The pelvic floor is a group of muscles, ligaments and connective tissue that attach from the pubic bone at the front of your pelvis, running like a hammock to your tailbone at the back.

The pelvic floor has several functions. It supports your pelvic and abdominal organs. It maintains bladder and bowel control. It helps the core muscles support the spine. It aids in achieving orgasm. And, during pregnancy it helps rotate the baby’s head into the correct birth position.

Why does the pelvic floor muscle become dysfunctional? 

How Pregnancy Affects Pelvic Floor Muscles

Let’s look first at pregnancy. In pregnancy oestrogen, progesterone and relaxin levels rise significantly causing ligament laxity, affecting the many ligaments supporting the pelvis and pelvic floor muscles. Therefore, the pelvic floor muscles need to work harder to support the pelvis and the growing uterus.

Childbirth, especially following delivery of a large baby, if forceps have been needed, if you have a natural tear or required an episiotomy or had prolonged pushing during delivery can also lead to pelvic floor dysfunction.

Postnatal Hormonal Shifts and Incontinence

After delivery, oestrogen and progesterone levels fall rapidly. If you are breast feeding you have an increase in the hormone prolactin, which is a milk producing hormone. Prolactin temporarily blocks oestrogen production,  keeping oestrogen levels low. Low oestrogen has many effects on the vaginal tissue but also leads to lower flexibility and increased stiffness of the pelvic floor muscles. This can change cervix position which decreases the ability of the urethra sphincter and urethra to contract, which can lead to incontinence.

In general life, pelvic floor function can also affected by chronic constipation, chronic coughing and persistent heavy lifting with bad technique.

What are the signs of pelvic floor dysfunction? 

The Pillars of Pelvic Floor Health

The pelvic floor needs to be strong, flexible, able to co-ordinate well with other muscles, adaptable to different loads and pressures, and be able to relax. A pelvic floor should be strong not tight! Any changes to these components can cause dysfunction. Signs of pelvic floor dysfunction are either related to passing urine, passing stools, sexual function or pain.

Pelvic Floor and Urinary Symptoms

Urinary concerns associated with pelvic floor weakness include leaking of urine, urgency of urination, feelings of heaviness or pressure. With pelvic floor tightness you may experience difficulty starting or maintaining the stream of urine, pain with urinating, needing to push to urinate or a sense of incomplete emptying.

Bowel Symptoms You Shouldn’t Ignore

With bowel function, if your pelvic floor is weak, you may experience the inability to hold in a stool or wind or have urgency with needing to pass a stool. If the pelvic floor is too tight you may experience constipation, the strong need to strain, sensation of incomplete emptying, pencil thin stools, heamorrhoids or pain on passing a stool.

How Pelvic Floor Imbalance Affects Intimacy

For Sexual function a weak pelvic floor may lead to loss of sensation or the inability to orgasm. With pelvic floor tightness you may have pain during or after intercourse or pain with orgasm.

Generally, a tight pelvic floor can also cause pelvic pain, burning, throbbing, heaviness or hip pain.

If you have any of these symptoms, during your pregnancy or postnatally you should see a women’s health physiotherapist for an assessment.

Laura Barrett

TMP Collaborator

Laura began her career in women’s health physiotherapy in 2004 after graduating with a first-class honours degree in physiotherapy from King’s College, London. Having initially gained valuable experience working in a large teaching hospital in London, Laura entered the private health sector in the UK in 2008 before moving to Dubai in 2010. 
From 2010 to 2017, Laura held multiple roles at polyclinics in Dubai, including Head of Women’s Health Physiotherapy & Clinical Pilates. Laura then returned to the UK, where she founded a successful Women’s Health Physiotherapy and Pilates business in Surrey and Oxfordshire before deciding to return to Dubai in 2021 with her husband and two young sons.
Having always practised within women’s health physiotherapy, Laura gained additional certification as a Mummy MOT® Practitioner and continues to ensure that pre-natal women are fit and healthy when entering this exciting phase of their lives and that post-natal women are supported in their recovery from pregnancy, through childbirth and into ‘mummy hood’, returning to work and exercise and having the confidence and ability to pursue previous or new hobbies.
Laura has also trained as a Restore Scar Therapy Practitioner offering scar therapy to all in Dubai including women following a c-section birth, mastectomies or gyneacological surgery.