The Role of a Pelvic Health Physiotherapist – Bump, Birth & Beyond

Updated: Feb 23


Hi, I'm Clare Bourne a Pelvic Health Physiotherapist based at Six Physio in Chelsea. I am a mum to a 2 year old girl and about to have my second baby. I am passionate about women getting the help they need throughout pregnancy, feeling empowered and understanding their bodies better.


We’ve all heard of physiotherapists, but what does a pelvic health, or women’s health as we can be known, physiotherapist do?

Well…we are specialist in caring for women and men throughout their lives with any problems related to the pelvis, the pelvic floor, the abdominal wall, pregnancy, postnatal, menopause, prostate surgery, bowels, sex, prolapse….the list really does go on. However, we are most well known for caring for women during pregnancy, following birth and for the rest of life. 

There are many things we take for granted through our younger life, generally we live pain free, are active and with a pelvic floor that keeps us continent, allows us to have sex and fall pregnant. Then we hit pregnancy and for some a lot of this can change. So let’s find out how a pelvic health physiotherapist could help you through the stages from Bump, Birth & Beyond…


Bump 


Pregnancy is often a real rollercoaster for us all, starting with a few months of feeling exhausted, sick, being sick, feeling anxious about whether all is ok with the baby and generally not sure of how to exercise, what is safe and feeling the changes start in your body.


Dream Birth Company Blogs & IGTV

@bumpsandburpees and @fitbritcollective have some great advice on the Dream Birth Company Blogs & IGTV, so be sure to check those out. 


Second trimester

Often we start the second trimester and we start to feel better and for lots of us we move through pregnancy without any hiccups. However, for some of us our body really feels like it is taking a hit.


There is help

Women can start to experience pelvic girdle pain or back pain and the message I want to share is that there really is effective help. It doesn’t have to just be ‘part of being pregnant’, early referral to a pelvic health physiotherapist, advice and treatment can make all the difference.


Where and how to access help

The best way to access this through the NHS is via your midwife or GP. Additionally if you would like to go privately a great resource is The Squeezy App Directory - https://www.squeezyapp.com/directory/. You can look up your local area and find your closest physio. Another great free resource is a booklet written about Pelvic Girdle Pain by the Pelvic, Obstetric, Gynaecological Physiotherapists which can be found here (https://pogp.csp.org.uk/system/files/pogp-pgppat_3.pdf) and a blog post I wrote with the @theobgynmum in collaboration with @bbhugme which can be found here (https://theobgynmum.com/pelvic-pain-in-pregnancy/).


Please don’t settle and accept pain

Other aches and pains not so widely talked about are rib flares, which can be due to the baby growing and pushing on our ribs. Again treatment is often very effective so please don’t suffer in silence. Pain within the hands and thumbs can also be common, towards the end of pregnancy especially, and there are two conditions, Carpal Tunnel Syndrome and De Quervain’s Tenosynovitis that can occur and be treated. So if you have any aches and pains please don’t settle and accept it as part of the course, ask for referral and help.

Pelvic Floor


What and where is your pelvic floor

The pelvic floor suddenly becomes the most talked about muscle group in our world, however so many of us don’t know how to contract these muscles or where they are. There is a brilliant blog by @elvie which you can find here all about the pelvic floor muscles, where they are, their importance and how to exercise them.

Ask for help if you need it

If you have any symptoms of urinary leakage or heaviness within the vagina during pregnancy please again ask for referral to a pelvic health physiotherapist. They will make sure you are contracting the muscles correctly and optimizing strength before delivery and birth. Research has shown that doing pelvic floor exercises during pregnancy reduces the risk of developing incontinence symptoms in pregnancy and after delivery. 

Birth


Support

Pelvic health physiotherapists help women to prepare for birth in a number of ways. If you experience back or pelvic pain we shall give you tips on the best positions for labour and work with your midwifery team to ensure you get the right support.


