Exercise and other lifestyle changes may help control risk factors for disorders
Approximately one third of women in the U.S. experience abnormalities related to pelvic floor muscles, such as incontinence and pelvic organ prolapse (the drooping of any pelvic floor organ such as the vagina, uterus or bladder).
The link between pregnancy, childbirth and pelvic floor dysfunction is widely studied, but the impact of these factors does not seem to present the entire picture. Approximately 50 to 75 percent of pelvic floor disorders are related to childbirth. However, many women will experience urinary
incontinence or prolapse without ever having children. Further, age seems to play a greater role in these disorders later in life.
Risk Factors for Pelvic Floor Disorders
Risk factors for pelvic floor dysfunction related to childbirth include having larger infants, having multiple pregnancies, prolonged pushing and operative vaginal deliveries with the use of forceps.
Factors not associated with childbirth are heredity, obesity and smoking.
Pregnancy Weight Gain
In most cases, the size of your baby is predetermined by your own genetics. However, limiting the amount of weight that you gain in pregnancy may make a difference. Normal weight gain in pregnancy should be limited to 15 to 25 pounds. Excessive weight gain in pregnancy is associated with large newborns and an increased risk for prolonged pushing or operative vaginal delivery.
While prolapse and bladder leakage seem to be more common in women who have had more than one pregnancy, limiting the number of offspring would only give a modest decrease in the incidence of these disorders. The largest risk occurs after just one delivery. Only small increases are seen after two or three additional pregnancies.
Vaginal vs. C-Section Delivery
What about avoiding the whole vaginal delivery altogether when we can deliver via C-section? In theory, this sounds like a good idea, but it actually doesn’t seem to fix the problem and may expose the mother to unnecessary surgical risk. This is likely due to the impact of pregnancy on pelvic floor disorders. Many women will experience urinary incontinence while they are pregnant, and pregnancy is an independent risk factor for incontinence regardless of delivery mode.
Supporting a Healthy Pelvic Floor
How can expectant moms lessen the impact of childbearing on pelvic floor muscles? While most risk factors are beyond our control, there are a few things we can do to support a healthy pelvic floor through pregnancy and beyond.
1. Do pelvic floor muscle exercises and build core muscle strength. Kegel exercises have been shown to decrease incontinence during pregnancy, but the effects don’t seem to last beyond this period. Improving core stability and strength may have more long-term benefits for improved pelvic floor function.
2. Live smoke-free. Tobacco use is associated with weakened collagen and elastin, which causes skin sagging and connective tissue weakness. Women who smoke have a higher incidence of pelvic organ prolapse. If you smoke, check with your healthcare provider for resources to help you quit.
3. Maintain a healthy body weight. Obese women report much higher levels of pelvic floor disorders than normal-weight women, regardless of childbearing. Talk to your provider, local fitness expert or nutritionist about creating a healthy diet and exercise plan before or during your pregnancy.
Chemen Tate, MD, is a practicing physician and Assistant Professor of Obstetrics & Gynecology at The Indiana University School of Medicine, Indianapolis.