All You Need To Know About Prenatal Pelvic Floor Physical Therapy

During my pregnancy with my son, I was acutely aware of the upcoming changes to my life and envisioned the joys and challenges of having a newborn. I anticipated long days filled with cuddles, endless diaper changes, and the inevitable sleep deprivation. However, I was caught off guard by the physical changes my body would undergo. Other mothers warned me about the possibility of bladder control issues, leaving me to wonder if postpartum life would mean constantly needing to cross my legs when I laughed or sneezed. Fantastic.

As a first-time mom, I was aware that postpartum panties would be part of my post-birth essentials, but the thought of investing in long-term diapers to manage incontinence was less than appealing. To my surprise, I learned that there is a proactive approach to help women mitigate these symptoms: pelvic floor therapy during pregnancy. I spoke with Dr. Nikki Berner, PT, DPT, a licensed, board-certified physical therapist and founder of The Fem Method Pelvic Health, to explore the advantages of pelvic floor physical therapy while expecting. It turns out that having bladder leakage isn’t something women should accept as normal.

Understanding the Pelvic Floor

The National Institute of Child Health and Human Development defines the pelvic floor as “the group of muscles forming a sling or hammock across the bottom of the pelvis.” These muscles are responsible for supporting the bladder, urethra, intestines, and rectum. During pregnancy, these muscles can become lax or weakened due to hormonal changes, the growing fetus, and other factors.

Signs You Should See a Pelvic Floor Therapist During Pregnancy

While visiting a pelvic floor therapist during pregnancy isn’t mandatory, there are certain symptoms that may signal it’s time to seek their expertise.

• Dysfunction of the SI joints (connecting pelvis and lower spine)
• Round ligament pain (discomfort in the lower abdomen/groin)
• Dysfunction in the symphysis pubis (joint between the left and right pubic bones)
• Low back or hip pain
• Pelvic girdle pain
• Bladder leakage

Additionally, you may wish to consult a physical therapist for labor and birth preparation or for a daily movement assessment.

Do Kegel Exercises Help with Pelvic Floor Dysfunction?

You might have come across Kegel exercises, which involve “lifting and holding, then relaxing your pelvic floor muscles” to strengthen them. While they’ve gained popularity in recent years, Dr. Berner notes, “Kegels only engage a fraction of your pelvic floor muscles. Often, they are not performed correctly.”

How a Pelvic Floor Therapist Can Assist During Pregnancy

If you’re like many, you may have heard the phrase “It’s normal” far too often, especially when it comes to women’s health. It’s common to dismiss your troubles as typical changes from pregnancy hormones, but that doesn’t mean you have to endure discomfort or pain. This is where pelvic floor therapists become invaluable. Every patient is unique, so care plans should be tailored to individual needs, but pelvic floor therapists generally focus on several key areas.

Conducting Assessments and Evaluations

If you’re unsure of your needs, that’s perfectly fine. Taking the initiative for your pelvic floor health is reason enough to consult a therapist. During your pregnancy, pelvic floor therapists can provide early education on proper nutrition and managing constipation, which is common during this period, as well as bowel control strategies.

A comprehensive prenatal physical therapy assessment is crucial for personalizing an exercise program. This evaluation will include examining the strength and mobility of your hips, spine, and pelvis, and assessing any existing dysfunction.

Preparing for Birth

Back pain is a frequent issue during pregnancy, often linked to an unstable pelvic floor. Dr. Berner helps alleviate pelvic floor tension through specific breathing techniques in various birth positions, ensuring the pelvic floor is relaxed for delivery. She emphasizes these methods throughout prenatal therapy so that patients develop a familiar response for when labor begins.

Anticipating Postpartum Needs

Pelvic floor care shouldn’t cease after childbirth. It’s equally important to learn how to protect your body during the postpartum phase. Engaging in pelvic floor physical therapy while pregnant can prepare you for potential issues after your baby arrives. This includes learning proper lifting techniques and how to safely engage your core, alongside mobility exercises that help prevent pain, optimize bathroom visits to reduce strain (goodbye, leaky bladder), and promote nutrition for a smoother healing process.

Considerations for Choosing a Pelvic Floor Therapy Program

Prior to contacting a pelvic floor therapist, take some time to think about your expectations as a patient. Everyone varies in terms of the level of involvement they desire from their pelvic floor therapist during this process. Here are a few aspects to contemplate when searching for the right therapist for you.

Your Preferences Regarding Team Structure

No two teams are alike, so it’s essential to inquire about the personnel who will be assisting you. Find out whether your main contact will be the pelvic floor therapist or a physical therapy technician. If multiple clinicians will be involved, ask how frequently you will meet with the pelvic floor therapist specifically.

Understanding Credentialing

Familiarize yourself with the credentialing process, as not all programs are created equal. The differences in leadership can be significant. As Dr. Berner highlights, this can be perplexing for patients. It’s crucial to understand that physical therapists and occupational therapists receive specialized training and credentials to be recognized as pelvic floor “rehabilitation providers.” Dr. Berner notes that professionals who are not PTs or OTs “may not be equipped to conduct internal muscle assessments, function evaluations, and rehabilitation,” which are vital for effectively addressing pelvic floor disorders. Various programs may incorporate pelvic floor therapy into their offerings, so it’s important to be informed about the specifics of what that means.

Your Desired Level of Hands-On Involvement

To formulate an effective care plan, an initial evaluation is required. However, consider how involved you want the prenatal physical therapy program to be. If you prefer less frequent in-person visits, virtual consultations can also provide valuable information.

The Structure of the Program

Reflect on any pre-existing medical conditions you may have. Then, discuss whether the pelvic floor therapist has experience with cases similar to yours. If they lack this experience, communicate about their comfort level in providing treatment for your specific needs. Dr. Berner emphasizes, “Your treatment plan should be tailored to how well your body is able to function.”

Additional Advantages of Prenatal Physical Therapy

Consulting with a pelvic floor therapist serves as an additional way to take charge of your health. Dr. Berner mentions that her clients often leave therapy feeling empowered to manage their birthing experiences rather than approaching labor with apprehension. In the context of pelvic floor physical therapy during pregnancy, she states, “The more prepared and informed women are about what to expect, the more confident they feel going into childbirth, leading to better outcomes.” So, the next time someone suggests that incontinence is a permanent issue, chuckle politely—without any accidents—and share the contact details of your pelvic floor therapist.