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.

The Philosophy of Total Physiotherapy

It's been a big week for Total Physiotherapy - officially opened on Monday, finally had the phone connected after a 6 week wait (don't ask!) and yesterday we received our final and most important delivery of equipment. It wasn't the treatment beds, the array of braces and supports we stock for each body part and it wasn't the HICAPS terminal so we can receive payments. I admit all of these are important and you wouldn't be able to run much of a Physio practice without these things. The most important equipment was the strengthening and exercise equipment - the bulk of which was delivered and set-up by Life Fitness yesterday. So what is this equipment and why is it so important, surely you can still provide quality Physiotherapy without it, after all we are not a gym. 

Firstly the equipment - Total Physiotherapy has a leg press machine, functional cable trainer, stationary bike, a range of free weights, multiple resistance bands and equipment to improve and re-train balance. Yes it is possible to provide a quality Physio service without this equipment but it is not possible to achieve the results Total Physiotherapy strives for without it. Physiotherapy is a profession where you should expect your therapist to provide Evidence-Based Practice in your management. This means that the treatments your Physio use should be supported by research, clinical studies, literature reviews and their own clinical experiences. Ultrasound, interferential and electrical stimulation are examples of treatments being used less in Physiotherapy as there is no quality evidence to support their effect on recovery from injury. There is growing and very strong evidence for the role of exercise in not only the management of a presenting injury but also improved performance following injury and prevention of further episodes. This includes strength and conditioning, technique correction, load management and improving motor control or the way different parts of the body work together to perform an activity.

Total Physiotherapy is designed to enable you to make the most successful recovery possible from your injury. The combination of a well equipped practice, Stuart's Exercise Physiology background and experience as a Physio mean you not only get the treatment and advice required to make a recovery from your injury but a supportive and comfortable setting to perform your rehab program. All of this with a Physio present rather than hoping you are doing the right thing on your own at home or in the gym. At Total Physiotherapy you will not only recover from your injury, you will make the best recovery possible.

If you would like to see what the practice looks like now it is fully equipped then check out the Gallery.