Pelvic Floor Healing After Miscarriage & Early Pregnancy Loss

Miscarriage and early pregnancy loss are, unfortunately, fairly common experiences for pregnant people. But the prevalence of pregnancy loss doesn’t make it any less painful or traumatic if you're going through it yourself.

There are many resources available to help you process a miscarriage or early pregnancy loss — including online community resources, psychotherapists, women’s healthcare providers, and Origin’s team of trauma-informed pelvic floor physical therapists.

What does the pelvic floor have to do with miscarriage or early pregnancy loss? And how can getting pelvic floor physical therapy support physical or emotional healing after a loss? Keep reading to find out.

What is a miscarriage or pregnancy loss?

Miscarriage and pregnancy loss are two terms that can be used interchangeably for the loss of a pregnancy before 20 weeks. If miscarriage occurs before 13 weeks, it’s considered an early pregnancy loss. If a pregnancy spontaneously ends after 20 weeks, the loss is instead considered a stillbirth.

Both miscarriage and early pregnancy loss are very common, so you’re far from alone if you experience either. As many as 1 in 5 clinical pregnancies (meaning the pregnancy is confirmed by a healthcare provider) may end in miscarriage, and around 80% of those pregnancy losses happen in the first trimester.

About 1% of people who are capable of pregnancy will experience recurrent pregnancy loss (two or more miscarriages). If someone has three miscarriages, experts recommend they visit their healthcare provider for an evaluation.

What are the signs of a miscarriage or early pregnancy loss?

According to the American College of Obstetricians and Gynecologists, the following signs may suggest a miscarriage or early pregnancy loss:

• Vaginal spotting or bleeding (with or without pain)
• A gush of vaginal fluid (with or without pain)
• The passage of tissue from the vagina

While light bleeding in early pregnancy is common (about 15-25% of pregnant people have vaginal bleeding in the first trimester), it’s always good to reach out to your prenatal care provider to rule out a miscarriage or ectopic pregnancy (when a pregnancy develops outside of the uterus) if you do experience any. That said, if bleeding is heavy or you feel menstrual-like cramping, it’s important to reach out immediately.

Why do miscarriages or early pregnancy loss happen?

About 50% of miscarriages are due to chromosomal abnormalities (abnormalities in the cells that carry our genetic material), which makes it difficult or impossible for the embryo to develop properly. While not all chromosomal abnormalities lead to miscarriage, some do. The chromosomal abnormality that most often results in miscarriage is trisomy 16 (an extra copy of chromosome 16).

Genetic material is fragile, and the rate of pregnancy loss increases with age. After the age of 40, a pregnant person has about a 1 in 3 chances of having a miscarriage (compared to the overall rate of 1 in 5). Sperm from older partners or donors may also contribute to increased rates of miscarriage, but the exact age at which that can happen is unclear.

Can a pelvic floor ISSUE cause a miscarriage or early pregnancy loss?

First, a quick refresher on pelvic floor dysfunction: Pelvic floor dysfunction (PFD) occurs when the pelvic floor is having trouble either supporting the organs held in place by the pelvic floor (the vagina, uterus, bladder, and bowels), holding in urine, stabilizing the lower back, hips, or pelvis, keeping sex pleasurable and pain-free, or circulating blood through the pelvic lymph nodes and vessels.

In most cases, PFD is caused by pelvic floor muscles that are too tight, too weak, or a combination of the two. This means that it can happen in people who’ve never been pregnant or can even be the result of a pregnancy. In fact, pregnancy and childbirth are two of the life stages when PFD is most common.

If the muscles or connective tissues that support the pelvic organs are injured or damaged in pregnancy or childbirth, it can increase the risk of developing pelvic organ prolapse (POP) — when one or all of the pelvic organs (uterus, bladder, rectum or small intestines) slip out of place. Most people with vaginal anatomy will develop some degree of prolapse, and the risk increases with each pregnancy. In most instances, POP occurs without any serious complications, but it can affect the normal functioning of the affected organ.

In the very, very rare event that a uterine prolapse happens during a pregnancy (seen in case reports here and here), it could lead to adverse outcomes like preterm birth or miscarriage if the prolapse is significant enough. But for the vast majority of PFD types, there shouldn’t be any effect on miscarriage rates.

Healing from a miscarriage or early pregnancy loss

After a miscarriage or early pregnancy loss, there may be emotional and physical recovery to contend with. There’s no wrong or way to navigate in the aftermath of any loss, and pregnancy loss is no exception.

Emotional healing after a miscarriage or early pregnancy loss

The authors of a 2021 paper on the effects of miscarriage that was published in The Lancet found that miscarriage is strongly linked to anxiety, depression, and suicide. In one study the paper cited with 537 women who had experienced a miscarriage, 18% of participants met the post-traumatic stress disorder criteria, 17% met the criteria for moderate or severe anxiety, and 6% met the criteria for moderate or severe depression. Pregnancy loss can also have a more far-reaching impact on identity and sense of self.

Emotionally healing may be challenging and will likely look different from person to person. For some, the thing that’s needed most is time to heal. Other people may benefit from processing the experience with a psychotherapist using therapeutic modalities like cognitive behavioral therapy or somatic experiencing (which centers the mind-body connection).

