Pelvic physiotherapy in pregnancy and beyond

Created on
January 4, 2024

What is a pelvic physiotherapist?

We are normal physios with extra training and experience in treating the muscles, nerves, skin, bones and joints of the pelvis. As part of our extra training, we learn about the bladder, bowels, uterus, periods, women’s sexual function and the changes to all of these during pregnancy and the postpartum period.

Pelvic floor

Prepare for birth

We will discuss birthing positions, show you how to relax and open your pelvic floor and keep you exercising so you are strong and fit for labour and parenting.

Bladder and bowels

Constipation can be an issue in pregnancy, due to hormones and the growing baby. Sometimes, this can be a muscle coordination issue, especially if it has been going on since childhood.

A sensation of “recurrent urinary tract infections” can be linked to pelvic floor muscle tension and if you had a lot of UTIs or suspected UTIs when you were young, it is important to check your pelvic floor release, especially if you are keen on delivering vaginally.

Back and pelvic pain

If you have any issues with back, tailbone, hip or pelvic pain during your pregnancy or after delivery, we can help with posture and movement advice, taping, massage and bracing if needed.

A history of pelvic pain or endometriosis is linked to pelvic floor muscle tension and if this has been an issue for you in the past, see a pelvic physio early in the pregnancy for assessment.

Scar management

Either a perineal scar or caesarean scar should not bother you after at most 12 weeks. During your post-natal appointment at about 6 weeks, we will check your scar and give you a management plan if it’s bothering you.

A sense of heaviness, prolapse or fear of prolapse

Sometimes after a delivery, you can feel a vaginal or pelvic drag or heaviness, worse with lifting or a long day on your feet. Pelvic physiotherapy can help healing with a graded exercise plan and support strategies so you can feel comfortable and happy and can get on with being a mum.

Return to exercise

Exercise is really important to help you feel good, strong and resilient. There can be lots of new challenges with being a new mum, and wih finding time to fit exercise in.

If you’re low on time, we can give you some exercises you can do at home. You may have had a vaginal delivery and a tear and feel a bit vulnerable. You may want good advice tailored to your body’s recovery. You may be worried about your tummy, you may have had a caesarean or noticed some abdominal separation.

Physios are excellent at planning a program to work with natural healing and help you return to your chosen activities, be it a walk with the pram,  a triathlon, or anything in between.

Painful sex

Sex should be fun and pleasurable, however sometimes after your baby is born it can feel a bit scary, awkward or painful. Your vulva can change due to lower oestrogen levels – the skin can get thin and lubrication decreases. The clitoris lies under muscle and if the muscles are tight it’s harder to get physically aroused.  

A vaginal delivery can lead to some real physical challenges – the muscles can be overactive and feel sore to touch, the brain can misinterpret signals – add that to low oestrogen and a baby crying, it can be hard to get your mojo back.

Pelvic physiotherapy can give you some practical strategies to rehab your sex life.

Pregnancy appointments

Initial appointment 16–20 weeks: we will ask some screening questions, check your pelvic floor (as long as you feel comfortable) and address any issues.

Follow-up 24–26 weeks: ensure your body is adapting to the physical changes of pregnancy, address any issues and plan for delivery/follow-up

Follow-up 32–34 weeks: among other things, discuss perineal massage, labour positions, use of TENS, check pelvic floor relaxation for delivery, address any issues and plan for breast feeding, and post-natal recovery – e.g. postnatal toileting and exercise.

After your delivery

About 6 weeks post-delivery: we will ask some screening questions, check your pelvic floor support and strength (as long as you feel comfortable) and address any issues. We will also advise you on appropriate exercises to begin at home that will strengthen your pelvic floor.

About 12 weeks post-delivery: plan to increase your exercise and talk to us to address any issues you’re experiencing.

About 16–20 weeks post-delivery: we will check your pelvic floor and see how it’s responded to regular exercise.

Get in touch as soon as you have questions or concerns

This is a general guide. If you have any concerns with bladder or bowel leakage, urgency, pain, vaginal heaviness, poor bladder sensation or anything else, please get in touch sooner rather than later.

If life, pregnancy complications or illness don’t allow you to see us during your pregnancy or immediate postpartum period, or things get worse further down the track, we are always here. Pelvic physiotherapy takes mental space and can sometimes be harder than normal physiotherapy. Please don’t hesitate to get in touch – we’d love to hear from you.  It’s never too early or too late to help with anything you’re experiencing.


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