Pregnancy Pelvic Floor Checks

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.

Pregnancy and Early Parenthood Pains

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My son Caelen is just over 16 months and is the most amazing gift my wife and I could have ever imagined. It has been so rewarding being a part of his development – from pregnancy, the short time he was a newborn (I never realised how short a time your baby is actually a new-born!) and to now, a wildly energetic, curious and cheeky 16 month old boy. While fascinated with his development, my wife and I have also become very familiar with the tired, aching bodies that come with having a baby. As a Physio it has been an invaluable learning experience seeing first hand what happens to a woman's body during and after pregnancy and the demands on your body of caring for a baby.  

There are two big changes to a woman's body during pregnancy that can have profound effects on how their body feels. The first is an increase in the hormone Relaxin – this causes the ligaments supporting the joints in the body to relax, allowing the baby to pass through the pelvis during birth. It's important to note that it is not just the ligaments in the pelvis that relax, it's all ligaments in the body. There are ligaments supporting every joint, this includes the spine, shoulders, elbows, wrist, knees and ankles. As a result these joints are more mobile and will be affected differently by the loads placed on them.  

The other change is a baby growing in your belly, gradually getting bigger and heavier as pregnancy progresses. A growing belly changes your centre of gravity, the curvature of the spine changes to cater for this as does the parts of your body that are getting loaded. In a sport setting, an athlete is more likely to get injured when there is a change to the loads they are exposing their body to. It is no wonder that women experience back, hip and other joint pains during pregnancy with the way their loads are changing. The good news is that although you are sore, generally no significant long-term injury results. However, if you are concerned by the pain and worried you may have a more serious injury discuss this with your GP, mid-wife or obstetrician.  

How should you manage this pain – or is it just something you have to put up with? Not every woman will experience discomfort at the same levels or at the same locations. It is possible to attain some relief and try to limit the amount of pain experienced. From listening to mums and mums-to-be and my experiences as a Physio there is a lot of variability in what works and how much relief each individual receives. Again, your GP, mid-wife or obstetrician can provide you some advice on what might work for you. My tips for managing and reducing pain during pregnancy are: 

• Keep muscles supporting your joints strong to counter the loss of stability provided by your ligaments. Important areas are the core and gluteal musculature, and muscles supporting the shoulders, knees and ankles. You may choose to continue gym training during pregnancy (at the appropriate levels), perform Pilates classes or a Physio can provide you with exercises you can perform at home or in a gym-setting.  

• Massage and gentle soft-tissue release can help reduce pain and help manage the consequences of the altered loading that has occurred. It is to be expected that certain muscles become over-loaded and tight as the way your body carries load changes. I try to identify and target these areas when treating pregnant women and often there is an immediate improvement.  

• As joints are relaxing it is unlikely that joint mobilisation is required or would be beneficial. Occassionally I have used mobilisations when I have thought a particular joint may be a little more overloaded than others. Even then it would only require a small amount of mobilisation and would be most likely used for the upper back or neck regions. Considering what is happening to the body strengthening and massage makes more sense to me. 

• Have some self-management tools available – the ones I believe to be most useful during pregnancy are hot and cold packs, massage balls, foam rollers and natural pain relieving creams. And treat yourself to some relaxation time - find how Total Physiotherapy and Yummy Mummy Day Spa can help with this at the end of the article! 

Stuart with Caelen - demonstrating some pretty poor holding posture!

Following the arrival of your new baby there is a flood of feel-good hormones, your body gradually returns to normal and you have this amazing little person in your life. It is not long until you have forgotten the pains of pregnancy. However, as my wife and I are still discovering, a young one puts a whole lot of new strains on your body. From spending regular periods feeding (and many babies prefer to feed from one side as we discovered), continuously holding/carrying/lifting your child, bending over your child as they get to sleep and long periods pushing a pram (not an exhaustive list) your body is still copping it! Shoulder, wrist, lower back or neck pains are the most common I see as a Physio and all of which both my wife and I have experienced over the past 16 months. 

My advice, and I say this knowing that it is impossible to diligently follow this while dealing with the demands and time constraints of having a baby, is: 

• Don't let soreness build up for too long - If you can get on to things earlier I find it is easier to settle down and the pain does not become as debilitating.

• Resume some of the core and gluteal strengthening exercises from pregnancy once your doctor says it is safe for you to do so. 

• Try to share the load between both sides of your body when carrying and feeding as much as possible. Favouring a side of your body is one of the most common reasons for shoulder, neck and upper back pain in new parents.     

• Gradually resume exercise in a structured way to avoid over-loading your body with an activity it is not used to – keeping the mind what it has just been through during pregnancy. It takes time for your body to adapt to what you are exposing it to so don't try to do too much too soon. If you are unsure of what you should be doing a Physio can help get you on track. 

• Ensure you pram is set-up so you can walk upright and comfortably. Avoid being bent over or slumped when pushing the pram.  

• The same self-management tools above are again very useful – if you can find the time to use them!
  
  I hope you enjoy the experience as much as my wife and I have. Embrace the changes to your body and the amazing new member of your family. Hopefully the tips above can provide you with some relief and if required Physiotherapy can provide some additional relief both during and after pregnancy.   

The above relates to my experiences with normal pregnancy-related pains and conditions. Unusual or severe pains should be discussed with the medical professional managing your pregnancy.  

Stuart McKay 
APA Physiotherapist, Owner Total Physiotherapy 
Writing this as both a proud dad and Physio 

Total Physiotherapy is a new Physio Clinic located on Clovelly Road Coogee. Thanks to the kindness of Yummy Mummy Pregnancy Day Spa also on Clovelly Road, for the month of February we are able to offer the first ten mums-to-be or new mums with a child under 12 months who come in for Physiotherapy a $50 Gift Voucher to use at Yummy Mummy Day Spa.