Physiotherapy
Pre/Postnatal Health
PRENATAL
Pelvic Health
Physiotherapy
Pregnancy is a time filled with new experiences, joy, and anticipation. Many women eagerly await the first flutters of their baby’s movement and wonder about the various symptoms they might encounter. Yet, one important aspect that is often overlooked is how to prepare the pelvic floor for pregnancy, childbirth, and the postpartum period. This crucial topic is rarely discussed, even though it should be a standard part of prenatal care.
The Impact of Pregnancy on the Pelvic Floor
As pregnancy advances, the pelvic floor naturally endures increasing pressure. This is due to the expanding baby bump, shifts in body weight, and changes in how surrounding muscles function. These muscles are required to work harder throughout pregnancy, making it essential to learn how to effectively engage and support this area.
If a woman’s pelvic floor becomes fatigued or lacks adequate strength during pregnancy, she may develop various pelvic health symptoms.
How Pregnancy Affects the Pelvic Floor
As a pregnancy progresses, there is a natural increase in the demand placed on the pelvic floor. This occurs due to the growing baby bump, pregnancy-related weight changes, and modified activity of adjacent muscles. Essentially, these muscles have to work harder during pregnancy, making it more important than ever to know how to properly connect to this area. If a woman’s pelvic floor becomes overworked and tired, or does not have the necessary strength throughout pregnancy, she may experience certain pelvic health symptoms.
Common Pelvic Health symptoms related to Pregnancy:
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Urinary incontinence when laughing, sneezing, coughing, or exercising
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Urinary frequency/urgency
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Urinary retention/incomplete emptying
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Pelvic floor heaviness/pressure
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Pelvic varicose veins
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Constipation
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Diastasis Recti Abdominis
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Pain with sexual intercourse (dyspareunia)
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Pain in the perineum/rectal region
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Lower abdomen pain
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Low back, pelvic, sacroiliac joint, tailbone or hip pain
Prenatal Pelvic Health Physiotherapy
Our Pelvic Health Physiotherapists are highly trained and deeply committed to supporting women in optimizing their pelvic health throughout pregnancy, labour and delivery, and the postpartum period.
Your initial visit will begin with a comprehensive health questionnaire, allowing your Physiotherapist to gain insight into your goals, symptoms, and any specific concerns. The physical assessment will include evaluating the muscles, ligaments, tendons, and connective tissues in key areas such as the abdomen, pelvis, hips, sacroiliac joints, lower back, and thorax.
With your informed consent, an internal examination of the pelvis and pelvic floor muscles may be conducted. This allows your Physiotherapist to assess anatomical changes, muscle tone, contraction symmetry, and areas of discomfort. If an internal assessment is not appropriate or preferred, a variety of external techniques are available to help identify the underlying cause of your symptoms.
What does Treatment involve?
Treatment is always personalized to meet each individual's unique needs. Your Physiotherapist will consider your health history, physical assessment results, and personal goals to create the most effective treatment plan. Potential treatment options may include:
Prenatal Pelvic Health:
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Bladder health management
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Constipation management
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Pelvic Organ Prolapse management
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Targeted manual therapy of the myofascial system
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Pelvic floor muscle downregulation and relaxation
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Pelvic floor muscle strengthening and training to optimize function during pregnancy
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Motor control training and strengthening of the deep core musculature
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Motor control training and strengthening of the abdominal wall, hips and thorax
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Discuss appropriate maternity belts and other supportive devices
Labour and delivery prep:
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Perineal massage
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Education regarding optimal positions for labour and delivery
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Breathing mechanics and techniques to optimize pelvic floor relaxation
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Education regarding how your birth partner can assist during labour and delivery
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Pain management strategies
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Discuss movement strategies in the event of a Cesarean birth
Postnatal stage prep:
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Develop a tailored postpartum movement and pelvic health plan for the few weeks after delivery
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Optimize pelvic health before delivery to facilitate pelvic floor activation postnatally
Postnatal Pelvic Health Physiotherapy
After giving birth, a woman’s attention naturally turns to her new role as a mother and enjoying those precious newborn moments. During this period, she might notice unexpected physical symptoms, such as pelvic pressure, urine leakage when sneezing, or abdominal weakness. Unfortunately, many think, "My friends warned me this would happen; this must be my new normal," and try to ignore these issues.
