Pregnancy & the Pelvic Floor: Part 2 Your Pelvic Floor Through Each Trimester

Written by Kelsie Mazur, DPT

In Part 1, we talked about what the pelvic floor is, what it does, and why it matters during pregnancy. Now let's talk about how the pelvic floor changes as pregnancy progresses. Because your pelvic floor doesn't experience pregnancy as one big event. It adapts right alongside the rest of your body. Your hormones change, your posture changes, your breathing changes, and your baby's size and position change. Your pelvic floor has to adapt to all of it.

So let's break it down trimester by trimester.

First Trimester: Changes You Can't Always See

You may not look pregnant yet, but your body is already changing. Hormonal shifts affect your muscles and connective tissues, your uterus is growing, and your body is beginning to adapt to pregnancy long before there's a noticeable bump. You may notice things like increased urinary frequency, constipation, bloating, fatigue, or changes in how exercise feels.

And while some of these changes are completely normal, it's important not to assume every symptom is simply "part of pregnancy."

Pain with urination, significant pelvic pain, leaking urine, or changes in bladder or bowel function are all things worth discussing with your healthcare provider. The first trimester is also a great time to start becoming more aware of your pelvic floor. Instead of immediately thinking about strengthening it, pay attention to how your body responds throughout the day. Are you holding tension without realizing it? Are you able to take a full, comfortable breath? Do you notice changes during exercise or everyday activities?

You don't need to have all the answers. Awareness is a great place to start.

Second Trimester: The Bump Arrives

For many people, the second trimester is when pregnancy starts to feel more real. Your belly is growing, your center of gravity is shifting, and movements that once felt automatic may start to feel a little different. Your abdominal wall is lengthening, your breathing mechanics can change, and your pelvic floor is adapting to all of these changes while still supporting your bladder, bowel, and pelvic organs. This is also when some people begin noticing increased urinary urgency, leaking, or pelvic pressure.

Here's an important reminder: Common does not always mean you have to live with it.

Pregnancy may change how your body functions, but that doesn't mean you have to ignore symptoms that are bothering you. Your workouts may need to change, too. Maybe you modify certain exercises, decrease your running mileage, take longer rest breaks, or focus more on breathing and pressure management. The goal isn't to prove you can do everything exactly the way you did before pregnancy. The goal is to keep moving in a way that supports your changing body.

Third Trimester: More Load, More Pressure

By the third trimester, your pelvic floor is supporting significantly more load than it was at the beginning of pregnancy. Your baby is bigger, your uterus is bigger, and there is simply less room for everything to move the way it did before. You may notice more pelvic pressure, increased urinary frequency, or that certain exercises feel different. (OR you may not 🙂).

And now your pelvic floor is also preparing for birth. This is where relaxation becomes especially important. We've talked about how the pelvic floor needs to be strong, but it also needs to be able to relax and lengthen. During birth, those muscles need to accommodate significant changes. One of the simplest ways to practice this throughout pregnancy is through your breathing. Instead of constantly bracing or holding your breath, practice taking slow, comfortable breaths and allowing your rib cage and abdomen to expand. Your pelvic floor, diaphragm, and abdominal muscles are all part of the same team. When one changes, the others have to adapt too.

Your body is changing because it's supposed to change. Your movement may change. Your exercise routine may change. And your pelvic floor may function differently than it did before pregnancy. That doesn't automatically mean something is wrong. At the same time, pregnancy doesn't mean you have to ignore pain, leaking, pelvic pressure, or other symptoms that are affecting your daily life. Your pelvic floor is supporting you through every day of pregnancy, not just preparing you for birth. So instead of asking, "How do I make my pelvic floor stronger?"

A better question might be:

"How can I help my pelvic floor adapt to what my body needs right now?"

And that's exactly what we'll continue talking about in Part 3, where we'll break down some of the most common pelvic floor symptoms during pregnancy and what you can actually do about them.

Let’s chat! Book an assessment and let’s get you back to feeling good in your body.

No referrals, no waiting, just answers. Did you know that we offer free 1-on-1 injury screens? Wattage Physical Therapy will take an in depth look at your ergonomics, posture, muscle tone, muscle weaknesses, and movement patterns to create a plan for YOU. If this article intrigues you, you can directly email me, Kelsie at Kelsie@wattagept.com. I would be happy to help you start the process of living a life free from pain.