Prenatal Pelvic Health

Pregnancy affects almost every system in the body. It affects our cardiovascular and respiratory systems, our endocrine and even our gastrointestinal system but the most obvious changes are that of the musculoskeletal system!

Physically, our body is forced to adapt to constantly changing hormones, alongside a rapidly growing fetus. Our abdominal wall stretches and expands to accommodate these demands and often our center of gravity and posture changes in response to the increased weight on the front of our torso.

This change in posture can cause increased stress and activity on the muscles surrounding the pelvis as well as the muscles INSIDE the pelvis (hello pelvic floor!) and lead to symptoms of pelvic girdle pain, pubic bone pain, lower back and tailbone pain. Your pelvic floor is also under progressively more pressure and load as your baby grows, which can create more tension in the muscles and contribute to pain.

Pain in pregnancy is never normal. Too often any type of discomfort or pain experienced in pregnancy is brushed off as a normal part of a pregnant woman’s journey. This narrative needs to change. Pain during pregnancy can lead to a decrease in physical activity, increased stress and anxiety, impact sleep quality and can lead to pain postnatally.

There are many things we can do to help alleviate your pain and get you moving easier and with less discomfort, so that you can better enjoy your pregnancy.

Although it’s true that urinary frequency (your need to pee) increases in pregnancy, bladder leakage is never normal.

It is not normal to leak when you laugh, sneeze or cough. It’s also not normal to leak when exercising and it’s a sign that something isn't functioning properly. In fact the LARGEST risk factor for bladder leakage later in life, is bladder leakage DURING pregnancy.

Kegels Aren’t The Answer. Kegel exercises (pelvic floor strengthening) aren’t for everyone. In fact, they can sometimes make bladder leakage worse, especially in pregnancy. Because pregnancy increases the demands on your core and pelvic floor, they can often become over-active or too tense. This tension limits their ability to absorb pressure (like that generated by sneezing) and can result in leakage or pain. This means that giving strengthening exercises to a mom with too much tension, would just build more tension and may make her symptoms worse.

So how do you know what to do? The best way to identify what is going on with your pelvic floor and the factors driving your bladder problem, is to have an internal assessment by a specialized physiotherapist. Your physiotherapist will be able to assess your pelvic floor muscle strength, tone, coordination and ability to contract/relax when you need it to. They will also look externally at your movement strategy, posture changes, core and hip strength to find the driver behind your leakage and then design a specific treatment plan for you.

Don’t wait until after birth to address your bladder issues. Early treatment not only makes the rest of your pregnancy more enjoyable, it also helps improve your postpartum experience. Contact a pelvic floor physiotherapist as soon as you experience issues.

Pregnancy is an amazing and wild journey and although it can be very exciting, it can also be nerve-racking to think about how the tiny human growing inside of you is going to have to exit your womb and greet the rest of the world.

As part of your prenatal visits, your pelvic floor physiotherapist will guide you through the evidence and options available to you during birth. This includes optimizing labour and birth positions, breathing strategies and pushing techniques, as well as perineum mobilization to help reduce the likelihood of perineum tears and trauma to your pelvic floor.

Our goal is to help you feel informed about your body and choices and give you the confidence to advocate for yourself during the birth process.

It has been well established that staying physically active in pregnancy is both safe and highly recommended. In fact, the 2019 Canadian Guidelines for Physical Activity in Pregnancy, recommend that all pregnant women (without contraindications) complete at least 150 minutes of moderate intensity exercise each week to achieve health benefits and reduce pregnancy-related complications.

Women who stay active in pregnancy have shown lower incidences of: depression,excessive weight gain, gestational diabetes, gestational hypertension, preterm birth, and lower rates of cesarean birth (ACOG, 2020).

Although most women know that staying active is beneficial, it can be overwhelming and frustrating trying to adapt your current exercise routine for your ever changing body, hormones and nausea and it can certainly feel confusing trying to navigate all of the contradictory advice online.

Whether you are an avid exerciser or just starting out, your physiotherapist will help guide you on how to modify your workouts, teach you on how to utilize and protect your pelvic floor and core during exercise and give you support and guidance as you progress through each trimester. From crossfit, to running, to yoga or swimming, no pregnancy is the same and you deserve individualized attention and support.

If you’re feeling confused about your current exercise routine, or are looking for more support, Please reach out. We are here to help. (Book Now).

For more information on the Canadian Guidelines for Physical Activity in Pregnancy click HERE

Planning for your postpartum experience DURING pregnancy is KEY.

During pregnancy, there is a ton of information and resources, planning and attention focused on the birthing process. Although childbirth is an amazing experience and absolutely deserves attention, it often comes at the expense of planning for your postpartum recovery.

This can leave moms feeling confused and overwhelmed as they are left to navigate their postpartum healing and transition to motherhood on their own.

Childbirth is a significant trauma to your pelvic floor and core, regardless of whether or not you’ve had a vaginal or c-section birth. Your physiotherapist will help prepare you for the immediate postpartum period (the first few weeks) with respect to incision and scar care, movement strategies and considerations, toileting strategies and breathing techniques as well as pelvic floor and core activation exercises to help reduce pressure on your pelvic floor and abdominal wall as you recover which can help prevent issues from developing later.

Past the 6 week mark, once cleared by your healthcare provider, your physiotherapist will also recommend that you come back for a thorough evaluation to assess for diastasis recti (abdominal separation), any scar tissue dysfunction (perineum or abdominal), address any pelvic floor symptoms you may be experiencing (urinary leakage, heaviness/pressure, painful intercourse) and set you up with a progressive and strategic exercise program to get you back to doing the movements and activities you enjoy. Too often, women are left to navigate their postpartum return to exercise on their own, which can not only lead to injury and frustration but overwhelm and unrealistic expectations about their recovery.

You can learn more about the importance of postpartum recovery and rehabilitation here