FAQs with a Pelvic Floor PT: What You NEED To Know if You Are Pregnant (2022)

FAQ’s with Dr. Anuja Mathew on Pre/Post-Natal Rehabiliation + General Women’s Health

By: Dr. Anuja Mathew, DPT, MsPT, OCS - Orthopedic and Pelvic Floor Physical Therapist

First, I would love to introduce myself. My name is Dr. Anuja Mathew and I am a licensed Physical Therapist in the states of New York and New Jersey. I am board-certified in Orthopaedics, with an Orthopedic Clinical Specialist certification (one that is earned by 5% of Physical Therapists across the country - not to toot my own horn), as well as trained in Women’s Health/Pelvic Floor. I’ve been in practice for over 10 years now, and am a strong promoter of manual therapy, therapeutic exercises, and biofeedback. I have been treating patients with orthopedic conditions such as sports injuries, tendonitis, arthritis, lumbar/cervical pain, and post-surgical rehabilitation. I also have experience in Women’s Health conditions such as Urinary Incontinence, pelvic pain, pubic symphysis dysfunction, diastasis recti, and prenatal and postnatal rehabilitation.

FAQs with a Pelvic Floor PT: What You NEED To Know if You Are Pregnant (1)

Congrats on being pregnant! Many people struggle to get to where you are, so be proud! Motherhood is a fun and rewarding journey, but it can also be a tough one. Many soon-to-be and new mothers might experience pain in places they haven’t experienced before, and working through those pains can be a challenging journey. This rewarding chapter in your life may also come with some unwanted side effects like lower back pain, soreness, or pelvic pain. These often occur during prenatal carrying and postpartum delivery. Physical therapy can help with any pains that might’ve popped up during this time, but it can also help you have a smoother pregnancy and birth in general.

A woman’s body is constantly changing during pregnancy. This increase in weight may cause an increased strain on the spine, along with the increased ligament laxity could cause pain and instability in the lumbar and thoracic spine and pelvis. The pelvic floor is a complexity of joints, ligaments, connective tissue, and muscles. All of which can be affected due to numerous reasons which cause tightness, weakness, and pain in your body.

Some common questions we get are during one’s pre or postnatal journey include:

1) Is it normal to have back low back pain during pregnancy? How can I prevent sciatica?

Some discomfort in your lower back is normal during pregnancy. In fact, the American Pregnancy Association reports that 50-70% of women experience back pain while pregnant. As your ligaments stretch and your pelvis widens, you will feel some discomfort in the first trimester. As your belly grows, the center of gravity shifts and this causes increased strain on your lower back. Anything more than just discomfort should be addressed right away. Sciatica is one of the more common diagnoses during pregnancy. A lot of times it could be pelvic girdle pain that is misinterpreted as sciatica. It would help to do some strengthening of your hip muscles to improve stabilization in your pelvis and reduce the pelvic girdle pain.

(Video) 3 Pelvic Floor Physical Therapy Tips For Pregnancy (from a Pelvic Floor Physical Therapist)

2) What exercises can be done during pregnancy to reduce low back pain? Do’s and Don'ts.

Exercises done during pregnancy should focus on hip strengthening, and gentle stretches for the lumbar spine, hamstrings, adductors, and glutes. Prenatal yoga is usually safe to perform.

Do not perform any abdominal exercises like crunches or sit-ups, as it might make your diastasis worse, and to be honest — there is a very little chance that you will get 6-pack abs while your belly is growing. If you have been a runner prior to pregnancy, you can continue running, but be careful in your 1st and 3rd trimester. A belly belt/support should be worn or Kinesio-taping should be done to prevent diastasis during your prenatal and postpartum journey.

Other good measures to take are strengthening your upper body during breastfeeding, as you most likely will have poor posture that might lead to upper back and shoulder pain. Maintaining good posture during pregnancy with postural awareness, strengthening, and stretching is a MUST. Though the Kegel is a good exercise to start during pregnancy, it is not always advisable for all pregnant patients. People suffering from vulvodynia, dyspareunia, or pelvic pain should focus on reverse Kegels and relaxation more than performing regular Kegel exercises.

3) Am I at risk for gestational diabetes?

Doing regular, gentle exercises, and walking can prevent gestational diabetes. So just remember to stay active during your pregnancy, and you should be good to go!

