"When I was pregnant with my son, I anticipated the huge life change and imagined what life with a newborn would be like. All-day snuggles, lots of diaper changes, and oh, the sleep deprivation. But all the body changes? There was one thing I definitely wasn’t ready for. Other mothers told me to prepare to lose control of my bladder. So, would that mean postpartum life would forever look like having to cross my legs when laughing or sneezing? Wonderful.
As a first-time mom, I knew I’d be wearing postpartum panties after giving birth, but I didn’t want to have to invest in my own set of diapers long-term to manage postpartum incontinence. To my surprise, there is a proactive solution that can help women prevent these symptoms. It consists of having pelvic floor therapy before you give birth. I sat down with Dr. Nikki Berner, PT, DPT, a board-certified, licensed, practicing physical therapist and owner of The Fem Method Pelvic Health, to discuss the benefits of pelvic floor physical therapy while pregnant. Turns out that having a leaking bladder isn’t normal.
Dr. Nikki Berner, Board-Certified, licensed, practicing Physical Therapist
With over 12 years of extensive clinical experience, Dr. Nikki understands first hand the impact childbirth and postpartum healing has on a woman’s body. As the owner of The Fem Method Pelvic Health and through her online program, The Pelvic Floor Recovery Method, she has served hundreds of women helping them get back to the symptom free, active life they deserve.
The pelvic floor defined
According to the National Institute of Child Health and Human Development, the pelvic floor “is the group of muscles that form a sling or hammock across the floor of the pelvis.” These muscles hold your bladder, urethra, intestines, and rectum in place. During pregnancy, these muscles can loosen or weaken due to hormones, your growing baby, and other factors.
Indications to see a pelvic floor therapist during pregnancy
Seeing a pelvic floor therapist isn’t mandatory during pregnancy. Although, if you’re having any of these symptoms, they may be indications that it is time to reach out to a pelvic floor therapist.
- SI joint (joints that connect the pelvis and lower spine) dysfunction
- Round ligament pain (pain in lower belly/groin)
- Symphysis pubis (joint between your right and left pubic bone) dysfunction
- Low back/hip pain
- Pelvic girdle pain
- Leaking bladder
Additionally, you may want to see a physical therapist as part of labor and birth prep. Or if you’re seeking a daily movement assessment.
Does doing kegels help with pelvic floor dysfunction?
You may have heard of the term Kegel exercises. This consists of “lifting and holding and then relaxing your pelvic floor muscles” in order to strengthen them. It has gained popularity throughout the media over the years. However, Dr. Berner points out, “Doing kegels only fires a portion of your pelvic floor muscles. Half the time, people aren’t doing them correctly.”
How a pelvic floor therapist can help during pregnancy
So, what will help? If you’re like me, you’ve heard the phrase, “It’s normal,” a countless amount of times. This usually happens when it comes to women’s health. It can be easy to play off your issues as “normal” because it can be difficult to pinpoint if changes in your body are due to the hormone changes that happen during pregnancy—or something else.
Don’t get me wrong. Your OB isn’t necessarily gaslighting you by saying round ligament pain is common. These symptoms may be common during pregnancy, but it doesn’t mean you have to be in pain or uncomfortable through the entirety of it. This is where a pelvic floor therapist can step in. Of course, every patient is different. The plan of care should specifically be tailored to you, but these are some things a pelvic floor therapist will focus on.
Providing an assessment and evaluation
It is OK if you are unsure of what your needs are. Wanting to be proactive about your pelvic floor health is enough to reach out to a pelvic floor therapist. During pregnancy, a pelvic floor therapist can start you on early education on proper nutrition and how to manage constipation, a common symptom during pregnancy, and how to control your bowels.
Another focus is on your assessment and evaluation. Having a full prenatal physical therapy assessment helps Dr. Berner put together an exercise program tailored to each of her patients. This assessment includes looking at the overall strength and mobility of your hips, spine, and pelvis, and most importantly, assessing if dysfunction is already present.
Getting you ready for birth
Back pain is another common symptom that can arise during pregnancy. This can be caused by an unstable pelvic floor. Dr. Berner works on getting rid of any tension in the pelvic floor by having her patients breathe in different birth positions to ensure that the pelvic floor is relaxed enough for birth. She repeats these exercises during prenatal physical therapy so much so that the sensation is ingrained when birth finally happens.
Preparing you for what to expect postpartum
Addressing your pelvic floor doesn’t stop after giving birth. It’s also important to discuss how to protect your body during the postpartum period. Having pelvic floor physical therapy while pregnant can have you feeling supported if any issues arise after having your baby. This includes having good body mechanics when lifting and practicing how to safely engage your core. Other mobility exercises focus on preventing aches and pains, being able to optimally go to the toilet to prevent excess pressure or straining (bye-bye leaky bladder), and having good nutrition for healing.
What to look for in a pelvic floor therapy program
Before reaching out to a pelvic floor therapist, reflect on what your expectations are as a patient. Everyone is different when it comes to how involved you want your pelvic floor therapist to be in your pelvic floor journey. These are some things to consider when finding a therapist best suited for you.
Your preference on team structure
No team is the same, so ask who will be working with you. Ask whether your primary provider will be the pelvic floor therapist or if it will be a physical therapy tech. If you’ll be seeing more than one person, ask how often you will have a visit with the pelvic floor therapist.
Credentialing
Be aware of credentialing. Not every program looks the same. There is a difference when it comes to who is running the show. According to Dr. Berner, it can be confusing to the public. It’s important to note that physical therapists and occupational therapists are specially trained and credentialed to be pelvic floor ‘rehab providers.’ According to Dr. Berner, providers who are not PTs or OTs “may not be trained in internal muscle assessment, function, and rehabilitation,” which is what is essential in addressing pelvic floor dysfunction. Programs out there can have pelvic floor therapy intertwined in their services, but be mindful of what that entails.
How hands-on you want to be
An initial evaluation is required in order to develop a plan of care, but take into account how hands-on—or hands-off—you want the prenatal physical therapy program to be. If you would rather not see your therapist as often, virtual visits are beneficial in getting information, too.
The program structure
Consider any existing medical diagnoses you have. From there, inquire if the pelvic floor therapist has worked with a case like yours. If not, then have the conversation on if they are comfortable treating you. Dr. Berner says, “Your treatment plan should be based on how the program can be tailored to how well your body can function.”
Additional benefits to having prenatal physical therapy
Meeting with a pelvic floor therapist is another avenue to be an advocate for your own health. Dr. Berner states her clients leave therapy feeling like they are able to manage their birthing experience rather than go into labor with fear. When it comes to pelvic floor physical therapy while pregnant, “The more that women are prepared and knowledgeable of what to do, the more confident they go into birth, and the better the outcomes,” says Dr. Berner. So, the next time someone tells you that peeing your pants is forever normal, politely laugh—without peeing—and tell them the name of your pelvic floor therapist.
Patty Schepel, Editorial Assistant
As the editorial assistant, Patty works with The Everymom’s team on pitches, creating original articles, updating existing content, photo sourcing, writing shopping product descriptions, inputting freelance articles, and more. When she’s not working, you can find her spending time with her family, training for half marathons—she ran one 16 weeks pregnant—traveling, cooking, reading a rom-com, and keeping her sourdough starter, Rose, alive.