Feb 23, 2023 • 10 min read

How Pelvic Floor Therapy During Pregnancy Can Help

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If you are pregnant or are hoping to be, you may have heard of people using pelvic floor therapy to recover after giving birth.

There are many benefits to pelvic floor therapy during the postpartum period, but you may be surprised to find out that pelvic floor therapy can also be beneficial during pregnancy, even as early as the first trimester!

But, why is the pelvic floor so important to know about during pregnancy? And how can pelvic floor therapy be helpful before the baby is born?

This guide goes over those questions and everything else you need to know about pelvic floor therapy during pregnancy, including issues it helps with, what to expect at your sessions, and more.

What is the pelvic floor?

The pelvic floor is a group of muscles at the very base of your core that forms a bowl or hammock shape that holds all of your pelvic organs, including your uterus, bladder, intestines, and rectum. These muscles extend from your tailbone to your pubic bone and attach along the inside of your pelvis.

Within this muscle group, there are three holes that make up your urethra, vaginal opening, and anus. The muscles of the pelvic floor are responsible for both holding in and pushing out waste. They are also responsible for helping to stabilize the spine and pelvis.

The pelvic floor muscles play a very important role throughout pregnancy and childbirth, though these can have damaging and harmful effects on the pelvic floor if it is not properly cared for.

What is pelvic floor therapy?

Proper care for the pelvic floor often requires physical exercise, which often comes in the form of pelvic floor therapy.

Pelvic floor therapy is physical therapy designed to help the pelvic floor muscles to build endurance and stamina. It can help to diminish or resolve issues such as:

  • Urinary incontinence
  • Fecal incontinence
  • Painful sex
  • Low back pain and sciatica
  • Organ prolapse

It also has been shown to help with the pushing stages of delivering a baby, as well as decreasing postpartum recovery time.

Pelvic floor therapist Dr. Nicole Cozean, creator of the podcast, “Pelvic PT Rising,” says that “every pregnant woman can benefit from pelvic floor therapy.” 

>> Find a pelvic floor therapist who accepts your insurance

How pelvic floor therapy can help during pregnancy

During pregnancy, the pelvic floor is shifting and changing continuously. From the increase in hormones to the weight of the baby, these muscles are stretched and can become loose. This can lead to a weak pelvic floor that leads to uncomfortable symptoms.

According to this National Institute of Health study,26% to 70% of women suffer from urinary incontinence during pregnancy, with 24% of these women saying that their symptoms are severe.

Another study showed that up to 35% of women suffer from sexual dysfunction during pregnancy. New research is also showing that 95% of women with chronic low back pain suffer from pelvic floor dysfunction.

Starting pelvic floor therapy during pregnancy is one of the best ways to decrease these issues.

Not only can pelvic floor therapy help moms to manage symptoms during pregnancy, but it can also help with labor, delivery, and postpartum recovery.

Research shows that women who begin pelvic floor physical therapy at 32 weeks or earlier have better outcomes for birth and postpartum recovery. Some of these benefits include:

  • Less likely to tear during a vaginal delivery
  • Increased confidence during pushing
  • Faster pushing stage
  • Quicker recovery time from cesarian section
  • Quicker recovery time for the perineum (the tissue between the vagina and the rectum)
  • Less likely to experience organ prolapse

>> Find a pelvic floor therapist who accepts your insurance

Let’s take a closer look at some of the benefits of pelvic floor therapy during pregnancy:

1) Pelvic floor therapy can make the birthing process easier

During labor, contractions are happening, and the cervix is opening to allow the baby out. It’s not just the cervix that has to open, however. The pelvic floor muscles also need to open. If these muscles are weaker, they will have less stamina and endurance.

Weak pelvic floor muscles are less effective in their ability to simultaneously relax to open while also engaging to push the fetus out. This can lead to ineffective pushing efforts and a more difficult birthing process.

A benefit of participating in pelvic floor therapy while pregnant is that these muscles will be stronger and have more endurance. They will also be able to relax and release more easily. This can significantly reduce pushing time. Having pelvic floor muscles that know how to both engage and relax, helps to decrease the risk of tearing.

