Optimize Your Pelvic Floor During Pregnancy to Enhance Recovery After Childbirth
Most women have heard that they should do “Kegels” during and after pregnancy. A Kegel is a contraction of the pelvic floor muscles. These muscles get a lot of press related to pregnancy because of the important role they play in supporting the pelvic girdle through all the hormonal and mechanical changes that occur in the body during this season!
Understanding your pelvic floor
Positioned like a hammock from pubic bone in the front to tailbone in the back, the pelvic floor is a group of muscles that supports the internal organs including the bladder and uterus. It also includes the sphincter muscles, which close and open the urethral and anal openings — relaxing to let urine and stool void when at the toilet. As the posture/weight distribution changes in the pregnant body, these support muscles must work harder in a “gravity dependent” position like standing and walking. For example, holding back urine may be easier when coughing/sneezing if you are lying down, but more difficult when upright.
Signs and symptoms of pelvic floor dysfunction during pregnancy
Why urinary leakage is common but not normal
Urinary leakage can be one sign that the pressure system made up by your deep abdominal, pelvic floor, and other muscles isn’t working properly. Although this is a common issue for women who have experienced pregnancy and childbirth, it is not normal! Another common pelvic floor dysfunction that can begin during pregnancy or after the birth of the baby includes vaginal pressure or bulging — sometimes a sign of pelvic organ prolapse. Similarly, diastasis recti can cause symptoms such as abdominal tenting or pouching during movements that increase abdominal engagement, like getting up from bed.
Many women don’t realize that seeing a pelvic health physical therapist during pregnancy, even in the absence of perceived issues, can improve muscle function and allow for a smoother birth experience and post-partum recovery. Early intervention can help prevent some of these issues altogether.
Understanding and engaging your pelvic floor muscles
Learning how to identify and contract and relax the pelvic muscles can be challenging. It’s hard to figure out if you’re engaging a muscle you can’t see, unlike a bicep muscle, which you can look at and know whether it’s flexed or not.
A pelvic health physical therapist can objectively assess the muscle strength, coordination, and endurance to give women feedback on where they’re at, utilizing internal and/or external biofeedback units and analyzing the information they gather.
Personalized pelvic floor therapy for pregnancy
After determining your pelvic floor muscle coordination, strength, and endurance, a pelvic health PT can develop a specific plan, tailored to address what your muscles need most for you to reach your individual goals. Many times, the pelvic floor muscles are overactive or shortened and need to be trained to relax and lengthen with “reverse Kegels” before beginning strengthening or uptraining of the pelvic floor muscles. In some cases, improperly performed Kegel exercises could even worsen symptoms, highlighting the need for personalized guidance.
Preparing for labor and birth
As baby’s due date nears, the focus often shifts from keeping the pelvic floor muscles strong to stabilize the pelvis, to training the pelvic muscles to lengthen and relax as the pregnant body gets ready for birth. Performing perineal massage during the last six weeks of pregnancy can help prepare the perineal tissue for the stretching required during vaginal birth and reduce perineal tearing
A pelvic health PT can assist with labor/birth preparation, helping women learn how to lengthen the pelvic floor for bearing down (pushing) during active labor. Practicing labor positions ahead of time helps the pregnant woman understand which positions may work best for her body.
Partners are included in the educational process during PT visits as well, learning techniques such as counterpressure that can assist with pain relief during labor. This collaboration between the PT and the birth team, including OB-GYNs, midwives, and doulas, ensures comprehensive preparation for labor.
Physical therapy after childbirth
Can you imagine someone who has had an orthopedic surgery such as a total knee replacement resuming normal activity without the support of post-operative physical therapy? Of course not! Then shouldn’t every woman also receive physical therapy to help with the physical recovery from childbirth?
Many times, the “all clear” to return to exercise at about eight weeks post-childbirth can result in confusion for the mother whose body doesn’t feel ready to resume higher-level activity like weightlifting or running. This is where physical therapy plays a key role in evaluation, education, and exercise prescription.
Whether the baby is born vaginally or via cesarean section, there is muscle recovery and often scar tissue management involved after birth. Problems such as constipation/hemorrhoids, urinary leakage, pressure/heaviness/bulging from the vagina, and painful intercourse are all frequently experienced issues that can improve drastically with pelvic floor muscle and breath training for improved pressure management in the core.
The benefits of comprehensive pelvic health physical therapy
Working with a pelvic health specialist before, during and after pregnancy can help you return to your optimal function and ensure your focus is on the joy of motherhood. If you want to know more, read our blog: What to Expect During a Pelvic Floor Evaluation.
Let us partner with you on your pregnancy journey.
Pelvic health physical therapy addresses the unique musculoskeletal structure of the pelvic floor. Working with a pelvic health specialist before, during and after pregnancy can help you return postpartum to your optimal function and ensure your focus is on the joy of motherhood.
