For many women, pelvic floor symptoms are something they expect after having a baby — not during pregnancy. So when things like leaking, pelvic pressure, or discomfort start showing up before delivery, it can feel confusing, worrying, or even isolating.
If this is happening to you, here’s an important thing to know right away: you’re not doing anything wrong — and you’re not alone.
Pelvic floor symptoms can begin during pregnancy, and in many cases, they’re your body’s way of asking for support as it adapts to major changes.
Why Pregnancy Affects the Pelvic Floor
To understand what you are feeling, it helps to look at the biology of what is happening inside you. Your pelvic floor isn’t just sitting idly by waiting for labor; it is actively adapting every single day of your pregnancy.
Hormonal Shifts
From the very beginning, your body is flooded with hormones like relaxin and progesterone. These hormones have an important job: to soften your ligaments and joints to accommodate a growing baby and prepare for birth. However, this softening also affects the connective tissues that support your pelvic floor, potentially making them less stiff and supportive than usual.
The Physics of Growing a Baby
As your baby grows, the downward pressure on your pelvic floor muscles increases significantly. Think of your pelvic floor as a hammock supporting your internal organs. During pregnancy, you are essentially adding a progressively heavier weight to that hammock for nine months. It is natural for those muscles to feel the strain.
Posture and Breathing
Pregnancy changes your center of gravity. As your belly expands, your posture shifts—often leading to an increased curve in the lower back (swayback) or a tendency to tuck your tailbone under. These postural changes alter how your core and pelvic floor muscles fire and coordinate. Even the way you breathe changes as the baby takes up more space near your diaphragm, which directly impacts how your pelvic floor manages pressure.
Common Pelvic Floor Symptoms During Pregnancy
Because of these significant physical shifts, symptoms can show up well before your due date. Here are some of the most common experiences women share with us:
- Leaking urine (incontinence): This often happens during moments of increased pressure, like coughing, sneezing, laughing, or exercising.
- Heaviness or pressure: You might feel a sensation of drag or fullness in the vagina or rectum, often described as feeling like "something is falling out."
- Aches and pains: Discomfort in the lower back, hips, tailbone, or pubic bone (symphysis pubis dysfunction) is frequently linked to pelvic floor function.
- Pain with movement: Turning over in bed, getting out of a car, or walking can sometimes trigger sharp or dull pain.
- Bladder challenges: You might feel like you can't fully empty your bladder or that you have to go immediately (urgency), even if you just went.
If you are nodding along to this list, please know that while these symptoms are common, they don't have to be something you just "put up with" in silence. Normalizing them means talking about them without shame—not minimizing the impact they have on your daily life.
Why Ignoring Symptoms Isn’t Always the Best Approach
There is a tendency in our culture to encourage mothers to "push through." We are taught that discomfort is just the price of admission for having a baby. While some discomfort is part of the process, pain or dysfunction is often your body’s way of asking for support.
Ignoring these early signals can sometimes lead to compensatory patterns. For example, if your pelvic floor is weak or overwhelmed, you might start clenching your glutes or overusing your back muscles to compensate. Addressing these issues during pregnancy can actually help set you up for a smoother postpartum recovery. You are essentially learning the tools and connecting with your muscles before the intensity of the newborn phase begins.
What Support Can Look Like During Pregnancy
Pelvic floor strength begins with awareness and gentle control—not just squeezing harder. If you’re not sure how to start, Dr. Rachel demonstrates a simple seated cue in this Facebook Reel to help you learn how to relax your pelvic floor, gently lift with your breath, and avoid over-clenching your glutes or core. These small, controlled movements coordinated with your breathing can make a big difference in comfort, stability, and bladder control.
This is where Pelvic Floor Physical Therapy comes in. Many women assume PT is only for rehabilitation after an injury or surgery, but in the context of pregnancy, it is also about preparation and maintenance.
Working with a pelvic floor physical therapist during pregnancy is gentle and respectful. It isn't about invasive procedures; it's about empowerment. Here is what support typically looks like:
- Education and Body Awareness: Learning where your pelvic floor is and how to connect with it. Believe it or not, many of us have never truly thought about these muscles until pregnancy!
- Breathing and Pressure Management: Learning how to breathe in a way that manages the pressure in your abdomen, which can protect your pelvic floor during daily tasks like lifting groceries or picking up a toddler.
- Strength vs. Relaxation: Not everyone needs to do Kegels. In fact, some women have pelvic floors that are too tight and need to learn how to relax and "let go" to prepare for birth. A Physical Therapist can determine exactly what your body needs.
- Birth Preparation: Discussing labor positions that protect the perineum and strategies for pushing that are effective and gentle on the pelvic floor.
You Don’t Have to Wait Until After Birth
There is a misconception that you have to wait until your six-week postpartum checkup to address pelvic floor health. But pelvic floor care isn’t just "rehab"—it’s "prehab."
Addressing symptoms now can give you more confidence in your body as you approach labor. It can improve your comfort during these final months of pregnancy, helping you sleep better and move with more ease. Most importantly, it gives you a head start on recovery because you will already know how to reconnect with your core and pelvic floor muscles once the baby arrives.
Listen to your body. If something feels off, you don't have to wait to ask for help.
You Are Not Alone
Every pregnancy is different, and every body adapts in its own unique way. Whether this is your first baby or your fourth, your experience is valid. If you are navigating pelvic floor changes, remember that you are not alone, and there is support available to help you feel strong and capable.
If you’re pregnant and noticing changes in your body that don’t feel quite right, a pelvic floor physical therapist can help guide you safely through pregnancy and beyond.
At Optimal Health Chiropractic & Physical Therapy, we are honored to support women throughout South Jersey. We are here to help you navigate this journey with confidence.
