Vaginal heaviness and pressure during pregnancy: why it happens and what can help

What that heavy feeling may mean, why more Kegels aren’t always the answer and what can make you more comfortable.

Vaginal heaviness during pregnancy can feel a bit like a tampon that isn’t sitting properly, except you obviously aren’t wearing one. There may be heaviness or downward pressure inside your vagina that’s barely noticeable in the morning but becomes much more apparent after you’ve been on your feet for a while. It doesn’t always show up as pain, which can make it difficult to explain the discomfort.

You may start wondering whether something has dropped inside your body (other than your baby!), whether you’ve been lifting too much, or whether you should have been more diligent about those Kegels everyone keeps recommending. And while “there’s a baby in there” is certainly true, it doesn’t really properly explain why your activities of daily living now feel a bit different and uncomfortable, and that explanation certainly doesn’t tell you what you can do about it.

The weight of your baby, uterus, fluid and placenta absolutely put more strain on your pelvic floor during pregnancy, but that’s not usually the whole picture. Constipation and straining, swollen veins around the vulva and changes in the support of the pelvic organs can also contribute to heaviness and pressure. Sometimes (in fact, often) there’s more than one thing going on. Before asking those muscles to squeeze more, it helps to find out what’s actually making you uncomfortable.

When does vaginal pressure need urgent medical attention?

New or increasing downward pressure on your pelvis and vagina needs prompt medical advice, especially before 37 weeks or if it feels as though your baby is pushing down. It can be a sign of preterm labour, even without painful contractions.

If the pressure comes with regular tightening feel, period-like cramps, a persistent new backache, bleeding, leaking fluid, changes in discharge or your baby moving less than usual, call your midwife, doctor or the labour and delivery unit at your hospital right away. Fever, burning when you pee or trouble emptying your bladder also needs prompt medical attention, as it could be a UTI or something similar. Severe pain, heavy bleeding, feeling faint or being unable to pee needs urgent care.

Why can your vagina feel heavy during pregnancy?

Your pelvic floor has more to support

Your pelvic floor sits across the bottom of your pelvis, a bit like a hammock underneath your bladder, bowel and uterus. Those muscles help support your organs, but they have other jobs too. They need to relax enough for you to pee and have a bowel movement, then contract when you need them to, like when coughing, laughing and lifting.

During pregnancy, there’s a growing baby, uterus, placenta and amniotic fluid above that hammock, while hormonal changes affect the supporting tissues as well. You may be taking exactly the same walk or working the same hours, but every day your pelvic floor is being asked to manage more than it was the day before.

This extra load can help explain why the heaviness shows up after you’ve been standing, walking or carrying your other child (thank you, gravity), and why you might feel better after a rest. Knowing that you’re comfortable in the morning but struggling by dinner is useful, even though it doesn’t tell us the cause on its own.

Constipation can add to the pressure

Constipation is a really common by product of pregnancy and can make vaginal heaviness considerably more bothersome. Your bowels may be moving more slowly, iron supplements may be making the stool harder, and having a bowel movement can start to involve a lot more pushing than it used to. That repeated downward pressure adds to what your pelvic floor is already managing.

The rectum sits directly behind the vagina, so what’s happening with your bowels can affect how the area feels. Your pelvic floor also needs to relax to let stool pass. If the muscles are having trouble letting go, you may find yourself straining even when the stool isn’t hard.

This is a truly perfect example of why pelvic floor physiotherapy isn’t just about strengthening. You may need help relaxing those muscles to make bowel movements easier.

Swollen veins can make the vulva feel heavy

Varicose veins can develop around the vulva during pregnancy, not just in the legs. This tends to come as a surprise, especially when you’re already trying to work out why the area feels swollen or uncomfortable.

These are called vulvar varicosities. During pregnancy, more blood flows through the pelvis, while the growing uterus can make it harder for blood to flow back towards the heart. Blood can collect in those veins, leaving the area around the vaginal opening feeling achy, full or heavy. You may notice blue or purple veins, although they aren’t always obvious.

Heaviness around the outside and downward pressure deeper inside your pelvis can feel similar to a varicosity, but they may have different causes. Where you feel it can help us understand what’s happening and what might help.

