When to Start Pelvic Floor Therapy During Pregnancy
Pelvic floor physical therapy can benefit women at any stage of their reproductive journey, from preconception through pregnancy. Understanding how the pelvic floor functions before the body begins to change gives a meaningful foundation for managing the demands of pregnancy.
Common symptoms during pregnancy include leaking, pelvic pain, heaviness, and constipation, all of which are influenced by the added weight, shifting center of gravity, and ligament relaxation that accompany a growing belly. Pelvic floor PT addresses these symptoms at every trimester, from managing fatigue and early discomfort in the first to building strength and preparing the body for labor in the third.
Working with a pelvic floor physical therapist during pregnancy supports not just symptom management but also labor preparation and long-term pelvic health. Techniques like perineal massage, breathing mechanics, and positioning for labor are all part of individualized pelvic therapy for pregnant women.
I want to start by saying that there is never a wrong time to start pelvic floor PT! As humans, we manage so many things, and even thinking about pelvic floor PT means that you care about your health.
In a perfect world, I would love to see clients preconception to start pelvic floor PT.
This helps give a baseline of where you are at and time to optimize pelvic floor function before pregnancy.
Your body changes so much during pregnancy so ideally it is best to understand how your pelvic floor works before your body starts to change.
Why Pelvic Floor Health Matters in Pregnancy
Your pelvic floor is the hammock of muscles at the bottom of your pelvis that gives your core and organs support- including your uterus which is where the baby lives during pregnancy! So pelvic floor health matters to keep baby supported as your belly grows.
As your body changes and your belly gets bigger, your center of gravity changes too, so that can affect your back, knees, and feet.
Don’t worry though, your pelvic floor PT can help you with those things too!
Common Pelvic Floor Symptoms During Pregnancy
Because of the increased weight as your belly grows there can be more pressure on the bladder increasing urgency and the risk of leaking.
The leaking can be caused by the urgency or from the increased stress on the pelvic floor. These conditions are referred to as urge and stress incontinence.
Along with the belly growth, your ligaments that hold your pelvis together become more relaxed which can cause pain around the pelvis in areas like the SI joint, and pubic bone (fire crotch).
That extra weight can also contribute to pelvic floor heaviness or pelvic organ prolapse.
Constipation is also a common symptom of pregnancy.
Best Time to Start Pelvic Floor Therapy
As I said before, it is never too early or too late to start pelvic floor PT! Getting a baseline before you develop any symptoms or conceive is best case scenario but definitely not necessary to treat you.
Everyone's pelvic floor journey is different, so don’t feel behind or pressured by what you see others doing!
First Trimester Considerations
During the first trimester, your body is changing rapidly to accommodate a tiny human.
This trimester comes with a lot of fatigue so the goals are to address any symptoms you are feeling as well as movement that feels good without draining your energy.
Second and Third Trimester Goals
As you move into the second and third trimesters the common goal of mitigating any symptoms you are experiencing remains.
The main goal during the second trimester is to get back to regular activity as you gain back energy lost during the first trimester, and build strength as tolerated.
The third trimester is all about mobility and lengthening the pelvic floor to prepare for birth. We work on positioning for labor as well as techniques to help with contractions. This is the trimester when we work on perineal massage to decrease the risk of tearing during a vaginal delivery.
Preventing Incontinence and Pelvic Pain
The first thing I teach my pelvic floor clients is proper breathing mechanics to decrease compensation and stress on the pelvic floor.
By learning how to breathe properly with movement we decrease the risk of incontinence because the whole core system is sharing the load and not letting it all fall on the pelvic floor.
During pregnancy we want to work on mobility because of how the body changes and decreases the ability to rotate.
By working on strengthening and mobility through pregnancy before you even have symptoms will help decrease your risk for problems later in pregnancy. We can also utilize belly bands and pelvic garments to help reduce stress in certain areas.
Preparing for Labor and Delivery
Working with a pelvic floor PT can be so helpful in feeling prepared for labor! There are so many different techniques and positions that your PT can teach you to help with labor and contractions. I also encourage my clients to bring their birth partner to sessions so that you both can learn and so that your partner can take an active role in making suggestions during labor because you will be more focused on what you are feeling.
What to Expect at Your First Appointment
During the initial visit I spend a lot of time chatting with my clients to better understand their whole health history, pelvic floor symptoms and habits, and goals to give me an idea of where we want to start for assessment and treatment.
Every client is different so there is no cookie cutter answer to exactly how the first session will look, but I like to call it a “choose your own adventure” if you will (I loved those books as a kid)!
Based on our discussion, we will decide together what is most important to assess.
That may be a movement assessment, strength testing, a hands-on assessment of your pelvis, and/or an internal (vaginal or rectal) assessment.
Then based on what we find I like to at least get started on one treatment. That could be hands on treatment or an exercise to work on at home.
I always spend time at the end of the session summarizing my findings and making a plan with you based around your goals.
Where to Find Pregnancy PT in Meredith and the Lakes Region
If you are local to the Lakes Region of New Hampshire and need help with your pregnancy journey, book a discovery call with me to get started!
I would love to be a part of your pelvic health journey!
My office is conveniently located in downtown Meredith, and I offer individualized pelvic therapy for women who want to stay healthy and active during their pregnancy.
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Disclaimer: The information provided on this blog is intended for general wellness education purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physical therapist, physician, or other qualified health provider with any questions you may have regarding a medical condition.