Empowering Your Pregnancy and Postpartum Journey with Pelvic Floor Physiotherapy

Pelvic floor physiotherapy has taken the world by storm in the past few years, and for good reason. Pelvic floor physiotherapy is an evidence-based, specialized form of physical therapy that focuses in on assessing and treating issues related to the pelvic floor muscles. It involves a wide variety of techniques to strengthen, relax, and connect to the pelvic floor muscles with the goal of improving their function, and decreasing symptoms related to pelvic floor dysfunction. Pelvic floor physiotherapy can play a pivotal role in a wide array of conditions, including urinary incontinence, painful intercourse, pelvic organ prolapse, vaginismus, and many more. Today we will focus on its role throughout pregnancy and postpartum.

How Pelvic Physiotherapy Can Assist In:

1. Preconception

First and foremost, it must be emphasized that physiotherapy is NOT a direct fertility treatment. However, research suggests that it plays a beneficial role in supporting the reproductive process by addressing concerns that may impact fertility. Through pelvic floor physiotherapy assessment and treatment, barriers to conception can be identified– for example: painful penetration, high pelvic floor tension, and postural dysfunction. A 10 year prospective trial published in 2015 explored how hands-on physiotherapy treatment can aid in the treatment of infertility. It was found that physiotherapy can help promote positive pregnancy outcomes by addressing potential barriers to conception through patient-centered, hands on care.

Additionally, painful intercourse, known as dyspareunia, is a common condition that is typically associated with sexual function issues such as anxiety during sex, vaginal dryness, or difficulty reaching an orgasm. This is a common barrier when it comes to conception. Through education, manual techniques, and pelvic floor muscle exercises (strengthening or lengthening exercises), pelvic physiotherapy can help to decrease dyspareunia symptoms, ultimately aiding in your conception journey.

2. First Trimester

Throughout pregnancy, the pelvic floor (and the rest of the body) goes through a lot of changes due to increased pressure and strain as the uterus grows. It is important to address these things early, as this can help prevent complications during pregnancy and birth. For some women, pregnancy symptoms such as pelvic pain, hip pain, and low back pain begin early, whereas for others, these symptoms don’t start until later in pregnancy. Whether or not you are experiencing symptoms in the first trimester of pregnancy, it is important to see a pelvic floor physiotherapist to better understand your baseline.

Additionally, research shows that early pelvic physiotherapy and muscle training can significantly reduce the risk of pelvic pain, musculoskeletal pain, incontinence, and other complications later in pregnancy.

3. Second Trimester

This is a critical period in pregnancy for managing symptoms and preparing the body for the challenges of the third trimester and labor. Pelvic physiotherapy plays a key role in symptom management, pain relief, and strengthening of the pelvic floor and surrounding muscles to support a healthy pregnancy. When it comes to symptom management, pregnant women can experience a whole range of different symptoms, from pelvic/low back pain to incontinence. Whether you experience these symptoms or other symptoms, pelvic physiotherapists are equipped to help you through external manual work, hands on techniques, and exercise.

Strengthening the pelvic girdle, including the glutes, adductors and core, is essential for maintaining overall stability and preparing for labor. It works to increase pelvic stability to keep the pelvis aligned, which can make it easier for the body to handle the demands of labour. A strong pelvic girdle can help the pelvis move more fluidly and maintain alignment during contractions and pushing.

Additionally, pelvic floor muscles play a vital role in labor. They need to be both strong (to support the weight of the growing baby) and relaxed (to allow the baby to pass through the birth canal). By strengthening the pelvic floor, you prepare to support the weight of the baby, reducing strain on the muscles. A strong pelvic floor and strong core also helps during pushing in labor, as it provides more control over the muscles that will help the baby move through the birth canal.

4. Third Trimester

The third trimester is split into two parts: early and late. This time is critical in preparing the body for a smooth labor and delivery.