Perineal massage

We also educate women about perineal massage to help prepare the vaginal tissues, including the pelvic floor, for birth. Research has shown that regular perineal massage from 35 weeks of pregnancy can help reduce the risk of vaginal tears or the need for an episiotomy during delivery. 

To learn how to do perineal massage watch this video that I recorded with @nessaorganics to help everyone prepare for birth.


Beyond 


The first six weeks

Now you have your precious little bundle and the first six weeks can seem like a overwhelming, special, emotional time filled with unconditional love and cuddles with your new bundle, but also a time of real physical recovery for you. Whether you’ve had a vaginal or abdominal birth (caesarean section) there is significant healing to take place and that is why the six week window is there as this is the average time for soft tissue healing, however it also doesn’t mean that miraculously at six weeks everything is back to normal, full strength and off we go. Your GP check is put in for between 6-8 weeks to represent this healing window, however this often does not provide a full physical examination. 


Clare examining a post partum client using an ultrasound machine to access muscle tone.

How pelvic health physiotherapist can help

Pelvic health physiotherapists are specialists in physical examination and recovery postnatally, helping women with pelvic floor rehabilitation, diastasis assessment and recovery, resolving any lingering aches and pains from pregnancy and treating any new aches and pains from motherhood.


So much of motherhood is done on one side of our body, burping, carrying, lifting car seats etc, and this can lead to muscular imbalances and in some cases pain. Also feeding, regardless of whether that be breast or with a bottle gets us in some less than optimum positions both day and night.


On the NHS referral to pelvic health physiotherapists is for those with more complicated pelvic floor tears, labeled as third and fourth degree tears, anyone experience urinary or faecal incontinence or anyone with symptoms of a prolapse, which often presents as a dragging sensation in the vagina.


Diastasis

Some women who are aware of a large diastasis will also be referred for treatment on the NHS. Diastasis is separation of the six pack abdominal muscles, which occurs in all of us during pregnancy, however in some women it will recover in the first 6-7 weeks, but some it will take longer and need specialist review.


The importance of scar massage

A message that often does not get through to women, unless they see a pelvic health physiotherapist is the importance of scar massage, especially those who have had a caesarean section. However this is also relevant for vaginal tear scars as well, especially if you are struggling to strengthen your pelvic floor or sex is painful after birth. Any scar can restrict the skin, connective tissue and muscle underneath so massage is a huge part of recovery. For more information check out the following videos I filmed for @nessaorganics


Vaginal scar

https://www.instagram.com/tv/B4u5eX9lUZy/


Caesarean section scars  

6 weeks - https://www.instagram.com/tv/B3UzZ3sFipk/

3 months - https://www.instagram.com/tv/B3XVtPIFNWu/


There is more awareness growing of the benefits of all women seeing a pelvic health physiotherapist after birth, which is what happens in France, and I dream of a day when this occurs in the UK. However, on the NHS we are not there yet, however privately you can access a full postnatal check.


Sometimes it just requires one session and therefore lots of women are starting to see this as in investment in themselves, their postnatal recovery and return to exercise. You can check out the Squeezy App Directory mentioned above, or the Mummy MOT website as well (https://www.themummymot.com/) where you can find a physiotherapist in your area who is passionate and specialises in postnatal recovery.



Post Natal Fitness


Return to exercise is so important for us all, for our physical and mental health but a graded approach is best and allows us to rehabilitate our body in the best way for motherhood. For anyone interested there is a brand new Postnatal Fitness Plan that launched in November by @fiit, called FIIT Mums. 


It is a 24 week programme with 4 stages, 20-30 minute exercise programmes covering pilates, yoga, cardio and strength. It has been designed to walk you from the 6 week mark back to impact exercise and includes a number of videos about all topics and aspects of motherhood we sometimes struggle to talk about, including postnatal sex. 


Please don’t suffer in silence

So there you have it, the areas where a pelvic health physiotherapist can help you. The main message is, there really is help out there, sometimes you have to ask your GP a few times for help and referral, or find your local private physiotherapist even if it is just a one off for some guidance, but please don’t suffer in silence. 


Thank you for reading,

Clare Bourne

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