4) How do I stop urine from leaking when I don’t want it to. And when should I go to the doctor/physical therapist?

Performing pelvic floor strengthening is not just in the form of Kegels but other strengthening methods integrated with core strengthening can prevent leakage.

If you notice any pressure in your vagina, any bulging from your vagina while passing urine or otherwise, you will need to consult your physical therapist or OBGYN to rule out pelvic organ prolapse. If the leakage of urine has prolonged for more than 6 weeks postpartum and is getting worse, then you need to see your physical therapist.

5) You guys can improve scar tissue? What benefits does that have besides aesthetic reasons?

Physical therapy can help with scar tissue mobility for C-section scar, episiotomy scar, or scarring from a 1st-3rd degree tear. Scar tissue causes fascial restriction, which means it can adhere to the surrounding soft tissue and organs. This will often cause pain, poor extensibility, and decreased strength in the area.

You should wait until 6 weeks postpartum to start massaging or mobilizing your scar tissue.

6) How can I get rid of this split down my ab muscles?

(Video) Exercise During Pregnancy | Doctors Answer FAQs and What You Should Be Doing

That split or gap is known as Diastasis Recti, which is the separation of the abdominal muscle. During pregnancy, the uterus moves up into the abdomen and stretches between the rectus abdominis muscles to make room for the growing baby. Diastasis Recti can cause low back or pelvic pain but don’t worry, a physical therapist can help in reducing this separation through soft tissue mobilization in the abdomen, strengthening techniques, and even breathing techniques!

Some things to remember during pregnancy to avoid diastasis are: do not perform abdominal crunches and use Kinesio tape or a belly support belt during your 2nd and 3rd trimesters.

Here’s how to perform a self-test at home to see if you have Diastasis: Lay on your back, lift head off the ground, leaving your shoulders resting. Take your fingers and feel down the central abdomen, beginning at the sternum and travel all the way down while assessing that central line until you hit your pubic bone. While feeling down the midline, here’s what to look for:

  1. How wide is your separation?

  2. How deep is it?

  3. Can you feel the walls on either side of the separation?

  4. Is there any bulging in your central abdomen as you lift your head? (if you do see bulging, it is a sign that there is significant weakness in the deep layers of the abdomen)

Postpartum Diastasis Self-Test

Strengthening Exercises for Postpartum

(Video) Top 5 Pelvic Floor Exercises

7) Sex hurts. Will it always be like this? When does the pain go away?

This is known as Dyspareunia, which is a recurrent pain that is often located in the genital area and may occur before, during, or after sexual activity. This pain might come on as a result of the way your body changes during pregnancy, infections/STIs, vaginal dryness, or just stress. But luckily there are things you can do at home, or we can do to help Dyspareunia. Simple stretches like child's pose, happy baby, along with diaphragmatic breathing and pelvic floor relaxation can go a long way. Pelvic floor massages and the trigger point release method using your finger, pelvic wand, or a miracle ball can help your symptoms as well. Pelvic wands and miracle balls are available online for purchase, however, we would not advise using these during pregnancy.

Child's Pose

FAQs with a Pelvic Floor PT: What You NEED To Know if You Are Pregnant (3)

Happy Baby Pose

8) What is Pubic Symphysis Dysfunction and how do I know if I have it or am at risk for it? What can help these symptoms?

(Video) What is Pelvic Floor Physical Therapy?! | how to become a women's health PT

Pubic Symphysis Dysfunction is when your ligaments that normally keep your pelvic bone aligned during one’s pregnancy become too relaxed and stretchy after childbirth. This causes the pelvic joint - or symphysis pubis - to be unstable and which in turn, causes pelvic pain. Some symptoms include difficulty while walking and pain in your pelvis, typically focused in the pubic area but can also radiate towards the upper thighs and perineum. This doesn’t only happen while walking, but can happen while one is lifting heavy items, climbing stairs, getting dressed, getting into your car, or even while in bed.

You can do many things to ease your discomfort. We would recommend Hip stabilization exercises during pregnancy and also using an SI loc belt. Avoiding triggers is also important, this includes keeping your knees together during transfers like getting out of a car or getting out of bed, sitting down while getting dressed, and avoiding heavy lifting.

9) Why do I need a Pelvic PT for my pre-natal/post-natal care when I already have an OB/GYN that I go to?

