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A banner image of several women holding signs touting the benefits of pelvic floor therapy for pregnant women.

TAKE CONTROL OF YOUR BODY DURING PREGNANCY

PREPARE YOUR MUSCLES FOR DELIVERY

Pregnancy is detrimental to pelvic floor and abdominal musculoskeletal function,
which can give rise to complications and long-term injury [source].

In therapy, we optimize your muscles to be free of myofascial trigger points so that they are in their best condition for delivery. We closely follow the American College of Obstetrics and Gynecology guidelines for exercise during and after pregnancy, so you can reduce pregnancy issues, complications, and discomfort before and after the birth of your child.

Pregnancy issues such as pelvic organ prolapse, bladder leakage, diastasis recti, and even fecal leakage arise from pregnancy and without treatment.  Due to this, women often suffer for a lifetime. The Obstetrics and Gynecological Clinics of North America recognizes the epidemiology of pelvic floor issues [source].

Research shows pelvic floor therapy to reduce the risk of 3rd and 4th degree tears and episiotomy in vaginal childbirth. Additionally, women who participated in therapy to prepare the pelvic floor for delivery spent less time in stage 2 labor and their babies had better Apgar scores [source].

There is also growing evidence that pelvic floor therapy during pregnancy can reduce the risk of injury and issues after pregnancy [source].

A pregnant woman standing holding a sign that says, "Therapy helps you prepare for delivery and manage complications.

Citations:

1. Hallock, J. L., & Handa, V. L. (2016). The Epidemiology of Pelvic Floor Disorders and Childbirth: An Update. Obstetrics and gynecology clinics of North America, 43(1), 1–13. 

2. Abdelhakim, A. M., Eldesouky, E., Elmagd, I. A., Mohammed, A., Farag, E. A., Mohammed, A. E., Hamam, K. M., Hussein, A. S., Ali, A. S., Keshta, N., Hamza, M., Samy, A., & Abdel-Latif, A. A. (2020). Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. International urogynecology journal, 31(9), 1735–1745. 

3. Woodley, S. J., Boyle, R., Cody, J. D., Mørkved, S., & Hay-Smith, E. (2017). Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. The Cochrane database of systematic reviews, 12(12), CD007471. 

You warm up your muscles before you excercise.
Do the same before you deliver!

The statistics  speak for themselves.

0 %
of women report pelvic-related issues after pregnancy.

[source]

0 %
of women experience urinary incontinence after a vaginal delivery (10% for cesareans).

[source]

0 %
of women suffer perineal trauma in delivery.

[source]

We can help with all these pregnancy issues:

(Click each issue to expand and learn more.)

Constipation in Pregnancy

CONSTIPATION IN PREGNANCY

Constipation is a common pregnancy and postpartum issue that becomes a chronic issue when not treated properly. Constipation that is developed during the pregnancy is typically dyssynergia or the discoordination of the abdomen and pelvic floor muscles.

The pelvic floor muscles become hypertonic (tight) and have a difficult time releasing a bowel movement.

A pregnant woman sitting on the toilet illustrating constipation in pregnancy.

There are four types of constipation, the first type being the most common in pregnant and postpartum women.

  1. Increased intra-abdominal pressure is accompanied with increased anal sphincter pressure.
  2. Difficulty generating adequate pushing force (intrarectal pressure), but has increased anal sphincter contraction.
  3. Difficulty generating adequate pushing force (intrarectal pressure), but has increased anal sphincter contraction.
  4. Difficulty generating pushing force and anal sphincter relaxation is incomplete.

Pelvic floor rehabilitation is up to 80% effective in the treatment of constipation [source].

Treatment may include:

  • Pelvic Floor Muscle Training
  • Neuromuscular Reeducation
  • Visceral Manipulation
  • Biofeedback
  • Compensatory Strategies
  • Scar Mobilization and Massage
  • Electrical Stimulation

Individualized evaluation and rehab care are essential to treat constipation developed during pregnancy.

Citation:

Rao, S. S., & Patcharatrakul, T. (2016). Diagnosis and Treatment of Dyssynergic Defecation. Journal of neurogastroenterology and motility, 22(3), 423–435.

Bladder Leakage in Pregnancy

BLADDER LEAKAGE IN PREGNANCY

Accidental urine leakage is not a normal part of pregnancy and childbirth, but it can be treated.
Over 50% of pregnant women experience accidental bladder leakage because the growing uterus puts pressure on the bladder and pelvic floor muscles [source]. 

As sphincter function may also become diminished during pregnancy, the result is often long-term accidental urine leakage after pregnancy.  Together with pregnancy-related hormonal changes, this reduces adequate pelvic floor muscle strength to hold urine in. 

