Beyond Kegels: Brittany Mahomes’ Pelvic Floor Woes Post-Childbirth

Welcome to Culture Clinic, MedPage Today‘s collaboration with Northwell Health to offer a healthcare professional’s take on the latest viral medical topics.

Brittany Mahomes, influencer and businesswoman, is married to her high school sweetheart Patrick Mahomes — the Kansas City Chiefs’ star quarterback who recently took home his third Superbowl win. Their daughter was born in 2021 and their son in 2022.

But she recently broke from her usual social media content of photos of her family life, brand deals, and husband, to post about pelvic floor health.

“Just a daily reminder: Once you have kids please take care of your pelvic floor. Seriously,” Mahomes wrote on her Instagram story to her 1.9 million followers, according to reports. “From: A girl with a fractured back,” she signed off.

Veronica Gillispie-Bell, MD, an ob/gyn at Ochsner Health Center in Kenner, Louisiana, told MedPage Today that Mahomes is likely talking about fracturing her tailbone or pelvis, which she said is a rare side effect of pelvic floor dysfunction. Gillispie-Bell noted that many people have to build back pelvic floor muscles after having kids.

“Damage to the pelvic floor is a very common thing to happen, not just in childbirth, but just in carrying a pregnancy,” she said, because carrying a baby stretches out the nerves and muscles, which can cause weakness. She explained that people who carried larger babies are more at risk for pelvic floor dysfunction because of greater pressure on their pelvic floor. The same goes for people who had a vaginal delivery and had to push for several hours.

According to a JAMA study from 2008, about a quarter of women will experience at least one pelvic floor disorder in their lifetime. The most common is urinary incontinence, followed by fecal incontinence, then pelvic organ prolapse. Age, parity, and obesity increased the likelihood of having at least one pelvic floor disorder.

Allison Grote, DPT, a pelvic floor physical therapist at Northwell Health in East Meadow, New York, told MedPage Today that she often sees patients struggling with urinary or fecal incontinence because one of the roles of the pelvic floor is maintaining continence. Pelvic floor weakness after birth commonly leads to urinary incontinence, where patients leak urine when they cough or sneeze.

“Your pelvic floor functions like a hammock and it runs from your pubic bone to your tailbone, and from your sit bone to sit bone on each side,” Grote explained. The pelvic floor is part of the core, she noted, alongside the abdominal and back muscles and respiratory diaphragm. When one of those muscle groups is weaker or imbalanced, the others have to work harder, which is why back issues can be a side effect of pelvic floor weakness. A small 2022 study in Physical Medicine and Rehabilitation found that about half of women seeking physical therapy for pelvic pain had coccydynia — tailbone pain.

Pelvic floor physical therapists perform an internal pelvic floor exam to “assess pelvic floor muscle tone, tenderness, coordination, as well as strength and endurance,” Grote said. Kegels, the most well-known pelvic floor exercise, are for strengthening — but sometimes the problem is that the pelvic floor is actually too tense and unable to relax.

“Being evaluated by a pelvic floor therapist can determine what the problem actually is, because maybe you need Kegels, but maybe you need some relaxation and lengthening of those muscles first so … they’re not tensile all the time,” Grote said. Stretching and diaphragmatic breathing helps the pelvic floor to lengthen and relax.

Grote also noted that everyone has a pelvic floor and that men can experience pelvic floor weakness or tightness, too, which can be tied to surgeries such as prostatectomies.

Both Grote and Gillispie-Bell said that excessive lifting for exercise or work causes stress to the pelvic floor. They also emphasized how all muscles, including the pelvic floor, get weaker with age. Gillispie-Bell noted that conditions affecting connective tissue, like diabetes, also increase risk for pelvic floor dysfunction. Decreasing amounts of estrogen as menopause sets in plays a role, too.

Estrogen helps with blood supply and to provide the elasticity to the tissue, Gillispie-Bell explained, adding that elasticity improves the tensile strength that keeps the pelvic floor supportive. Gillispie-Bell urged fellow physicians to specifically ask patients about urinary incontinence when coughing or sneezing because they often don’t bring it up themselves.

“I think it’s a mix of being embarrassed to thinking, ‘Well, this is just what happens when you get older,’ and not knowing that there are things that you can do, and things that you can do that are not always surgery,” she said. “So I think as physicians, we should not always expect our patients to be forthright with that symptom.”

Pelvic organ prolapse is a more serious pelvic floor disorder, where weakness of the pelvic floor results in organs shifting out of place, which Gillispie-Bell said can occur to varying degrees. She’s even had elderly patients with complete procidentia, a severe stage of pelvic organ prolapse where the entire uterus falls out.

Non-surgical treatment includes trying to put the organ back in place and using a pessary for added support, but many people do need surgery and a visit with a urogynecologist, Gillispie-Bell said. Surgical interventions could include a hysterectomy to remove the uterus, or colpocleisis, which closes off part of the vagina and is only an option for women who are no longer sexually active.

“Sometimes mesh is used to help kind of pull the tissue up and keep it into place,” Gillispie-Bell explained, adding that surgical mesh has become controversial because it can “erode through the vaginal tissue” especially in menopausal women whose tissue is drier and thinner.

Grote encouraged physicians who see patients struggling with incontinence or pelvic floor pain to refer them to a pelvic floor physical therapist.

“Let us help these patients,” she said. “We have the tools and we know what to do.”

Please enable JavaScript to view the

comments powered by Disqus.