Pelvic Floor Series Part 3. The Ligaments of the Pelvic Floor.

What are the pelvic floor ligaments?

We hear a lot about the pelvic floor muscles, but the pelvic floor anatomy also includes ligaments. These ligaments attach and suspend your pelvic organs within your pelvis.

Ligaments are gristly, sinewy, strong bits of connective tissue that connect joints and other parts of your body together. Generally ligaments aren’t very stretchy. They don’t lengthen and then snap back like brand new elastic. They’re not like muscles which are designed to both lengthen and shorten. Ligaments, once stretched, are unlikely to return to their original length and tension. 

BUT, your uterine ligaments which connect with, support, and suspend your womb, are different to the normal ligaments found in the rest of your body. 

Uterine ligaments are made up of a combination of smooth muscle AND fibroelastic connective tissue, sometimes called ‘fibro-muscular connective tissue’. This means that whilst your uterine ligaments are very strong and supportive, they’re also designed to lengthen. Which is a good thing during pregnancy when they need to stretch in relation to your growing womb.

You might have heard of some of your uterine ligaments, they include the round ligaments, the broad ligament, the pubocervical ligaments, the utero sacral ligaments, the transverse cervical/cardinal ligaments.

If you’re pregnant or have ever been pregnant, you might be familiar with your ’round ligaments. They stretch such a lot during pregnancy as the womb expands and sometimes they can become incredibly and unexpectedly painful and uncomfortable!

What do the pelvic floor ligaments do?

Basically they suspend your uterus inside, and in relation to your pelvis, pelvic organs, pelvic bones and muscles.

Your uterine ligaments attach your uterus (womb) to the inside surface of your pelvis – to the back, sides, and front of your internal pelvis, almost like the way guy ropes help to stabilise a tent from the outside. (Guy ropes are the ropes that attach a tent to the ground and create tension and suspension of the tent structure and walls.)

These ‘guy rope like’ uterine ligaments ‘give’ a little under increased pressure or high impact movements like running, jumping, or coughing, and then hopefully they spring back. But they can absolutely be strained through bearing down during childbirth, or constipation, and also just through the weight of the womb during pregnancy, or not resting enough during postpartum. 

And Interestingly the uterosacral ligaments insert onto your sacrum, coccyx, sacroiliac ligaments, and piriformis muscle which makes them deeply involved in the way your lower back, pelvis and hips all work.

So what happens to the Ligaments of the pelvic floor?

During pregnancy your pelvic floor ligaments stretch and lengthen to accommodate your growing baby inside your womb. So even if you give birth via a cesarean, these ligaments will be stretched and will take time after birth to recover and heal. There’s just no way around the need for women to rest and recuperate post birth to support full physical recovery! 

Uterine ligaments are MADE to stretch to accommodate your expanding uterus. But this also means that sometimes they become a little over stretched. Think of how well used elastic will stretch out, but then can be slow to recoil. 

Particularly if there was a long pushing phase during a vaginal birth, it’s incredibly important to recognise that these ligaments will need time to heal in order to return to their normal length and tension. Because lengthened, loose, and saggy pelvic ligaments can absolutely contribute to pelvic organ prolapse. Which is something you definitely want to avoid.

Standing upright for even short periods of time in the early days and weeks after birth can prevent the pelvic ligaments from returning to their healthy state of length and tension. And loading the pelvic floor (as in lifting something heavy like a toddler, or doing high impact activities like running) whilst the ligaments are still over stretched from pregnancy and birth, can easily cause a pelvic injury like pelvic organ prolapse. (A pelvic organ prolapse is when the organs within the pelvis move down out of their original position. This can sometimes cause pain, leaking, discomfort and distress.)

Postpartum rest is vital for a woman’s long term pelvic health and function. 

How can you support your pelvic floor ligaments?

During early postpartum you need to prioritise rest and recovery. This means plenty of lying down, especially in the first two weeks after birth. Not standing or sitting upright for long periods. Not walking for long periods of time. Not returning to jogging, or high impact exercise, or heavy lifting (baby capsules and toddlers are heavy!) before healing and rehabilitation have occurred. 

A simple guide for better postpartum recovery is to walk or stand for a maximum of 20 minutes in those first few weeks after birth. Or, if you feel symptoms like heaviness, aching, or dragging in the pelvic floor region, then you need to sit down or lie down immediately to take the weight off those healing pelvic floor ligaments.

Given abundant postpartum rest in the early weeks after birth, and then a graded return to everyday life and exercise, the pelvic ligaments CAN absolutely recover to function. This means they’re able to suspend and support the organs within your pelvis in connection with your pelvic bones, and in coordination with the muscles of your pelvic floor.

Because all these parts of your pelvis aren’t separate. They work together as an integrated whole. Which is why it really helps if the surrounding areas like the pelvic bones and muscles are balanced, connected, and able to both activate and release. 

And this is why it’s really helpful to get some structural body work from a practitioner like an osteopath or chiropractor who has a special interest in treating postpartum women. And this is also why rehabilitative support from a women’s health physiotherapist or a pilates instructor with training in postpartum recovery can be so valuable to your healing.

Here’s where you can read Part 1. All about the Pelvic Bones, and Part 2, The Pelvic Floor Muscles.

And here’s my free e book where you can learn more about early postpartum recovery.