Additionally, during pelvic floor therapy, as a mother is preparing for labor, the therapist will coach her through “push prep.” During this time, the mother may learn:

  • Effective breathing techniques for pushing
  • How to engage her muscles in order to push effectively
  • Which positions would be ideal for her to push in
  • How her partner can best support her by pushing

2) Pelvic floor therapy improves postpartum recovery time

It has been shown that women who participate in pelvic floor therapy during their pregnancy have decreased postpartum complications.

Because they have been working for several months at strengthening these muscles, the blood flow to this area of the body is increased. Increased circulation causes faster healing!

Some of the things women who do pelvic floor therapy during pregnancy include:

  • Their perineum heals more quickly
  • They do not struggle with urinary incontinence, or their struggle is greatly decreased
  • They avoid organ prolapse (a pelvic organ slipping down into the vaginal canal)
  • They can go back to enjoying sex with more ease.

On top of these benefits, oftentimes women who have been working with a pelvic floor therapist will go into their postpartum period with a plan in place for their postpartum recovery. They will already know what symptoms to watch out for as far as pelvic floor dysfunctions are concerned.

3) Pelvic floor therapy reduces issues that stem from a weak pelvic floor during pregnancy

It is uncommon for a woman to go through pregnancy without any symptoms of her shifting and stretching pelvic floor.

However, women who use pelvic floor therapy have great tools to help navigate, diminish, and even avoid many of the common pelvic floor symptoms that often go along with being pregnant.

Urinary incontinence

Pregnant women regularly complain that they cannot laugh, sneeze, or jump without urine leaking out.

One wonderful benefit of pelvic floor therapy through pregnancy is that it truly helps with urinary stress incontinence. Research has shown that pelvic floor therapy can not only alleviate this symptom but can sometimes help women to avoid it altogether.

Low back pain & sciatica

Another benefit of using pelvic floor therapy while pregnant is that it can help with low back pain and sciatica. Studies have found that 95% of women who struggle with chronic low back pain also have some sort of pelvic floor dysfunction.

Additionally, many women come to therapy for sciatica pain, only to discover that the root cause of their issue is a weak pelvic floor.

Ability to orgasm

Pelvic floor therapy can also increase a woman’s ability to orgasm, and often this is an area in which pregnant women have difficulty. Research shows that over 50% of women lose interest in sex during pregnancy, however, women who use pelvic floor therapy have been shown to improve their sex lives.


Pelvic floor therapy can even help with that terrible pregnancy constipation. Pelvic floor therapists are specially trained to help the rectum relax and let stool out, and they can teach techniques for doing this when constipation hits.

>> Find a pelvic floor therapist who accepts your insurance

Why pregnancy causes the pelvic floor to change

As the pregnant body is learning to support a whole growing human, while simultaneously getting ready for birth, the pelvic floor undergoes some changes.

Hormonal shifts

Firstly, the hormonal shifts involved with pregnancy cause the entire body to loosen. One of the initial hormones released by a pregnant body is called relaxin.

This hormone causes all the muscles and ligaments in the body to relax and loosen so that the body can stretch to carry a baby and then birth a baby. This loosening also occurs in the pelvic floor, making it harder to constrict and properly hold in stool and urine.

Extra strain on muscles

Next, the pelvic floor has a large role as a core muscle group in the body. It is responsible for stabilizing a person’s hips and spine. As a pregnant woman’s body shifts and grows, her pelvic floor muscles need to work harder in order to stabilize her spine and hips.

On top of this, the pelvic floor is responsible for holding up the weight of the growing baby. This causes those muscles to stretch and strain.  

It is no wonder that so many pregnant women struggle with things like urinary incontinence, low back pain, and painful sex! This core group of muscles is so important for everyday functioning, and yet they have so much extra work during pregnancy.

What to expect in your first pelvic floor therapy visit

The first visit with a pelvic floor therapist is all about getting to know your baseline. The therapist will take you back to a patient room and will begin by asking general questions about your goals in working with them.

They will then most likely do a range of motion assessment. They will ask you to do simple movements such as touching your toes or bending to the side and will assess how your muscles are working together.

