Pregnancy changes your body in incredible ways; ways that are hard to anticipate till you start carrying that little human in your belly. Your growing baby, changing hormones, shifting posture, and the increasing demands placed on your muscles all work together to prepare you for childbirth. But while pregnant women often hear about and even experience morning sickness, swollen feet, and back pain, there is one important area which often remains ignored and rarely discussed—the pelvic floor.
As a mom, I have experienced pelvic floor symptoms myself during and after pregnancy, but as a pelvic health physical therapist and having the awareness that the symptoms can be addressed and that I don’t have to live with them forever, I was able to work on my body appropriately to eventually live a symptom free life. However, most women lack this awareness and tools to address their symptoms which they choose to silently suffer with for years to come. When I talk to my clients who are pregnant or postpartum, one of the most common things I hear is:
“I thought this was just a normal part of pregnancy.”
The truth is that many pelvic floor symptoms are common, but they are not something you simply have to live with. Whether you’re currently pregnant or navigating life after delivery, understanding your pelvic health can make a significant difference in your comfort, confidence, and recovery.
What is the Pelvic Floor?
The pelvic floor is a group of muscles, ligaments, and connective tissues that form a supportive “hammock” at the base of your pelvis. For more details on pelvic floor, refer to my blog Understanding the Pelvic Floor: A Beginner’s Guide – The Pelvister
These muscles help:
- Support your bladder, uterus, and bowel.
- Control bladder and bowel function.
- Support sexual function.
- Stabilize your core alongside your diaphragm and deep abdominal muscles.
- Assist during childbirth.
During pregnancy, these muscles work harder than ever before.
How Pregnancy Affects Your Pelvic Floor
Pregnancy places gradual and continuous stress on the pelvic floor. As your baby grows, your center of gravity shifts, your abdominal wall stretches, and your pelvic floor hammock stays under constant and progressive pressure due to supporting significantly more weight than it normally would.
Hormonal changes also make your ligaments more flexible in preparation for birth. While this is essential, it may leave some women feeling less supported around their pelvis.
As a result, you may notice:
- Leaking urine when coughing, laughing, sneezing, lifting or exercising
- Increased urinary urgency or frequency
- Pelvic heaviness or pressure
- Pain around the pubic bone or tailbone
- Hip or low back discomfort
- Pain with intercourse
- Constipation or difficulty emptying your bowels
Experiencing one or more of these symptoms does not automatically mean your pelvic floor is weak. In many women, the pelvic floor actually becomes tight, overworked, or poorly coordinated, which requires a very different treatment approach.
Kegel’s Aren’t the Answer for Everyone
One of the biggest misconceptions I come across is that people think that Kegels is the only exercise that can address all pelvic floor symptoms. I have spoken to women who have told me that they have been doing Kegels from years but never saw any change in their symptoms. Most of them started doing Kegels because somebody told them that every woman should be doing Kegels to maintain good pelvic health or they came across this exercise on the internet. And now, this would be even more surprising for you: studies show that atleast 24% to 50% of people perform Kegel exercises incorrectly without guidance. Many of these people will either “bear down” instead of contracting the muscles upward, or they unconsciously squeeze their stomach, thighs, or buttocks instead of isolating the pelvic floor.
While Kegels have their place, they are not a one-size-fits-all solution.
If your pelvic floor muscles are already tight or unable to relax properly, repeatedly squeezing them may actually worsen symptoms such as:
- Pain with intercourse
- Pelvic pain
- Constipation
- Tailbone pain
- Difficulty emptying the bladder or bowel
- Persistent feelings of pelvic tension
Before beginning pelvic floor strengthening, it’s important to understand how your muscles are functioning.
Sometimes your pelvic floor needs to learn how to relax before it learns how to strengthen.
Simple Tips to Support Your Pelvic Floor During Pregnancy
1. Don’t Ignore Leaking or Pelvic Pressure
Many women assume bladder leakage or pelvic heaviness is simply a part of pregnancy, let alone mentioning these symptoms to their providers. Even if they do mention it to their providers, many providers just label the symptoms as part and parcel of pregnancy. Even if some providers do not give this label, they still fall short on stressing enough that the symptoms need to be treated.
