Should You See a Pelvic Floor Physical Therapist During Pregnancy?

Pregnancy is an exciting time, but whoa, there are a lot of changes happening. But there’s a lot you can do to relieve pregnancy aches and pains — and many of these fixes start with your pelvic floor.

Meet Your Pelvic Floor

You’ve heard of the bicep muscles in your arms or the hamstring muscles in your legs, but many people don’t know about their pelvic floor muscles. Your pelvic floor is made up of layers of muscles, ligaments, and fascia (or connective tissue) that stretch from your pubic bone in front of your body back to your tailbone. Together, these structures make up the bottom or “floor” of the bowl-shaped pelvis. Here’s a “top-down” view of the bones and the muscles that make up the female pelvic floor.

Your Pelvic Floor During Pregnancy

Your pelvic floor supports your body’s organs: the vagina, uterus, bladder, and rectum, to name a few. Just as your abdominal muscles stretch to accommodate your growing baby, your pelvic floor muscles also undergo changes to compensate for pregnancy-related body issues, such as:

• Your bladder has more pressure from your uterus, which makes you need to pee all the time.

• Your hips and pelvis are affected by hormones released to relax ligaments, which allows them to expand for childbirth. This can cause pain and instability.

• Your upper and lower back may hurt because your growing breasts and belly are changing your center of gravity, which affects your posture and gait.

• Your bowels and rectum are more prone to constipation because of hormone changes and other factors, such as dehydration.

All of these changes affect your pelvic floor muscles, which can lead to what’s known as a pelvic floor disorder (PFD). Many symptoms during pregnancy can point to a pelvic floor disorder, including:

• Leaking pee occasionally, constantly, or with certain activities (like coughing or exercising)

• Urinary urgency and frequency, or feeling like you “gotta go” all the time

• Difficulty starting to pee or completely emptying your bladder

• Difficulty pooping, including frequent constipation, problems with hemorrhoids, fissures, trouble finishing a bowel movement, or leaking feces (staining your underwear)

• Pelvic pressure, bulging, or a feeling of heaviness in your vagina

• Pelvic pain that doesn’t go away or pain during sex

• Low back or hip pain that’s unexplained by musculoskeletal issues or injury

Your Pelvic Floor on Physical Therapy

Pelvic floor physical therapy can treat many different issues you may experience during pregnancy:

• Pelvic floor muscle training: Strengthening and relaxing the pelvic floor can provide support for your pelvic organs and baby, reduce urinary leakage, and help you prepare for birth.

• Core and hip strengthening. As your pelvis expands and the weight of the growing abdomen pulls your pelvis forward, your center of gravity shifts. This creates tightness in your low back muscles and your core muscles become overstretched and weakened. Learning safe pregnancy exercises to activate the core and hips can reduce low back and hip pain and improve your ability to move throughout your pregnancy.

• Breathing exercises. Believe it or not, there is a proper way to breathe. Learning to breathe deeply using your diaphragm (a dome shaped muscle under your ribs) helps promote stability in your abdomen and low back and relaxes the pelvic floor, which is crucial during labor.

• Labor preparation. Whether you are trying to prepare for the big event or you have aches and pain from pregnancy or past injuries that you think may affect labor and delivery, a pelvic floor PT can recommend exercises to help, as well as suggest labor and delivery positions.

Ask your Hinge Health physical therapist or coach about adding pelvic floor exercises to your plan.

Key Takeaways

1. Your pelvic floor is made up of layers of muscles, ligaments, and fascia (or connective tissue) that stretch from your pubic bone in front of your body back to your tailbone.

2. Body changes during pregnancy can impact the normal function of your pelvic floor muscles and cause a range of symptoms, from leaking urine and constipation to back and hip pain.

3. Pelvic floor physical therapy can help reduce some pregnancy-related symptoms and prepare your body for labor and delivery.

References

1. Wu, J. M., Vaughan, C. P., Goode, P. S., Redden, D. T., Burgio, K. L., Richter, H. E., & Markland, A. D. (2014). Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstetrics and gynecology, 123(1), 141–148. doi: 10.1097/AOG.0000000000000057 https://pubmed.ncbi.nlm.nih.gov/24463674/

2. Posture During Pregnancy. (n.d.). Cleveland Clinic. Retrieved May 23, 2022, from https://my.clevelandclinic.org/health/articles/6913-pregnancy-correct-posture--body-mechanics