When to Start Prenatal Pelvic Floor Therapy?
Authored by Dr. Maryssa Steffen, PT, DPT, and Board-certified Pelvic Health Clinical Specialist
When To Start Pelvic Floor Therapy During Pregnancy?
Do you want to know when to start Kegel exercises in pregnancy?
Do you wonder whether you’re doing them correctly—or whether they’re even right for you?
You can work with a pelvic floor specialist as early as the first trimester. Prenatal pelvic floor physical therapy is not just for people who are leaking urine or in pain—it can also be preventative and supportive as your body changes.
First Trimester: Build a Foundation Early
Working with a prenatal pelvic floor physical therapist early in pregnancy can support:
Neck, low back, tailbone, hip, and knee pain relief
Early signs of pelvic organ prolapse during pregnancy
Postural and hip strengthening to support your changing center of gravity
Education around bowel and bladder habits to reduce:
constipation
urinary leakage
pelvic floor strain
risk of vaginal tearing during childbirth
This phase is often about education, awareness, individualized breathing practices, core muscles and hip stabilizers coordination exercises, not progressive strengthening programs.
Second Trimester: Address Symptoms as Your Body Changes
In the second trimester, pelvic floor therapy can help you:
Reduce or stop leaking pee during pregnancy, especially with sneezing, coughing, or jumping
Improve pelvic floor coordination to prevent constipation and improve bowel function
Treat pelvic pain, including:
round ligament pain
pubic bone pain
vulvar pain
low back and sacroiliac joint pain
hip pain and tailbone pain
hemorrhoids
Learn strategies to manage pelvic organ prolapse symptoms if present
You may also receive individualized pelvic floor exercises that include:
pelvic floor awareness and isolation/activation exercises
coordination with breathing
abdominal–pelvic floor integration for repetitive daily activities and function
specific endurance training to support pregnancy and postpartum recovery
Third Trimester: Prepare for Birth and Recovery
Pelvic floor therapy in the third trimester and up to delivery can support:
Pain management
Ongoing urinary leakage
Perineal massage to reduce risk of significant vaginal tearing or episiotomy and decrease perineal pain at 3 months postpartum (Chen et al., 2022)
Education on how to push during labor using breath and pelvic floor coordination exercises
Your pelvic floor therapist can also collaborate with your birth team—OB-GYNs, midwives, and doulas—to help you understand:
your birthing options
proposed interventions (induction, scheduled C-section, hospital birth, etc.)
how to support your body during and after delivery
confirming you have sufficient resources and specialists if you are a high risk pregnancy (e.g. DIE endometriosis)
Dr Maryssa Steffen, PT, DPT, Board-Certified Pelvic Health Specialist
You Don’t Have to Be Leaking to Benefit
If you are pregnant, you do not need to be leaking urine now to reduce your risk of urinary leakage postpartum or later in life. Prevention is an option.
Many people hear about Kegels during pregnancy, but pelvic floor contractions are not one-size-fits-all.
A “Kegel” is simply a pelvic floor muscle contraction/gripping. These muscles help:
close the urinary and anal sphincters
support pelvic organs during pressure (coughing, sneezing, lifting)
contribute to arousal and orgasm
However:
some people have strong pelvic floor muscle “grip” strength and still leak
others have lighter pelvic floor muscle “grip” strength and no symptoms
excessive clenching can create pelvic floor tension, pain with sex during pregnancy, or difficulty relaxing for birth
Why a Pelvic Floor Specialist Helps
Research suggests pelvic floor muscle training is more effective when it is individualized (Woodley et al., 2020).
A pelvic floor specialist is trained to:
consider your medical history and birth plan
assess posture, breathing, hips, and core—not just the pelvic floor
prescribe exercises that support pregnancy, labor, and postpartum recovery
coordinate care with your birth team
If internal pelvic floor therapy is appropriate for you—and you’ve been cleared by your OB-GYN for penetrative sex and exercise—you may learn:
how to relax your pelvic floor for birth
how to coordinate muscles for pushing
practices to reduce risk of prolapse, constipation, and urinary leakage
Prenatal Pelvic Floor Therapy in Oakland, CA
If you’re in California, you can book a discovery call to learn more about prenatal pelvic floor physical therapy at Bodyful Physical Therapy and Wellness.
We offer:
in-person prenatal pelvic floor therapy in Oakland
Telehealth services throughout California
Your body is adapting in powerful ways. You deserve guidance that is informed, individualized, and supportive as you prepare for childbirth and postpartum recovery.
