During pregnancy, one topic I wish got a lot more attention is pelvic floor physical therapy.
We hear plenty about prenatal vitamins, glucose tests, and nursery prep, but not much about how to take care of your pelvic floor—even though it’s under more strain than ever during pregnancy, and this is when pelvic floor dysfunction starts to occur for many women.
Pelvic floor physical therapy strengthens, relaxes, and coordinates the muscles that support your bladder, bowel, and uterus. It can help you have less pain during pregnancy, prepare your body for delivery, and recover faster postpartum.
But when should you start pelvic floor therapy during pregnancy? You can start anytime, but sooner often means better outcomes and fewer symptoms. Whether you’re in your first trimester or third, it’s never too early—or too late—to start taking care of your pelvic floor!
What Is Pelvic Floor Physical Therapy During Pregnancy?
Your pelvic floor is a group of muscles at the base of your pelvis that functions like a hammock to support important organs, including your bladder, bowel, and uterus.
During pregnancy, these muscles are under more strain as your baby grows and your body changes.
Pelvic floor physical therapy during pregnancy helps you manage uncomfortable symptoms, prepare for birth, and prevent postpartum complications like back pain, urinary incontinence, diastasis recti, and pelvic organ prolapse.
As a pelvic floor PT, there are a few common myths about pelvic floor therapy during pregnancy that I want to clear up:
- Pelvic floor PT is NOT just doing Kegels: Kegels are actually often harmful because sometimes your muscles need to learn how to relax, not squeeze harder.
- You DON’T need to wait until you have symptoms to start pelvic floor therapy: Pelvic floor PT is preventative, and starting during pregnancy can help you avoid issues later.
- Pelvic floor therapy is NOT only for postpartum: You don’t need to wait until after you’ve had your baby to start working on your pelvic floor—pregnancy is one of the best times to begin.
Many women in my practice think about pelvic floor PT as something to do postpartum or once they start having issues like leaking or pain.
But addressing your pelvic floor during pregnancy can reduce how severe those symptoms are, or prevent them from happening in the first place!
How Does Your Body Change During Pregnancy?
Pregnancy changes your body in so many different ways:
- Your center of gravity shifts forward as your baby grows, which affects your posture and how you move
- Your organs get pushed upward and compressed, which can cause heartburn, shortness of breath, and rib pain
- Your pelvic floor muscles are under constant pressure from the weight of your growing uterus and baby
- Your abdominal muscles stretch to make room for your baby, which causes diastasis recti, a separation of the muscles down the center of your belly
- Pregnancy hormones like relaxin loosen your ligaments to prepare your pelvis for birth, but this can also cause instability and pain in your lower back, hips, and pelvis
- You may experience urinary incontinence, leaking when you cough, sneeze, or laugh
- Pelvic girdle pain, SI joint pain, and pubic symphysis pain are common as your pelvis expands and shifts
- You might feel pressure, heaviness, or pelvic pain in your vagina as your baby drops lower
- Round ligament pain can happen as your uterus expands and the ligaments supporting it stretch
All of these changes can be uncomfortable and limit what you’re able to do, especially if you want to stay active during your pregnancy (which is SO beneficial for both you and your baby!).
Benefits of Pelvic Floor Therapy During Pregnancy
Pelvic floor therapy during pregnancy can make a huge difference in how you feel and how your body handles labor and postpartum recovery.
The benefits include:
- Less pain during pregnancy: Pelvic floor PT can help reduce back pain, hip pain, pelvic girdle pain, and pubic symphysis discomfort.
- Preparation for delivery: Learning how to relax and coordinate your pelvic floor muscles can help you push more effectively during labor.
- Prevention of postpartum issues: Strengthening and coordinating your pelvic floor during pregnancy can reduce your risk of urinary incontinence, prolapse, and severe diastasis recti after birth.
- Faster postpartum recovery: When you’ve already been working on your pelvic floor and core during pregnancy, you’re starting from a stronger foundation postpartum.
- Better body awareness: Pelvic floor therapy teaches you how to connect with your muscles, breathe properly, and move in ways that support your changing body.
This applies to women who already have kids, too.
If you’re pregnant again and dealt with pain or symptoms in a previous pregnancy, starting pelvic floor therapy early can help you avoid repeating those same issues. You don’t have to wait until you’re postpartum or done having kids to improve your pelvic floor health!
In my practice, many second, third, and fourth+ time moms have pain and symptoms start earlier in subsequent pregnancies, but pelvic floor PT can help prevent this.
