Pelvic Health Physiotherapy during Pregnancy
Are you pregnant and keen to look after your pelvic floor? Do you want to exercise to maintain your optimal health during pregnancy? Do you want to look after your back and pelvis during pregnancy?
Pelvic health physiotherapy can help maintain a happy and healthy bladder while your body undergoes the natural changes while you are pregnant. During pregnancy you will receive plenty of good advice however few specialists discuss with you the potential issues with bladder and bowel control problems which may occur during pregnancy and after childbirth.
Pregnancy and childbirth significantly increase the risk of bladder and bowel leakage and prolapse. These are all common issues, and much can be done to reduce risk and resolve these issues should they arise.
This guide will take you through the essentials to help you plan, build and progress through your pregnancy more effectively. The team are here ot help you, so should you have any questions please feel free to call or email to discuss in more detail.
Common symptoms of a bladder or bowel control problem may include:
• urine leakage when you laugh, cough, sneeze, lift and exercise.
• having to rush to the loo urgently for your bladder and bowel.
• leakage from your bowel.
• feeling a dragging or heaviness or lump or bulge in the vagina.
• difficulty emptying your bladder and bowel.
Good bladder and bowel health during pregnancy
You can help reduce the risk of these problems happening by following these simple tips;
1. Eat well – A good balanced diet should include meat for essential nutrients, some fruit and vegetables and you should reduce sugar intake and processed foods as they add little value to your baby’s development.
2. Drink well – Aim for 1.5 to 2 L of fluid per day, which will depend on your exercise levels and time of the year, mostly water, unless otherwise directed by your doctor. Avoid caffeine, alcohol, and sugary drinks as they can irritate your bladder.
3. Ensure you have good toileting habits
• Don’t go to the toilet to empty your bladder just in case – Wait until you feel that your bladder is full before you go.
• Empty your bowels on the first good urge – For most people this occurs in the morning and after food and a hot drink.
• Sit properly on the toilet – a small step under your feet can improve your ability for you to open your bowels.
4. Do your pelvic floor exercises – Your pelvic floor muscles help to control your bladder and bowel and support your pelvic organs. There is plenty of information throughout our website to help guide you further. Therefore, we need these muscles to work well to prevent and manage bladder and bowel concerns.
Pregnancy and childbirth are risk factors for a weakened pelvic floor or change in normal function. Again, these are all things that can be addressed but wouldn’t it be great to be a step ahead and avoid these issues form arising if at all possible?
Research has shown that by doing pelvic floor muscle exercises during pregnancy it will help the muscles recover more quickly after birth. Pelvic floor muscle exercises will also reduce the risk of bladder and bowel problems during and after pregnancy. Your pelvic floor muscles form the base of your pelvis they stretch like a hammock from the pubic bone to the tailbone and from side to side. These muscles can be challenging to use correctly so it is important to learn to activate these muscles correctly. This is best done with the assistance of a women’s pelvic health physiotherapist. Your women’s pelvic health physiotherapist will be able to give you strategies to help you master this if you find it difficult initially, which is not uncommon. They will help you then design a pelvic floor muscle training program to work on at home.
5. Stay active during your pregnancy – You should remain active during pregnancy. Current recommendations suggest 20-30 minutes of exercise per day. This will help keep your bowel moving and help you avoid constipation, while also help keep your body functioning well which will assist you as your body changes through pregnancy.
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EXERCISE DURING PREGNANCY
Exercise during pregnancy with regular exercise recommended during pregnancy, even if you have never exercised prior to pregnancy. This should be under the guidance of your doctor, midwife. or women’s pelvic health physiotherapist.
Clearance from you doctor or midwife is required as there is a small minority of women who should not exercise while pregnant.
Benefits of exercise in Pregnancy
• helps back pain or the prevention of it
• improves physical fitness and develops tissue tolerance
• reduces the risk of gestational diabetes (as does improved diet during this period)
• decreases chance of having a caesarean or operative vaginal delivery
• reduces cramping, swelling and constipation
• improves sleep and recovery (your body is going through a lot right now)
• improves mood You should read the RCOG guidelines ( https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/physical-activity-and-pregnancy/ ) Physical Activity and Exercise During Pregnancy, as these will inform you of the precautions that should be taken during pregnancy.
