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  • Writer's pictureDr. Kelly Sammis, PT, CLT

Pregnancy + Postpartum Pelvic Health

Updated: Mar 19, 2023

The journey to and through motherhood is, no doubt, filled with an array of emotions. It can be, and should be, one of the most empowering times in a woman’s life. You are selflessly giving up your body to a little life that you don’t even know yet. It can also be an overwhelming journey at times, especially as you are watching your body grow and change in ways you never thought possible. Pregnancy truly is magical…through the fatigue, morning sickness (ahem, all day sickness for some), swollen ankles, postural changes, sleep deprivation and hormonal chaos, YOU are bringing a new life into this world. You and your pregnant/postpartum body are pure magic, connecting in a completely new way during each phase…but what if at some point in the journey you feel that you’ve lost that connection?

You’re not alone, Mama!

It is very common for women to feel less connected to their bodies during pregnancy and postpartum, especially if your body isn’t responding as magically as you expected it to. Society puts a lot of pressure on “bouncing back” after baby, but that truly isn’t reality. Every woman heals differently, their tissues heal at different rates, their journey and path completely unique. What is reality is that your world will be opened up to a whole new kind of love, a new sense of being and it will expose you to one of the best jobs in the world…Mama.

Educating ourselves about our body transformation, the distress that can accompany childbirth and the norms of the postpartum transition can be empowering. It allows us to better understand these beautiful, yet occasionally uncomfortable, changes that our bodies are experiencing.

Let’s dive in!

It is important to understand that while a lot of postpartum experiences are common, they may not necessarily be normal. We are going to dive into the top 8 topics I discuss with my clients during pregnancy and postpartum. So without further adieu, here it is…the 8 things you might not know about your pregnant and postpartum body.

1. Mind body connection — establishing a connection with key muscles during pregnancy and postpartum is integral for the birthing process and in recovery following birth. Connecting to these muscles and understanding the anatomy and function of these muscles can allow women to experience an effective delivery and to better integrate mindful movements into their daily routines during pregnancy and postpartum.

What muscles are the most integral?

- the pelvic floor musculature

- the diaphragm

- the transverse abdominis

- the deep spinal/low back musculature (aka the multifidus)

Copyright © 2019 Shelby Hoge @sahogeart. Image produced for use by KL Therapies, LLC. All rights reserved.

Also important to consider is EVERYTHING else that attaches to the pelvis, but those listed above should be a primary focus when considering pregnancy and postpartum care.

2. Postural changes — While postural changes are expected and a normal part of the pregnancy process, moderate to high intensity pain and impaired overall function are not! Maintaining good exercise habits, understanding how to manage your ever changing posture and receiving treatment for underlying pain and dysfunction are all important for a healthy and happy lifestyle both during pregnancy and postpartum.

3. Diastasis Recti — AKA diastasis recti abdominis [DRA], abdominal separation, and the dreaded “mommy tummy” or “mommy pooch” (full disclosure, I despise the last two terms).

DRA refers to the separation between the two medial borders of the rectus abdominis muscles, or the “6 pack muscles”. The separation occurs naturally during pregnancy as the baby grows and the belly expands and it should slowly close in the following weeks and months postpartum. The separation is typically measured in finger widths by practitioners and if the width is over 2 finger breadths wide after normal healing times, it is suggested that you consult with a healthcare specialist that is trained in treating DRA.

Want to check yourself? Check out the handouts page for tips on a self assessment.

*Please note, the right and left rectus abdominis muscles are NEVER fused together, they are separated by a collagenous connective tissue called the linea alba. So, if your healthcare provider told you that you can fully eliminate the separation, I would consider finding another practitioner.

4. Return to exercise — Certain exercises, especially heavy abdominal work, can put additional stress on your body and lead to or worsen dysfunction. It is important to note that if you see or experience any of the following it is indicative of an abnormal pressure within your body:

- doming, coning or tenting near the linea alba/abdominal wall

- incontinence/leakage

- discomfort or pain

- sensation of pelvic heaviness

- abnormal breath pattern — especially holding your breath!

This abnormal pressure can contribute to or worsen DRA, prolapse, and/or bladder, bowel and sexual dysfunction. Slowly reestablishing the connection with the muscle groups listed in the first section BEFORE returning to higher function exercise is integral.

5. Bladder woes — let us not channel our inner Billy Madison here, peeing your pants is NOT cool…or normal for that matter! Urinary urgency, frequency and incontinence are all very common dysfunctions in my clients during pregnancy and postpartum, but they are not normal.

What is normal?

- emptying your bladder every 2-4 hours (this will lessen in late stage pregnancy)

- a calm sense of bladder urge that signals you to empty

- no need to push or strain to feel sensation of complete bladder emptying

- no incidence of waking at night secondary to bladder urge

- no leakage…ever.

Incontinence comes in many forms. Some experience urge incontinence which happens when you have a sudden urge to urinate and the bladder contracts when it shouldn’t, resulting in leakage of urine. Typically this will happen on the way to the bathroom, when you hear running water, when you’re unbuttoning your pants, etc. Others will experience stress incontinence which happens when there is an increase in intra-abdominal pressure, for example when you cough, sneeze, laugh, pick up baby, exert yourself during exercise, etc. Mixed incontinence refers to a combination of both urge and stress incontinence, certainly not the ‘best of both worlds’ here. Then there is the lovely coital incontinence where you lose urine during sexual intercourse, what a turn on for your partner, right?!

No form of incontinence is normal, so if you’re experiencing any (or all) of these contact your pelvic health provider to get assessed!

6. Bowel disruption — Constipation and difficulty with bowel movements is common during pregnancy and postpartum but, again, is not normal. Proper positioning (hello, squatty potty), maintaining proper breath patterns, avoiding straining, staying hydrated, and sticking to a healthy diet and exercise regimen are all contributors to experiencing a healthy BM. Some practitioners will also recommend supplements to assist with passing stool (bless you, Magnesium) and these can also be incredibly effective!

7. Painful sex — Healthy sex should never be painful. I repeat, healthy sex should never be painful! Unfortunately, when your pelvic floor muscles and nerves are out of balance this can lead to painful intercourse. Common symptoms my clients report are painful penetration (superficial and/or deep), painful symptoms (aching, burning, cutting, cramping, etc) during or after intercourse, and/or pain or difficulty with climax. This is NOT NORMAL. Evaluation and assessment by your pelvic health practitioner may reveal neuromuscular and musculoskeletal dysfunction that may be contributing to painful intercourse.

8. Surgery isn’t your only option — There are many conservative options to return to a healthy, functioning body postpartum. Surgery is not the only option for pelvic organ prolapse, pelvic pain, diastasis recti, abdominal/inguinal hernias, nor incontinence. Conservative options, such as evaluation and treatment by a pelvic health practitioner, should almost always precede a surgical option.

I will leave you with is not vain, selfish or low priority to desire a body that functions as it should. You deserve to feel connected to your body again and to feel like the empowered goddess that you are…after all that body of yours created this little life and delivered him/her earthside! What’s more empowering than that?

To health + wellness for your pelvis,


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