However, while these symptoms are very common, they should not be accepted as normal and can be treated. Research shows that women who engage in pelvic floor muscle training experience significant improvements in their symptoms compared to those who do not³⁴. Additionally, Pelvic Floor Physiotherapy has been proven effective in preventing common postnatal problems like stress urinary incontinence, with benefits that last over time⁵.
Some pelvic health issues that appear later in life may actually originate from the postpartum period. So, if you have older children and recognize these symptoms, this message applies to you as well.
What causes Pelvic Health Symptoms?
Pelvic health symptoms can develop when the pelvic floor muscles are either underactive (hypotonic—too relaxed) or overactive (hypertonic—too tight). In both cases, the muscles are unable to contract and relax as they should, which impacts their ability to perform everyday functions effectively.
Experiencing either a hypertonic or hypotonic pelvic floor is common after childbirth, as pregnancy, labour, and both vaginal and Cesarean deliveries can significantly affect the pelvic floor’s function.
Common Postnatal Pelvic Health Symptoms
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Urinary Incontinence
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Urinary frequency/urgency
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Urinary retention/incomplete voiding
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Fecal incontinence
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Constipation
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Pressure/heaviness in pelvic region
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Pelvic Organ Prolapse
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Pain with intercourse
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Pain in perineal/rectal region
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Perineal scar pain
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Ceasarian Birth Scar pain/stiffness
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Tailbone pain (coccydynia)
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Low back or hip pain
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Diastasis Rectus Abdominis (Ab separation)
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, the physical exam findings, and your functional goals to determine the best course of treatment. Options may include:
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Education regarding your symptoms, condition, assessment findings, and treatment plan
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Bladder retraining
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Constipation management and bowel retraining
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Targeted manual therapy of the myofascial system
-
Pelvic floor muscle downregulation and relaxation
-
Pelvic floor muscle strengthening and training
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Motor control training and strengthening of the deep core musculature
-
Motor control training and strengthening of the abdominal wall, hips and thorax
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Perineal scar mobilization and management
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Cesarean birth scar mobilization and management
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Postural education and retraining
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Diastasis Recti Abdominis retraining
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Pelvic Organ Prolapse management strategies
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Functional retraining of the neuro-muscular system to achieve movement and activity goals
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Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Pelvic Health
Diastasis Recti Abdominis
What is Diastasis Recti Abdominis (DRA)?
Diastasis Recti Abdominis (DRA) refers to a horizontal separation of the two muscle bellies of the rectus abdominis—the “six-pack” muscles in the abdomen. This separation occurs when the linea alba, the white connective tissue running down the center of the abdomen that connects these muscles, stretches in response to pressure. This pressure may result from increased intra-abdominal pressure—such as holding your breath while lifting something heavy—or from direct mechanical pressure on the abdomen, like during pregnancy.
It’s important to understand that some level of DRA is present in 100% of women by 35 weeks of pregnancy.(15) It is a normal part of the body’s adaptation to the growing uterus. However, having a DRA during pregnancy does not necessarily mean it will remain after childbirth.
DRA’s are also found in men, women who haven’t been pregnant, and children.
A DRA could occur above, at, or below the belly button, or in all 3 of those regions.
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Common Symptoms of DRA
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A separation of the rectus abdominis muscle, that may be visible or felt
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Low back, pelvic, or hip pain
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Poor trunk posture
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Feeling weak through the midsection, unable to activate the core
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Doming or tenting of the middle of the stomach. This can occur during activities such as lifting, rolling over in bed, or certain exercises
The Pelvic Floor, the Core, and their role in Diastasis Recti Abdominis
The pelvic floor muscles are located within the pelvis, connecting to the pubic bone, tailbone, and sitting bones. They function like a supportive hammock for the internal organs. Beyond organ support, these muscles play key roles in bladder and bowel control, sexual function, circulation, and—critically—core stability.
