Pelvic health physiotherapy
Are you a clinician? See the clinical version of this page.
- Start pelvic floor exercises early; they lower the chance of leaking urine later.
- Exercises are adjusted on flare or tired days, not stopped altogether.
What this involves
What pelvic health physiotherapy is
A physiotherapist with special training assesses and helps you train the pelvic floor and surrounding muscles, and gives you a plan for pregnancy and recovery.
Bladder control (leaking urine)
Doing pelvic floor muscle exercises early in pregnancy, before any leaking starts, can lower the chance of leaking urine later in pregnancy and in the months after birth. The exercises are safe. If leaking has already started, the evidence that these exercises fix it during pregnancy or soon after birth is less clear, though they work well for women in mid-life. A pelvic health physiotherapist can teach the technique.
Pelvic girdle pain
Pain around the pelvis and hips is common in pregnancy and after it. It is often felt at the back of the pelvis, over the pubic bone, or in the buttock, and it tends to be worst with the things that load one leg at a time: turning in bed, stairs, getting out of a car, or walking far. It is treatable. The strongest evidence is for exercise: the clinical practice guideline reports strong, high-level evidence that exercise improves how well the pelvic floor, back, and hip muscles work, and says physiotherapists should prescribe exercise for that. It is also honest about the limit of what is known: how much this changes pain and day-to-day function afterwards is less certain. Exercise that hurts should be adjusted rather than pushed through, and a pelvic belt, a walking aid, hands-on treatment, or advice on daily activities can be used alongside while you build up.
Tummy-muscle separation (diastasis recti)
The tummy muscles naturally separate in pregnancy. Gentle, guided exercise supports recovery afterwards.
Getting ready for birth and recovering after
Your physiotherapist can help you prepare for labour and guide your recovery, including your pelvic floor, in the weeks after birth.
If you have a rheumatic disease
Your plan is adjusted for your joints and energy levels, and on tired or flaring days the exercises are scaled to suit you. There is one extra thing worth knowing. New pelvic, low back, or hip pain in pregnancy is not automatically just pregnancy. Most of it is pelvic girdle pain, which is mechanical and common, but the pelvic girdle pain guideline lists inflammatory arthritis among the other things that cause pain in the same places, naming ankylosing spondylitis (axial spondyloarthritis), psoriatic arthritis, rheumatoid arthritis, and lupus. It also notes that pain coming from a systemic cause can look very like pain coming from the muscles and joints. That is not a reason to worry about every ache; it is a reason to describe new pelvic or hip pain to the team who knows your disease, rather than assuming. Mention it sooner if it wakes you in the second half of the night, if morning stiffness lasts more than about 30 minutes, or if it feels like your usual disease pain rather than a new strain.
The numbers, in plain terms
62% lower risk
Starting pelvic floor exercises early in pregnancy, before leaking begins, was linked to about 62% lower risk of leaking urine in late pregnancy.
29% lower risk
It was also linked to about 29% lower risk of leaking urine 3 to 6 months after birth.
When to call your team
- Any vaginal bleeding or a leak of fluid: contact your maternity team.
- New, severe pelvic pain that stops you walking.
- Any of the general pregnancy red flags on your condition page.