Pregnancy and childbirth are transformative experiences—but they can also place considerable strain on a woman’s pelvic floor. While delivering a healthy baby is always a priority, many women are left with physical changes after birth that are often under-recognised and undertreated.
Birth-related pelvic floor dysfunction includes issues arising from trauma to the muscles, ligaments, or nerves that support the bladder, uterus, vagina, and bowel. These changes can result from vaginal delivery, instrumental birth (especially forceps), prolonged labour, or even caesarean section, due to hormonal softening and mechanical load.
Common Postpartum Pelvic Floor Problems
Some women experience symptoms soon after delivery, while others may not notice problems until months or even years later. Common concerns include:
- Urinary incontinence, especially with coughing, sneezing, or exercise (stress incontinence)
- Pelvic organ prolapse, where the bladder, uterus, or bowel bulges into the vagina
- Bowel control issues, such as gas leakage, urgency, or incomplete emptying
- Pain with intimacy, often due to scarring or pelvic floor muscle spasm
- Perineal trauma, particularly after assisted delivery or episiotomy
The Role of Birth Injury
The first vaginal birth is the most significant risk factor for pelvic floor injury. Contributing factors include:
- Large babies
- Long pushing phases during labour
- Use of forceps or vacuum delivery
- Third and fourth-degree perineal tears, including obstetric anal sphincter injuries (OASI)
Even when delivery appears uncomplicated, subtle damage to pelvic nerves and muscles may occur due to the pressure of the fetal head during birth.
Anal Sphincter Injury (OASI)
OASI can lead to anal incontinence and have a profound impact on a woman’s quality of life. While repair is often done immediately postpartum, some women benefit from later surgical intervention. Dr Karmakar is experienced in both early and delayed management of OASI, using tools such as endosonography and manometry to guide care.
High-Impact Exercise and the Pelvic Floor
Returning to physical activity is important—but high-impact exercise, particularly in the early postpartum period, can strain the pelvic floor. Activities such as jumping, running, and CrossFit-style training increase intra-abdominal pressure, which can worsen incontinence or prolapse symptoms. In an opinion piece co-authored by Dr Karmakar, elite female athletes—including those who had never given birth—showed a significantly higher rate of urinary incontinence compared to non-athletes. For those with a history of childbirth, the risk is even greater. Postnatal physiotherapy and gradual return to exercise are key. High-risk women—such as those with prior pelvic surgery, existing prolapse, or multiple deliveries—should work with specialists to scale exercise intensity safely and avoid long-term complications.
Karmakar, D., & Dwyer, P. L. (2018). High impact exercise may cause pelvic floor dysfunction: FOR: Scale, strengthen, protect!. BJOG: An International Journal of Obstetrics & Gynaecology, 125(5), 614-614.
Personalised Treatment Options
Treatment is tailored to each woman’s needs and goals. Options include:
- Pelvic floor physiotherapy
- Pessaries for support
- Urethral bulking or fascial slings
- Surgical prolapse repair
- Sphincteroplasty for anal incontinence
Surgical intervention is generally advised after completing childbearing, but this is not always required. Dr Karmakar offers multidisciplinary care that considers lifestyle, family plans, and symptom severity.
Ongoing Support Beyond Birth
Care shouldn’t end at the six-week postpartum visit. As a urogynaecologist and maternity clinician, Dr Karmakar ensures a continuum of care from birth through recovery. Whether you are newly postpartum or navigating long-standing symptoms, your experience matters—and you deserve support that restores both comfort and confidence.
