Pregnancy is an incredible journey, but let’s be honest—it also brings some unexpected changes to your body. While everyone talks about morning sickness and swollen ankles, there’s one area that often gets overlooked until problems arise: your pelvic floor.
Your pelvic floor is a group of muscles and fascia (think internal skin) that act as a hammock, supporting your bladder, bowel, and uterus. During pregnancy, these muscles and fascia are under significant pressure as your baby grows and hormonal changes soften your connective tissues. The good news? Identifying issues early means you can address them before they become bigger problems postpartum.
Here are five signs that your pelvic floor needs some attention during pregnancy:
1. You're Leaking When You Laugh, Cough, or Sneeze
A little leak when you sneeze might feel embarrassing, but you’re definitely not alone—it affects around 1 in 3 pregnant women. However, just because it’s common doesn’t mean it’s “normal” or something you should accept. This stress incontinence happens when your pelvic floor muscles can’t maintain enough pressure to keep your urethra closed during activities that increase abdominal pressure, allowing a small amount of urine to leak.
What to do: A pelvic health physiotherapist can assess your pelvic floor function and teach you proper activation techniques. Often, it’s not about doing more Kegels—it’s about doing them correctly and coordinating them with your breathing and movement.
2. You Feel Heaviness or Pressure "Down There"
That dragging sensation or feeling like something is pushing down into your vagina, especially at the end of the day, can be a sign of pelvic floor strain. As your baby grows, the weight and pressure increase on your pelvic floor, and some women’s tissues respond with this uncomfortable heaviness. This is often a normal feeling associated with being on your feet for too long at once whilst pregnant. However for a few women, this can be early signs of pelvic organ prolapse, or varicose veins.
What to do: This is not something to “wait and see” about. Early intervention with pelvic floor exercises, posture adjustments, and strategies to manage intra-abdominal pressure can help you feel more comfortable throughout pregnancy, and prevent anything else from worsening.
3. You're Experiencing Pelvic or Hip Pain
Pelvic girdle pain affects up to 1 in 5 pregnant women and can range from mild discomfort to severe pain that limits your ability to walk, roll over in bed, or climb stairs. This pain often stems from underlying weaknesses or dysfunction of muscles supporting the pelvis becoming exacerbated with the change of hormones relaxing your ligaments, combined with changes in your posture and the way you move.
What to do: Women’s health physiotherapy can address the root cause through specific exercises to strengthen and support your pelvis during movement, manual therapy to release tight muscles, and advice on positioning and movement strategies. You don’t have to suffer through this—treatment works! Bonus, if you treat it in pregnancy, the likelihood of it continuing after birth drops dramatically!
4. You're Constipated or Straining on the Toilet
Constipation is incredibly common in pregnancy due to hormonal changes and the pressure of your growing baby on your bowel. But chronic straining puts significant downward pressure on your pelvic floor, increasing your risk of haemorrhoids, pelvic pain, and prolapse both during pregnancy and after birth.
What to do: A pelvic physio can teach you optimal toileting positions (hello, squatty potty!), breathing techniques to avoid straining, and pelvic floor relaxation strategies. We’ll also discuss diet, hydration, and lifestyle factors that support healthy bowel function.
5. You Have No Idea What Your Pelvic Floor Is Doing
If you’ve never had your pelvic floor assessed, you’re essentially preparing for one of your body’s biggest physical challenges without knowing if your “team” is ready. Many women know how to turn on their pelvic floor muscles, but do you know how to relax and lengthen them correctly? This is often the missing link in preparing your body for a vaginal birth.
What to do: Consider a pelvic floor assessment as essential pregnancy care, just like your routine antenatal appointments. A pelvic health physiotherapist can check your muscle function, teach you correct technique, and develop a personalized program to prepare your body for birth and support your recovery afterward.
The Bottom Line
Pregnancy is the perfect time to be proactive about your pelvic health. Addressing issues early doesn’t just make you more comfortable now—it can prevent long-term problems after birth and set you up for a stronger recovery. Invest in your health! Your pelvic floor deserves the same attention you give to preparing your nursery or choosing your birth plan.
If you’re experiencing any of these signs, or simply want to optimize your pelvic health for birth, reach out for an assessment. Your body is doing incredible work growing your baby—let’s make sure it has the support it needs.
References:
Mørkved, S., & Bø, K. (2014). Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. British Journal of Sports Medicine, 48(4), 299-310.
Gutke, A., Lundberg, M., Östgaard, H. C., & Öberg, B. (2008). Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms. European Spine Journal, 17(10), 1177-1184.