Obstretricians and urogynecologists recommend pelvic floor therapy as a safe and effective treatment to prevent accidental urine leakage during and after pregnancy. In therapy, we optimize pelvic floor muscle function so you can stay dry. [source] 
Illustrated and labeled image showing different organs and items in a pregnant woman's pelvis.

Treatment options may include:

  • Bladder Training
  • Neuromuscular Reeducation
  • Pelvic Floor Muscle Training
  • Manual Therapy as Needed

 The goal in therapy is to be 100% dry with all activity, including laughing and sneezing.

Citations:

1. Sangsawang, B., & Sangsawang, N. (2013). Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. International urogynecology journal, 24(6), 901–912.

2. Kocaöz, S., Eroğlu, K., & Sivaslıoğlu, A. A. (2013). Role of pelvic floor muscle exercises in the prevention of stress urinary incontinence during pregnancy and the postpartum period. Gynecologic and obstetric investigation, 75(1), 34–40.

Pubic Pain in Pregnancy

PUBIC PAIN IN PREGNANCY

Two illustrations of female pelvic bones, one showing a normal pelvis struction and the other showing pubic symphysis separation.

Being pregnant can be difficult enough. When pubic pain is added into the mix, relief can feel impossible.

Studies show 31% of pregnant women suffer with pubic pain [source], or symphysis pubic dysfunction (SPD). Symptoms of SPD are described as a stabbing or burning pain in the pubic area that may be accompanied by pain radiating into the abdomen, buttocks, and legs. It can become very uncomfortable to walk, sit, complete daily activities, or simply get comfortable. SPD is caused by an increased space at the pubic symphysis.

Delivery is often curative for SPD; however, 25% of women continue to experience pubic pain four months postpartum. Additionally, traumatic delivery can exacerbate SPD symptoms [source].

Higher rates or earlier onset of pubic pain during pregnancy are predicative of chronic pelvic pain after pregnancy, which is why it’s important to treat SPD promptly [source].

Pelvic floor therapy at You’re In CONTROL! is comprehensive and individualized to reduce pain and promote functional ability in pregnancy through restoring stability and control of the pubic symphysis.

Treatment options may include:

  • Manual Therapy to Decrease Stress to the Joint
  • Gentle Joint Mobilization to Align the Joint
  • Neuromuscular Reeducation for Pelvic Coordination
  • Taping to Reduce Pain and Provide Stability
  • Education in Positioning and Posturing 
  • Education in Birthing Positions That Are Less Stressful on the Joint

Treating pubic pain during pregnancy helps prevent long-term pelvic pain and serves to normalize the pathological tissues injured from the joint instability.

Citations:

1. Howell E. R. (2012). Pregnancy-related symphysis pubis dysfunction management and postpartum rehabilitation: two case reports. The Journal of the Canadian Chiropractic Association, 56(2), 102–111.

2. Damen, L., Buyruk, H. M., Güler-Uysal, F., Lotgering, F. K., Snijders, C. J., & Stam, H. J. (2002). The prognostic value of asymmetric laxity of the sacroiliac joints in pregnancy-related pelvic pain. Spine, 27(24), 2820–2824.

Back Pain in Pregnancy

BACK PAIN IN PREGNANCY

Around half of all pregnant women experience back pain. Symptoms can range from a dull ache to stabbing or radiating pain with peak episodes related to activity or time of day. Pain will often interfere with work, sleep, caring for other children, sexual activity, and more. Approximately 25% of women who experience back pain in pregnancy will continue to have back pain after pregnancy and 8% of them will experience severe disability [source]. 

Back pain during pregnancy, often referred to as lumbopelvic pain or pelvic girdle pain, can be debilitating and have lifetime disabling effects if not properly treated. 

A photo of a pregnant woman in an office obviously experienceing back pain.

Treatment of back pain in pregnancy should always consider imbalances of the pelvic floor muscles. Our treatment options for back pain in pregnancy may include:

  • Manual Therapy and Myofascial Techniques
  • Neuromuscular Reeducation
  • Core Stability Training
  • Pelvic Floor Muscle Training
  • Taping to Reduce Pain and Provide Stability
  • Education in Positioning and Posturing
  • Education in Birthing Positions That Would be Less Stressful to the Back

Pregnancy-related back pain impacts women’s lives dramatically. Low back pain is the most common cause of sick leave after delivery [source]. If you are experiencing back pain from pregnancy, ask your medical provider if therapy is right for you.

Citations:

1. Wu, W. H., Meijer, O. G., Uegaki, K., Mens, J. M., van Dieën, J. H., Wuisman, P. I., & Ostgaard, H. C. (2004). Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 13(7), 575–589. 

2. Stuge, B., Hilde, G., & Vøllestad, N. (2003). Physical therapy for pregnancy-related low back and pelvic pain: a systematic review. Acta obstetricia et gynecologica Scandinavica, 82(11), 983–990. 

