Pregnancy is one of the most incredible periods of physical change that the human body can experience. As your body grows and adapts to support your baby, it undergoes significant hormonal, musculoskeletal and pelvic floor changes.
For many women, these changes occur without major difficulties. For others, pregnancy may bring symptoms such as bladder leakage, pelvic girdle pain, constipation, feelings of heaviness or concerns about exercise and birth preparation.
One of the most common things we hear in clinic is – “I wish I had known about pelvic health physiotherapy earlier.”
The good news is that Pelvic Health Physiotherapy isn’t just for treating problems. It can also help women prepare for pregnancy, birth and recovery, while providing confidence that they are exercising safely and looking after their bodies during this important life stage.
Before Pregnancy: The Ideal Time to Start
If possible, the best time to see a Pelvic Health Physiotherapist is actually before pregnancy. A pre-conception appointment allows us to establish a baseline understanding of your pelvic floor function, identify any existing concerns and discuss exercise, bladder and bowel health before the additional demands of pregnancy begin. This can be particularly valuable for women who:
- Experience bladder leakage
- Have constipation
- Have pelvic pain or painful intercourse
- Have prolapse symptoms
- Have had a previous birth injury or traumatic birth
- Have hyper-mobility or connective tissue disorders
- Participate in running or high-impact sport
Many women enter pregnancy with pelvic floor dysfunction that has never been assessed. Addressing these issues early often makes pregnancy and postpartum recovery easier.
Early Pregnancy: When Questions Begin
Many women are surprised by how much conflicting advice exists during pregnancy.
Can I keep running?
Can I lift weights?
Can I do abdominal exercises?
Should I stop exercising altogether?
For women who are experiencing symptoms, have a previous history of pelvic floor dysfunction, or simply want reassurance around exercise, an early pregnancy appointment can be incredibly helpful. We commonly assist with:
- Bladder urgency and frequency
- Constipation
- Stress urinary incontinence
- Pelvic pain
- Exercise modifications
- Previous birth trauma concerns
Sometimes the most valuable thing we provide is reassurance and education that movement is not only safe, but beneficial.
The Most Important Pregnancy Appointment: Second Trimester (13–24 Weeks)
If there is one appointment we recommend to almost every pregnant woman, it is a pelvic health assessment during the second trimester. At this stage, most women are feeling more comfortable than they were in the first trimester, and there is enough time to optimise pelvic floor function before the increasing physical demands of late pregnancy. During this appointment we typically assess:
- Bladder function
- Bowel function
- Pelvic floor strength
- Pelvic floor coordination
- Pelvic floor relaxation
- Pelvic floor tone
- Existing symptoms
- Exercise participation
- Risk factors for postpartum dysfunction
Importantly, we also discuss the role of the pelvic floor during both pregnancy and birth. Many people think the pelvic floor only needs to be strong. In reality, it also needs to be able to relax, lengthen and coordinate effectively.
Understanding Exercise During Pregnancy
One of the biggest misconceptions surrounding pregnancy is that women should stop exercising or dramatically reduce activity levels. Current guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) recommend that women with uncomplicated pregnancies continue participating in regular exercise throughout pregnancy. Exercise during pregnancy has been shown to:
- Reduce the risk of gestational diabetes
- Reduce excessive weight gain
- Improve cardiovascular fitness
- Improve mental health
- Reduce low back and pelvic pain
- Support postpartum recovery
We encourage women to continue moving throughout pregnancy where medically appropriate. However, pregnancy does require some modifications.
Current exercise recommendations during pregnancy have become more conservative than they were previously, particularly regarding exercise position and intensity. While not everyone will experience symptoms, some physiological changes can occur without obvious warning signs. As the uterus grows, certain positions may reduce blood flow return to the heart and potentially affect blood flow to the uterus and baby. For this reason, we strongly recommend following current evidence-based guidelines rather than relying solely on how you feel during exercise.
One example is exercise performed flat on your back. From approximately 12 weeks gestation onwards, we recommend avoiding any form of exercise in a fully supine position. As the uterus grows, it can compress major blood vessels, reducing blood flow back to the heart and potentially affecting uterine blood flow. Some women may experience symptoms such as dizziness, nausea or feeling unwell, while others may notice no symptoms at all.
Other important exercise considerations during pregnancy include:
- Avoiding prolonged breath-holding or straining during lifting
- Monitoring for symptoms of pelvic floor dysfunction, including urinary leakage, heaviness or vaginal pressure
- Modifying impact exercise where appropriate
- Managing pelvic girdle pain or pregnancy-related musculoskeletal symptoms
- Adjusting exercise intensity and training loads as pregnancy progresses
Every pregnancy is unique. An individual assessment can help ensure that your exercise program remains safe, appropriate and aligned with your goals throughout pregnancy.
Birth Preparation: 32–34 Weeks
One of our favourite appointments is the birth preparation consultation. By this stage, birth is beginning to feel very real and many women have questions about what they can do to prepare. This appointment focuses on:
- Perineal massage education
- Pelvic floor relaxation
- Learning how to effectively bear down and push
- Labour positions
- Birth preparation exercises
- Optimising recovery after birth
Research suggests that perineal massage performed from approximately 34 weeks can reduce the likelihood of severe perineal trauma and episiotomy, particularly for first-time mothers. We also discuss an often-overlooked aspect of birth preparation: Learning how to relax the pelvic floor. Birth requires the pelvic floor to lengthen and release. Understanding this process before labour can improve confidence and reduce fear around birth.
After Birth: Your Postpartum Assessment
Many women assume that once the baby arrives, the hard work is done. In reality, the postpartum period is a time of significant healing and recovery. Whether you have had a vaginal birth or a caesarean birth, your body has undergone enormous change. A postpartum pelvic health assessment is recommended between four and eight weeks after birth. During this appointment we assess:
- Pelvic floor function
- Healing of any perineal tears or scars
- Caesarean scar recovery
- Bladder symptoms
- Bowel symptoms
- Prolapse symptoms
- Return to exercise goals
- Return to sex information and support
- Birth experience and recovery
Many women are surprised to learn that pelvic floor dysfunction can occur after both vaginal and caesarean births. Our goal is not simply to identify problems, but to provide a clear roadmap for recovery and return to activity.
Returning to Exercise and Sport
One of the most common postpartum questions we receive is – “When can I get back to exercise?”
The answer depends on many factors, including your symptoms, birth history, healing and previous activity levels. For some women, this may mean returning to walking and strength training. For others, it may involve a gradual return to running, team sport or high-intensity exercise. A pelvic health assessment can help identify any factors that may increase your risk of:
- Urinary leakage
- Prolapse symptoms
- Pelvic pain
- Delayed recovery
The goal isn’t to stop women exercising. The goal is to help them return to the activities they love with confidence.
Every Pregnancy Deserves Pelvic Health Care. Pregnancy and postpartum recovery are not simply periods to “get through.” They are opportunities to support your body, improve recovery and build confidence for the years ahead.
You don’t need to be experiencing symptoms to benefit from seeing a pelvic health physiotherapist. Whether you are planning a pregnancy, currently pregnant, preparing for birth or navigating life with a new baby, pelvic health physiotherapy can help you understand your body, move with confidence and optimise your recovery.
If you would like to learn more about pelvic health physiotherapy during pregnancy or postpartum, our team is here to help. genhealthhamilton.com.au/services/pelvic-health-physiotherapy/
