The changes a person’s body goes through during pregnancy is nothing short of miraculous; our posture changes, our hormones shift, we even manage intra abdominal pressure differently in order to accommodate our growing baby. Miraculous as it may be, it’s important to recognize these are significant changes to our bodies and often require specific training to optimize function for pregnancy, labor and delivery, and postpartum recovery. Below, we’ll discuss 5 of the most common changes and how pelvic floor physical therapy can enhance your pregnancy, labor and delivery, and postpartum experience.

1. Postural changes

Naturally, our posture will change during pregnancy to accommodate the growth of the baby. The curve in our low back increases (lordosis) and our pelvis tilts forward to compensate as our center of mass moves in a forward direction. This postural disruption can contribute to stress on the vertebrae and irritation to the nerves in the low back causing low back, hip, and lower extremity pain. Exercise to strengthen the abdominal, lumbar, and pelvic floor muscles will help maintain better posture as pregnancy progresses and help restore normal posture after delivery. Recent guidelines show vigorous exercise is safe during all phases of uncomplicated pregnancies and, in fact, women should be encouraged to get 150 minutes of moderate intensity exercise each week (Mottola et al. 2018). Women who strength train during pregnancy tend to have less low back pain during pregnancy, delivery, and even in the postpartum period (Davenport et al. 2018). Take home point? Don’t stop moving and lifting heavy things during pregnancy! A pelvic floor physical therapist can assess your strength and coordination and prescribe a safe and effective strengthening regimen to reduce pain during both pregnancy and postpartum periods.

2. Bladder and bowel habits

Externally, it is easy to see the postural changes our body goes through during pregnancy. However, it is important to recognize the shift inside the body and understand the impact on the organs in order to make room for the growing baby. As pregnancy progresses, the bladder is squeezed downward between the uterus and the pubic bone contributing to increased urinary frequency. The GI system (stomach and intestines) is pushed upward into our diaphragm while the bowel is pushed backwards against our spine. The bladder communicates with our brain via receptors based on stretch; when the organ is full and stretched, it relays a message to the brain to let us know it’s time to empty. During pregnancy though, the space is limited and the stretch receptors are more frequently activated, sending signals to the brain at much higher rates. Further, hormone increases of progesterone and HCG (human chorionic gonadotropin) contributes to increased urinary urgency (Gomes et al. 2018). Although these changes are normal, a visit to a pelvic floor therapist before and after pregnancy can help with understanding the relationship between the brain, organs, and pelvic floor muscles to enable more control for less trips to the bathroom (and better sleep!). Urge drill blog

3. Pain with intercourse

Although sex is completely safe during pregnancy, it can often be uncomfortable. For some obvious reasons, like the large belly, but other less obvious reasons like increased blood flow to the vaginal tissue. More blood flow to vaginal tissue can cause increased sensitivity, and changes in hormones can contribute to dryness (Romeikiene et al. 2021). Lubricants can reduce pain and exploring positional changes to allow for different penetrative depths often help as well. It is also common to see increased tone (or tightness) in the pelvic floor muscles as they become more loaded carrying the additional baby weight. In the postpartum period, the muscles in the pelvic floor are often hypertonic (or tight); this may be due to direct trauma from a vaginal or instrument assisted birth, or simply recuperating from the long duration pressure from carrying the baby in a women who delivers via cesarean section. A pelvic floor therapist can reduce muscle tone in the pelvic floor with manual therapy techniques and educate you on how to properly relax the muscles prior to sex. Pelvic floor relaxation blog

4. Intra abdominal pressure management related to laboring and pelvic organ prolapse

As we discussed, the diaphragm is compressed during pregnancy as the organs of the GI system are squeezed upward into this large breathing muscle. Symptoms of shortness of breath and pelvic heaviness are common during pregnancy due to the inability of the diaphragm to work optimally. The diaphragm and pelvic floor muscles work together as a piston, controlling intraabdominal pressure as we breathe. Imagine the top and the bottom of a soda can that descend and ascend together with each breath. This is most important for labor when appropriate breathing and pushing mechanics can reduce the pressure on the pelvic floor and decrease risk of prolapse. Learning how to relax the pelvic floor and utilize the abdominal muscles for a coordinated push while exhaling is one part of an intrapartum appointment with a pelvic therapist, usually scheduled around 34 weeks.

5. Reducing risk of injury during delivery

It is estimated that up to 85% of women experience some type of tearing or grazing of perineal tissue during vaginal delivery (Smith et al. 2013). Fortunately, there are techniques to help reduce the risk of tearing (Beckmann et al. 2013). One such technique is self perineal stretching, in which the introitus (or vaginal opening) is stretched in a sweeping down and outward motion. This technique begins at 35 weeks gestation and is performed 1-3x/week for 10 minutes. The stretching should be performed in conjunction with pelvic floor relaxation, which we discussed earlier. Of note, the literature suggests this technique is most effective for first time deliveries and less effective for subsequent deliveries. For more information on perineal massage, schedule a visit with a pelvic floor physical therapist around 34 weeks. Perineal massage blog

Author:

Dr. Chelsey Vasquez, PT, DPT, CMTPT, PRPC

Mend Physical Therapy