Understanding Pregnancy Posture: Impact on Pelvic Health & Well-being
Posture is dynamic and plays an important role in movement and how your body functions and feels.
During pregnancy your posture can change significantly, altered by physical adaptations to baby growth.
Most pelvic floor problems that stem from posture are related to pelvis, rib and hip alignment or position in relationship to each other. The most common posture change that occur in pregnancy is an increased lumbar lordosis (increased low back arch) which flares the ribs and tips the pelvis forward. To compensate you may attempt to tuck your bum and use a wider base of support by turning your hip out into a “duck feet” position. Both scenarios can impact the whole core system, which includes the pelvic floor.
The pelvic floor is attached to the bottom of the pelvis, connecting the pubic bone and tailbone forming a figure eight around the 3 pelvic holes and splaying out to the sit bones. This connection to the pelvis means there is a direct relationship between the bony position of the pelvis and the length tension relationship of the pelvic floor muscles.
What does this mean? For a muscle to be fully functioning it has to be within a certain length that provides optimal tension to the fibers. I call this the Goldilocks rule. If a muscle is held in a shortened or lengthened position for long periods of time the fibers are unable to efficiently contract when needed. This is especially important for the pelvic floor, which is a reactionary muscle, turning on and off involuntarily to function. So what postures cause the pelvic floor to shorten or lengthen and stay there?
Let’s take a look at how each of these areas impacts how the pelvic floor functions based on the posture adopted in pregnancy, beginning with the pelvis.
When the pelvis tips forward from the weight of baby it does two things with the pelvic floor. The first is it shortens the anterior (front) fibers while lengthening the back fibers. The second is it places more pressure into the front of the pelvis. How may this reflect in your symptoms? It can cause, symphysis pubis dysfunction/pain or sacroiliac joint pain; incontinence, vaginal pressure, and may increase vulva varicosity discomfort.
The opposite occurs when your pelvis tips backward in either compensation for an anterior tip or when you are sitting and tucking your bum under. The pelvic floor shortens in the posterior (back) fibers and makes the body rely on the pelvic floor muscles more to hold the pelvic organs (including your baby) up. The orientation of the pelvis in neutral position allows some of the weight of your pelvic organs (bladder, uterus and colon) to rest on your pubic bone. When you tip away from this position for long periods of time it strains the pelvic floor more. Which can contribute to incontinence, hemorrhoids, prolapse/pressure symptoms, sacroiliac joint pain, tailbone pain, and butt pain.
Next up the hips.
Half of hip joint is part of the pelvis. Hip musculature attaches to your sacrum and pelvis. As you move your hip it shortens & lengthens these muscles. Hip movement influences the pelvic floor by changing sit bone positions and the tension in the hip external rotator (ER) muscles. What tends to happen in pregnancy is the hips turn out to create a wider base of support in the feet for balance and sacroiliac joint stability. This turn out narrows the sit bones and shortens the pelvic floor. In addition to the bony structure change influencing the pelvic floor, the turn out over utilizes the hip ER muscles which also shortens the posterior pelvic floor.
Just like above a shortened pelvic floor is unable to react when necessary. It can contribute to symptoms such as urgency, inability to hold pee with an urge or sneeze (etc), difficulty pooping, pelvic girdle pain, hemorrhoids, pelvic pressure/prolapse sensations, and deep pain with sex.
Lastly the ribs.
Rib positioning influences the pelvic floor is more of an indirect way through your breathing and abdominal muscles. During pregnancy, your ribs tend to flare in the front due to the spine extension from baby pulling the spine forward and stays in a more lifted position, promoting a chest breathing pattern. Chest breathing reduces how much respiratory diaphragm (RD) movement occurs as your breath. Your pelvic floor mimics the RD. If your RD is not moving through a full range of motion, neither will the pelvic floor. A smaller range of motion reduces the pelvic floors power. Power is required for force closer of both the sphinctor muscles in the pelvic floor to stop leaking and the pelvic joints to support movement.
This rib position from common pregnancy posture increases the ZOA, or angle where the ribs meet at the top of the abs. This can change the abdominal muscle function in response to intra-abdominal pressure. Since the pelvic floor and abdominals work as a unit for the core system, when one isn’t working efficiently the other will pull more weight. You may notice with this change more pressure into the pelvic floor, prolapse symptoms, increase in varicose vein symptoms, bladder control issues especially with increased pressure like sneezing, lifting, etc.
As you can see posture or the way you hold your body for long periods of time impacts on your pelvic floor in various ways. Which can result in symptoms related to pelvic floor function as well as how your body may response to birth. Because remember, your pelvic floor is the exit point for baby during a vaginal birth. If your pelvic floor is tight from how you stand or sit, it can change how much the tailbone and sacrum move as baby descends and may take longer to stretch during pushing. It can also influence your birth recovery, regardless of how your birthed.
So even though posture is dynamic and you should be moving through various postures throughout the day. It can be extremely challenging to maintain posture that doesn’t strain or stress muscles in pregnancy. So if you find yourself in a position that I’ve mentioned, it does no good to tear yourself down. Take note of how it makes you feel, then see if you can find a position that favors more of a neutral posture. Ideally, neutral posture takes the least amount of muscle energy to maintain, but during pregnancy this can be hard. So using props to help sit up, think pillows or placing a foot on a stool while standing. But the best way to support your posture is through targeted and correct exercise.
Posture exercises build awareness, strength, endurance and resiliency in your body. And since your body changes on an almost daily basis in pregnancy, your exercises should be adaptable and designed to suppor these changes. Which is why beginning early can help you establish muscle memory and build then retain strength to reduce your body wanting to fall into the common patterns as baby gets bigger. But if that is not an option, learning how to minimize the impacts can be a life saver.