Personally, I had debilitating SI joint and pubic symphysis pain during my first pregnancy. I did pelvic floor PT with my second and third pregnancies, and it dramatically improved how I felt and allowed me to stay active until birth + have a much better postpartum experience!
When Is the Best Time to Start Pelvic Floor Therapy During Pregnancy?
The best time to start pelvic floor therapy is in your first or second trimester, but it’s never too late to begin. Even if you’re already in your third trimester, you can still benefit!
Starting pelvic floor therapy at any point during pregnancy can help you manage symptoms and reduce your risk of pelvic floor dysfunction postpartum.
What to Expect When Seeing a Pelvic Floor PT
At your first appointment, your pelvic floor physical therapist will ask questions about your pregnancy and any symptoms you’re experiencing. They might do an internal exam, gently inserting a gloved, lubricated finger into your vagina to feel how your pelvic floor muscles contract and relax.
From there, your PT will create a treatment plan with exercises and techniques to improve pelvic floor coordination. You’ll do these exercises at home and come back to see your pelvic floor PT to assess your progress, usually once a week.
Finding a good pelvic floor therapist is important!
Look for someone who specializes in pregnancy and postpartum care, listens to your concerns, and takes the time to explain what’s happening with your body. You should feel comfortable asking questions and discussing pelvic floor issues that might feel embarrassing to bring up.
What If I Can’t See a PT in Person?
Many pregnant women don’t have the opportunity to see a pelvic floor PT in person.
The cost can be high, especially if you’re paying out of pocket. You might not have a qualified pelvic floor therapist near you, or the waitlist could be 3-6 months long. And if you already have other kids, finding time to drive to appointments and arrange childcare can feel impossible.
As a pelvic floor physical therapist, I created Strong Expecting Mama to give you access to expert guidance from home.
The program includes pregnancy-safe workouts for all three trimesters, exercises to prepare your body for delivery, education on how to manage common pregnancy symptoms like back pain and pelvic pressure, and strategies to prevent postpartum complications.
Here are a few examples of the topics you’ll cover inside the program:
- Perineal stretching
- How to push
- Pelvic floor labor prep
And more!
Each class is 15-20 minutes, so you can fit them into your schedule without needing to leave your house or find childcare! You can also easily message me if you have any questions as you start pelvic floor exercises and need support.
Is Pelvic Floor Therapy Worth It While Pregnant?
Yes! Pelvic floor therapy during pregnancy can help you feel more comfortable, stay active, and prepare your body for birth and postpartum recovery.
Even if you don’t have symptoms yet, starting pelvic floor PT as early as possible during pregnancy is one of the best investments you can make in your long-term health and pelvic floor function.
FAQs
Are pelvic floor exercises safe during pregnancy?
Yes, pelvic floor exercises are safe during pregnancy, but it’s important to modify certain things and to do them correctly. This is why working with a pelvic floor physical therapist or following a pregnancy-specific program is so important!
How many times per week should I do pelvic floor exercises while pregnant?
I recommend doing pelvic floor exercises at least 2-3 times per week in 15-20 minute sessions. It’s important to take rest days and allow your body to recover, but pelvic floor exercises IS something you want to stay consistent with! If you’re seeing a PT in person, they’ll give you exercises to do at home between your sessions.
What happens if I don’t do pelvic floor exercises during pregnancy?
You’ll be more likely to experience uncomfortable symptoms during pregnancy and postpartum, such as urinary incontinence, pelvic pain, severe diastasis recti (abdominal separation), hip discomfort, pain during sex, back pain, rib pain, sciatica, and more.
Pregnancy puts a lot of strain on your pelvic floor, and addressing it proactively can make a big difference in how you feel during pregnancy and how quickly you recover postpartum.
Is the third trimester too late to start pelvic floor therapy?
No, it’s not too late! Starting pelvic therapy in your third trimester can still help you prepare for delivery, manage pregnancy discomfort better, and set yourself up for a smoother recovery during the postpartum period. Even doing it for just a couple of weeks can be helpful. It’s NEVER too late to start!
Strengthen Your Core and Pelvic Floor in Pregnancy with Strong Expecting Mama
If you’re ready to protect your pelvic health during pregnancy but can’t (or don’t want to!) see a pelvic floor physical therapist in person, Strong Expecting Mama is for you!
For less than a single co-pay, you get a full pregnancy program and a pelvic floor PT in your corner.
Learn more about Strong Expecting Mama!