As a key component of the core system—alongside the transverse abdominis (TA), multifidus, and diaphragm—the pelvic floor is essential in DRA rehabilitation. This connection is especially important due to its relationship with the TA muscle.
The TA is a deep, broad muscle that lies just beneath the linea alba and connects to it via fascia. When the TA activates, it generates tension through the fascia that helps restore strength and stability to the linea alba.
When a pelvic floor contraction is combined with a TA contraction, it enhances the recruitment of the TA muscle(16), allowing for more tension to be transmitted to the linea alba.
Key takeaway: Activating the pelvic floor enhances TA engagement, which increases tension through the linea alba—helping to strengthen and restore the connective tissue, supporting recovery from DRA.
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, the physical exam findings, and your functional goals to determine the best course of treatment. Options may include:
● Education regarding your symptoms, condition, assessment findings, and treatment plan
● Bladder retraining
● Constipation management and bowel retraining
● Targeted manual therapy of the myofascial system
● Visceral mobilizations
● Pelvic floor muscle downregulation and relaxation
● Pelvic floor muscle strengthening and training
● Motor control training and strengthening of the deep core musculature
● Motor control training and strengthening of the abdominal wall, hips and thorax
● Postural education and retraining
● Diastasis Recti Abdominis retraining
● Pelvic Organ Prolapse management strategies
● Functional retraining of the neuro-muscular system to achieve movement and activity goals
● Neuromuscular Stimulation of the Pelvic Floor
● Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
If you are unsure of whether Pelvic Floor Physiotherapy will help with your symptoms and condition, we highly encourage you to contact us for a 15 minute Free Phone Consultation. One of our specialised Pelvic Floor Physiotherapists will discuss your concerns with you, and help you determine whether this is the best course of treatment for you.
1. Navarro Brazález B, Torres Lacomba M, de la Villa P, Sanchez Sanchez B, Prieto Gómez V, Asúnsolo del Barco Á, McLean L. The evaluation of pelvic floor muscle strength in women with pelvic floor dysfunction: A reliability and correlation study. Neurourology and urodynamics. 2018 Jan;37(1):269-77. available from : https://www.ncbi.nlm.nih.gov/pubmed/28455942
2. Sherburn M, Murphy CA, Carroll S, Allen TJ, Galea MP. Investigation of transabdominal real-time ultrasound to visualise the muscles of the pelvic floor. Australian Journal of Physiotherapy. 2005 Jan 1;51(3):167-70.
3. Von Bargen E, Haviland MJ, Chang OH, McKinney J, Hacker MR, Elkadry E. Evaluation of Postpartum Pelvic Floor Physical Therapy on Obstetrical Anal Sphincter Injury: A Randomized Controlled Trial. Female Pelvic Med Reconstr Surg. 2021 May 1;27(5):315-321. doi: 10.1097/SPV.0000000000000849. PMID: 32282525.
4. Dumoulin C, Lemieux MC, Bourbonnais D, Gravel D, Bravo G, Morin M. Physiotherapy for persistent postnatal stress urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2004 Sep;104(3):504-10. doi: 10.1097/01.AOG.0000135274.92416.62. PMID: 15339760.
5. Mørkved S, Bø K. Effect of postpartum pelvic floor muscle training in prevention and treatment of urinary incontinence: a one-year follow up. BJOG. 2000 Aug;107(8):1022-8. doi: 10.1111/j.1471-0528.2000.tb10407.x. PMID: 10955436.
6. Navarro Brazález B, Torres Lacomba M, de la Villa P, Sanchez Sanchez B, Prieto Gómez V, Asúnsolo del Barco Á, McLean L. The evaluation of pelvic floor muscle strength in women with pelvic floor dysfunction: A reliability and correlation study. Neurourology and urodynamics. 2018 Jan;37(1):269-77. available from : https://www.ncbi.nlm.nih.gov/pubmed/28455942
7. Sherburn M, Murphy CA, Carroll S, Allen TJ, Galea MP. Investigation of transabdominal real-time ultrasound to visualise the muscles of the pelvic floor. Australian Journal of Physiotherapy. 2005 Jan 1;51(3):167-70.