An OBGYN is usually the first doctor people think of when it comes to prenatal care, delivery, and the postpartum journey. However, they usually aren’t trained to address the musculoskeletal implications like a Physical Therapist is. A Pelvic Floor Physical Therapist is even more apt to treat your pains and discomforts if you are pregnant, just gave birth, or just have any pelvic pains that might be also causing your abdomen, back or hip pain. However, not all OBGYNs will know when to refer their patient to a Pelvic Floor Physical Therapist, which is why often we encourage people to ask for a referral from their physician themselves. Some OBGYNs still may not give a referral, but you can always come straight to us and we can give you a free consultation!

No one deserves to live in pain, and the best way to help it is to prevent any further complications from happening. We believe in Preventative health as much as Reactive health, which is why seeing a Pelvic Floor Physical Therapist is important, especially while pregnant, to prevent any pain or conditions from happening in the first place. Here’s to healthy pelvic floors, and tearing down the stigmas that often surround Women’s Health issues!

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Our Phone Number if you have any questions: (646)-886-8687

(Video) Pelvic floor exercises during pregnancy | txt4two Program | Mater Mothers

FAQs

Can I do pelvic floor therapy when pregnant? ›

A pelvic floor physical therapist like Regional One Health's Darianne Butler can help, either during pregnancy or after a patient gives birth.

How does pregnancy affect pelvic floor? ›

How does pregnancy affect my pelvic floor? During pregnancy, the pelvic floor stretches to make room for the growing baby. Over time, the muscles become weak from being weighed down. Instead of bouncing back to provide support, the weakened muscles may not return to their optimal location.

How should I prepare my pelvic floor before pregnancy? ›

Performing with an empty bladder, your first goal should be to tighten your pelvic floor muscles for 5 seconds. Then relax them for 5 seconds. Try to do 5 reps on your first day. As you gain confidence from your new routine, aim for 10 seconds at a time, relaxing for 10 seconds between contractions.

What should I ask my pelvic floor PT? ›

Asking A Pelvic Floor Physical Therapist: Frequently Asked Questions
  • What is pelvic floor PT? ...
  • Where is my pelvic floor, and what exactly does it do? ...
  • How do I know if I have a pelvic floor problem? ...
  • What does a pelvic floor evaluation or treatment look like? ...
  • Can I do pelvic floor PT when I'm on my period?
Jul 19, 2020

How do you know if your pelvic floor is weak? ›

Symptoms of pelvic floor muscle dysfunction
  1. leaking urine when coughing, sneezing, laughing or running.
  2. failing to reach the toilet in time.
  3. passing wind from either the anus or vagina when bending over or lifting.
  4. reduced sensation in the vagina.
  5. tampons that dislodge or fall out.
  6. a distinct bulge at the vaginal opening.

How does your lower stomach feel in early pregnancy? ›

Lower abdominal pain is normal during pregnancy and is most common between 18 and 24 weeks. Your growing uterus is pulling and straining the muscles that support it. You may feel sharp pains or just a mild pulling sensation. It often occurs when you cough, sneeze, stand up, sit down, roll over, or during sex.

How do you tell if a woman is pregnant by looking at her? ›

You cannot diagnose a pregnancy by merely looking at a woman's eyes. This is a historical and outdated method of detecting pregnancy.

How do you feel your uterus in early pregnancy? ›

To feel the uterus, have the mother lie on her back with some support under her head and knees. Explain to her what you are going to do (and why) before you begin touching her abdomen. Your touch should be firm but gentle.

What should I expect at my first pelvic floor physical therapy? ›

Based on your history and symptoms an exam will be perform. This may include observation and palpation of back, pelvis, hips, abdomen and pelvic floor. Your therapist is looking for restrictions of mobility or movement, cause of pain or cause of pain that is referred to another location.

How long does pelvic floor PT take? ›

How long are the appointments? Your first appointment may last 60 to 90 minutes for all your questions to be answered and to allow your therapist to understand your symptoms. After the evaluation, you can expect your sessions to last 30 to 60 minutes.

How long is physical therapy for pelvic floor? ›

Length of Treatment

One visit per week for eight weeks is a common scenario for pelvic floor physical therapy. However, the length of treatment will vary depending on the diagnosis, severity of the dysfunction and your individual goals.

