How Miscarriage Can Affect The Pelvic Floor

*Note: This blog may be triggering or difficult to read for those affected by miscarriage. Miscarriage is a senitive medical event. This blog was written for the purpose of providing educational content on the issues that may arise during or after a miscarraige in relation to the pelvic floor.

** For the purpose of this blog, the term “female” and “woman/women” will be used to reference those assigned “female” at birth, though we acknowledge that a vast array of folx can carry and birth a child.

Women and those with the ability to give birth are often told of the effects that pregnancy and delivering a baby will have on the body and the pelvic floor, but did you know that miscarriage can affect the pelvic floor as well?

Hormonal shifts during miscarriage

When a child-bearing person becomes pregnant, the body immediately begins to shift the hormonal balance to support the fetus. Hormones that are affected by miscarriage are:

• Estrogen: estrogen is released mostly by the ovaries, and is one of the hormones involved in breast development, armpit and pubic hair, and the menstrual cycle. When a person becomes pregnant, estrogen kicks into high gear.
  During one pregnancy, a person can produce more estrogen than they would for their entire life when not pregnant. High levels of estrogen can cause ligament laxity (hypermobile or flexible joints,) which make the pelvic floor looser. A decrease in estrogen can cause a lack of vaginal lubrication, which could lead to pain or tearing during intimacy.
  During a miscarriage, estrogen levels drop drastically. Imagine a line graph where it spikes up (at conception) and then suddenly falls off.
• Relaxin: during pregnancy, relaxin is produced by the placenta. To prepare the body for birth, relaxin assists with relaxing muscles and ligaments. Because this hormone relaxes your muscles and joints, it can cause instability in the pelvic floor.
• Progesterone: progesterone is produced by the ovary and is important for the first few months of pregnancy as it provides nutrients to the embryo in early pregnancy. The drop in progesterone can cause mood swings, sleep disturbances, and irregular menstrual cycles. 

Depending on the stage of pregnancy that the miscarriage occurs, your hormone levels will affect your emotional state as well as your physical health. The further along that someone is in their pregnancy, the more that the body will have to work to re-shift the hormones to get back to pre-pregnancy state.

Pelvic Floor Dysfunctions Caused by Miscarriage

• Pelvic Pain: Pelvic pain can be used as a generalized term to encompass any pain occurring in the pelvic region.In the case of a miscarriage, RPOC (Retained Products of Conception) can be one of the causes. RPOC, or more simply known as retained tissue, is fetal or placental tissue that stays in the uterus after a pregnancy, but is most common when a miscarriage occurs. This can cause increased pelvic pain, cramping, and back pain.
• Boney Alignment: as stated above, during pregnancy there are new hormones, such as relaxin, moving through the body. These hormones cause looseness or laxity through the ligaments which can cause shifts in the joints. These shifts can compress or stretch various structures causing pain or improper movement patterns. Overtime, if left untreated, people may experience loss in range of motion or even muscle strength.
  Think about a suspension bridge, like the Golden Gate Bridge or the Brooklyn Bridge – if some of the support beams were twisted, the bridge would be completely out of whack and eventually it would become unusable.
• Incontinence: the body loosens muscles and ligaments to prepare for birth, which may cause the muscle used to control your bladder, the detrusor muscle, to become lax. When the muscle cannot control the bladder, it may cause urinary leakage when laughing, coughing, sneezing, and even exercising.

Other dysfunctions that may be caused by miscarriage:

• Ligament pain
• Pelvic scarring
• Internal bleeding, in cases of ectopic pregnancy
• Constipation 
• Hypertonic Pelvic floor

Symptoms of a miscarriage

You may be experiencing a miscarriage if you have any of the following symptoms:

• Vaginal Bleeding: Light spotting, heavy bleeding, and brownish discharge could all be signs of a miscarriage. Light bleeding is more common during the first trimester of pregnancy, but should still be examined by a doctor.
• Cramping: some people notice cramping in their lower stomach area during a miscarriage that feels similar to period cramping, although for some it is more painful. This cramping normally stops within two weeks. 

Other miscarriage symptoms include:

• Passing tissue or blood clots from the vagina
• Back pain
• A sudden disappearance of previous pregnancy symptoms like morning sickness or tender breasts

If you have noticed these symptoms, I recommend contacting your OB/GYN or Primary Care Physician as soon as possible to rule out miscarriage.

I’m here to help

Experiencing a miscarriage is traumatic not only to your emotions, but to your body. A pelvic floor physical therapist can diagnose any miscarriage related pelvic pain and provide a treatment plan to start recovery.

Your feelings and concerns are valid after going through a miscarriage; if you don’t feel seen, I’m here for you. I offer a free, 20-minute discovery call where we can discuss your symptoms and issues to figure out the best route for your pelvic floor recovery.

Looking for additional resources on pelvic health? My YouTube channel holds dozens of videos where I offer free pelvic floor training, yoga exercises, and more. My instagram page takes a little bit more of a light hearted approach while still providing educational content. And of course, if you have a specific pelvic floor subject you’re looking for more information on, a quick search of my blogs may give you the answers you need.

More content you may like:

• Pelvic Pain 101
• Taking Care of the Pelvic Floor Before, During, and After Conception
• What Happens to Your Body During Pregnancy
• What Does a Pelvic Floor Physical Therapist Do?

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