What's the best exercise to do during Pregnancy?
• walking – especially if you are starting out
• swimming – low loading for the joints
• cycling on a stationary bike – low load for joints and good if starting out
• pregnancy exercise classes eg; Pilates or Yoga – target approach to strengthening & lengthening
• strengthening exercise classes with light weights – strength is good for you
What exercise should be avoided during pregnancy?
• hot yoga – temperature issues more than anything, your body can struggle to adapt
• any sport that carries a risk of falling e.g. gymnastics, horse riding, skiing, contact sports
• sky diving
• scuba diving
• any exercise that hurts! This all seems obvious, but it is still worth putting out there.
When can I return to exercise after the birth?
During the first 6 weeks you should focus on rest and recovery. During this time, once comfortable, you should start some gentle walking and pelvic floor exercises. Your women’s pelvic health physiotherapist will have taught you to do your pelvic floor muscle exercises while you were pregnant.
We recommend that you visit your women’s pelvic health physiotherapist after your 6 week post-natal appointment with your doctor or midwife. At this appointment your clinician will give you advice on progression of activities and exercise recommendations.
This is important, as resuming exercise or incorporating new exercise helps establish lifelong habits, and will aid your recovery to good health. These recommendations will vary from person to person depending on many factors such as mode of delivery and presence or absence of medical or surgical complications.
PELVIC GIRDLE PAIN
Pelvic girdle pain and back pain during pregnancy can affect up to 50% of women.
The great news is that conservative treatment such as physiotherapy, targeted exercises and massage can all help get you back to your best again.
Why do we get pelvic girdle and back pain while pregnant?
During pregnancy there are so many changes to the body that may contribute to pelvic and back pain. Some of these changes may include:
• postural changes
• stretching of your abdominal muscles
• pressure and stretching on your pelvic floor muscles
• increase body weight
• inflammation
Management of pelvic girdle pain or back pain
A women’s pelvic health physiotherapist can work with you to identify the problem and give you individualised advice, treatment and an exercise program for your condition. Some examples of treatment may include:
• advice on rest and ice
• pelvic support belt
• targeted exercise program focussing on balance and support
• General exercise advice
• SI Joint Physiotherapy assessment & treatment
During Pregnancy Plan
FURTHER INFORMATION
Make an appointment with a Pelvic Health Physiotherapist to have an assessment.
At this appointment you will be assessed for any bladder, bowel, prolapse or back or pelvic pain concerns. Goals surrounding exercise will be established. We know that pelvic floor muscle weakness is common during pregnancy and may lead to bladder leakage or prolapse. Prevention is better than cure and our team can help guide you through the right steps. You will have a personalised pelvic floor muscle training program designed and any other bladder and bowel or pain concerns addressed. General exercise advice will be given. For prevention you may see your women’s pelvic health physiotherapist a couple of times to help guide you through, however it may be more if you have symptoms.
After the delivery it is advised that you see your pelvic health physiotherapist once you have had your 6-week check with your doctor of midwife. At this appointment a thorough assessment will occur and a treatment plan established. Management will focus on any current concerns initially and then will aim to assist you to develop a long-term exercise plan so you can achieve your health goals. This can guide you through to your return to exercise with our Pelvic Health team at Body Logic Health where we offer Reformer Pilates, massage, early exercise training and return to running planning for you, once our women’s health physiotherapist is happy you are ready for the next step. This normally happens between 6 and 12 weeks depending on your progress and other factors.
Your Pelvic Health Team at
Body Logic Health
Our pelvic health team includes Lindsay MacIsaac as our Women’s Pelvic Health Physiotherapist, and she is supported by our team of Pelvic Health Rehabilitation experts working in Pilates, Running, Foundation Training, who are Katherine Pester, Federica Benotti and Monique Nobrega
Conditions that our women’s pelvic health physiotherapist treat include:
• Stress urinary incontinence
• Urge urinary incontinence and urinary urgency
• Urinary frequency and nocturia
• Pelvic organ prolapse
• Post gynaecological surgery management
• Pre and post natal care including pregnancy related pelvic girdle pain, abdominal separation
• Pelvic pain including vaginismus, dyspareunia and chronic pelvic pain
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