Pelvic health physiotherapy during pregnancy

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Pelvic health physiotherapy during pregnancy

It is safe and appropriate to seek for pelvic health physiotherapy at any point in your pregnancy. If you are experiencing pain or have any concerns, you can start treatment at any point. If you do not have any concerns but want to be proactive, it is recommended to see a pelvic floor physiotherapist for an assessment around 25 weeks of pregnancy.

Pelvic health physiotherapy during pregnancy can help:

  • To prevent urinary incontinence: Pelvic floor muscle exercises during pregnancy decrease the risk to have urinary incontinence in late pregnancy of 62% and after delivery of 29%.[1]
  • To prevent tears during delivery and postnatal perineal pain: Perineal massage during pregnancy reduces the risk of perineal tears during delivery, particularly the risk of more severe tears (third- and fourth-degree), as well as it showed better wound healing and less perineal pain after the delivery.2 Pelvic floor muscle exercises during pregnancy are also related to less severe tears during delivery.[3]
  • To push for a shorter time during delivery: Pelvic floor muscles exercises during pregnancy are related with shorter duration of the second stage of labour during delivery.[3]
  • To prevent a diastasis recti abdominis (abdominal separation): Diastasis recti abdominis is the partial or complete separation of the rectus abdominis, or “six-pack” muscles, which meet at the midline of your stomach. Some exercises should be avoid during pregnancy (ex: crunches) and others should be favoured (ex: core engagment) in order to limit the diastasis recti abdominis.[4]
  • To reduce low back, pelvis and pubic symphysis pain: Physiotherapy could help to reduce musculoskeletal pain intensity using different modalities as posture correction, muscle relaxation, specific exercises, muscle stretches and the use of a pelvic belt.

What to expect at the assessment in pelvic health physiotherapy?:

This treatment is appropriate for any pregnant woman. The initial assessment comprises a one-hour individual pelvic health evaluation conducted by a registered women’s health physiotherapist. Depending on the purpose of the consultation, it may include a postural examination, an abdominal evaluation, a perineal assessment and a vaginal assessment.

 

References

1. Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, Kernohan A, Hay-Smith EJC. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020 May 6;5(5):CD007471. doi: 10.1002/14651858.CD007471.pub4. PMID: 32378735; PMCID: PMC7203602.

2. Abdelhakim, A. M., Eldesouky, E., Elmagd, I. A., Mohammed, A., Farag, E. A., Mohammed, A. E., … & Abdel-Latif, A. A. (2020). Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. International urogynecology journal, 31, 1735-1745.

3. Sobhgol, S. S., Smith, C. A., & Dahlen, H. G. (2020). The effect of antenatal pelvic floor muscle exercises on labour and birth outcomes: a systematic review and meta-analysis. International Urogynecology Journal, 31, 2189-2203.

4. Mota, P., Pascoal, A. G., Vaz, C., João, F., Veloso, A., & Bø, K. (2018). Diastasis recti during pregnancy and postpartum. Women’s Health and Biomechanics: Where Medicine and Engineering Meet, 121-132.

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