Published May 08, 2025
The pelvic floor performs many functions, yet it often gets overlooked until childbirth. Understanding how the pelvic floor works and how it could be impacted by pregnancy can help patients get the care they need.
In women, the pelvic floor is the muscle system that harbor three organ systems that sit together: The bladder, vagina and rectum. These muscles and their attachments work in synchrony to coordinate and maintain three main functions associated with the pelvic floor:
Because the pelvic floor is comprised of soft tissue, certain factors such as childbirth can tear or stretch it, leading to urinary or bowel incontinence and pain during intercourse. Pelvic floor damage may also cause dropping or bulging of pelvic organs, also known as pelvic organ prolapse. All these conditions are called pelvic floor disorders. While vaginal delivery increases the risk of pelvic floor disorders, those who undergo a cesarean (C-section) are not totally immune for this condition.
“No matter the type of delivery, you're still having the strain of the extra weight on the pelvic floor muscles through the duration of the pregnancy. That can impact a patient postpartum, no matter how you deliver,” said Lawrence + Memorial Hospital physical therapist Andrea Spelman, PT, DPT. Spelman works in a specialized program at L+M that offers pelvic health rehabilitation to patients who delivered via C-section, those who had complex vaginal deliveries, and by request.
Since the pelvic floor impacts different organ systems, a variety of specialists including gynecologists, urologists, gastroenterologists, and physical therapists participate in the care of pelvic floor disorders. Urogynecology is a relatively new subspecialty that often takes the lead in caring for patients with pelvic floor disorders after childbirth.
A urogynecologist can treat patients using surgical and non-surgical techniques for problems including:
“There are a lot of effective treatments that we offer. We can cure incontinence. We can cure prolapse. We know pregnancy and childbirth may lead to dramatic changes in the pelvic floor support, but we like to wait on many of these interventions because most pelvic floor problems which occur during and after a pregnancy resolve spontaneously. We also do not like to do anything permanently until family planning is complete,” said urogynecologist Oz Harmanli, MD, professor and chief of Yale Urogynecology & Reconstructive Pelvic Surgery, Yale School of Medicine. “So, what can we do in the meantime? Physical therapy is very effective in expediting the pelvic floor recovery. There are also other tools we can use for urine control and support.”
Some reasons to see a pelvic floor physical therapist include:
It's important to wait until birth lacerations are healed before considering any intervention. Once patients are cleared, physical therapy can start just a few weeks after childbirth. However, physical therapy may be beneficial to all women experiencing symptoms months or years after childbirth.
“It’s never too late,” said Spelman. “Ages ago, you would hear that if you leak urine when you sneeze ‘Oh, welcome to the club.’ It’s not necessarily this badge of honor that we need to be wearing as moms anymore. These things can be addressed.”
“Most damage can happen during the passage of the baby through the birth canal. However, the weight of the baby and changes happening to the pelvic floor muscles and bone structure during pregnancy takes a toll as well,” said Dr. Harmanli.
All pregnant patients should be instructed to work on strengthening their pelvic floor muscles during pregnancy by doing Kegel exercises, which involves activating the muscles as if they are trying to stop their urine stream. If patients are experiencing any pelvic pain during pregnancy, they may also benefit from physical therapy.
Dr. Harmanli also recommends learning techniques to reduce anxiety and help coordinate the pushing efforts during childbirth, leading to improved outcomes during the postpartum period.
