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What happens to the pelvic floor DURING pregnancy?

We've reviewed how the pelvic floor works under non-pregnant conditions and there was lots of talk about the "trampoline" and the "canister" - Click here for a refresher!

How does all of that change when there is now a baby growing inside the canister?!

Well, to begin, we have to remember that any impairments that existed before pregnancy, will still exist and potentially worsen during pregnancy. That back pain you've been experiencing for years, the hip twinge you get in the gym, the weak core that an infinite number of crunches never seem to strengthen - will all still be there when you get pregnant. That's why we think it is SO important to see a pelvic health PT before things even start to change. It's important to know where you're starting from.

Around 18 weeks of pregnancy is when the baby starts to grow larger in your uterus to the point where it's growing outside of the limitations of the pelvic ring. This is typically when your pregnancy starts to "show."

Your internal organs are starting shift around to make space for the baby, sometimes leading to an increased upward pressure onto your diaphragm, the "roof" of the canister. This may mean breathing might start to get a little bit more shallow, especially after you've eaten and food is moving through your digestive system.

Your pelvic floor now has more weight/pressure to support from below. This is when stress incontinence can occur due to the increase in pressure within the canister system. If your pelvic floor muscles are not prepared for the increase in load, they may not be able to withstand the further increase in pressure that comes with a cough and a sneeze.

The increased load on your pelvic ring can also cause dysfunction of the pelvic joints (the SI joints and the pubic symphysis). A joint that moves too little (stiffness) might be painful, but a joint that moves too much might (hypermobile) might also be painful. Because of this, SI joint pain or pubic joint pain can begin to occur due to altering biomechanics within the trampoline/canister systems.

Your center of gravity is also starting to shift forward because the "load" of your growing abdomen is moving away from your spine. The center of gravity is defined as the average location of the bulk of weight of an object. The bulk of your body's weight is moving toward the front of your body. The biggest change we see with this is that your standing posture can start to transition from upright to more of a "swayback" where your hips are pushed forward or your pelvis is anteriorly tilted.

This posture starts to put more pressure on your spine, alters your core's ability to help stabilize your trunk, and puts a lot of pressure on your pelvic floor. This posture also can lead to feelings of more urinary urgency. Your baby is quite literally growing on top of your bladder. The swayback posture pins your bladder between the weight of your baby and your pubic bone.

Also at this time, your abdominal muscles and skin are starting to undergo a prolonged stretch that is only going to intensify. The round ligaments, which are the ligaments that anchor your uterus to your pelvis are also starting to stretch. This can cause discomfort in the lower parts of the abdomen.

In the picture on the right, you can see the full uterus covering the baby. The long white line running from the middle of the uterus to the pubic symphysis is the round ligament.

As your pregnancy progresses, so do all of these impairments. There is more load on your pelvis and pelvic floor, more pressure in your abdominal canister, and less range of motion for your diaphragm to take a deep breath.

Now, I know you're probably thinking - isn't that all just the name of the game? Isn't that what we sign up for when we decide to get pregnant?

And the answer is NO! It doesn't have to be!

That would be the same as saying, "This marathon is going to hurt my knees anyway so no use training! I decided to run this marathon so I signed up for whatever hurt is coming my way!"

Absolutely not. We train for hard things all the time. We prepare, strengthen, progress, evolve, grow, learn. Pregnancy is a marathon that can be prepared for and trained through the progression.

In physical therapy, we anticipate and address the impairments as they arise or even before they become a problem.

We can prescribe you specific exercises and stretches to maintain strength and stability within your pelvis, maintain mobility in your thoracic spine and ribcage for breathing, and achieve full pelvic floor control and coordination within a growing system.

We can teach you how to consciously use your pelvic floor and core systems when exerting yourself, when exercising, when sneezing, etc.

And we can teach you how to do all of this for your birth as well!

During your pregnancy, our goal is to create a supported & lifted environment for your pelvis from within your deep core canister system. When you are training for labor, the goal is to elongate & lengthen these muscles and utilize the deep core system to move the environment downward. And no, this doesn't mean you just scream at the top of your lungs with your knees at your chest like you see in the movies. There is a way to learn the proper techniques for birth, but it is imperative you spend time training your muscles under normal conditions first!

If you are experiencing any pain, incontinence, constipation, OR if you are simply pregnant and want to ensure things stay strong and mobile, email us at or give us a call at 267-570-3603.

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