Benefits of pelvic floor PT during pregnancy

One phrase I heard way too often during my first pregnancy was, “it’s the hormones.” I have a sinus infection, google or the nurse advice line would reply with, “it’s the hormones”. I feel bloated, “it’s the hormones”. I have back pain, “it’s the hormones”. I have hip pain, “it’s the hormones”. I feel like I have to pee ALL OF THE TIME and I’m only in my first trimester, so it’s not like baby is so big pushing on my bladder, “it’s the hormones”.

I honestly got really sick of hearing it, and it made me feel like there was nothing I could do to better my situation, and make myself feel semi-normal during my pregnancy. I was a PT, and I had done some research on pelvic floor therapy, but I didn’t know it well at the time. Therefore, during pregnancy one, I simply succumbed to my discomforts and adopted the moto “it is what it is”.

I was two- years postpartum when I decided to dive into continuing education to pursue pelvic health PT full-time. I sat in a conference room with about 100 other female PTs for three days, the weekend before the world shut down due to Covid. It was an intro- to pelvic floor class, lecture and lab. During that weekend, I had so many, ah-ha! moments, and why didn’t anyone tell me this- moments! I was a little upset. Here I was being thrown solution after solution to all of these complaints I had during my pregnancy and early postpartum. The knowledge and research was there. But my providers were ill-informed, and therefore, were unable to inform me.

I haven’t come across anything that suggests a connection between pelvic floor PT and sinus issues during pregnancy, but I can attest to how pelvic floor PT can assist with the other complaints I had.

What happens during pregnancy? There is a shift in hormones, progesterone goes through the roof high in order to maintain the pregnancy, and there is an increase in the hormone relaxin (it helps increase laxity of ligaments at the pelvis to allow baby to make their entrance). However, relaxin is not ligament specific, and it does affect all of the ligaments in the body. This increase in laxity at all of the body’s joints can lead to instability of the joint, and therefore muscles surrounding the joints have to work harder to maintain that stability. If the muscles are weak going into pregnancy, working overtime can cause those muscles to hurt, which manifests itself into back pain, hip pain, pelvic pain, wrist pain, ankle pain, and more.

Increased hCG (human chorionic gonadotropin) can lead to increased blood flow, causing the kidneys to filter more, therefore producing more urine. Increased progesterone can lead to decrease in laxity of pelvic floor muscles and ligaments, the same muscles and ligaments that help support the bladder. This can lead to a decrease in bladder capacity, signaling you to need to urinate more frequently.

So yes, it is the hormones that are signaling the cascade of symptoms one may experience during pregnancy, but the hormones are affecting tissues (muscles, ligaments, joints) and these are areas that Physical Therapy can assist with.

Whole body strengthening during pregnancy can help muscles maintain appropriate strength to achieve stability in joints and decrease pain throughout the body. Pelvic floor muscle strengthening can help with support around the pelvis, assists with sump pump function of body to help decrease swelling, helps support the pelvic organs, including bowel, bladder, and uterus, and therefore can decrease urinary urgency. As a pelvic floor PT, I would be remised if I left out the importance of focusing on pelvic floor lengthening as well during pregnancy. This not only helps promote balance, to ensure your muscles are not overworked, but it also helps ensure they know how to get out the way during delivery, so as the uterus is pushing your baby out, your pelvic floor is letting baby come through (not gatekeeping).

Pelvic Floor PT during pregnancy not only helps solve problems, but it can also help prevent them. With any major surgery to the body, doctors will assign PT for pre-hab, because they understand muscle memory and that it is easier to rehabilitate the muscles after a major trauma to the area if there is existing strength and muscle knowledge there. Having a baby, although natural and beautiful, is a trauma to the pelvic floor, and recovering in postpartum will be that much easier, if during pregnancy, we trained the muscles to help prevent urinary leakage, constipation, bowel leakage, pelvic organ prolapse, hip/ back pain, pain with intercourse, diastasis recti, etc…  

Have women been having babies since the beginning of time? Yes. Did Physical Therapy, let alone pelvic health PT exist hundreds of years ago? No. Modern problems require modern solutions. Prior to this age we are in now, women/ people were more mobile, we worked in the homes, around the homes, away from the homes. We were not sedentary. Today, we sit in front of a computer 4-12 hours a day, we’re in our cars, sitting, driving for 1-2 hours to work each day. Our bodies are not as mobile, and therefore we may have more issues of pelvic floor tension leading to other dysfunctions. Even if we are extremely athletic, depending on the sport we dedicate ourselves to, this may also lead to increased tension in the pelvic floor. Modern problems require modern solutions. This is why we focus on this part of the body, as it connects our lower body to our upper body and handles a lot of the things important to us.