How to Help Pelvic Pain During Pregnancy (Prenatal Pelvic Floor Physical Therapy Tips)
Pain during pregnancy is common, but that does not mean it is normal.
There are many factors that affect pelvic pain during pregnancy including hormonal, biomechanical, nervous system, and postural changes.
Pelvic pain should not be normalized discomfort- it can be addressed with targeted care like prenatal pelvic floor physical therapy.
What Causes Pelvic Pain in Pregnancy?
The most common narrative that has existed for a long time to explain pelvic pain during pregnancy is the hormone relaxin. Relaxin plays a role in inducing collagen remodeling to increase flexibility in ligaments, joints, and tendons. This has caused people to explain the pains of pregnancy as having “loose joints” or “lack of stability”.
What we now know is that this narrative is not the full story. Relaxin peaks during the first 12-14 weeks of pregnancy. So while it may explain increased feelings of flexibility in the beginning of pregnancy, it certainly does not explain the pain that can show up or get worse in the 2nd and 3rd trimester.
Research shows that cortisol is the hormone that most increases throughout pregnancy and most likely contributes to pain patterns and increased sensitization. This is important to understand because it helps change the narrative and imagery of feeling “unstable” or that “your pelvis is out” which can create stories and feelings of fragility and weakness. Increased pain during pregnancy is actually more attributed to the nervous system creating more sensitivity at the pelvis so that the brain can monitor and protect this vital area. When we frame this pain as a nervous system response, it allows us to pause and reframe how we address it. It also helps decrease the feeling that something might be wrong with you when in fact your body is having a normal response to try to protect you and your baby.
That being said, we do not want to normalize pain in the sense that we do not do anything to support the body and the nervous system during this time. When we are able to address this pain through a nervous system lens, we can create sustainable and meaningful change that not only has the potential to decrease pelvic pain throughout the pregnancy, but can also help prepare the birthing person for the birthing experience as nervous system regulation is key to decreasing tearing and having better birth outcomes overall.
Though the nervous system certainly can be the driver for pelvic pain during pregnancy, there are also real changes in the biomechanics of the core and weight distribution that can also affect pain patterns. As the belly grows, it shifts the birthing person’s center of mass and also makes the core harder to engage because the muscles are more lengthened. The lumbar spinal curve usually increases in response as well and this can create more load on the spine and sacroiliac joints. More load on the spine with less core support and more cortisol is the perfect storm to set people up for pelvic pain patterns. However, quality pelvic floor physical therapy can address all of these factors to help decrease pain during this time.
Lastly, everyone’s pelvic floor is working harder during pregnancy. The pelvic floor is part of the core and also lengthens and bears more load during the growth of the baby. It is important to have your pelvic floor assessed during pregnancy if you are developing pelvic pain, urinary incontinence, or pain with penetration.
Common Symptoms and When to Seek Help
Pain With Sex During Pregnancy- With the increased pelvic floor tension and cortisol mentioned above, the pelvic floor can become more sensitive during pregnancy and cause pain with sex.
Pain After Sex During Pregnancy- You can also experience pain after sex during pregnancy because the muscles are more sensitive and may even have a harder time relaxing.
Urinary and Bowel Discomfort- If you are experiencing any urethral pain, incontinence, urgency and frequency, or rectal pain your pelvic floor muscles may be tight and overactive.
All of these symptoms are common during pregnancy and can be addressed with a good prenatal pelvic floor physical therapist.
How Prenatal Pelvic Floor Physical Therapy Helps
As pelvic floor specialists, we are experts in both manual therapy and exercise. An assessment at Bodyful will include a comprehensive check of your functional movements and core pressurization techniques, as well as a thorough assessment of your pelvic floor. With informed consent, pelvic floor physical therapists can perform an internal assessment to check each individual pelvic floor muscle as well as your ability coordination contraction, relaxation, and pushing. This type of work can help address pelvic pain and prevent tearing during birth.
The manual therapy prenatal pelvic floor specialists can provide is more beneficial than just generic "perineal massage” because we can be more specific with each pelvic floor muscle as well as help your brain and nervous system understand how to stay relaxed under pressure, pain, and stretch. This type of neuromuscular re-education is more effective than just stretching because muscles respond to nervous system states.
As pelvic specialists who are experts in movement, we can also help you learn appropriate postural cues and exercises, as well as targeted glute and core strengthening to allow your pregnancy to be healthy and have better postpartum outcomes. Diaphragmatic breathing is essential for both nervous system/pelvic floor regulation as well as for appropriate core engagement. You will learn the most up to date approaches when working with us at Bodyful.
Safe Self Care Tips for Home
Gentle Breathing- Try breathing into your ribcage and not just your belly. Your diaphragm is underneath your ribcage and breathing here can begin to regulate your pelvic floor.
Stretching- Some good stretches for the pelvic floor include popular yoga poses such as child’s pose, happy baby, and yogi squat (deep squat). Don’t forget to stretch your hips in internal rotation too as this creates more opening at the base of the pelvis.
Posture- One of the best things you can do for your pelvic floor and core is check in with your posture. Especially when lifting or doing loading tasks, try to make sure your ribcage is stacked over your pelvis.
Sleep Support- It is important to have proper support when sleeping during pregnancy. Since sleeping on the side is more common during this time, make sure you have a pillow between your knees to keep your hips neutral and decrease pelvic pain.
