The term “pelvic health” refers to a growing practice within physiotherapy. For physiotherapist Erica Gambarotto, it’s a specialty that was born out of personal experience. Originally trained as an orthopedic physio, Erica became alarmed by the drastic changes in her body while pregnant with twins. “I was running to the washroom all the time, amongst other embarrassing bodily malfunctions,” she recalls. “I started taking professional courses in pelvic physiotherapy, initially with the goal of treating myself. Turns out, it is a fascinating area of study, and I haven’t looked back.”
The twins are now 3 years old, and Erica practices pelvic health physiotherapy at Lifemark Physiotherapy. She estimates that at least half her clients are pregnant women or new moms seeking treatment post-delivery. Here, she answers some common questions about pregnancy’s effect on the area known as your “pelvic floor.”
What is the pelvic floor?
It’s a group of muscles in three layers, spanning the area between your sitting bones, pubic bone and tailbone. These muscles play an important role in:
- Holding up your pelvic organs (bowel, bladder and uterus)
- Providing continence (the ability to control elimination of urine and feces)
- Reaching orgasm
- Stabilizing your core
- Acting as a pump to remove lymphatic drainage
What is going to happen to these muscles when I’m pregnant?
Similar to a sling, the pelvic floor helps to support the developing baby within the pelvis. As fetal size and weight increases, this area gets challenged like never before. When the pelvic floor (and surrounding) muscles are not functioning to the best of their ability, an expectant mother may experience symptoms such as pubic bone pain, sacroiliac joint pain, hip pain, painful sex, perineal heaviness and incontinence.
Is there anything I can proactively do to prevent issues later?
Pelvic physiotherapy treatment can occur during pregnancy as long as there are no concerns with the placenta, the pregnancy is not deemed high-risk, and the attending midwife or obstetrician is in favour of it. Research shows that pelvic physiotherapy during pregnancy can help shorten the second stage of labor (the pushing stage), ease pregnancy-related pain and reduce the chances of urinary incontinence postpartum.
What about Kegel exercises?
A common misconception about pelvic floor physiotherapy is that it simply involves teaching women how to do a Kegel exercise properly. Kegels are useful, but they are not necessarily the answer to every problem. If your pelvic floor is tight and over-active, doing extra muscle contractions may actually make things worse. The goal is to achieve proper recruitment and balance of the pelvic muscles.
How long will it take for my pelvic floor to recover post-delivery?
Several factors will influence a mother’s recovery time, such as the number of babies delivered, duration of pushing, degree of tearing and medical interventions used (such as forceps, vacuum, episiotomy, or C-section). Each mother’s recovery and journey will be unique to her circumstances. A physiotherapist specializing in pelvic health will do an individualized assessment and create a customized program of exercises and/or stretches.
What are some signs that I should seek help?
Dysfunction of the pelvic floor muscles can cause a number of symptoms, including:
- Stress incontinence (leaking with sneezing, coughing or jumping)
- Urge incontinence (leaking after sudden urgency)
- Painful sex
- Pain in the perineum, tailbone, sacroiliac joints, hips or lower abdomen
Do I really need treatment, or is this just “the new normal” after having a baby?
Peeing your pants, though common after childbirth, is not something you have to live with. The same principle applies to ongoing pelvic pain, chronic back pain, or discomfort during sex several months postpartum. These issues can be treated, so please do not suffer in silence. When in doubt about your recovery and symptoms, always bring it up with your family doctor or gynecologist. As in other areas of motherhood, always trust your instincts.
Want to learn more? Check out this video on pelvic floor health after a Cesarean Birth with Pelvic Health Physiotherapist, Dr. Sinead Dufour: