When to Start Pelvic floor physical therapy during Pregnancy
If you are like any of the active women I help during pregnancy, you might be wondering when to start pelvic floor physical therapy in pregnancy.
As a physical therapist with 17 years of experience and more than 10 years specializing in pelvic floor problems for active women navigating pregnancy, postpartum perimenopause and beyond, I think the biggest thing I see in pregnancy is that many women are not prepare for what is to come when it comes to navigating unexpected pelvic floor birth injuries and their goals of returning to sport.
This article will walk you through—
The myth about waiting until something is wrong to get help in pregnancy
The benefits of getting started early or at the end with pelvic floor physical therapy during pregnancy
Why DIY birth prep can sometimes back fire
If you are like any of the active women I help you have probably spending years learning how to take care of your health because you
Strength train
You prioritize your nutrition
You invest in gear that helps you feel strong and capable.
It’s important to know that pregnancy doesn’t mean you have to stop caring, in fact- this season might be one of the most important seasons to have support.
Pelvic floor physical therapy during Pregnancy: Why You don’t have to wait until there is a problem before you get help
Pregnancy already comes with a lot of uncertainty —
A changing body
Concern if your baby is growing well
Excitement and the unknown of parenting
It also makes sense women don’t know to seek help because our society has normalized that pain and leakage and suffering is just part of womanhood.
This is what I wish more people knew- you don’t have to wait until there is a problem to get help.
When to start pelvic floor physical therapy during pregnancy
Why women often wait to get help in pregnancy
The challenge is that during pregnancy when women start to have symptoms like leakage, pain, or realize “my baby due in two months I should do something about the pain that’s interfering with my ability to walk up the stairs and I’m scared about what it means to move in labor” — then there’s a sense of emergency or panic.
And for the active moms I help there is fear about what postpartum fitness will look like and fear of losing athlete identity.
If lifting weights, Crossfit, running, and hanging out with your friends at the gym is important to you, it makes perfect sense that you will have questions about your body and all of the changes during pregnancy and birth.
But the thing is — it doesn’t have to get to crisis mode to get help.
1. You can get pelvic floor therapy before there is a problem in Pregnancy
Women are often trying to do the right thing by researching online but they get conflicting information— I see this all the time with the women I help, many whom are educators, lawyers, doctors, and committed to their health.
Whether you are educated or not, this doesn’t mean you have to figure out pregnancy, your pelvic floor, birth prep, and returning to exercise on your own.
We live in amazing times where there is a lot of information available for just about everything, but not all of it is accurate, not all of it applies to your body, your pregnancy, your unique history, or your goals.
2. You can start as early as 1st trimester or 2nd trimester.
Don’t wait until the end of your pregnancy if you can avoid it. Come in when you have more time margin!
In the last 2 months of a pregnancy majority of women are strapped for time with wrapping up work projects, nesting, and OB follow ups, etc. First and 2nd trimester allow you get started with less panicking, plus if you have a pelvic floor problem that has developed or been exacerbated with pregnancy such as bladder urgency, constipation, or leakage, you start addressing it earlier before your brain starts cementing habits about your pelvic floor.
Less panic equals more calm, confidence and preparedness for birth.
Research from the UK supports starting supervised pelvic floor therapy by a qualified provider as early as 20 weeks and that mothers participate in a 3 month program so that they have the opportunity to reduce risk of bladder leaks, pelvic organ prolapse, as well as lower risk of severe pelvic floor injury.
In the clinic, I find the additional benefits for moms who start in the first or 2nd trimester is this- they more likely to avoid misinformation that has the potential to cause anxiety and fear in pregnancy.
The challenge is that a lot of women don’t realize how misinformation causes anxiety and fear.
It looks like this
You read about a list of do’s and don’ts for diastasis recti
You read about pelvic floor issues and realize you know nothing about it
All of this on top of all the things you aren’t supposed to be eating since you are now pregnant
Then instead of being confident and feeling prepared, you have more fear about doing something wrong.
On the contrary — being reassured, having a personalized approach, knowing what to do when things feel off can give so much peace of mind which frees your mental energy for the things that are important to you.
Pelvic floor PT during 3rd trimester is amazing for help moms feel confident to handle labor challenges as well as have options to practice effective pushing.