Pain around the pelvic joints can happen too

Pregnancy-related pelvic girdle pain can affect the pubic area, groin or back of the pelvis. Some people are able to walk reasonably comfortably but find that rolling over in bed or standing on one leg to put their socks on hurts far more than they expected. Others find walking more than a block or two incredibly uncomfortable, and finding a comfortable position for sleep may be a challenge.

Pelvic girdle pain isn’t the same as a heavy feeling inside the vagina, and it’s absolutely possible to have both things happening at once. Getting information about which movements hurt, where you feel the pain and when the heaviness begins helps us understand whether there’s more than one thing going on.

Our pregnancy chiropractic page explains more about care for back and pelvic discomfort during pregnancy.

Does vaginal heaviness mean pelvic organ prolapse?

Heaviness can happen with prolapse, but it isn’t enough on its own to tell us that something has prolapsed.

Pelvic organ prolapse happens when the tissues supporting the pelvic organs weaken, allowing one or more of those organs to bulge into the vagina. You may feel heaviness or a bulge, or you might notice that emptying your bladder or bowels has become more difficult. Pregnancy itself affects pelvic support, so prolapse isn’t something that can only happen after a vaginal birth.

The word “prolapse” makes this sound much more dramatic than it often is. It’s easy to picture an organ falling right out of your body, when the actual tissue change is likely much less severe than that. The amount of heaviness also doesn’t tell us how far anything has moved or how much treatment you’ll need.

A pelvic examination can be so helpful in understanding your individual situation. Comparing yourself with pictures online isn’t often useful, because most of us don’t usually have a super clear sense of what our pelvic anatomy looked like before pregnancy.

Our guide to pelvic organ prolapse after birth explains the different types and what care can involve postpartum.

What can help with vaginal heaviness during pregnancy?

What will help you depends entirely on why you’re feeling heavy. Exercises may be useful, but so may treating constipation, changing how much you’re doing at once or any number of other things.

It helps to know what’s actually causing the problem before trying several things at once.

Modify the things that cause discomfort

If the heaviness builds during a longer walk, shorter walks with a break may be more comfortable for now. If it happens after standing for a long stretch, changing position or sitting for part of the activity, if possible, may help.

Of course, being told to rest more doesn’t change the length of your shift or explain how you’re supposed to get a toddler into a car seat. This is precisely why advice needs to be more specific for your particular situation. A pelvic physiotherapist can assess the movements and activities that are causing discomfort for you and provide a treatment plan that is unique to you.

Lying on your side may ease pressure from vulvar varicose veins, while pelvic girdle pain may need you to make adjustments to the movements that hurt. You may need some help deciding what to change without needlessly changing your activities of daily living.

Make bowel movements easier

If constipation is a problem for you, this should be addressed, alongside any pelvic floor exercises or treatment that you are doing. Drinking plenty of water, adding fibre gradually and maintaining daily activity can help soften your stool and keep things moving. If you’re not much of a water drinker, try adding something to the water to make it more palatable.

Placing a small footstool in front of your toilet can help you sit with your knees above your hips during bowel movements. Give yourself time to let the pelvic floor relax instead of holding your breath and repeatedly pushing harder. Avoid sitting on the toilet for a long time or repeatedly straining, as both can contribute to hemorrhoids.

If your stool is still difficult to pass, a pharmacist can discuss treatment that’s suitable during pregnancy. Iron supplements commonly contribute to constipation. Ask your pharmacist or health care provider about an alternative to your current iron supplement if that seems to be contributing to the problem.

Find out whether a support garment would actually help

There are plenty of support garments available for pregnancy, but remember that a belt for pelvic girdle pain and a garment for vulvar varicose veins aren’t doing the same job. They may both be sold as pregnancy support, but that doesn’t mean they’re interchangeable.

Before buying one, it is important to know whether you’re trying to support painful pelvic joints or swollen veins around the vulva. Your pelvic physiotherapist can help you work that out.

Should you be doing more Kegels?

There’s plenty of advice available online and in the media about strengthening the pelvic floor during pregnancy. Pelvic floor muscle training can be helpful, and the Canadian pregnancy physical activity guideline recommends it to reduce the risk of urinary incontinence, with attention to proper technique.