Preventing Tears in Delivery

PREVENTING TEARS IN DELIVERY

Scared of tearing down there?  Vaginal tearing is common in first-time vaginal childbirth. These tears occur in the perineal space, the space between the vagina and rectum.  

The pelvic floor muscles are at significant risk for tearing in vaginal childbirth with up to 80% of women experiencing some sort of perineal tear or laceration. Muscle tissue will tear when stretched beyond 150% of its resting length. During childbirth, the pelvic floor muscles can be stretched up to 259% of their resting length, which traumatizes the pelvic floor [source].

Women who expercience tears during childbirth have an increased risk for prolapse, bladder, bowel, and sexual issues. Some muscle tears can create severe long term pelvic pain issues.

A medical illustration showing what makes up the pelvic floor muscles and and structures in women

Vaginal tears are classified into 4 different types:

  • 1st Degree Tear: a small tear only affecting the skin.  These may need a stitch or two, but usually heal quickly on their own.
  • 2nd Degree Tear: a deeper tear that affect the skin and underlying muscles.  Stitches are necessary. Expect a couple weeks to recover.
  • 3rd Degree Tear: a deeper tear of the vaginal muscles that reach the anal sphincter.  The stitches may require anesthesia due to the complexity.  Pelvic pain or discomfort is common for several months afterwards.  Fecal incontinence can be a side effect when scar tissue prevents the anal sphincter from fully closing.  Fortunately, this can be resolved with pelvic floor therapy.
  • 4th Degree Tear: encompasses all of the above and extends through the rectal lining.  Surgical repair is necessary and pelvic floor therapy prescribed to resolve pelvic floor dysfunction.

Episiotomy is a surgical laceration or cut of the perineum.  While it used to be a routine procedure in childbirth, research has shown it does not heal better or preserve tissue of the pelvic floor.  Episiotomies are performed as emergency procedures to aide safe delivery.  A recent study of 3,467 women across multiple countries showed 3rd and 4th degree tears and episiotomies were significantly reduced when women prepared their pelvic floor muscles for delivery. Additionally, these women also experienced better wound healing, less perineal pain, and shorter second term labor which resulted in better Apgar scores for baby [source].

Obstetricians acknowledge the role of prenatal pelvic floor muscle training in preventing perineal lacerations during childbirth [source]. Randomized clinical trials show perineal massage is effective in reducing tearing during delivery [source]. Prenatal muscle conditioning services not only address the aches, pains, bowel, and bladder issues in pregnancy, but also optimize your pelvic floor muscles to safely deliver and minimize the risk for laceration and other complications.

At You’re In CONTROL! we teach our prenatal clients how to prepare their muscles for delivery.  Additionally, we will teach our clients what changes to expect after delivery and how those changes can be rehabbed.  Talk with your OB/GYN about pelvic floor therapy or call us for more information.  

Prenatal muscle conditioning services typically include:

  • Education in Routine Perineal Massage
  • Partner Training in Routine Perineal Massage
  • Pelvic Floor Muscle Training for Flexibility and Endurance in Delivery
  • Core Stabilization to Prevent Pelvic Imbalance
  • Connective Tissue Manual Techniques to Eliminate Trigger Points
  • Education in Adaptive Techniques and Biomechanics to Prevent Tears in Delivery
  • Education in Strategies for Thermotherapy
  • Education in Strategies to Prevent Prolapse in the Perinatal Period

We recommend making a prenatal appointment with us around 26 weeks gestation to prepare your muscles for delivery. Prenatal therapy can improve delivery outcomes for both you and baby.  We will guide you to take control and become less scared about tearing down there!

Citations:

1. 10 Tips to Boost Vaginal Birth Recovery. eMediHealth. (2021, May 20).

2. Peirce, C; C Murphy, M Fitzpatrick, M Cassidy, L Daly, PR O’Connell, C O’Herlihy (2013). Randomised controlled trial comparing early home biofeedback physiotherapy with pelvic floor exercises for the treatment of third-degree tears (EBAPT Trial). BJOG: An International Journal of Obstetrics & Gynaecology, 120 (10).

3. Perineal massage to prevent perineal trauma in childbirth. (n.d.).

4. Abdelhakim AM, Eldesouky E, Elmagd IA, Mohammed A, Farag EA, Mohammed AE, Hamam KM, Hussein AS, Ali AS, Keshta NHA, Hamza M, Samy A, Abdel-Latif AA; Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. Internal Urogynecol Journal. 2020 September; 31 (9):1735-1745.

1

Decide to Take Control
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Don’t put it off. Decide to take control of your body.

2

MAKE AN APPOINTMENT
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Let's Get Started!

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WORK YOUR PROGRAM
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Use the app, do your exercises, take control of your life.

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You’re in Control!
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Feel like a natural woman again!

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