Lastly, with your consent, they will do an internal pelvic floor exam. During this phase of the visit, using a gloved hand, they will feel the inside of your vaginal wall for weak muscles, tight spots, and any organ prolapse. They may also assess how functionally your pelvic floor is engaging by directing you to cough.

After this, they will discuss their findings with you and will give you their suggestion as a plan of care. They will then probably teach you a few different exercises to work on before returning for your next visit.

>> Find a pelvic floor therapist who accepts your insurance

Common pelvic floor therapy exercises

A common misconception is that pelvic floor therapy is only about building strength in the pelvic floor. It is not simply about strength, but it is also about learning how to relax the pelvic floor muscles.

Women will run into issues from a pelvic floor that has been overworked without the addition of relaxation exercises.

Here are a few common pelvic floor exercises you may be taught if you work with a pelvic floor therapist:

  1. The Kegel:  The Kegel is probably the most widely known pelvic floor exercise. It is performed by squeezing your pelvic floor as if you were holding in both urine and stool at the same time. While performing a Kegel, it is important to make sure that the buttock and thigh muscles stay relaxed, and that it is truly the pelvic floor muscles being engaged.
  2. The Elevator Kegel:  The Elevator Kegel is performed by picturing an elevator rising up your vaginal canal and as it goes up, the vaginal wall gradually squeezes around it. This is done by taking slow deep breaths, and contracting the pelvic floor while inhaling, and releasing slowly while exhaling.
  3. The Pulsing Kegel: The Pulsing Kegel is done by strongly squeezing the rectum and the vagina quickly and then releasing immediately. This is done in sets of 10 squeezes until the pelvic floor muscles start to feel fatigued.
  4. The Deep SquatThe Deep Squat assists in lengthening and relaxing pelvic floor muscles, while also helping them to stay engaged. To do it, place your legs wider than the hips and slowly squat down as far as possible without pain while the hands stay pressed together at the chest.  
  5. Child’s Pose: Child’s Pose helps to lengthen pelvic floor muscles and eases low back discomfort. To do this, kneel and sit back on your heels. Then, walk your hands out to the front, as far as they can go, with the chest staying close to the ground.  Allow the lower back to stretch out.

When to see a pelvic floor therapist

A pelvic floor therapist is typically a physical therapist or an occupational therapist who has obtained an additional certification, such as a CAPP, PRPC, or WCS.

It has been shown that the earlier a woman starts using pelvic floor therapy during pregnancy, the more effective it will be in reducing her pelvic floor dysfunction. And so, it is totally appropriate to start pelvic floor therapy during the first trimester.

However, research suggests that for pelvic floor therapy to be the most effective in making the pushing phase of labor easier and decreasing the risk of tearing, a woman should at least start by week 32 of pregnancy.

In addition, if you are dealing with any of the following, pelvic floor therapy can help:

  • Urinary incontinence
  • Fecal incontinence
  • Organ prolapse
  • Back pain
  • Loss of enjoyment of sex
  • Constipation

If you’re not sure where to get started with finding a pelvic floor therapist, we at Zaya Care can help. We have a network of maternal health providers, including pelvic floor therapists, that often accept insurance.

>> Find a pelvic floor therapist who accepts your insurance

Final thoughts on pelvic floor therapy during pregnancy

The pelvic floor has a gigantic job during pregnancy and birth.

Pelvic floor therapy is a tool that can significantly help the pelvic floor do its job well by keeping the muscles of the pelvic floor strong, supple, and well-circulated. This will decrease pelvic floor issues during pregnancy and can make birth—and the recovery after—much easier.

Pelvic floor therapy is an extremely helpful tool to be considered when planning for prenatal care. Pelvic floor therapy sets a woman up with a support system that will educate her on her body, help her be the strongest version of herself, and teach her how to resolve issues during pregnancy.  

Maintaining a healthy pelvic floor is a very important part of having a good quality of life during pregnancy, and there is no better way to help this than by using pelvic floor therapy!

Looking for a pelvic floor therapist? Zaya Care can help you find a pelvic floor therapist that accepts your insurance.

Denise Heisler is a labor and delivery nurse and mother of two. Pregnancy and birth have been a passion of Denise since she was in high school. Her hope is to help pregnancy and birth be an empowering experience for every woman.