While these symptoms are certainly common, they can often be improved with proper guidance and exercises.
The earlier they’re addressed, the easier they are to manage.
2. Learn to Breathe Well
Your diaphragm and pelvic floor move together like dance partners. The diaphragm is located right below the rib cage, and the pelvic floor is situated right under the pelvis.
When you inhale, your diaphragm gently lowers and your pelvic floor naturally lengthens.
When you exhale, both return upward.
Learning diaphragmatic breathing (which is different from belly breathing) helps reduce stress, improve pressure management, and encourages better coordination between your diaphragm, core and pelvic floor. I would be doing disservice if I did not stress on the fact that learning to breathe well is usually the first step towards improving your pelvic floor symptoms.
3. Stay Active—But Listen to Your Body
Exercise during pregnancy offers countless benefits, including improved circulation, better mood, easier recovery, and maintenance of strength. Walking, swimming, prenatal strength training, and appropriate mobility exercises can all be wonderful options.
However, I also come across clients who are pregnant and push through persistent pelvic pain, heaviness, leaking, or increased symptoms during exercise. These symptoms are signs that your body may need some modifications rather than simply pushing through. It’s important to respect the needs of your body which will change at every stage of your life.
4. Avoid Constipation
A lot of women experience constipation during or after pregnancy, even when they never had any history of constipation. It can happen because of hormonal changes which can slow down your GI tract, or increased pressure on the rectal canal making it difficult for the stool to pass through or due to pelvic floor dysfunction like tightness or incoordination. Constipation places repeated strain on the pelvic floor especially if you have been consistently straining to move your bowels. Constipation can also increase pressure on the bladder often leading to leakage.
Simple habits can make a huge difference:
- Stay hydrated.
- Eat adequate fiber if tolerated.
- Use a footstool when having a bowel movement to relax the pelvic floor
- Avoid frequent and prolonged straining to move bowels.
- Respond to the urge to have a bowel movement instead of delaying it.
- Practice diaphragmatic breathing on the toilet seat instead of straining to move bowels.
Healthy bowel habits are one of the easiest ways to protect your pelvic floor.
5. Practice Good Pressure Management
Every cough, sneeze, lift, or transition from sitting to standing creates pressure inside your abdomen.
Rather than holding your breath, try gently exhaling during the effort.
This simple strategy helps distribute pressure more efficiently and may reduce unnecessary strain on the pelvic floor.
What Happens After Delivery?
Whether you had a vaginal birth or a Cesarean birth, pregnancy itself places significant demands on the pelvic floor.
Recovery doesn’t happen overnight.
Your body deserves time, patience, and gradual rehabilitation.
In the weeks and months after delivery, some women experience:
- Urinary leakage
- Pelvic heaviness
- Pain around the scar or perineum
- Pain during intercourse
- Abdominal separation (diastasis recti)
- Constipation
- Difficulty returning to exercise
- A feeling that their core just doesn’t feel the same anymore
Many women are told these symptoms are simply part of becoming a mother.
They aren’t.
There is so much that can be done to help.
Five Things Every New Mom Should Remember
1. Don’t Rush Back Into High-Impact Exercise
There is a reason why your OBGYN wants to examine you only at 6 weeks postpartum. Your body needs the full window to heal from birth and revert hormonal changes. The uterus takes about 6 weeks to shrink back to its normal pre-pregnancy size; surgical scars from a C-section or deep tissue tears get enough time to structurally knit together. In short, your tissues take time to heal, even if you feel good.
Many women make the mistake of returning to activities like running, jumping, or heavy lifting too soon, to lose pregnancy weight and get back in shape. If the tissues and muscles haven’t healed enough or they haven’t become strong enough to support during heavy or high impact activities, it can lead to or increase risk of leakage, or pelvic pain, or pelvic pressure/heaviness, or prolapse.
A gradual return under the guidance of a pelvic floor physical therapist usually leads to better long-term outcomes.
