Q&A with Pelvic Health Physio for Pregnancy and Postpartum

In talking with clients in session I get a fair amount of questions about Pelvic Floor Physiotherapy. I thought I would get some of these questions answered by an expert in the field, my physiotherapist herself!

In sessions, I may also refer clients to a Physiotherapist if any pain or discomfort during pregnancy or postpartum is not getting better with massage alone.


FAQ answered by Leah Milne over at Lakeview Physiotherapy in Calgary, AB:


Q: What are some common reasons why women come to see you during pregnancy?


There are so many! I’m lucky to see a lot of women who come because they want to learn about their bodies, and want to know what they can do throughout their pregnancy, and postpartum to take care of their pelvic floor to prevent problems. We can even teach techniques to help during labour and delivery like perineal massage, breathing techniques, optimal positions for labour and delivery.


I do also see a lot of patients during their pregnancy for pain. This could be lower back or tailbone pain, pubic symphysis pain, abdominal pain or rib pain and discomfort. A lot of times these problems can be from issues with alignment and/or muscular imbalance. A thorough history and assessment can guide treatment of the patient and help improve symptoms. Just because you are pregnant does not mean that pain is normal, and most of the time there is something that we can do to help to manage the discomfort!


Another reason that patients will come to see a Pelvic Health Physiotherapist in their pregnancy is Urinary or fecal incontinence. For some, it was pre-existing to their pregnancy, but for others, symptoms may start in their pregnancy. Again, a thorough history and assessment is key, and we can often find ways to improve symptoms and prevent a future worsening of the problem.


Some patients will also come in with increased symptoms of discomfort during intercourse. This can be due to many factors, including, hormonal changes, changes in the tension of the Pelvic floor muscles (think too tight, or too loose), as well as pressure related changes that could be part of the pregnancy or more posture and tension related. Again, this is something really important to have checked out, especially if you are planning for a vaginal birth!


Q: What happens during an assessment? Do you do an internal exam – is it mandatory?


Generally speaking, an internal, vaginal examination is the gold standard assessment tool for pelvic health physiotherapists, as we can get the most accurate assessment of what is going on in the pelvic floor. There are however reasons when we would not do an internal vaginal assessment, for example: during the earlier stages of pregnancy when an ultrasound has not been able to clear out any issues with baby or placenta position, or if the person is too uncomfortable lying on their back. Some people might also be uncomfortable with this type of examination, thus in cases like this, we can modify our examination to the patients’ comfort level. For example, we can get a sense of the pelvic floor muscles function by palpating over the tailbone or inner groin area, we can also look at the pelvic floor contraction and how the person is engaging the muscle. A big part of our job is education and awareness; we can often give feedback, or advice without doing a full internal examination.


Q: What does labour prep look like with you?


There is so much to know and learn about labour and delivery! Everyone is unique in their experiences and fears as well as in their body and pelvic floor. A history and assessment are where we usually start to see if there are any things that we need to focus on for that individual. Some things that we would often cover are:

How to relax and release the muscles of the pelvic floor

How breath can be used to increase and decrease tension in the pelvic floor

Optimal positions for labour and delivery (again, this may vary depending on the person)

Optimal positions for pushing and how to push.

Preparing the pelvic floor for labour and delivery,

Postpartum recovery and care.


Q: When and why should women see you postpartum?


The best time to check in with a Pelvic Floor Physiotherapist is around 6 weeks postpartum. At this time, most of the swelling and discomfort has subsided, and we can get a good assessment of the true function of the pelvic floor. Plus, it is still early enough to take advantage of the body’s natural healing and make any necessary changes early on, before other habits have been formed.


I would always say to come in sooner than later, especially if you have any concerning symptoms that need to be addressed! Don’t wait!


Q: What if everything seems “normal.” Should someone still see you before or after baby? What are the benefits?


Pregnancy itself puts a massive strain on the body, think about how much your core muscles expand and change during this time! The way that your body functions is going to change! Knowing how best to use your new body, especially as it is healing is very important. It is also important to note that symptoms might not arise right away. Often patients start to notice symptoms when they begin to do more activity! Thus, I would always recommend making sure that you know where your body is at, and how to use it optimally BEFORE increasing activity levels, even if you feel great!


Q: What is the deal with kegels anyway and why does every book recommend you do them?


Kegels can be a really good exercise for the right person, but they are not suitable for every person. Instead of thinking of the Pelvic Floor muscles, let’s think of your butt muscles instead. Some people have a tight and overactive butt muscle, and this may or may not cause them problems, while others might have really weak glutes. Do you think that the same exercise is going to be suitable for both types of people? The answer is obviously NO! Of course not! Plus, just like there are lots of ways to strengthen the butt muscles, there are also lots of ways to strengthen the pelvic floor muscles! And what exercises are right for you will depend on your body and the types of loads and demands that you put on your “system.”


Quite honestly, there is limited research in the Pelvic Health field, but it growing quickly. There is some pretty good evidence that shows poor pelvic floor strength has a correlation with stress urinary incontinence. With this research, everyone has “jumped” on the kegel bandwagon! But unfortunately, we have not talked about what a “kegel” is? How do you do it properly? What should it feel like when you “kegel,” how should they be done and when should you do them? And we have most definitely not talked about who should do them and who might need to steer clear!


Before you start “kegeling,” I would recommend visiting a pelvic health physiotherapist to see if you would be a good candidate for pelvic floor strengthening. Kegels are more than “squeezing  your vagina.” A pelvic floor physiotherapist can tell you if you can engage and relax your muscles well, how to use your breath and posture to optimize the function of your pelvic floor and how this will relate to the things that you do day-to-day!

For more information, resources and links to local pelvic health physiotherapists-check out Part 1 of this article.

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