How a pelvic floor therapist can help women during pregnancy and after

You’ve probably heard advice for a healthy pregnancy that covers everything from prenatal vitamins to the perfect pillow — but there’s one topic that rarely makes it into the group text: your pelvic floor.

Those hidden muscles at the base of your body quietly hold up the weight of your growing baby, support your organs, control leaks and help your core stay stable. And when they’re overworked or overwhelmed? You feel it — in your hips, your back, your bathroom habits and sometimes in your confidence.

That’s where pelvic floor physical therapy comes in. It’s not fringe and it’s definitely not “too late” to start. It’s intentional, evidence-based, hands-on care that helps pregnant women move better, feel better and prepare their bodies for delivery and postpartum life. And the best part? You don’t have to “just deal with it.”

What exactly is a pelvic floor physical therapist?

A pelvic floor physical therapist is a physical therapist who specializes in the muscles at the base of your pelvis — the ones that support your bladder, uterus, rectum and help with things like posture, stability, sex and going to the bathroom. These muscles can get tight, weak, overworked or just “out of sync,” especially during pregnancy when your body is changing fast and carrying extra weight.

What physical changes does a pregnant woman experience that pelvic floor physical therapy could help with?

When you’re pregnant, your abdomen is expanding, which can put more pressure on the lower back. Pregnancy-related pelvic girdle pain (PGP) and symphysis pubis dysfunction (SPD) can occur because of the widening of the pelvic bones. You might experience pelvic pain because of the muscle compensation patterns and increased stress on the pelvic region – a result of a body that's changing very quickly.

Urinary incontinence is a possibility during pregnancy because you've got increased downward pressure on your organs. If you think about a baby growing in your abdominal cavity, you can see there's more pressure and more weight over the bladder. That pressure can cause urinary leakage.

Diastasis recti is something else pregnant women should be aware of. Also known as diastasis rectus abdominis or diastasis, it’s when the fascia that connect the rectus abdominis muscles – the abs – separate during and after pregnancy. Nearly every mom will have some sort of diastasis when she gets into that late third trimester.

The condition can cause low back pain, constipation, urine leakage and hernia. There are specific exercises you can do for it.

Pelvic organ prolapse (POP) is another condition resulting from increased pressure on your organs. Those organs can sometimes even come through the pelvic floor muscles externally. It’s important to be aware of the signs and symptoms of POP for earlier intervention. Feelings of pressure or heaviness in the pelvic region are often the first signs.

How does pelvic floor physical therapy address these things?

Pelvic floor physical therapists use body mechanics and breathwork to show you effective ways to move your changing body, while minimizing discomfort.

If you are experiencing low back, hip or pelvic girdle pain, there are stretching and mobility exercises that can help keep the body happy and moving. Strengthening exercises can be helpful for second and third trimester, too.

They also give women tools they can use when they're in labor. A pelvic floor physical therapist can educate you on different positions for labor that help facilitate the opening of the pelvis. They can show you how to tap into their body’s natural instincts to deliver a child; the biggest thing is learning to let go and use the breath to generate pressure.

Some women will tear at the perineum – the area between the vulva and the anus. Or, their doctor will make space surgically (for the baby) by cutting the perineum. A pelvic floor physical therapist can teach you how to do perineal massage, which allows you to prep those tissues, getting them to relax and creating more space for the baby.

Are Kegels part of pelvic floor physical therapy?

There can be a place for Kegels in pregnancy, but they’re not appropriate for everyone. If an expectant mom comes in with a history of pelvic pain or painful intercourse, Kegels are typically not recommended. Kegels do sometimes have a place in helping to strengthen a weak pelvic floor.

Can pelvic floor physical therapy help make a vaginal delivery easier?

Absolutely, but it can also help with a C-section, too.

How can someone make an appointment with a pelvic floor physical therapist and does insurance cover it?

Patients are welcome to start pelvic floor physical therapy anytime throughout their pregnancy, or postpartum. It's never too late to start. Even just one visit can be empowering and informative.

For pelvic floor physical therapy, you’ll need a referral from either your physician, midwife, physician assistant or nurse practitioner.

Insurance coverage for physical therapy (of any kind) is based on each individual’s plan. It’s best to contact your insurance company to confirm coverage and your copayment amount.

If a woman comes for just one visit during her pregnancy, what can she expect?

You'll look at activity modification, body mechanics and adaptive equipment that’s specific to each person’s routine and changing body. A pelvic floor physical therapist will give you tools for dealing with back, hip or pelvic girdle pain in the form of mobility exercises and stretches that are great for any expectant mom. You'll talk about prep for labor: positioning ideas and pain management with the use of simple tools like pillows, braces, wedges and exercise balls.