Early in the third trimester, the goals are the same as the second trimester – strengthening the pelvic floor and entire pelvic girdle and starting with hip openers combined with some stretching. A study done in 2020 shows that continued pelvic floor strengthening throughout this stage of pregnancy can reduce the risk of pelvic organ prolapse and improve labor outcomes.

Later in the third trimester, the focus shifts to symptom management, relaxation, stretching, and preparing for labor positions to optimize delivery outcomes. Here, breathing exercises are key to help the body relax and ensure the pelvic floor muscles can lengthen and release during labor. Studies show that breathwork and relaxation techniques prior to labor can promote blood flow, reduce muscle tension, and help labor progress while managing pain.

Finally, you may have heard of perineal massage before. It is an effective tool that can help prevent tearing and promote elasticity in the perineum during delivery. The perineum is the space between the vaginal and rectal openings. Starting later in the third trimester, gentle perineal stretching can help prepare the tissue for the stretch during childbirth. It isn’t meant to permanently change the length of the perineal tissue, but instead, allow you to feel pressure in that region, and practice breathing into it. This way, during labor, your muscles have a better chance at staying relaxed, and in turn, decrease the likelihood of tearing during delivery.

5. Postpartum

The postpartum period is key for recovery, and pelvic physiotherapy supports musculoskeletal healing, restores core and pelvic floor function, and aids in a safe return to activity. One common concern amongst new mothers is diastasis recti.

Diastasis recti is the separation between the rectus abdominis muscles which are the two vertical “six-pack” muscles in the abdomen. This condition occurs when the tissue connecting the two sides of the rectus abdominis stretches and weakens, creating a gap between them. The most common cause of this is pregnancy, due to the expanding uterus which puts pressure along the abdominal wall. This may sound scary, but it is quite common, and reversible through physiotherapy assessment, education, and targeted core strengthening.

One other thing that you can do to support your postpartum recovery is breath work. Breathing exercises help you reconnect with your core and pelvic floor to restore core stability, prevent incontinence, and support pelvic floor health. Breathing exercises and light core work are the first steps in return to activity. A pelvic floor physiotherapist will guide  you through such exercises and help choose exercises that are right for you wherever you may be in your journey.

References

Braga, L., & Hennessey, M. (2019). The impact of pelvic floor muscle training on incontinence: A clinical review. BMC Women’s Health, 19(1), 125. https://pmc.ncbi.nlm.nih.gov/articles/PMC6494625/

Dorey, G., & Clift, S. (2001). Pelvic floor muscle training for the treatment of urinary incontinence in women. American Journal of Obstetrics and Gynecology, 185(3), 708 714. https://pmc.ncbi.nlm.nih.gov/articles/PMC1395760/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8073097/

Kegel, A. H. (2015). The role of pelvic floor exercises in preventing and treating incontinence: A review. International Urogynecology Journal, 26(7), 1007-1015. https://pubmed.ncbi.nlm.nih.gov/25691329/

Lifemark. (n.d.). How pelvic floor physiotherapy can help during pregnancy. Lifemark. https://www.lifemark.ca/blog-post/how-pelvic-floor-physiotherapy-can-help-during-pregnancy

Morkved, S., & Bo, K. (2013). Pelvic floor muscle training during pregnancy: A systematic review and meta-analysis. PM&R, 5(1), 1-11. https://pmc.ncbi.nlm.nih.gov/articles/PMC3717046/

Murphy, B., & Gallagher, T. (2019). Pelvic floor dysfunction in pregnancy: A critical review. International Urogynecology Journal, 30(2), 267-276. https://pmc.ncbi.nlm.nih.gov/articles/PMC7203602/

Paquette, S., & McGillion, M. (2020). The role of pelvic floor physiotherapy in post-partum recovery: A systematic review. Journal of Women’s Health, 29(5), 620-630.

Sapsford, R., & Hodges, P. (2020). Pelvic floor muscle training for women with pelvic pain: A systematic review. Physical Therapy Reviews, 25(1), 1-12. https://pmc.ncbi.nlm.nih.gov/articles/PMC7657576/