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Pregnancy & Post-Partum

Physiotherapy for Pregnancy and Post-Partum

Pregnancy is a time of abundant change in your body.  It is also a time of significant preparation and great anticipation.  What women are often not prepared for are some of the potentially challenging consequences of pregnancy including incontinence, pelvic organ prolapse and pelvic girdle pain. ​​

Pelvic Girdle Pain

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  • Can include pain in areas including the sacroiliac joint (SIJ), tailbone, pubic bone and pubic symphysis

  • Pelvic girdle pain can be a common problem in pregnancy.  The good news is that your pelvis is NOT unstable. 

  • There are simple solutions to resolving the pain and functional challenges for pelvic girdle pain. 

  • Look at Cecile Rost’s work online  (https://rosttherapy.com/information-for-patients/pelvic-girdle-pain-symptoms/)​

  • Come in to see us.  We will show you how to resolve this problem quickly and independently!

  • Watch this great video to get the latest information on what the research says about pelvic girdle pain!

Incontinence

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  • Urinary Incontinence is very common during pregnancy. If you are experiencing this, you are not alone.  Approximately 40% of first-time Mom’s will experience urinary incontinence during pregnancy, with an additional 15% experiencing incontinence in the early post-partum period. 

  • It is also very common for incontinence symptoms to not show up until 2-3 decades after your delivery, so chances are if you do not have symptoms right away, 1 in 3 women will still get symptoms as they go through menopause and beyond.

  • There is Level 1 evidence supported by both the Canadian Physiotherapy Association (CPA) and the Canadian Society of Gynecologists that pelvic floor muscle training with a physiotherapist who uses internal palpation is recommended to prevent urinary incontinence both during and after pregnancy.

  • Strengthening your pelvic floor from Week 20 onwards during pregnancy has also been shown to reduce the second stage of labour; in other words, Kegels will help reduce the length of time you spend in the “pushing” stage.

  • All in all, it is a great idea to have your pelvic floor assessed in pregnancy, and be taught how to properly strengthen and relax your pelvic floor muscles. Consider doing this even before symptoms start!

Pelvic Organ Prolapse (POP)

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  • Pelvic Organ Prolapse (POP) is another potential consequence of pregnancy and delivery. 

  • Having a Caesarean Section does not protect you against POP since the pregnancy alone can create problems for your pelvic floor muscles, especially when paired with chronic constipation. Check out the Bristol Stool Scale online:(https://en.wikipedia.org/wiki/Bristol_stool_scale)

  • If your bowels are not Type 3 or 4 on a consistent basis, see a pelvic floor physiotherapist for some easy strategies to help with this significant contributing factor. 

  • The third factor that contributes to POP is a prolonged second stage of delivery, including the use of instrumentation (forceps and suction) during delivery. ​

Labour and Delivery Preparation

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  • Make sure that you prepare a labour and delivery plan that includes lots of movement (walking, rocking, stretching, and breathing) to help minimize trauma to your pelvic floor during labour and delivery. 

  • Perineal massage and other pelvic floor preparatory techniques can be a useful tool to optimize pelvic floor function prior to delivery 

  • Take extra special care of your pelvic floor in the post-partum period, especially in the first 6 weeks post-partum.  Get plenty of rest and don’t start an aggressive exercise plan until your family doctor, midwife or pelvic floor physiotherapist can assess your pelvic floor.  You should have at least Grade 3/5 strength in your pelvic floor muscles with good timing and coordination before starting an exercise program that includes running, jumping and weight lifting.  This will minimize the risk of prolapse in the post-partum period. 

  • Your pudendal nerve (the nerve that controls your pelvic floor muscles) takes six weeks to recover from the trauma of a vaginal birth.  Give it time to do this, so that it can do its job controlling your pelvic floor muscles through the rest of your lifetime.

Forceps, Suction and other Instrumentation

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  • Anal incontinence (loss of control of gas) and fecal incontinence (loss of control of stool) are also very common, especially in those women who have instrumental delivery- forceps or suction. 

  • There can be trauma to the anal sphincter during instrumental birth. 

  • The Irish Clinical Practice Guidelines (2012) recommends that a physiotherapist specializing in pelvic floor rehabilitation be involved right from the beginning in restoring these tissues to their optimal function. 

  • With early detection and repair, followed by internal physiotherapy, 80-90% of function can be restored after a traumatic childbirth.

Call or email to book your appointment today!

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