Top 4 Reasons to see a Pelvic Health Physiotherapist Pre and Postnatally

There are many reasons to see a pelvic health physiotherapist both pre and postnatally. Here are my top 4:

1. To assess the state, health and function of your pelvic floor muscles

In order to truly know the state of the pelvic floor muscles ( the muscles that work hard to support our pelvic organs and the increasing pressure of a growing babe, keep us continent of bladder and bowel contents, and allow us to have pleasurable, painfree intercourse), an internal vaginal/rectal evaluation is required and highly recommended. During this exam, the physiotherapist will assess if the muscles are too tight or too weak. Muscles that are either too tight or too weak can lead to different conditions, including:
1) pelvic organ prolapse characterized by heaviness, pressure or bulging typically experienced at the vaginal opening
2) urinary incontinence or leakage of urine with a cough, sneeze, jump or run
3) pain with intercourse if the muscles are too tight and are not able to sufficiently relax and lengthen.

Although most women have heard about kegels, they are not appropriate for every woman in the pre and postnatal period and only an internal exam can determine if they are appropriate for you or not. The prenatal period is a great time to learn how to properly recruit and use the pelvic floor and inner core muscles – and this knowledge and training can  be used in the postnatal period as well. As your due date approaches, your physiotherapist can also help you get your pelvic floor ready for delivery through options such as teaching you perineal massage, as well as discussing with you optimal labour and delivery positions.

2. To assess for diastasis rectus abdominus or ‘ab separation’

Your pelvic health physiotherapist will assess for the integrity of the soft tissue on your abdomen. During pregnancy, we know that the soft tissue joining the right and left sides of the abdominals stretches and thins. In the prenatal period, your physiotherapist can discuss optimal ways of moving to decrease the ‘tenting’ or ‘doming’ that is sometimes seen along the midline of the abdomen when the tissue has stretched. In the postnatal period, your pelvic physiotherapist can give you advice about which exercises to do to help regain the strength of your abdominal muscles, as well as discuss which activities and exercises to avoid or modify so the separation is not exacerbated.

3. To assess for and treat pelvic girdle pain or low back pain

During pregnancy and after delivery, some women experience pain in the pelvic girdle or low back, often either at the pubic symphysis, the front of the pelvis, or at the back, at the sacro-iliac joints. This can be very painful and even debilitating in some cases. A pelvic health physiotherapist can assess the root cause of the pain, treat this pain with hands-on techniques and develop a home exercise plan to help you self-manage your symptoms.

4. Scar tissue management whether vaginal or c-section delivery

Whether you birthed your baby by c-section or vaginally and had some amount of tearing of soft tissues, scar tissue management is an important component of postnatal recovery. Scar tissue is often less flexible than other tissue and can (but certainly does not always!) lead to the experience of pain with intercourse, pain when using your abdominal muscles or bladder issues such as the need to urgently void your bladder. Your pelvic health physiotherapist can help to soften the scar tissue and desensitize the tissues so that you can resume your activities of daily life, including exercise and intercourse, in a pain-free manner.


What to expect during a pre and postnatal pelvic physiotherapy assessment:

An initial assessment is appropriate at any time prenatally (preferably into your second or third trimester) and usually at about 6-8 weeks postnatally, after your midwife or doctor has given you clearance to resume regular activities. Initial assessments typically take place over 60 minutes and include both a conversational and physical exam component.

To start, the physiotherapist will ask you many questions about any symptoms you may be experiencing, but also about medical history, pregnancy, labour and delivery, exercise, pain, bladder, bowel, and sexual function. This conversational interview is designed to gain a comprehensive view of the function of all the pelvic organs and inner core/pelvic musculature, as well as your whole body health – both physically and mentally/emotionally.

The second part of the initial assessment is a physical exam. Depending on the reason for your visit, this might include both an external and internal component. The physiotherapist will assess the bones, muscles and joints of your spine, hips, and pelvic girdle, as well as any other area of the body relevant in your specific case. Your pelvic physiotherapist will also assess the integrity of the muscles and soft tissue on your abdomen, as it relates to the presence of a diastasis rectus abdominus. An internal vaginal and rectal exam may also be warranted. In this case, the physiotherapist will assess the muscles of the pelvic floor, looking at their ability to contract, their strength and endurance, noting any areas of pain or tension. If you have had a c-section or vaginal birth with some degree of tearing, care will be taken to assess healing and mobility of the scar.

During the exam, the physiotherapist will talk you through what is being done and what the findings are, ultimately using this information to formulate a personalized treatment plan to optimize the health of your pelvic floor and inner core, assisting you in reaching your pre and postnatal goals.

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