Bringing a new life into the world is an extraordinary journey, but it can also take a toll on the body, especially the pelvic floor. The pelvic floor is the hammock of muscles that are at the bottom of the pelvis for both men and women. Pelvic floor therapy is a holistic approach that offers invaluable benefits during pregnancy and beyond into the postpartum period.

Understanding the Pelvic Floor

Before we delve into the benefits of pelvic floor therapy, let's understand what the pelvic floor is. The pelvic floor comprises muscles, ligaments, and connective tissues that support the pelvic organs, including the bladder, uterus(for women), and rectum. These muscles play a vital role in supporting the pelvic organs, maintaining urinary and bowel continence, and facilitating childbirth, through the ability of learning how to feel these muscles contract, co-contract with surrounding muscles of the pelvis, and most importantly, how to relax these muscles. Throughout pregnancy and postpartum, the pelvic floor undergoes significant changes and stress and strain, leading to issues like urinary incontinence, pelvic pain, prolapse, diastasis recti, back pain, and hip pain. It is essential to incorporate targeted exercises and stretches to promote strength, flexibility, and resilience.

Benefits of Pelvic Floor Therapy During Pregnancy

• Optimal Muscle Function: Pelvic floor therapy aims to optimize muscle function, providing strength and support to accommodate the growing uterus and the changes in the body during pregnancy.
• Prevention and Management of Discomfort: Therapy techniques help alleviate common discomforts such as back pain, pelvic pressure, and urinary leakage, improving overall comfort during pregnancy.
• Preparation for Labor and Delivery: Pelvic floor therapy includes exercises and relaxation techniques that prepare the pelvic floor for labor, potentially leading to smoother deliveries and reduced risk of perineal trauma.

Benefits of Pelvic Floor Therapy Postpartum

• Promotes Healing: After childbirth, pelvic floor therapy aids in the healing process by addressing perineal tears, episiotomies, or cesarean section scars, promoting tissue repair and reducing pain.
• Restores Muscle Tone: Therapy helps restore muscle tone and function in the pelvic floor, core, and surrounding muscles, addressing issues like urinary incontinence, pelvic organ prolapse, and sexual dysfunction commonly experienced postpartum.
• Emotional Well-being: Pelvic floor therapy provides a safe space for women to address emotional and psychological aspects of childbirth, daily life challenges, and all other concerns, facilitating a smoother transition into motherhood and promoting overall well-being.

What to Expect During Therapy

Assessment: A thorough assessment by a pelvic floor therapist includes:

○ Subjective: Extensive gathering of history, including previous births, bladder and bowel habits and routines, sexual health, previous medical history, exercise routine, etc.,

○ External exam, including evaluating posture, muscle strength, flexibility, coordination, and movement patterns

○ Internal exam: Only with consent and if determined necessary and beneficial, an internal vaginal exam is performed to assess the pelvic floor muscles, which will help to identify areas of tension or dysfunction and provide feedback to these muscles for helping the individual connect with this area of the body.

Personalized Treatment Plan: Based on the assessment findings, a personalized treatment plan is designed, incorporating a variety of techniques such as manual therapy, exercises, functional movements that are able to be incorporated into your daily routine, bladder and bowel retraining, education, labor and delivery preparation (if pregnant), and achieving personal goals related to health.

Continuity of Care: Pelvic floor therapy offers ongoing support throughout pregnancy and postpartum, adapting treatment as needed to address changing needs and challenges.

Example of exercises/ stretches to begin incorporating into your daily routine with pregnancy and/or postpartum (This is not medical advice, please remember to check in with a pelvic floor therapist and health care provider for more guidance)

1. Diaphragmatic breathing: The diaphragm is a dome shaped muscle that lies underneath our rib cage and helps us to expand our lungs in order to strongly and effectively breathe. This muscle is very important to learn how to properly use in order to connect with our pelvic floor muscles as they move together and synchronously. It is also very important for helping our nervous system to enter its parasympathetic state of “rest and digest.” It can be particularly helpful during labor and with strong contractions, helping our bodies to relax and navigate to decrease pain that is often associated with contractions as the baby is making its way into the world. Here is how to practice proper diaphragmatic breathing:

a. Start with laying down on your back (if comfortable) or slightly reclined-can perform in many different positions.

b. Place one hand on your chest and the other hand on your belly.

c. Inhale gently through the nose, filling your lungs with air, and feeling your belly rise as you simultaneously feel your chest rise as well (we do want to feel both rising equally, not one more than the other).

d. Exhale gently through the mouth (blow out a candle) and feel the belly and chest fall back in

e. With more practice: begin to feel the breath filling the ribs in the front, sides, and back of you, your back muscles expanding and stretching with the inhales, the pelvic floor muscles relaxing with your inhales, contracting with your exhales.

2. Squats:

a. Squats engage the pelvic floor muscles, hips, and thighs. They help maintain pelvic alignment, alleviate lower back pain, and prepare the body for childbirth.

b. Starting with feet hip-width apart, slowly sitting the hips back, ensuring that you keep a straight spine throughout, lowering down into squat position.

c. Be mindful of keeping knees in (rather than turning out) and behind your toes.

d. Take a deep breath in at the bottom, exhale gently (blow out a candle), press through the heels of your feet (to feel your glutes working) and start to come back up to stand.

3. Cat-Cow Stretch:

a. Cat-Cow Stretch promotes spinal mobility, relieves tension in the lower back, and stretches/mobilizes the pelvic floor muscles.

b. Start on your hands and knees, arch your back and point your tailbone up to the sky (cow), take a gentle breath in through the nose and fill your belly as best as you can, exhale gently through the mouth, and then start to round your back and tuck your tailbone in (cat)

4. Child's Pose:

a. Great for relaxing and opening up the pelvic floor muscles.

b. Kneel on the floor, sitting your hips back and then lowering your torso forward, reaching your arms out in front of you and resting your forehead on the ground. Modification (if pregnant or uncomfortable with sitting your hips back) is to stick your butt up to the sky.

c. Hold position for a few deep breaths - focusing on using the diaphragm breath to breathe into the back of the ribs, lower back, and releasing tension in the pelvic floor muscles.

Pelvic Floor Care in the Postpartum Period

Gradual Return to Exercise:

● Ease back into exercise after childbirth, starting with gentle pelvic floor exercises and stretches. (as seen above)

● Listen to your body and avoid high-impact activities until cleared by your healthcare provider. (especially for the first 3 months)

Seeking Professional Guidance:

● Consider consulting a pelvic floor therapist for personalized guidance andsupport in your postpartum recovery journey.

● A therapist can assess pelvic floor function, address any issues, and provide tailored exercises and stretches.

Conclusion

Pelvic floor therapy is a valuable tool for promoting optimal pelvic health during pregnancy and postpartum. By addressing issues proactively and holistically, it empowers women to embrace their journey into motherhood with confidence and vitality. Also by incorporating some of these targeted exercises and stretches into your routine, you can support pelvic floor strength, flexibility, and resilience, promoting a smoother childbirth experience and aiding in postpartum recovery.

Remember to listen to your body, consult with your healthcare provider, and seek professional guidance with a pelvic floor therapist when needed as you embark on this transformative journey into motherhood. Best of luck to you if you are currently on this journey :)

Want to discuss pelvic floor health with Alexis? Contact her at: alexiskessaris@gmail.com