When to Start Pelvic Floor Therapy During Pregnancy

In pregnancy, the tissues within your pelvic floor become stressed, and the joints within the pelvis become flexible and unstable. This can lead to fecal and urinary incontinence, constipation, pain, and even organ prolapse. 

Research shows that about 60% of pregnant women suffer from at least one of these pelvic floor disorders.

One of the best ways to reduce your chances of being affected by these issues is by going to pelvic floor therapy. Pelvic floor therapy typically includes both internal (if and when you are comfortable) and external manual therapy and exercise administered by a specialized physical therapist.

But when should you start pelvic floor therapy? And how do you know if you need it?

Research suggests that you should start by at least 32 weeks of pregnancy, but starting earlier may be beneficial. Most often, women have an assessment during the second trimester when body changes, including extra weight and pressure, become more noticeable. However, some women start as early as the first trimester.

This guide will help you decide if pelvic floor therapy is right for you, when to get started, how to find a qualified therapist near you, and more.

When to start pelvic floor therapy during pregnancy

Women have to cope with so many body changes during pregnancy and childbirth! 

Between the hormonal shifts, the ever-increasing weight of the baby, and the physical act of carrying and birthing an entire human, the pelvic floor undergoes significant change. 

The pelvic floor is a region made up of layers of muscles, ligaments, fascia, and nerves that run along the base of your pelvis like a hammock. It helps keep organs in place, plays a role in sexual function, and helps control your bowel and bladder.

Pelvic floor therapy during pregnancy can help this region handle the extra stresses of pregnancy so that it can continue to work as it should.

But pregnancy affects everybody differently. So, the “ideal time” to begin pelvic floor therapy during pregnancy varies from person to person. 

Starting pelvic floor therapy during the first trimester

It may be beneficial for some mothers-to-be to begin pelvic floor therapy as early as the first trimester. Women who have a history of pelvic floor issues, have had a previous vaginal delivery, or are showing early signs of pregnancy-related dysfunction, should be seen as soon as possible. 

In the first trimester, therapy would focus on strength-based resistance exercise, low-impact cardio (walking, swimming), and stretching and mobility exercises. 

Though getting started feels difficult when you’re pregnant, exercise is very important for both mom and baby. Not only can it reduce the risk of pelvic floor dysfunction, but it can also help prevent back pain, improve mental health, and reduce the risk of other health issues down the road. 

Starting pelvic floor therapy during the second trimester

The second trimester is a great time to start pelvic floor PT, as pregnancy symptoms like nausea begin to subside. Core strengthening exercises are very important at this point, as they will help reduce the risk of diastasis recti, SI joint dysfunction, and lower back and pelvic pain. 

An exercise program properly monitored by your PT is important to ensure muscles engage correctly to avoid injury. 

Your exercise program will also include upper and lower body strengthening. This improved strength will help you be more efficient during labor and delivery. The exercises will be tailored to your growing belly and changing center of gravity.

Typically, internal pelvic floor assessment and treatment begins in the second trimester (with your consent). This will clue you and your therapist in on how your pelvic floor muscles are functioning. 

It will also answer the questions: Do you know how to use them? Do you know how to relax them? Pelvic floor-specific exercise will be prescribed accordingly. 

Starting pelvic floor therapy during the third trimester

If you haven’t already started pelvic floor therapy at this point, start now! The third trimester is all about pain management and birth preparation. 

You’ll work on gentle stretching, positioning exercises, and partner massage techniques to help with pain relief. You’ll learn birthing positions and breathing strategies to be prepared for labor. You’ll even go over some recovery tips to help you through the early days with your new baby.

Manual therapy will continue (with your consent), now preparing your perineum to relax and expand naturally during labor. This will help reduce the risk of significant tearing. 

Benefits of starting pelvic floor therapy during pregnancy

It’s important to be aware of pelvic floor dysfunction symptoms. Be proactive about communicating any that come up with your healthcare provider(s), so you can get the support you need as early as possible. 

Be an advocate for yourself and understand the following benefits of pelvic floor physical therapy:

• Muscle strengthening. Improve the strength of your pelvic floor musculature, as well as your core and upper and lower extremities. This will lower the risk of dysfunction, help with successful labor, and lead to an easier recovery.
• Labor and delivery preparation. Learn breathing, relaxation, and positioning techniques to help you through labor. Reduce the risk of tearing by way of perineal massage.
• Pregnancy-related pain relief. Reduce (and prevent) aches and pains in the lower back and pelvic region.
• Incontinence prevention. Reduce the risk of incontinence both during and after pregnancy by starting therapy early and building a solid foundation to support your pelvic organs. 
• Pelvic organ prolapse prevention. Pelvic organs can descend into the vagina during pregnancy due to increased pressure on the pelvic floor. Pelvic floor therapy can help strengthen this musculature and support the pelvic organs.
• Recovery. Being proactive with your pelvic health makes postpartum recovery easier.
• Emotional well-being. Emotional health depends so much on physical health. Addressing pelvic floor dysfunction early improves quality of life for both the short and long term.

How to find a pelvic floor therapist during pregnancy

Pelvic floor therapy is essential through pregnancy and the postpartum period, but because of the intimate nature of the treatment, many women shy away from seeking help. Finding a qualified therapist who you trust is paramount through this process. 

Here is what you should look for:

• Licensed Physical Therapist who specializes in pelvic floor therapy. Therapists should have an extensive list of continuing education classes within the pelvic floor genre, particularly through the Herman and Wallace Pelvic Rehabilitation Institute and the American Physical Therapy Association. 
• Credentials and years of experience. Look for a therapist who has at least three years of clinical experience. If you must see a newer graduate, make sure they’ve got an experienced mentor they work with regularly.
• Approach and technique. Ensure that the therapist performs both internal and external therapy. Make sure appointment times offered are at least 45-60 minutes to ensure adequate time for proper internal and external treatment.
• Cost and insurance coverage. It is your responsibility to know your benefits and to be prepared to cover your treatments.
• Location and accessibility. Look for a clinic that is nearby. However, know that to find someone highly qualified, you may need to travel a little bit further.
• Referrals from your OBGYN, friends, and family. Ask people you trust for recommendations.

Finding the right pelvic floor therapist may take a few consultations. Don’t be afraid to keep looking until you feel completely comfortable and supported.

And welcome to the amazing world of motherhood!