3. The Challenge with DIY birth prep
Most women don’t realize this, but pelvic floor health is not intuitive to every woman - The American College of Obstetricians and Gynecologists support women getting personalized assessment to understand the risk of major injury and specifically to understand if you have an underlying pelvic floor dysfunction so that you be better prepared for the pushing phase to reduce your injury risk and also have information to make an informed decision so that bladder leaks, painful intimacy, or distressing sensations of pelvic organ prolapse do not have to be a barrier to your quality of life.
It's important to know that historically, attention to the pelvic floor and what is normal and not normal for changes in pregnancy, its role in birth, intimacy, and sport function is not an area of the body that women have not historically been educated on…just think about the first time you needed to put in a tampon.
What can pelvic floor physical therapy help with during pregnancy?
Working with a pelvic floor physical therapist like myself during pregnancy is not just about treating problems that are interfering with your life and fitness, for many women it is the opportunity:
to get personalized information about their changing bodies
better understand their pelvic floor so that you have a healthy pelvic floor throughout your pregnancy
stay active during their pregnancy. which gives you massive benefits of decreasing the risk of gestational diabetes and decreasing the risk of gestational hypertension
Some of the common things addressed and prevented include:
Pelvic pain
Back pain
Pubic symphysis pain
Diastasis concerns
Staying active in pregnancy when you have back pain
Preparing for the physical and mental demands of birth
Understanding pelvic floor full range of motion for birth so that you lower your injury risk
Preparing for postpartum recovery and fitness.
What are the benefits of having a healthy pelvic floor during pregnancy:
Having a healthy pelvic floor throughout your pregnancy means you are less likely to be dealing with:
bladder urgency
excessive trips to the bathroom at night
stay on top of avoiding bladder leaks
painful bowel movements
painful sex
Working with a pelvic floor physical therapist during pregnancy also helps you have better insight of preexisting issues in your body.
That old knee injury from when you played soccer in college,
your old back issues,
and even medical history like asthma all influence the health of your pelvic floor.
My goal is not that you worry about your body, but you understand it better– as it is not your fault that you were never taught about what is normal for changes in your body given that our medical system focuses so much teaching women for decades on how to avoid getting pregnant, want to expect when you actually get pregnant, or even what happens as we age.
Here’s the thing about Googling “is this normal in pregnancy”
You can Google just about anything related to pregnancy and the pelvic floor. But Google can’t assess your body, it doesn’t know about your training history, your past medical history, it definitely can’t assess your pelvic floor, and put all those pieces together for your birth goals and postpartum fitness.
This is exactly where I come in and where personalized pelvic floor therapy is valuable.
Why I created the Empowered Pregnant Athlete Program
I have purposely created my Pregnancy Program for moms who want guidance in the 1st & 2nd trimesters avoid misinformation about Diastasis, and so that people can ample time to practice pelvic floor range of motion for birth. — All of this helps women stay active so that they are less likely to be sidelined by pain at the end of pregnancy because we catch issues before they get to the surface.
THE 3 PHASE METHOD IS DESIGNED & TAILORED TO YOU—
WHAT TO EXPECT WORKING TOGETHER DUring Pregnancy by trimesters
1st Trimester: Guidance to take the guess work out of what is causing your tailbone symptoms in pregnancy by getting to the root of why your body pain is showing up
1st & 2nd trimester: Help you gain skills for better body awareness in your pelvic floor so that you can better understand what your body signals are telling you so that you can prepare for an easeful birth without fear of tearing your pelvic floor or dreading labor pain
2nd & 3rd trimester: Help you understand effective pushing strategies, lengthening of pelvic floor, and continued fitness routines so that you build resilience so that you can confidently approach birth, recover faster, and get back to working out the way you want without having to fear pelvic floor symptoms like leakage or prolapse distracting you.
✅ Phase 1, Clarity: In this pillar we get to the root of the problem so that we can effectively manage the mechanisms of your symptoms. We also cut through the outdated information online about pregnancy and exercise so you can understand how to keep up a high level of fitness and set your postpartum recovery up for success.
✅ Phase 2, Calm: Help you gain clarity on diastasis recti as we seperating myths from facts, so that the fear of doing something wrong doesn’t slow down your workouts setting you up for keeping your core strong throughout pregnancy which prepares you for an easier postpartum recovery.
