Pelvic Floor Therapy Can Help with Pregnancy Issues

By Natalie J. Sebba, DPT, Scripps Memorial Hospital La Jolla

For most women, pregnancy is a wonderful experience, and we’re amazed at how our bodies change as we prepare to give birth to the tiny human being we’ve created.   For some, however, these remarkable changes may have undesirable consequences.

During pregnancy, our body structure changes to accommodate the needs of the growing fetus. Most women carry an additional 25 to 35 pounds during pregnancy; this places a significant extra load on the pelvic floor muscles, which help to support the pelvic organs as well as control bladder and bowel function. If these muscles aren’t strong enough to support the extra weight, they may become increasingly weaker as the baby grows. Delivery, too, can be traumatic for the pelvic floor if the muscles are too tight or don’t release correctly to let the baby pass through the birth canal.

These weakened muscles can lead to problems such as incontinence (bladder leakage) or pelvic organ prolapse. Prolapse occurs when a pelvic organ, such as the bladder, is not correctly supported by the pelvic muscles, drops out of position, and pushes against the vaginal walls.  This can cause discomfort or a feeling of “heaviness” in the pelvis, as if something is falling out. Women can also develop pelvic floor muscle or nerve damage during delivery.

Pelvic floor physical therapy can address such muscle weaknesses. Often, physical therapists who specialize in pelvic floor rehabilitation are able to teach women how to exercise and strengthen their weakened muscles to eliminate incontinence and correct prolapse. Physical therapy can also help prevent incontinence or prolapse in women who have an increased risk of developing these conditions.

What can increase the risk? Several factors. Women with weak pelvic floor muscles or organs that are already slightly prolapsed are at much higher risk. Participation in high-impact sports such as running, jumping or gymnastics may increase risk as well, as these activities place downward pressure on the bladder and pelvic floor and can weaken muscles that are not strong enough to withstand the strain. Multiple births and back-to-back births also can increase risk: Twins and triplets place greater than usual strain on the pelvic floor, while having children very close together in age gives the body less time to recover between births. A complicated vaginal delivery is another factor.

Age, however, is not a risk factor.  An older mother who has always been diligent about keeping her pelvic floor muscles strong may have less risk than a younger mom who has never done any muscle work.

Learning how to strengthen our pelvic floor muscles, ideally before pregnancy, is one of the best things we can do for our bodies. Women’s magazines often remind us to do “Kegel exercises.” Named after gynecologist Arnold Kegel, MD, these exercises strengthen the muscles. But how many women know how to do them correctly? The common suggestion of stopping the flow of urine midstream is not a good idea and can actually increase the risk of bladder problems. The correct positioning, type of contraction and time held vary greatly depending on each woman’s body.

As specialists in pelvic floor physical therapy, one of our goals is to evaluate each woman’s pelvic floor strength, coordination and function, and then create a customized strengthening plan.  We help women develop an exercise plan they can do on their own to enhance the strength of their pelvic floor for a lifetime.

Pelvic floor therapy is not just for women who are pregnant or planning to become pregnant. All women can benefit from stronger pelvic floor muscles, especially if they are active or have other factors that increase the strain on their pelvic floor.

Most general physical therapists aren’t trained to do pelvic floor therapy. Be sure to look specifically for a certified pelvic floor physical therapist, or a board-certified women’s health physical therapist, who will have the additional training and experience required to treat these specialized conditions.

Natalie J. Sebba, DPT, is a women’s health physical therapist with an additional certification in pelvic floor rehabilitation.  She practices at Scripps Memorial Hospital La Jolla. Join Natalie for a free seminar on “Pregnancy and Your Pelvic Floor” on Oct. 7 at 6 p.m. at Scripps La Jolla.  To register, call 1-800-SCRIPPS.