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Although the pelvic floor plays an important and major role in pregnancy, not many women are aware of its function or even its existence, as most turn their primary focus and attention to the fetus and whether the baby is growing healthily.

The importance of good pelvic floor muscles before, during and after pregnancy cannot be over-emphasized; in this article, we will do an in-depth exploration of what you need to know about the pelvic floor and pregnancy.

What is the Pelvic Floor?

The pelvic floor is very much hidden from view and actually consists of muscles that span across the pelvis (very much like a hammock) and serves to support a woman’s pelvic organs, namely the bladder, uterus (womb) as well as the rectum (bowel) – both in terms of anatomical position as well as function.

How Your Pelvic Floor is Affected?

Before her first pregnancy, a woman’s pelvic floor muscle is typically strong, and all her pelvic organs are well supported.

During pregnancy, like many of the other body parts, your pelvic floor also responds to hormonal changes by stretching and loosening. Weight from your growing baby also contributes to extra strain on the pelvic floor, particularly in the second and third trimester as your belly expands.

During labour and childbirth, for example, during vaginal delivery and especially for assisted vaginal deliveries such as vacuum or forceps extraction, some women may sustain trauma to the pelvic floor, which may lead to weakening with subsequent pelvic floor dysfunction later on in life (including pelvic organ prolapse and urinary incontinence). How this occurs is attributable to multiple factors, including mechanical pressure and injury to the blood vessels/nerves supplying the pelvic floor as the baby’s head descends into and out of the birth canal.

Does pregnancy ruin your pelvic floor?

Whilst it is known that your pelvic floor stretches in response to hormonal changes and the increasing weight of your fetus throughout pregnancy, it does not necessarily “ruin” your pelvic floor. Most importantly, you should be aware of your pelvic floor changes in pregnancy and start your pelvic floor exercises as early on in pregnancy as possible, continuing them well into your postpartum days.

Does a weak pelvic floor make getting pregnant difficult?

No. The ability to get pregnant (aka conceive successfully) is a complex interplay of elements involving age, uterus, fallopian tubes, ovaries, ovulation, egg quality, sperm and other lifestyle factors. Neither a weak (or strong) pelvic floor affects your chances of conceiving.

Will my pelvic floor muscles become stronger by themselves?

No – as Helena Rubinstein famously said – there are no ugly women, only lazy ones. The same goes for your pelvic floor; it is not possible for your muscles to get strong by themselves without you putting in a concerted effort to strengthen them on a consistent basis. Conversely, if you do not do anything for your pelvic floor – risk factors like age, menopause, pregnancy, childbirth and chronic abdominal straining can result in continued weakening of your pelvic floor over time.

What happens if my pelvic floor is too tight?

Pelvic floor overactivity refers to a condition where your pelvic floor muscles are overly contracted with a baseline level of tension and there is difficulty in relaxing. Over time, this can eventually affect your urinary, gastrointestinal, sexual function, including a sensation of discomfort and pain.

Does having a strong pelvic floor help with labor and delivery?

Having a strong pelvic floor may not help directly with your chances of a fast or smooth labor and delivery, but it can go a long way in decreasing the effects of damage that the pelvic floor undergoes throughout pregnancy and childbirth.

Should I choose C-section for delivery so my pelvic floor is not affected?

Although there have been studies showing reduced risk of pelvic organ prolapse and urinary incontinence following C-section versus vaginal delivery, it is important to note that C-section does not come without its own set of risks, including the risk of bleeding, wound infection, injury to surrounding organs, as well as implications on subsequent pregnancies such as scar rupture and abnormal placenta implantation. Keep in mind that the mode of delivery is also just one of many risk factors that can contribute to pelvic floor dysfunction later on in life – you should discuss your concerns with your ObGyn who can then take your individual pregnancy circumstances into consideration and make a joint, holistic decision about what is best for you.

Conclusion

Pregnant or not – as long as you are a woman, empower yourself and know the importance of looking after your pelvic health! Having a weak pelvic floor can put you at an increased risk of pelvic organ prolapse as well as urinary incontinence, which can significantly affect your quality of life.

So don’t shy away from issues involving your pelvic health, and seek care from a urogynaecologist who will be well-equipped in answering all your questions and teaching you about all you need to know about your pelvic floor.

Dr Ng Kai Lyn is an Obstetrician and Gynaecologist with a sub-speciality in urogynaecology. She manages and treats gynaecological conditions such as uterine fibroids, ovarian cysts and endometriosis. She is also experienced in treating bladder and urinary problems and is trained in the latest surgical techniques for pelvic organ prolapse and pelvic floor reconstructive surgery.

Incorporated in 2005, Singapore Medical Group (SMG) is a healthcare organisation with a network of private specialist providers across four established pillars - Aesthetics, Diagnostic Imaging & Screening, Oncology and Women's & Children's Health. Within Singapore, SMG has more than 40 clinics strategically located in central Singapore and heartland estates. Beyond Singapore, SMG also has an established presence in Indonesia, Vietnam and Australia. Learn about our privacy policy here.

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