Women Deserve to Know: the Stretched Pelvic Floor Muscles (PFM) can recover after delivery!

Pelvic floor muscles are very important because

 a. they respond to stretch during sex which facilitates an orgasm

 b. they support and promote function of the pelvic organs

 c. they contract to delay urination or defecation

 d. they relax to permit voiding or defecation

The pelvic floor, or pelvic diaphragm, is like a trampoline that spans the entire pelvic cavity. Urethra, vagina, and rectum pass through the diaphragm.

A recent study done in Norway  done by Jette Star-Jensen and others was published in the March 2015 issue of Obstetrics and Gynecology looked at the postpartum changes in pelvic floor connective tissue which included muscles in a group of first time mothers. Throughout their pregnancies transperineal ultrasounds were taken at five times, 21 weeks, 37 weeks, and 6 weeks, 6 months, and a year post birth. Women were asked to be at rest, bear down (known as Valsalva), and contract the pelvic floor muscles. The connective tissue of the pelvic ring was assessed as the levator hiatus area, as well as bladder neck mobility.

 

85% the 274 women assessed before birth delivered vaginally, the others had cesarean deliveries. There was no difference in the women who delivered by c-section. The vaginal group displayed significant increased in all three measurements with comparing 12 months postpartum to 21 weeks of pregnancy.The group of women who had c-sections compared to the ones who had vaginal births were able to reduce the pelvic opening with muscle contraction more than those who had vaginal deliveries.

The ability of the deep diaphragm muscle and connective tissue to stretch might help protect the muscle during delivery(parturition). However, the stretch offers less stiffness to support the organs and hold the skeletal pelvis together. The levator ani (deep pelvic floor muscles) do not seem to recover completely twelve months after delivery. At twelve months, the vaginal and cesarian delivered women displayed no significant differences in an enlarged pelvic outlet. This phenomena might indicate persistent pregnancy changes as in other studies. Women need to be aware that the most change occurs during the first six months post delivery, but changes might persist. The pelvic floor appears to have great potential for recovery from pregnancy and birth, Due to the significant changes in the pelvic floor muscles during pregnancy and birth, the pelvic floor might be less able to develop pelvic floor disorders when other risk factors such as weight gain, poor deep synergistic trunk muscle strength and endurance, breath holding (valsalva) when having a bowel movement, excessive coughing with allergies. Therefore, we at Women’s Health Physical Therapy urge every women during the postpartum period to seek a pelvic health therapist for supervised individually tailored exercises to regain the strength, endurance, coordination and proper timing of contraction and relaxation of the pelvic floor muscles for proper function in isolation and with the other deep trunk muscles.

Please contact a Pelvic Floor therapists in your area. If you are in the Richmond, Virginia area, you may contact Women’s Health Physical Therapy for more information about Postpartum Strong – from the Inside Out!