Always running for the bathroom since you pushed out a baby? Uncomfortable bumps where the sun don’t shine? Blood in the toilet? Motherhood can be both a dream and an episode of American Horror Story. Pregnancy brings all the changes – physical, hormonal, and emotional – some more welcome than others.
Many pregnant women and new moms assume pain, incontinence, or anorectal problems are their “new normal.” But at Betty Health, we believe there’s nothing normal about being in pain, and relief begins with understanding your own body. So let’s get started!
“I was four months pregnant on my honeymoon and spent it in the hotel bathtub doing a daily sitz bath due to hemorrhoids. Sexy ;). At least the view was nice!”
Anonymous, Mother of 2
Pelvic Floor and Pregnancy 101
How well do you know your pelvic floor? (It’s OK if the answer is a shrug emoji).
What we call the pelvic floor is a group of muscles and connective tissues that attach to the bottom of your pelvic bones – from your pubic bone ( in front) all the way back to your tailbone. The pelvic floor supports and stabilizes as you stand, walk, lift something heavy, pee and poop, even sneeze. It also keeps the bladder, bowel (large intestine), and uterus in their rightful places.
A healthy pelvic floor is both flexible and strong, like a suspension bridge. And like a bridge, a stressed or weakened pelvic floor can start to sag.
During pregnancy, the uterus, fetus, amniotic fluid, and placenta (a whole extra organ your body builds during pregnancy and then expels!) put extra pressure on the pelvic floor. In addition, the placenta secretes a hormone (relaxin) to add “stretch” to pelvic ligaments. This helps the pelvic bones shift to make space for the fetus, but also contributes to pelvic floor “sag.”
Changes to the pelvic floor due to pregnancy can lead to uncomfortable symptoms. About half of pregnant women experience symptoms like the following.
Going *way* more often?
Repeat after us – it’s not in your head, you DO have to pee more during pregnancy. That’s because blood volume increases by around 25%. That extra fluid is great for getting oxygen and nutrients to the fetus. But as it’s processed through the kidneys, your bladder gets full more often. Meanwhile, the uterus puts pressure on the bladder, the urethra, and the pelvic floor muscles, further increasing your urge to go.
That’s just the front door. Toward the back, the perineum (the area between the vagina and anus) can also stretch or weaken. Sometimes, labor and delivery cause tears in the perineum or the anus, further compromising muscle strength and resulting in fecal incontinence (trouble controlling gas or stool). A bit more on this below.
Not going *enough*?
Constipation is common during and after pregnancy. Increased progesterone (another hormone) can slow digestion and make bowel movements painful or less frequent. And the uterus can put pressure on the bowels, causing “back-ups.”
Chronic constipation, if not addressed, can lead to more serious problems. Straining to go can lead to anal fissures, small tears in the anus that can cause pain or bleeding, or inflamed internal or external hemorrhoids. Be proactive about sharing constipation symptoms with your healthcare team.
“Everyone said that the first poo after having a baby would be awful – and it was. And I got grumpy hemorrhoids from it. But I never knew that eight years after having my last baby, I’d still get irritated hemorrhoids when I had to strain.”
– Dr. Sarah Lunsford, Co-Founder & COO of Betty
Pressure in the pelvis?
A feeling of pressure can be a symptom of pelvic organ prolapse – a serious but less common condition that can result from pelvic floor weakness (and, in rare cases, from untreated chronic constipation). Prolapse occurs when the ligaments connecting the uterus, vagina, bladder, and rectum elongate, allowing the organs to shift position. In severe cases, the organs can bulge into each other or even outside the body, requiring vaginal pessaries or surgery. (A pessary is a removable device, usually made of silicone, that supports the pelvic organs.)
Trauma to the perineum during childbirth?
Nearly every woman experiences some sort of trauma to the perineum during delivery, from minor skin tears that heal quickly on their own to deeper tears that can affect quality of life. Some tears affect the muscle of the perineum (part of the pelvic floor), requiring stitches, but up to 11% of women experience tears in the anal sphincter, requiring surgical repair.
Perineal tearing can cause quite a few irritating symptoms: urinary or fecal incontinence, discomfort during sex, and worry about future pregnancies. We’ll talk more about perineal trauma and healing in a future article. For now, we’ve put a few ideas at the end of this article.
Pain during intercourse?
Uncomfortable sex is fairly common during and after pregnancy. While you’re pregnant, the cause could just be a fuller than average bladder or how your body is carrying the fetus. Or, hormonal changes could be causing vaginal dryness or soreness. Vaginal or perineal tears (or episiotomy – a cut between the vagina and anus during childbirth) during labor and delivery can cause postpartum discomfort during intercourse.
For many women, pain eases as the body heals. Make sure you give yourself the time to do so. Water-based lubes also help, and talking openly with your partner. If you’re concerned about your symptoms, always share your concerns with a healthcare professional.
“When I gave birth to my first child, I was too late for getting any epidural and wasn’t sure of the right way to push. I ended up getting a full hemorrhoid all the way around. It was so painful and I had to use a donut pillow to sit on for weeks before the pain subsided.”
-Mom of 2, Grandmother of 4
Ways to boost pelvic and anorectal health before, during, and after pregnancy
All this might have you questioning how the human race has even survived ;-). First, if you are dealing with pelvic floor or anorectal issues during pregnancy or postpartum, know you aren’t alone. Nine out of 10 women experience these types of issues at some point in their life.
Second, make sure to reach out to a healthcare professional about your symptoms and concerns. While you can deal with many of these issues at home (with some of the techniques we’ll recommend in a moment), others may require intervention from a trained healthcare professional.
And third, there are some easy ways to help address some of these issues (and prevent others) at home.
During your pregnancy:
- Attend birth classes, which often include stretching and breathing exercises to activate the pelvic floor muscles.
- Try perineal massage to reduce the risk of injury during labor and delivery. Check out this primer on the technique and how to do it safely.
- For inflamed, irritated hemorrhoids, learn more about how to treat that condition.
Everyday practices before, during, and after childbirth:
- Exercise and maintain a healthy diet. Try daily walks if more intense exercise wasn’t in your pre-pregnancy routine. Drinking enough fluids and eating a fiber-rich diet can help manage or avoid constipation.
- Practice pelvic floor exercises (a.k.a. “Kegels”). Be sure to ask a physical therapist (there are some that specialize in pelvic floor therapy) or other healthcare professional to teach you the proper technique. For exercises and support we love Dr. Sarah Reardon and Dr. Margo K .
- Practice proper pooping! See our helpful post for easy ways to making going #2, well, easy.
“I had been warned about tearing and peeing in my pants and much of the other less desirable things about pregnancy and childbirth, but not hemorrhoids. Thankfully mine were not painful; the worst thing about them was just their mere presence and feeling like it was just something I had to deal with.”
-Mother of 4
We’re in this together!
At Betty, we’re creating a community devoted to empowering women to love and care for all parts of themselves. We’d love to hear from you about how we might best support you and your anorectal health.
And if you’re willing to share how pregnancy has affected your pelvic health on social media, brava! Make sure to tag us @bettyhealth.co so we can support you along the way.
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