2. Cesarean Births Need Rehabilitation Too
A C-section isn’t just abdominal surgery. The abdominal wall, breathing mechanics, posture, and pelvic floor all undergo significant changes. Any kind of abdominal surgery in general will impair the function of the abdominal muscles depending on the kind of surgery performed. During pregnancy, the vertical abdominal muscles (the rectus abdominis) stretch out by an average of an additional 50% of their full pre-pregnancy length to accommodate the baby. This impacts every layer of your core leading to alteration in its overall function and strength. Additionally, if a C-section is performed on the same muscles which are already prone to developing a dysfunction later due to being over stretched during pregnancy, this further throws them closer towards developing dysfunction, scarring, weakness or incoordination.
Hence, women with C-section births also need rehabilitation like learning about scar mobility techniques, rebuilding core coordination, and gradually restoring movement confidence.
3. Pain Isn’t Something You Should Simply Accept
In my clinical practice, I have seen so many women reporting that they had never experienced pain with sex before they got pregnant, but things changed for them after they gave birth. I could see how confused they were with this new development in their body and while some of them started to consider that there was something wrong with them, the rest simply accepted the pain as an after effect of pregnancy and chose to just live with it.
Pain with intercourse, persistent pelvic pain, or ongoing discomfort months after delivery should not be ignored. It can be due to reasons like tightness in the pelvic floor which could have developed after delivery as a part of healing; scar tissue formation following a perineal tear; incoordination in the muscles; vaginal dryness due to hormonal fluctuations post-delivery; stress due to various factors including motherhood and lack of sleep.
What most women do not realize is that these issues are often treatable and that in most cases they can have a pain free, enjoyable sex life again.
4. Your Core is More Than Your Abs
As I have mentioned earlier, under Cesarean births the abdominal wall also undergoes significant changes regardless of a vaginal or a C-section delivery. However, not many people realize that the core is not just the Abs and that a strong core isn’t about doing hundreds of crunches.
It involves coordinated teamwork between your diaphragm, abdominal muscles, pelvic floor, and back muscles.
Rebuilding this system takes time, requires good pressure management to recruit the right muscles at the right time.
5. Ask for Help Early
How many of you have waited for years before even paying attention to your symptoms, let alone seeking help? You don’t have to answer me, but I guess your heart already knows the answer. One of my goals is to educate women not to wait six months—or years—to seek help.
Many pelvic floor concerns respond much better when addressed early. In my clinical practice, I repeatedly see patients getting better sooner and faster who have chosen to seek help soon after they started to experience pelvic floor symptoms. Infact, studies agree with the use of pelvic floor muscle training in pelvic floor dysfunction prevention in prepartum and postpartum periods.
So, if something doesn’t feel right, trust your instincts and seek help sooner rather than later.
When Should You See a Pelvic Health Physical Therapist?
Consider scheduling an evaluation if you experience:
- Urinary leakage that continues to bother you
- Pelvic heaviness or a bulging sensation
- Pelvic pain
- Pain with intercourse
- Tailbone pain
- Persistent low back or pelvic girdle pain
- Difficulty returning to exercise
- Constipation or straining
- Difficulty emptying your bladder
- A feeling that your core never recovered after pregnancy
You don’t need to wait until symptoms become severe before asking for help.
The Bottom Line
Pregnancy and motherhood are life-changing experiences, but discomfort shouldn’t be accepted simply because “everyone goes through it.”
Your pelvic floor plays an important role in your daily life—from using the bathroom and lifting your baby to exercising, laughing, and enjoying intimacy.
Looking after it is not a luxury; it’s an investment in your long-term health.
Whether you’re preparing for birth, recovering postpartum, or several years into motherhood, it’s never too early—or too late—to learn more about your pelvic health.
Your body has done something extraordinary. It deserves care, support, and rehabilitation just like any other part of your body.
And perhaps the most important thing to remember is this:
You don’t have to wait until something feels “bad enough” to seek help. Sometimes the smallest symptoms are your body’s earliest way of asking for support.