I also help you master effective pushing techniques and learn how to advocate for yourself throughout your pregnancy to your lower risk of major birth injury while setting your postpartum fitness up for success and of of your sex life.
✅ Phase 3, Confidence: This pillar will equip you with the tools of self management for your nervous system so that you can catch burn out and overwhelm before symptoms show up in your body allowing you to nail the basics of keeping your pelvic floor healthy throughout your pregnancy.
Clients also gain amazing skills for decision making so that you can to go from feeling frazzled about not having time for yourself to being that mom who has her shit together and who everyone asks “how do you do it”?
This isn’t about adding another thing to your to-do list, its about having personalized support so that you can have your questions answered and be able to make informed decisions based on your body and your goals.
Especially if being active is important to you.
You Don't Have to Wait Until You're Struggling to Get Support
Pelvic health and mental health have a lot in common and one of those things in common is the stigma around getting help
I look forward to the day where society normalizes women taking the time early on to understand their bodies in pregnancy.
Research supports this and while our medical system is doing it’s best, some providers (midwives/OBs) only refer to pelvic floor physical therapy in pregnancy if there is a problem versus recommending this as a preventative and supportive option for long term pelvic health by injury risk reduction in birth.
If you feel blindsided by the changes that have happened in your body during pregnancy and answers from your OB that have you asking more questions, you aren’t alone. The truth is, the current system is doing it’s best, but it is not designed to fully equip women for birth.
And for women with preexisting back or pelvic floor issues heading into pregnancy, it's important to know: give yourself the gift of time to work with a provider.
Which means- you don’t have to wait until the pain is so bad you can’t walk, you don’t have to wait until leaking embarrasses you in your work day, you don’t have to wait until you are worried about how you will move in labor, and you don’t have to wait until you are postpartum to think about your recovery.
You Don't Have to Wait Until Something Is Wrong to Invest in Your Health
There is a difference between waiting for a problem to happen and being proactive about your health.
If you are the kind of woman who invests in strength training, quality food, running shoes, coaching, or other things that help you feel and perform your best, pelvic health deserves that same attention.
Pelvic floor physical therapy during pregnancy isn't about assuming something will go wrong.
It's about understanding your body, reducing your risk of being sidelined by pain, preparing for birth while gaining clarity on how to minimize your birth injury risk , and having a plan for your postpartum recovery and fitness while bonding with your baby.
For the women I help within the programs at Radiance PT, that kind of personalized support is worth investing in because they don't want to spend the last few months of pregnancy wondering, “Is this normal?” or “Should I be doing something about this?”
The cost of not having help isn’t just back pain, even though thats annoying, it looks like
Modifying every workout because of pelvic pressure that feels like your organs are escaping
Giving up running with your friends because you are fearful of leaking
Losing confidence in your body and avoiding intimate moments with your partner
It’s the time lost in researching if what you are experiencing in your body is normal
Getting support early allows you more time, more options, and ultimately more confidence
Like my client who started working with me after her pregnancy loss, she had been working with a different physical therapist for her back pain but found herself stuck with unanswered questions about fitness in pregnancy and fear of back pain interfering with her goals of an unmedicated birth.
Working together, she went from fearful of bending to confidently returning to her usual fitness routines and when she was pregnant again, she had confidence and trust to handle the labor sensations and welcome her sweet baby into the world without an epidural.
Caring for your Mental Health and Physical Health during Pregnancy Matters.
Life is hard, pregnancy is hard.
And so is birth and parenting— there is so much that you are not going to be able to
control, but having the habit of caring for mental and physical health goes a long way.
We have normalized suffering for the sake of motherhood for too long. it’s important to know that there’s amazing resources to feel good, such as feeling distressed or that body issues taking out space in your mind that doesn’t have to consume you.
You don’t have to wait until you are struggling to get support.
If you are an active mom who wants personalized guidance during pregnancy - not just another generic checklist from the interwebs- the Empowered Pregnant Athlete Program was created for you.
We start by looking at what is happening in your body now so that you can stay active without fear or misinformation slowing you down
I help guide you to a deeper understanding of your pelvic floor so that you can find ease when things hurt the most in labor
We create a plan that supports the active lifestyle you what when your baby is born.
You deserve to have support before pain or symptoms start disrupting the life you want to live as an active mom.