When should you start doing pelvic floor exercises in pregnancy? ›

The NHS recommends to start pelvic floor exercises as soon as you find out you're pregnant. After your baby is born, ask your doctor about starting to do Kegels again, along with walking and gentle stretches These can help with your recovery from childbirth.

How do you open your pelvis when pregnant? ›

Coming into a wide leg squat position helps open the pelvis, and gravity will naturally promote lengthening in the pelvic floor. This is best performed as a repetitive exercise instead of a position that is held. Step your feet wider then your hips, with your feet angled out slightly.

How do you open your pelvic floor? ›

Lie on your back with your knees bent. Place your left ankle on your right knee, like a figure four. Pull your right thigh toward your chest to feel a stretch on the outside of your left hip. Hold for 30 seconds, and then repeat on the other side.

What does pelvic floor pain feel like during pregnancy? ›

Early in pregnancy, many women have pelvic pain. Pelvic pain refers to pain in the lowest part of the torso, in the area below the abdomen and between the hipbones (pelvis). The pain may be sharp or crampy (like menstrual cramps) and may come and go.

How do you know if your pelvic floors are good? ›

If your pelvic floor muscles are strong, "you should feel the area under your fingers lift and pull upward," Wright says. Also, "there should be no additional pressure toward your fingers if you are contracting correctly," she adds.

Does walking help pelvic floor? ›

Regular gentle exercise, such as walking can also help to strengthen your pelvic floor muscles.

When do pregnancy cramps start? ›

It occurs anywhere from six to 12 days after the egg is fertilized. The cramps resemble menstrual cramps, so some women mistake them and the bleeding for the start of their period. The bleeding and cramps, however, are slight.

What should you not do before pregnancy test? ›

Don't drink too much water, or any liquid, before taking a pregnancy test. Excess fluids can impact the accuracy of the test results, so if your urine is diluted or pale yellow, hold off on taking a test. Diluted urine tends to also have diluted hCG levels which can skew the test results.

What kind of cramps indicate pregnancy? ›

Implantation cramping or bleeding may be an early sign of pregnancy. It is easy to mistake period cramping or a light period for symptoms of implantation. Because of the similarity of symptoms between menstruation and implantation, it helps to know the other early signs of pregnancy.

What is the fastest way to know if you are pregnant? ›

The cheapest, easiest, most accessible way to confirm you're pregnant is with a home pregnancy test. This form of testing can identify a positive pregnancy result as early as two weeks after fertilization, making it one of the fastest ways to learn more about your situation.

How do you tell if you are pregnant by touching your cervix? ›

The texture of the cervix also changes in early pregnancy due to increased blood flow. If the woman has not conceived, the cervix will feel firm to the touch, like the tip of a nose. If she has conceived, the cervix will feel softer, more closely resembling the lips.

Where is womb located right or left? ›

Also called the womb, the uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum. Ovaries. Two female reproductive organs located in the pelvis.

What part of the breast hurts in early pregnancy? ›

For many women, the nipples are particularly sensitive in these early weeks. They can be so tender to the touch that it hurts to dry off after a shower or put on a bra (go braless with confidence!).

When should you start doing pelvic floor exercises in pregnancy? ›

The NHS recommends to start pelvic floor exercises as soon as you find out you're pregnant. After your baby is born, ask your doctor about starting to do Kegels again, along with walking and gentle stretches These can help with your recovery from childbirth.

How often should you do pelvic floor exercises when pregnant? ›

How often should I do my pelvic floor exercises? Once you get used to doing them, start off with 5 squeezes 5 times a day. Increase this to 10 squeezes 5 times a day if you can. Try to do a mixture of slow and quick squeezes.

Can I do physical therapy while pregnant? ›

Is it safe to exercise and do physical therapy while pregnant? Exercise and PT are both safe and effective during pregnancy! Before coming to PT and participating in exercise, OBGYN clearance is always required.

When should you start pelvic floor therapy? ›

When should I see a pelvic floor physical therapist?
  • Pain during urination or when the bladder is full.
  • Urine leakage when coughing, sneezing or laughing.
  • A strong urge to urinate yet feeling unable to empty the bladder.
  • Painful bowel movements and/or constipation.
  • Pain during or after sex.
Jan 27, 2020

How does your lower stomach feel in early pregnancy? ›

Lower abdominal pain is normal during pregnancy and is most common between 18 and 24 weeks. Your growing uterus is pulling and straining the muscles that support it. You may feel sharp pains or just a mild pulling sensation. It often occurs when you cough, sneeze, stand up, sit down, roll over, or during sex.

