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A woman’s pelvis is designed to accommodate a growing baby and support its weight until the baby’s due date. Though pregnancy is not without its challenges, and many women experience pelvic floor damage. As pregnancy progresses, particularly in the third trimester, the weight of the baby becomes more uncomfortable, especially the added weight of the baby on the mother’s bladder.
Pelvic floor muscles can become weakened by pregnancy, childbirth, constipation, a chronic cough and hormonal changes during menopause and aging. It can take commitment to restore pelvic floor tone and strength during pregnancy and after having a baby.
The pelvic floor is a group of muscles in the pelvis which support the bladder, bowel and uterus. A complex network of muscles, ligaments and nerves all help to control the bladder and bowel and support a healthy sex life.
When the pelvic floor muscles become weak, they don’t work as well as they should. Involuntary light bladder leakage e.g. passing wee, or even poo from the rectum is more common for women who have experienced pregnancy, childbirth, constipation, are overweight or do repeated, heavy lifting.
During pregnancy, the hormone relaxin has a softening effect on the mother’s muscles, helping her body to prepare for childbirth. When this hormonal effect is combined with the weight of the baby, extra pressure is placed on her pelvic floor muscles. The uterus, bladder and bowel are not as well supported in their correct positions and drop lower in the pelvis because of the muscles overstretching. During childbirth, there’s more stretching of the ligaments and muscles and potentially damage to the mother’s pelvic floor.
Think of the pelvic floor as a trampoline of muscles supporting all the organs of the pelvis. When it’s new and unused, the springs are taut and rebound quickly after they’ve been stretched. But if the springs are stretched a lot and continual pressure is placed on them e.g., from pregnancy, they don’t recoil as well as they once did. Discomfort or even pain in the pelvis area is not uncommon in the third trimester of pregnancy.
Many pregnant women describe an aching or dragging sensation in their pelvis, especially during their final trimester. Sometimes it may feel as if there’s not much holding the baby in, and one day, you’ll just look down and your baby’s right there!
It can become harder with each passing week of pregnancy to focus on the pelvic floor muscles and try to lift and squeeze them. From around 35 weeks pregnant many women start to experience bladder weakness, due largely to the weight of the baby.
Your baby won’t be deliberately trying to make your life uncomfortable, though there will be certain positions they’ll get into which make it impossible to forget they’re there. When their large bony head is pressing on your bladder, they kick your side, or knee you up under your ribcage, you’ll certainly know about it.
Engagement is not always a diamond ring on the fourth finger of the left hand! A baby’s head is engaged when the widest part of their head has passed through the mother’s pelvis. For women having their first baby, engagement can happen in the last few weeks of pregnancy. For subsequent pregnancies, engagement may not happen until labour has already started.
Another name for engagement is ‘lightening’ because there’s not as much pressure high in the tummy, making it easier for the mother to breathe and eat. Though as the baby drops lower into the pelvis, there’s an increase of pressure lower down in her pelvis and pelvic pain. It becomes harder to hold on when needing to wee, and there’s often more of an aching and dragging sensation in the vagina.
Most women find their second trimester of pregnancy is the most comfortable. The early days of nausea and exhaustion have passed and the baby is not yet so big that moving around and sleeping has been impacted. As the baby grows, gains weight and is more active, there’s generally a flow on effect to the mother and pelvic pain is not uncommon.
Many women are horrified when they don’t make it to the toilet on time and wet themselves. But there are strategies which can help to rebuild bladder tone and hold wee in the bladder until getting to the toilet. Kegel’s exercises, also called pelvic floor exercises help to restore bladder tone.
Bladder training helps to ‘stretch out’ the bladder with longer times between toilet visits. Pessaries work by blocking the urethra and strengthening pelvic floor muscles. And some medications help to control an overactive bladder or bladder spasms.
Sometimes incontinence continues after the baby is born. Childbirth can cause damage to the nerves which control the bladder and changes in the position of the bladder and/or urethra. Damage can happen to the perineum from a tear or episiotomy. Speak with your maternity care provider about your individual risks.
Written for Poise by Jane Barry, midwife and child health nurse, 03/06/2021
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