How Does Breastfeeding Affect the Pelvic Floor?

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As a pelvic floor physical therapist, I see many new moms with pelvic floor dysfunction who are also breastfeeding. Common postpartum pelvic floor issues include pain with intercourse, pelvic organ prolapse, and urinary incontinence. How does breastfeeding affect these issues?

Soon after giving birth, the amount of estrogen in your body dramatically drops as prolactin, the hormone that stimulates milk production, kicks in. While you are breastfeeding, prolactin will continue to stay elevated, keeping estrogen levels low. This hormonal balance is important for maintaining your milk supply, but it comes with an unfortunate side effect for the pelvic floor. Low estrogen can cause vaginal dryness and often results in pain or discomfort with sexual intercourse. When you are breastfeeding, using a water based lubricant can combat this dryness to make intercourse more comfortable. If sex is still painful despite using lubrication, don’t hesistate to seek out help from your doctor and a pelvic health physical therapist, as there are many other reasons why sex can be painful in the early postpartum period.

It is also completely normal to feel like you don’t want to have sex while you are breastfeeing due to hormonal changes. In addition to stimulating milk production, prolactin also creates a strong psychological urge to be able to see or hold your baby all of the time. On top of that, breastfeeding releases a hormone called oxytocin. Often referred to as “the love hormone,” oxytocin gives moms feelings of contentment and pleasure while they are nursing. These hormonal effects can cause a mom to satisfy her physiological need for affection from breastfeeding, making her less likely to want affection from her partner (1). Many moms describe this as feeling “touched out” by the end of the day. This is both healthy and normal, and usually improves when the baby starts eating solid foods and sleeping through the night. 

Women with pelvic organ prolapse following childbirth are often told that their symptoms should improve after breastfeeding. It is true that many women do have an improvement in prolapse symptoms after they wean, but breastfeeding moms should be reassured that there is no evidence that breastfeeding slows the healing of the pelvic floor muscles or worsens pelvic organ prolapse long-term (2,3)

Prolapse symptoms are also correlated with sleep quality (4), which is incredibly hard to come by in the early weeks after having a baby. Many parents deal with this stage by taking “shifts” so that each parent gets at least one four-hour stretch of sleep every night.  Even if you are staying at home with the baby while your partner is working, your sleep is just as important (if not more!). Getting enough sleep is important for healing from childbirth, managing postpartum mood disorders, and being able to stay alert while caring for your baby. 

Breastfeeding moms, however, often feel like they have to do all of the nighttime feedings to establish a strong milk supply. This can mean that they are waking up every 2-3 hours to feed their baby for several weeks until the baby starts sleeping for longer stretches. I did this, and let me tell you, there is a reason why sleep deprivation is a form of torture. If you are worried about having a successful breastfeeding relationship with your baby while getting a safe amount of sleep, I recommend working with a good lactation consultant to help you develop an individualized plan. 

Many new moms also struggle with bladder control and urinary incontinence. This might mean having difficulty with making it to the bathroom or leaking urine with laughing, coughing, or sneezing. Similar to prolapse, there is no evidence that breastfeeding makes any of this worse long-term (3). However, any breastfeeding mom will tell you that breastfeeding triggers an insatiable thirst (5)! It is important to stay hydrated while breastfeeding, but drinking water constantly can also make you have to go to the bathroom more frequently. On the other hand, restricting fluid intake makes your urine more concentrated, which can irritate the bladder and trigger a strong urge to urinate even when the bladder is not full. If you are struggling with controlling your urges to go to the bathroom or leaking urine, there are many strategies that pelvic floor physical therapy can use to address this.

The decision of whether or not to breastfeed, and for how long, is a deeply personal one. Breastfeeding has a few short-term side effects on the pelvic floor, but it should not cause or worsen pelvic floor dysfunction in the long run. Regardless of your breastfeeding status, if you are having symptoms of pelvic floor dysfunction after giving birth, a pelvic floor physical therapist can help guide you during your postpartum recovery. 

Disclaimer:  The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.

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  1. Polomeno V. Sex and Breastfeeding: An Educational Perspective. J Perinat Educ. 1999;8(1):30-40. doi:10.1624/105812499X86962
  2. Lovejoy DA, Roem JL, Blomquist JL, Pandya PR, Handa VL. Breastfeeding and pelvic floor disorders one to two decades after vaginal delivery. Am J Obstet Gynecol. 2019;221(4):333.e1-333.e8. doi:10.1016/j.ajog.2019.05.010
  3. Iris S, Yael B, Zehava Y, et al. The impact of breastfeeding on pelvic floor recovery from pregnancy and labor [published online ahead of print, 2020 May 19]. Eur J Obstet Gynecol Reprod Biol. 2020;251:98-105. doi:10.1016/j.ejogrb.2020.04.017
  4. Ghetti C, Lee M, Oliphant S, Okun M, Lowder JL. Sleep quality in women seeking care for pelvic organ prolapse. Maturitas. 2015;80(2):155-161. doi:10.1016/j.maturitas.2014.10.015
  5. James RJ, Irons DW, Holmes C, Charlton AL, Drewett RF, Baylis PH. Thirst induced by a suckling episode during breast feeding and relation with plasma vasopressin, oxytocin and osmoregulation. Clin Endocrinol (Oxf). 1995;43(3):277-282. doi:10.1111/j.1365-2265.1995.tb02032.x


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