What pelvic floor exercises should you do when pregnant? ›

Pelvic floor exercises can be done anywhere — while sitting, standing or lying down.
  1. Squeeze and draw in the muscles around your anus (back passage) and vagina at the same time as if you are trying to stop a wee.
  2. Hold the squeeze as you count to 8; relax for 8 seconds. ...
  3. Repeat as many as you can, up to 8 to 10 squeezes.

What exercises are not safe during pregnancy? ›

Any exercise that may cause even mild abdominal trauma, including activities that include jarring motions or rapid changes in direction. Activities that require extensive jumping, hopping, skipping, or bouncing. Deep knee bends, full sit-ups, double leg raises and straight-leg toe touches. Bouncing while stretching.

When does your stomach start to get hard when you are pregnant? ›

During the first trimester

With the growth of the uterus and development of the baby, the belly can start to feel firmer, even early on in pregnancy. Hardening is mostly due to excessive stretching of abdominal muscles. This generally happens around weeks 7 and 8.

How do you know if you are doing pelvic floor exercises correctly? ›

Feel the muscles in your vagina, bladder, or anus get tight and move up. These are the pelvic floor muscles. If you feel them tighten, you have done the exercise right. Do not make it a habit to do the exercises each time while you urinate.

Does pelvic floor affect fertility? ›

The short answer is no. PFD does not seem to be a cause of infertility. However, because PFD is associated with difficulties in sexual function, it could indirectly make it more difficult to conceive naturally, by making intercourse unpleasant or even painful.

What precautions should take during pregnancy? ›

Eat breakfast every day. Eat foods high in fiber, and drink fluids (particularly water) to avoid constipation. Avoid alcohol, raw or undercooked fish, fish high in mercury, undercooked meat and poultry, and soft cheeses. Do moderate-intensity aerobic activity at least 150 minutes a week during your pregnancy.

How does pregnancy test show positive? ›

Pregnancy tests work by reacting to the amount of hCG in either your urine or blood. In a urine test, a piece of reactive paper detects the hCG. This might then show a plus sign, double vertical lines or even the word “pregnant.”

How do you read a PT strip? ›

If only one coloured line appears on the strip, the test is negative and you are not pregnant. If two coloured lines appear, the test is positive, which means you are pregnant. Even if the lines are light in colour, you may assume you are pregnant. - The test has been taken prematurely.

How do you prepare for pelvic floor PT? ›

To prepare for pelvic floor physical therapy, you should arrive dressed in comfortable clothes that allow you to move your legs freely without restricting your movement. Your exam includes an internal component, so make sure your groin and genital area is clean before your appointment.

What is done during pelvic floor physical therapy? ›

During pelvic floor therapy, we teach you exercises to stabilize and strengthen your core, or the major muscles that stabilize the trunk, including the pelvic floor, abdominal, back, and diaphragm. This also involves re-training and strengthening your pelvic floor muscles.

What should I expect at my first pelvic floor physical therapy? ›

Based on your history and symptoms an exam will be perform. This may include observation and palpation of back, pelvis, hips, abdomen and pelvic floor. Your therapist is looking for restrictions of mobility or movement, cause of pain or cause of pain that is referred to another location.

Videos

1. Pelvic Floor Physical Therapy- what is it and who can it help?
(Fave Lifestyles)
2. Pelvic Floor Exercises For Pregnant Women
(Pregnancy and Postpartum TV)
3. Top 3 Pelvic Floor Exercises - Simple Pelvic Floor Physical Therapy Exercises at Home!
(Jessica Valant Pilates)
4. Pelvic Floor Facts | How Well Do You Know Your Pelvic Floor?
(Dr. Susie Gronski, PT, DPT)
5. Pregnancy Related Pelvic Girdle Pain | Physiotherapy | Mater Mothers
(Mater)
6. Introduction - 4 x Self-Help Videos on Pelvic Floor Muscle Exercises
(The Rotunda Hospital, Dublin, Ireland)

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