However, a heavy feeling doesn’t accurately tell us what specifically needs strengthening. You may actually need a bit of help learning how to down-regulate those muscles so they can relax before you can accurately and effectively strengthen the right ones. Being able to relax your pelvic floor is every bit as important as being able to contract it.

It can be incredibly difficult to accurately tell what you’re doing with muscles you can’t see. You may be putting a lot of effort into the exercise while holding your breath, bearing down or squeezing without fully releasing between repetitions.

Pelvic floor physiotherapy can help you learn what the movement should feel like and work out whether strength, relaxation or coordination needs more attention. Our article on pelvic floor tightness explains why more squeezing isn’t always the answer.

If an exercise increases the pressure or leaves you sore, pause it and get some guidance. Doing more of an exercise that’s making you uncomfortable may not help.

What happens at a pelvic floor appointment?

Your first appointment will begin with a conversation about the pregnancy, when the heaviness started, what makes it better and worse, and what you’ve already tried. Your physiotherapist will also ask about bladder and bowel habits, previous births or surgery, your pain or discomfort, and the activities that have become difficult as a result of this discomfort.

You don’t need to know whether to call it pressure or heaviness. Explaining that something feels uncomfortable when you walk, or that you’re comfortable until the afternoon, gives us useful information.

The examination may include your breathing patterns, as well as the function of your abdomen, hips, back and pelvic floor. An internal vaginal examination can provide more information, but whether it’s appropriate depends on your pregnancy. It should always be thoroughly explained to you before you give your consent, and you can decline, pause or stop at any point. There are other ways to begin if you don’t want an internal examination.

If you’ve had a painful examination before, that matters too. Your physiotherapist can talk through what might make this visit more comfortable and explain each part before proceeding.

Treatment may include exercises, help with bowel habits or changes to the way you do something. If you booked your appointment because walking has become uncomfortable, your pelvic physiotherapist should explain what may be contributing and how the exercises or other changes could help.

Our guide to what a pelvic floor physiotherapist does explains more about the appointment.

A few questions that may come up

Does vaginal pressure mean my baby has dropped?

A baby moving lower into the pelvis can increase pressure late in pregnancy, but the feeling alone can’t confirm their position. Unfortunately, it also can’t tell you when labour will begin. Babies often move lower, or “engage” in the pelvis in the last weeks of a first pregnancy. In subsequent pregnancies, this may happen later or not until labour begins.

Can I keep exercising?

That really depends on what’s causing the heaviness/discomfort and how your pregnancy is going. It makes sense to ease off any activity that is causing your symptoms and make sure to always get any new or worsening pelvic/vaginal pressure assessed.

Feeling heaviness or discomfort during one specific exercise doesn’t necessarily mean you need to stop exercising altogether. You may need to simply modify what you’re doing or how much you’re doing at once, with guidance based on your individual assessment.

Can this happen before I’ve ever given birth?

Yes, this can happen during a first pregnancy too. The pelvic floor is already supporting the growing pregnancy before birth happens.

Do I need to wait until after birth for physiotherapy?

No. Pelvic floor physiotherapy can help during pregnancy with heaviness, leaking, pelvic discomfort and difficulty with everyday movements. Your physiotherapist will take your pregnancy and any medical precautions into account when deciding how to begin.

You don’t have to put up with it until birth

It’s so common for providers to brush your symptoms off as “normal” pregnancy aches and pains, which will resolve after the birth of your baby. Knowing that something may improve after your baby arrives can be reassuring, but it definitely doesn’t do anything to help you today. And the reality is that most of those “normal” pregnancy aches and pains are not so much “normal” as just “common”, and remarkably treatable. There is no reason to suffer during pregnancy, especially when excellent and effective treatment is available to help you be comfortable for the duration of your pregnancy.

Our pelvic floor physiotherapists in Toronto, Newmarket and Mississauga can help you understand what’s contributing to the heaviness and what may make you feel better. You don’t have to spend weeks trying exercises on your own before coming in.

The appointment is a chance to explain what has changed and get advice that goes further than doing more Kegels or waiting for the pregnancy to be over.

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You can also explore our prenatal care services for help with other parts of pregnancy.