Pelvic Floor Therapy During Pregnancy
When most people think of pelvic floor physical therapy, they think about seeking help after delivering a baby- after pelvic floor dysfunction has already happened. Some common reasons that people will seek postpartum care include pelvic pain, incontinence, painful intercourse, diastasis recti, or pubic symphysis pain. What is not commonly known is that a pelvic PT’s care can be sought out during pregnancy or even before pregnancy to help alleviate active problems or to prevent them from occurring in the first place. During pregnancy, your body changes dramatically over nine months leading up to a culmination of pelvic floor trauma. Your body continues to adapt and adjust in the months following delivery into the “fourth trimester,” also known as the 12 weeks postpartum. Up to 78% of women will report lower back or pelvic girdle pain during pregnancy, 75% of women will report some level of urine leakage during pregnancy, and between 40 and 90% of women report that they receive little to no information about Kegels, episiotomies, and urine or fecal leakage*. Another common thing that women will experience is something called diastasis recti, or the splitting of the abdominal muscles due to severe stretch and strain. Nearly all women will experience some level of diastasis during pregnancy. While this condition is not painful, it can make it very difficult to engage your abdominal muscles afterwards which can then lead to core, back or pelvic floor dysfunction. So what can a pelvic floor physical therapist do to help address these issues during pregnancy? To begin, they can address current aches, pains, and pelvic floor issues. They can help you to relieve pain and help you maintain an active lifestyle throughout pregnancy. They can also help you to build up core and pelvic floor muscle endurance to increase physical activity safely. Pelvic floor PT’s can also help to teach you different pushing options, different labor and delivery positions, and stretches that will help reduce the likelihood of perineal tearing. Physical therapy during pregnancy can also decrease the length of labor! Pelvic floor PTs can help you to improve breathing techniques to improve pelvic floor lengthening, strengthening, and endurance as well as to coordinate breath during the pushing phase of labor. By teaching you targeted activities and stretches specific to your body, they can help you prepare your body for the extreme sport that is labor, delivery, and postpartum motherhood. Additionally, they can help you prepare for and navigate through your postpartum recovery. Pelvic floor PT can be helpful with four things: prevention, physical exercise, pain, and preparation for labor, also known as the four P’s. Prevention: Pregnancy amplifies or exaggerates whatever our body is already doing. To help prevent minor incorrect movement patterns from developing into sources of pain or dysfunction, PTs can provide education on proper posture and technique with activities of daily living. Physical exercise: They can help teach proper breathing strategies to utilize during exercise that help protect your pelvic floor, back, and abdominal muscles. They can also help with postural education and pregnancy-safe exercises. Pain: low back and hip pain, pelvic pain, or postural pain are all within the scope of practice of what a pelvic floor physical therapist can address during pregnancy. Preparation for Labor: Coordination of breath, lengthening of pelvic floor muscles, perineum stretching (manual tissue work), and increased muscle flexibility to get into labor positions that help to open up the birth canal. So what does a pelvic floor PT session look like during pregnancy? Each patient is treated as an individual so there is no one size fits all treatment approach, but typically, you can expect a one-hour-long individualized evaluation followed by several 45-minute follow-ups. This consists of a head-to-toe assessment of how your body is moving, what your pelvic rotation looks like, a breathing pattern assessment, a hip mobility screen, and possibly a pelvic floor assessment as well. Once areas of dysfunction are identified, your PT will hone in on those for our treatment approach! At Healthy Core, all three of the physical therapists utilize a very hands-on approach to their treatment style, focusing on manual therapy techniques, fascia mobilization, Integrative Dry Needling, and more. One important aspect of treatments is to decrease the muscle tone of pelvic floor muscles to achieve a more relaxed pelvic floor. This can help with the labor and delivery process. Talk to your doctor or health care provider about physical therapy. A referral is not needed in the state of Ohio (and most other states too) for you to see a physical therapist. However, you will want to know any precautions and get clearance from your healthcare provider before beginning an exercise routine during pregnancy. If you are not currently pregnant and thinking of becoming pregnant soon, why not prepare your pelvis for the "extreme sport" it is about to go through for the next 12 months? For more information or to schedule a FREE consult with one of our pelvic floor experts, call (330)528-0034 and learn what we can do to help you navigate your pregnancy. * Clinton, S. C. et al. (2017). Pelvic girdle pain in the antepartum population: Physical therapy clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the section on women's health and the orthopaedic section of the American Physical Therapy Association. Journal of Women’s Health Physical Therapy. * Sangsawang, B and Sangsawang N. (2013). Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. International Urogynecology Journal.
written by Joanna Pavlak, DPT - December 2022