When and Why Should I Get My Pelvic Floor Assessed During Pregnancy?

By Kathryn Melvin, APA Physiotherapist, Pilates Instructor and Total Physio’s Women’s Health Physiotherapist.

Initial Assessment: Week 13-25

This can occur at any time during your pregnancy, however we recommend coming in as soon as possible after your first trimester, ideally around 13 weeks. This may be the first time someone has checked your pelvic floor, movement patterns and strength, and it allows your women’s health physio to advise you on how much and what type of exercise, pelvic floor strengthening or relaxation you need to do. This is usually an external pelvic floor assessment that allows your physio to gage your baseline. They will use the measurements and outcomes taken in this session to compare to those after you have given birth. The second trimester is normally when individuals begin experiencing pelvic girdle pain, rib pain or pregnancy-related back pain. However, we still recommend you see a physio during this time, even if you do not have any symptoms.

Follow-up Assessment: Week 20 +

Between 18-22 weeks, most individuals will have a “morphology” scan. Following this, we recommend booking in to see your pelvic floor physiotherapist again. After this scan, you can usually have an internal pelvic floor assessment. During this assessment, your physio will see how your pelvic floor is functioning at the mid-point of your pregnancy, and also check in on the rest of your body to ensure we are minimising the risk of potential musculoskeletal dysfunction.

Your 20-week appointment will normally involve :

• Explanation of what the pelvic floor is, how it functions normally and how you can prepare it adequately for birth.

• Discussion of and preparation for your birth plan, if required.

• Any pelvic floor symptoms (leaking, urgency, “heaviness” felt around the vagina/pelvis), other aches and pains (e.g., lower back, ribs, pelvic girdle) and treatment to address these.

• Taking a baseline of pelvic floor tone, strength and muscle coordination.

• Screening for risk factors for longer second-stage labour/risk of prolapse or high degree perineal tears.

• Ensuring bladder, bowel and sexual function is all in line with normal pregnancy-related changes.

• Advice regarding safe exercise during pregnancy.

• DRAM (Diastasis Rectus Abdominus Muscle) Assessment.

• General assessment of and management for any other niggles, aches or pains. This is especially important, since the second half of pregnancy can place a greater load on your pelvic floor, hips, back and pelvis.

Birth Preparation: 34 weeks

• Discussion of birth plan and potential risks for your pelvic floor.

• Measurement & assessment of perineal tear or prolapse risk factors.

• Demonstration of perineal massage.

• Assessment of pushing technique, tone and function of pelvic floor.

• Discussion of labour positions..

• Early post-partum advice, pelvic floor and C-section advice.

• How to manage bowels and bladder in the early days.

• Measurements for abdominal and perineal compression shorts.

Kathryn is available for appointments at Total Physiotherapy on Monday, Tuesday, Wednesday and Friday.