Svetlana Marianer, MSc PT
Pelvic Floor Physiotherapy and Pregnancy: What You Need to Know
Updated: Oct 13, 2022
This article was written for Lumino Health by Kristen Mayne written in consultation with Svetlana Marianer, MSc PT and can be found here.
What is pelvic floor physiotherapy?
Pelvic floor physiotherapy was almost unheard of in Canada 15 years ago. But this specialized physiotherapy treatment is gaining in popularity and helping patients, says Svetlana Marianer. She’s a registered physiotherapist who specializes in pelvic floor physiotherapy at The Orthopaedic Therapy Clinic in Toronto. Marianer shared what pelvic floor physiotherapy is all about.
What does the pelvic floor do?
Before delving into pelvic floor physiotherapy, let’s talk about the pelvic floor itself. The pelvic floor is a group of muscles that create a support structure for the pelvic organs, Marianer says. In females, the pelvic organs are the bladder, bowel and uterus. The pelvic floor muscles help control the bladder and bowel. They also work with the muscles of the back and abdominal wall to support the low back. Being pregnant and giving birth stretches the muscles of your pelvic floor. According to the Canadian Physiotherapy Association, one in three women in Canada have some form of pelvic floor dysfunction.
How do you know if you have pelvic floor issues?
Unintentional urine leaks are just one of the many symptoms that you can experience related to the pelvic floor. Marianer says if you’re experiencing any of the following symptoms, consider getting a pelvic floor assessment:
leaking urine when you exercise, laugh, cough or sneeze
constantly needing to go to the toilet
finding it difficult to empty your bladder or bowel
a prolapse, which may feel like a bulge in the vagina, or a feeling of heaviness or discomfort
pain in your pelvic area or pain during intercourse
What happens at the first pelvic floor appointment?
The first appointment begins with a discussion with your physiotherapist about:
your history of pelvic pain
The physiotherapist will then talk with you about what’s happening with your body, your concerns and your goals. Next, they will do an internal and external exam. Marianer says she also gives patients a short anatomy lesson. “It’s important that patients understand why we’re doing what we’re doing during treatment.” For the external exam, the physiotherapist will look at your muscles from your core muscles in your abdomen to your leg muscles. “We want to see how they’re working together. The pelvic floor is a big part of our core,” explains Marianer. Next, the internal exam allows the physiotherapist to assess the muscle integrity of your pelvic floor. “Through the internal exam I can feel whether the muscles are too tight or too soft. And whether you can contract and hold your muscles,” says Marianer. Once the assessment is done, the physiotherapist will discuss the treatment plan. This may include soft tissue work and pelvic floor exercises to do at home.
Can you do pelvic floor physiotherapy while pregnant?
Pelvic floor physiotherapy during pregnancy can help prepare you for giving birth. “It’s recommended that you begin pelvic floor physiotherapy anywhere between the second and third trimester,” says Marianer. “Pelvic floor treatment can help ensure the muscles are elastic enough for birth.” It can also act as a preventive measure. “For example, incontinence is common during pregnancy. But if you’re leaking all the time, then perhaps there’s a problem with muscle integrity. Maybe the muscles aren’t strong enough to hold and control the bladder. That’s something that a patient can work on during pregnancy,” Marianer says. After birth, she says you can restart pelvic floor physiotherapy roughly 4-6 weeks postpartum.
What about those who’ve had a C-section? Can they benefit from pelvic floor physiotherapy?
If you’ve had a C-section, Marianer says it’s still a good idea to see a physiotherapist for pelvic floor physiotherapy. Carrying a baby for nine month impacts the pelvic floor. The incision can also cause a variety issues with the pelvic floor. “As I mentioned, a big part of our pelvic floor is our core,” says Marianer. “With a C-section, an incision is made in the abdominal muscle. As the muscle heals, tissues bind to one another and can create pain and discomfort. It can also reduce elasticity which can make bending forward uncomfortable.” A physiotherapist can assess your C-section scar and treat the area with scar massage.
How long does it take for pelvic floor physiotherapy to work? And what are the outcomes following pelvic floor physiotherapy?
The number of treatments needed to treat a pelvic floor issue varies. “Often one to three sessions can make a real difference for patients. But if it’s a more serious problem it can take more time,” Marianer says. The goal, Marianer says, is to have recovery – to reverse what the patient is going through. “There are different variations on how one recovers. But the goal is to be better than where you were before.” Looking for a physiotherapist? Search for a physiotherapist near you and request an appointment.
Written in consultation with Svetlana Marianer, Registered Physiotherapist, MSc. Pht.