriented and our patient population that often opts for fixing things as opposed to preventing them from occurring in the first place.
Realistically, PFMT prior to pregnancy will not prevent pelvic floor anatomical changes and dysfunction in everyone. Unquestionably, obstetrical trauma (9 months of pregnancy, hours of labor and vaginal delivery of a baby that can be plus or minus 9 pounds, repeated several times) can and will often cause some element of pelvic floor dysfunction, whether the PFM are fit or not! However, even if pelvic training does not prevent all forms of pelvic floor dysfunction, it will certainly impact it in a very positive way, lessening its degree and accelerating the healing process. Furthermore, mastering PFMT (a.k.a. Kegel exercises) before pregnancy will make carrying the pregnancy easier and will facilitate labor and delivery and the effortless resumption of the exercises in the after-delivery period, as the exercises were learned under ideal circumstances, prior to PFM injury.
Preventive health routines are commonly practiced with respect to general physical fitness. We work out not only to achieve better fitness, but also to maintain fitness and prevent losses in strength, flexibility, endurance, balance, etc. So why not apply this to the pelvic floor as well?
Bottom Line: Birth trauma can be detrimental to your pelvic health, resulting in a variety of pelvic floor issues. Fortunately, these pelvic floor dysfunctions are treatable conditions. The best approach is a proactive and preventive, pursuing pelvic floor muscle training before pregnancy. In fact, pelvic exercises can be beneficial to any woman, even if pregnancy is not a consideration.
Wishing you the best of health,
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Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– newly available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com
Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48
Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11
Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc
Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon. In the works is the female PelvicRx pelvic floor muscle training DVD.
Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount.
Tags: Andrew Siegel MD, Arnold Kegel MD, delivery, incontinence, Kegel exercises, labor, pelvic floor dysfunction, pelvic floor muscle training, pelvic floor muscles, pelvic organ prolapse, pregnancy, sexual dysfunction, The Kegel Fix, vaginal laxity
Our Greatest Wealth Is Health 
May 21, 2016 at 8:30 AM |
Yes the PFM can take a hit during vaginal delivery, but I have had 2 and am doing ok! Whether c section or vaginally delivery , the muscles and pelvic organs are changing during the 9 months. Having an elective c section will not necessarily avoid these changes. I have seen vaginal deliveries actually help some of my patients with pain. I don’t want people to fear a vaginal delivery and perceive it as “trauma.” But yes changes occur and you know how happy I am that you believe in the pelvic floor PTs!