Pregnancy is a period of intense musculoskeletal, physical and emotional changes.
The physiotherapist is able to assess and monitor physical changes, focusing primarily on maintaining well-being. We are also able to examine and treat the patient who has specific musculoskeletal impairments, incorporating knowledge of tissue damage and regeneration to the changes that occur during pregnancy.
Although natural, pregnancy requires specific health care. It is now known that, among these precautions, exercises for the pelvic floor muscles (PFM) are essential.
During pregnancy, as you can imagine, the overload on the pelvic floor muscles is radically increased. After all, in addition to supporting the constant weight of pelvic organs, the pelvic floor now needs to support the full weight of the baby and embryonic attachments (placenta, amniotic fluid, etc.) throughout the day – especially when the woman is standing or walking. There is also the change in posture with the increase in the abdomen weight it generates a compensatory behavior that will weaken the pelvic floor due to the increase in overload.
If these muscles are weakened, pelvic floor dysfunctions can happen, such as: pelvic prolapses (pelvic organs can end up descending, leaving their normal positions), incontinence of urine, gas or feces of varying degrees, momentary or not.
Although traumas that can occur to the pelvic floor muscles at the time of labour may predispose to pelvic floor dysfunctions, increasing evidence has shown that they are not the only risk factors determining their occurrence. There are several other obstetric and neonatal risk factors, such as: Newborn weighing more than 4 kg, prolonged second stage of labour, use of oxytocin and assisted vaginal delivery with the use of forceps or vacuum extractor.
Aiming at the prevention of pelvic dysfunctions, both in pregnancy and postpartum, the International Continence Society recommends (Based on scientific evidence from studies of high methodological quality) that intensive and supervised training of the pelvic floor muscles be performed. When the dysfunction is already established, muscle training is considered a first-line conservative treatment resource.
Physiotherapeutic intervention during pregnancy
Usually, pregnant women seek a Pelvic Floor Physiotherapist for: Preparation for childbirth, relief from pain and discomfort, prevention of dysfunctions, such as musculoskeletal and urogynecological disorders (urine leakage, gas leakage, pain), or with the objective of performing guided physical exercises.
Role of Pelvic Floor Physiotherapy in preparing for labour
It is estimated that the fetal head is four times larger than the diameter of the urogenital hiatus, causing an expressive stretching of the pelvic floor muscles during the expulsive period. These muscles are naturally prepared for this during pregnancy, as the hormones released relax the muscles and allow for greater muscle stretching. Nevertheless, under certain conditions, the pelvic floor muscles can be traumatized during childbirth as a result of spontaneous perineal lacerations or episiotomy.
For the prevention of perineal trauma, we can use in the clinic:
- Massagem perineal
- EPI-NO – small “balloon” that should be placed in the vagina opening and inflated to each woman’s limit, held for a few minutes and removed very slowly. Can be used from the 34th week.
Baracho, Elza. Fisioterapia Aplicada À Saúde da Mulher – 5ª Ed.
DINIZ, AMARAL. Intervenção Fisioterapêutica para Prevenção e Tratamento da Incontinência Urinária Durante a Gestação: Revisão Da Literatura. 2008.
Hay-Smith J,Mørkved S, Fairbrother KA,Herbison GP. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews 2008, Issue 4. Art.No.: CD007471.
Withford. et al. Pelvic floor exercises and symptoms of urinary incontinence during pregnancy. Midwifery (2007) 23, 204–217