Physical healing after a miscarriage or early pregnancy loss

Sometimes, though not always, pregnancy tissue remains in the uterus after a miscarriage. Next steps will depend on how far along the pregnancy was.

If there are no signs of infection, a provider may suggest what’s called “watchful waiting” — or letting the pregnancy fully pass on its own. This can take up to two weeks. Medication can also speed up the process.

If there is heavy bleeding, certain health conditions, or there are any signs of infection, a provider will likely recommend an in-clinic procedure.

Physical recovery may move faster than emotional recovery because it can be a bit more straightforward and easy to predict. But the physical effects of a miscarriage are far-reaching, impacting the mind and body in other ways.

How a miscarriage or early pregnancy loss can impact the pelvic floor

During miscarriage and miscarriage management, it's common to experience heavy bleeding and cramping, as the body returns to its pre-pregnancy state. This pain can sometimes trigger a tension response in the pelvic floor muscles.

Pain and discomfort can also come from the pregnancy itself. Even if a pregnancy doesn’t continue to term, the body has undergone major changes to prepare for growing a fetus and then childbirth. The longer a pregnancy progresses before miscarriage, the more changes the body will have made — potentially leading to more effects on the pelvic floor.

In early pregnancy, these are some of the ways the pelvic floor can be affected:

• Increased blood supply and a change in hormones can result in more frequent trips to the bathroom.
• Increased progesterone levels in support of a growing pregnancy (and prenatal vitamins with iron) can make you constipated, which puts stress and strain on the pelvic floor muscles.
• An increase in the hormone relaxin, which helps the muscles expand and loosen up in preparation for a growing pregnancy, can sometimes reduce stability in the pelvic joints, tailbone, and coccyx, creating more work for the abdominal and pelvic floor muscles.
• One of the earliest signs of pregnancy can be the Chadwick’s sign — or redness caused by vascular changes (increased blood flow and congested blood vessels) in the pelvic area brought on by pregnancy.
• By 12 weeks, the uterus is about the size of a grapefruit and the placenta could weigh up to 51 grams — meaning there’s already extra weight sitting on your pelvic floor muscles.

The emotions we feel after a miscarriage can also leave a lasting imprint on our pelvic floors, explains Dr. Ashley Rawlins, PT, DPT, a physical therapist and the clinical learning and development lead at Origin. “Research shows those who have experienced trauma are more likely to have increased pelvic floor muscle activity, and this likelihood is even greater if you have symptoms of PTSD,” she says. “This increased pelvic floor activity can lead to a variety of symptoms including pelvic pain, sexual pain and dysfunction, and bowel and bladder dysfunction.”

How pelvic floor physical therapy can help with healing from a miscarriage or early pregnancy loss

Pelvic floor physical therapy can be a way to merge efforts to emotionally and physically heal from a miscarriage or early pregnancy loss.

When we experience a trauma like pregnancy loss, it can live on in our bodies. If, for example, someone’s pregnancy loss manifests in an emotional and physical disconnect from the vagina and/or uterus, creating the space to release trauma and tension with a trauma-informed physical therapist can be a form of healing.

Pelvic floor physical therapy can also help your body manage pains and discomfort from pregnancy. Because pregnancy (even one that doesn’t continue to term) puts so much stress on the body, pelvic floor physical therapy can help you restore the pelvic floor muscles to decrease pelvic pain and urinary incontinence.

“Pelvic floor physical therapists tend to always approach pelvic pain from a trauma-informed perspective, meaning they have an enhanced understanding of how our emotions impact us physically (and vice versa) — and use the knowledge to help calm the nervous system while healing pain,” Rawlins explains. “Often, psychotherapy is utilized as a complement to pelvic floor physical therapy treatments — and they will be able to help you find a trusted provider that will help you work together as you heal from the pain and trauma at any stage of pregnancy loss.”

Healing with Origin

Origin’s trauma-informed physical therapists take a biopsychosocial approach to healing the pelvic floor. “We often focus on patient education, mindfulness, and movement-based therapies as a means to help patients learn how their brain and body changes contribute to chronic pain,” Rawlins explains.

Pelvic floor physical therapy isn’t yet a standard of care in reproductive health, but we believe it absolutely should be. Research shows that people who can get pregnant receive very little information about pelvic health in pregnancy or postpartum — both of which are also experienced with pregnancy loss.

“Checking in with your pelvic floor physical therapist on a regular basis is just as important as seeing your dentist or gynecologist for ongoing care and preventative screenings,” Rawlins says. “A pelvic floor physical therapist can help you understand the current state of your pelvic health and help you optimize your pelvic floor muscle function as you transition through the various stages of life.”

Community resources for miscarriage and early pregnancy loss

As a society, we don’t talk enough about how common miscarriage is. Supportive communities like the ones listed below can help those of us who’ve experienced pregnancy loss build relationships with people who’ve been through the same:

• Grieve Out Loud: An online space for people to share their experiences and grieve together.
• Miscarriage Matters: A peer community of parents who’ve experienced pregnancy loss.
• Postpartum Support International: Loss and Grief: A list of tools, support groups, and other resources curated by a leading postpartum support organization.
• Return to Zero: H.O.P.E.: Holistic support for all types of parental loss and bereavement.
• SHARE: Pregnancy and Infant Loss Support, Inc: A support group for pregnancy and infant loss that has more than 75 chapters nationwide.