When to Start Prenatal Pelvic Floor Therapy?
Authored by Dr. Maryssa Steffen, PT, DPT, and Board-certified Pelvic Health Clinical Specialist
Do you want to know when to start kegel exercise in pregnancy? Do you wonder if you are “doing it right?”
You may work with a pelvic floor therapist as early as early as your first trimester:
Neck, lower back pain, tailbone, hip, or knee pain relief.
Signs of prolapse during pregnancy.
Posture strengthening and hip strengthening to improve postpartum outcomes including limiting risk of developing pain and improving ability to lift and hold your baby.
Education and answer your questions about healthy bowel and bladder habits to reduce risk for vaginal tearing, constipation, and pelvic organ prolapse when postpartum.
You may work with a pelvic floor therapist as early as your second trimester:
Treat and reduce urinary leakage with sneezing and jumping.
Reduce constipation and improve pelvic floor coordination.
Treat and reduce sharp pelvic pain, round ligament pain, pubic bone pain, vulvar pain, low back and sacroiliac joint pain, hip pain, tailbone pain and hemorrhoids.
Learn to manage and reduce pelvic organ prolapse symptoms.
Receive a prescription for individualized pelvic floor exercises that encompass pelvic floor awareness, activation and isolation of the muscles to improve delivery outcomes, how to push your baby down with breathing, pelvic floor coordination with abdominal muscles to improve postpartum strength, and how to train your pelvic floor endurance.
You may work with a pelvic floor therapist in your third trimester and up until your delivery date:
Pain management
Leaking urine
Perineal massage to reduce risk of significant vaginal tears or episiotomy and to reduce risk of perineal pain at 3 months postpartum (Chen et al., 2022).
Your therapist can consult with other members of your birth plan team to improve coordination of care and the support you deserve.
Your therapist can also help you to understand your birthing options. Learn more about any suggested interventions proposed by your OB-GYN (scheduled C-section, induction, hospital birth, etc.) and how you can improve your functional outcomes after delivery and beyond.
If you are currently pregnant, you do not need to be leaking urine now to prevent urine leakage when you are postpartum or older. Prevention is an option.
If you are pregnant, or planning to become pregnant soon, do you know why you may have heard about kegels or prenatal pelvic floor exercises?
A “kegel” is the name given to a pelvic floor muscle contraction. When your pelvic floor muscles contract, they shorten to cause movement. For example, the muscles in the palm of your hand contract when you close your fist. When your pelvic floor muscles contract, they tighten around your urinary and anal sphincters to prevent you from losing control.
Your pelvic floor muscles contract when you hold your pee, hold your poop, when you are aroused and orgasm, and when you hold your pelvic organs in your body during a sneeze.
If you heard about kegels, it is likely that the context is to prevent urinary or bowel incontinence (peeing and pooping when you are not at the toilet), to improve orgasm quality, and to prevent pelvic organ prolapse.
However, pelvic floor contractions are not a “one-size-fits-all.” In other words, some people have a light contraction force and yet they do not have any symptoms and they are pleased with their orgasm quality. In contrast, other people may have a strong contraction force and they complain of urinary leakage, vaginal heaviness, and diminished orgasm quality.
Oftentimes, people experience pelvic floor symptoms and dysfunction due to clenching and squeezing their muscles a lot. This habit or excessive pelvic floor tension causes tightness.
If you are pregnant, you may be wondering what your pelvic floor strength is, and why it may matter for you.
“It is possible that pelvic floor muscle training is more effective in preventing urinary incontinence when it is targeted to the individual (Woodley, et al. 2020).”
An example of a targeted approach is to consult with a pelvic floor therapist to see if pregnancy pelvic floor therapy is right for you. A pelvic floor therapist is a board licensed professional who is trained to understand your medical history, your birth plan, and the inter-relationship of your body systems, to effectively and safely prescribe a prenatal pelvic floor exercise program. We can also consult with your other providers on your birth plan team.
If you are appropriate for internal pelvic floor therapy, you will learn how to coordinate your muscles well, how to relax them adequately, how to push during the active stage of labor, and how to limit the risk of pelvic organ prolapse, constipation, and urinary leakage.
You will learn how to relax your pelvic floor muscles for birth.
You are appropriate for internal pelvic floor therapy if you have been cleared by your OB-GYN to participate in penetrative sex and exercise.
If you are in the state of California, book a discovery call to learn more about our prenatal pelvic therapy. We offer Telehealth and in person visits. Our office is located in Oakland, CA.
