5 Reasons to See a Pelvic Floor Physiotherapist (Pregnancy and Postpartum)

By Julia Di Paolo

Through pregnancy and labour, a woman’s pelvic health can become impaired, making a pelvic floor physiotherapist an integral part of any woman’s prenatal and postpartum recovery toolbox. Here are my top 5 reasons why I think all expectant mothers, and those immediately postpartum, can benefit from a pelvic floor health assessment.

Prevention is key

My ideal client came in recently. She came for an ankle sprain two weeks before her wedding (Oh yes, we treat all types of injuries. We're still regular physios). As we were chatting, I asked the inevitable question all newlyweds get asked only I had an ulterior motive… 

Me: So when are you having kids?;

Her: Not sure, in a year or so;

Me: OK, well be sure to come in before you plan on getting pregnant;

Her: (alarmed) WHY?;

Me: So we can make sure your body is fully aligned. Know how you take folic acid BEFORE you get pregnant to improve the likelihood that the baby does not have a neural defect like spina bifida?;

Her: YES;

Me: Well, don't you think growing a baby inside an aligned body will be easier on you and the baby rather than growing one inside a body with all sorts of compensations already? How do you think your body would adapt to all those changes?;

Her: Oh, OK.

She came in to see me two months before they "pulled the goalie." We worked on alignment issues resulting from old injuries, assessed her pelvic floor, and taught her how to kegel correctly incorporating the Core Breath. We followed her in her second trimester and in her third, and taught her how to push the baby out. She came back two weeks post-natal to see how she was healing and to start some pelvic floor muscle retraining. At six weeks postpartum we conducted an internal exam to see how her recovery was progressing. Now three months postpartum, she is ready to begin some real exercises, incorporating her pelvic floor muscles into real movement. At her last visit, she said she was lucky that her pregnancy, birth and recovery went so well. It's not luck! She worked hard and smart! Prevention is key.

Really understand how the system is working. 

Would you find it odd to see a doctor and have him assess a skin condition from outside of your jeans? Why do doctors send us to get x-rays when we might have broken a bone? To find out the truth of course – what is really going on in there. Pelvic floor physiotherapists are trained to conduct internal exams on patients. We have specific training for assessing the muscles, connective tissues and nerves that make up the pelvic floor and we conduct this by performing an internal exam of the vagina and rectum. In Ontario, physiotherapists who have this special designation have to be registered with the College of Physiotherapists of Ontario. Click here to see if your physio can offer you the best pelvic assessment and treatment available.

Kegels aren’t right for everyone: pelvic health knowledge out there isn’t always the best advice

Nearly every pregnant woman I meet has heard about the kegel. That’s great that the knowledge of this tool for improving the performance of the pelvic floor muscle is out there. But here is what I also know: 30% of women don’t know how to perform a kegel properly. And, with certain conditions already present, a kegel can actually make your situation worse. The only way to know if you should be doing a kegel, and how to do it correctly, is to see a pelvic health physiotherapist.

Problems don’t just go away: pain, incontinence, prolapse

Sometimes when we have problems with our nether regions we just hope that they will go away. Is it because we are embarrassed to talk about them? When we experience pain during intercourse, we should not ignore this. If you have a 3rd or 4th degree tear during delivery you are 270% more likely to have pain during sex. It is so common that there is a medical term for it: dyspareunia. Only had a 2nd degree tear? Well you are 80% more likely. The pain can be on penetration, when he gets deep, or just in certain positions. There are other reasons for dyspareunia too including prolapse, vulvodynia, vestibulodynia, fissures, surgery and menopause. Pelvic health physiotherapists can assess the problem internally and find out why you are having pain.

Same goes for incontinence, which can be common post pregnancy and delivery. Having to know where every bathroom is on your way to work, timing your potty breaks so you don't leak when you walk to catch the bus, leaking pee when you jump on the trampoline with your kids… Ladies: leaking urine at any time when you are not sitting on a toilet wanting to pee is incontinence. It is unacceptable and it is CUREABLE!!!!!

Now, we have to talk about Pelvic Organ Prolapse. Pelvic organ what??? Caused by trauma (including pregnancy and labour), this is when your organs start to droop or descend into your vagina. It is as unpleasant as it sounds. Unfortunately, many women are unaware they even have one, and sadly women that know they have one are unaware that we can help. We have an 80% improvement rate with therapy. If the prolapse is what we call a “grade one,” we can cure it. A grade 2 and even 3 we can make considerably better. I have even rehabbed women with prolapse back to running safely! Left untreated, the prolapse will become a grade 4, which requires surgery. And even with surgery, rehabilitation is not guaranteed: 50% of prolapse surgeries fail within 5 years (link?). Scary stuff. So don’t let it get that far. Getting to see a pelvic floor physio, and coming at the first sign that something isn’t right (or better yet, during pregnancy!), is key.

The Dreaded Mummy Tummy

“Mummy tummy” refers to that pooch that women can get after having children. This little pooch seems to be present no matter how hard a woman works out. In fact, many exercises are actually making this pooch worse, and many women aren’t even aware of this. Diastasis Recti is the actual term for “Mummy Tummy” and it refers to a condition that happens often with pregnancy and labour: the muscles of the abdominals become separated. 

A pelvic floor physiotherapist can help ensure the integrity of your muscles remain during pregnancy and delivery, can show you exercises to perform during pregnancy that will help your muscles and can aid recovery postpartum where a diastasis is present.

Not convinced? What would it take? Already been? What did you learn? How did it change your life? Spread the word…! Tell two friends why they should go to a pelvic floor physiotherapist! Together we can