The Role Pelvic Floor Physiotherapy Plays in Prenatal Health Care

Part 1 – Prenatal Baseline Recommendations

If you are considering getting pregnant or maybe you are pregnant or perhaps you just had a baby.  You need to strongly consider involving a pelvic floor physiotherapist in your health care team.  When I think of what kind of role a pelvic floor physiotherapist can play in a mom’s care plan two quotes come to mind.

  1. An ounce of prevention is worth a pound of cure – Benjamin Franklin
  2. Knowledge is power -Sir Francis Bacon

This Blog is going to focus on the quote “knowledge is power” and future blogs in this series titled “The Role Pelvic Floor Physiotherapy Plays in Prenatal Health Care” will complement quote #1 prevention.

What is a Baseline?

A baseline involves using tools and assessment techniques that can be easily used by another person to assess certain levels of function, strength, and health status.  The information and data gathered in a baseline test can be used to compare to an individual’s state after injury or change in health status.  Blood pressure measurements gathered by a cuff is a common assessment that can be used to track changes over time, by tracking blood pressure, changes in cardiovascular health can be identified and perhaps treated before a more serious health condition develops.

Pelvic Floor Physiotherapy Baselines should include:

    1. Pelvic Floor muscles –  the muscles can be assessed using a strength, endurance, and coordination assessment tool.
    2. Diastasis Rectus Abdominus

I would recommend you see the same Health Practitioner for your Baseline and postpartum follow-up assessment.  If you must see a different practitioner than you will need to know the following information from your Baselines:

1. Pelvic Floor muscles – the data or numbers that were recorded for your strength, endurance, and coordination.

2. Diastasis Rectus Abdominus – the data or numbers that were recorded and how many measurements were taken, the anatomical landmark that was used relative to the multiple measurements and what position your body was in, and what movements were used to create the changes in the Rectus Abdominus muscle tone. 

Why is a Baseline Beneficial?

  1. Pelvic Floor Muscles – This is frequently overlooked and often goes unnoticed until someone starts to have symptoms. In my practice, I have seen all sorts of women from young kids, to teens to someone that fits between the age range of 20- 88. Some of these individuals have a very strong pelvic floor and leak urine and others have a weak pelvic floor and leak. This tells me that having a strong pelvic floor does not mean that you will be symptom-free.   There are limited studies that have been completed on what number of measurement defines a strong pelvic floor.  What the research does consistently identify is that pregnancy and delivery will reduce the pelvic floor muscle strength and that when you compare women who have never been pregnant to women who have, the strength is less in the women who have been pregnant. What is not clear is what the magic number is that defines when someone has regained full strength.  Therefore, the best strength comparison is your own individual strength comparison.  If prior to getting pregnant you are symptom-free and post-pregnancy you develop symptoms, your baseline number can help guide treatment by determining if your symptoms are due to pelvic floor weakness.
  2. Diastasis Rectus Abdominus (DRA) – Research varies around the condition of DRA.  Most of the research indicates that to be considered to have a DRA you need to have around 2 centimeters of separation between the 2 medial sides of the Rectus Abdominus Muscle.  Research has also discovered that some women prior to pregnancy have a baseline that is greater than 2 cm and that measurement can be dependent on where along the abdomen the distance is assessed. In my practice, I have had women worried and concerned because they have been told that they have a 4 cm or 4 finger separation and they need to get back to less than 1 finger separation or less.  This worry is completely unnecessary and research has indicated that not everyone falls within the 2 cm normals.  Your normal could be 1.5 cm above your belly button and 2.5 cm below.   The best comparison is your own individual comparison that is measured during baseline tests.

Resource List

  1. Antonio CorvinoDario De RosaCarolina SbordoneAntonio NunziataFabio CorvinoCarlo Varelli,  Orlando Catalano. Diastasis of Rectus Abdominis Muscles: Patterns of Anatomical Variation as Demonstrated by Ultrasound. Polish Journal of Radiology 2019; Dec 15; 84:e542-e548. doi: 10.5114/pjr.2019.91303.
  2. Yun Zhao , Mei XiaoFei TangWan TangHeng YinGuo-Qiang SunYin LinYong ZhouYan LuoLu-Man LiZhi-Hua Tan. The Effect of Water Immersion Delivery on the Strength of Pelvic Floor Muscle and Pelvic Floor Disorders During Postpartum Period: An Experimental Study. Medicine (Baltimore). 2017 Oct;96(41):e8124. doi: 10.1097/MD.0000000000008124.
  3. Yun Zhao 1Li Zou 2Mei Xiao 3Wan Tang 1Hai-Yi Niu 4Fu-Yuan Qiao 4 Effect of Different Delivery Modes on the Short-Term Strength of the Pelvic Floor Muscle in Chinese Primipara. BMC Pregnancy Childbirth 2018 Jul 3;18(1):275. doi: 10.1186/s12884-018-1918-7.
  4. Thorgerdur Sigurdardottir 1Thora SteingrimsdottirArni ArnasonKari Bø. Pelvic Floor Muscle Function Before and After First Childbirth. Int Urogynecol J.  2011 Dec;22(12):1497-503. doi: 10.1007/s00192-011-1518-9.
  5. Poorandokht Afshari 1Fariba Dabagh 1Mina Iravani 1Parvin Abedi 2Comparison of Pelvic Floor Muscle Strength in Nulliparous Women and Those With Normal Vaginal Delivery and Cesarean Section.  Int Urogynecol J. 2017 Aug; 28(8):1171-1175. doi: 10.1007/s00192-016-3239-6.
  6. Gertrude M Beer 1Antonius SchusterBurkhardt SeifertMirjana ManestarDaniela Mihic-ProbstSina A Weber The Normal Width of the Linea Alba in Nulliparous Women. Clin Ana. 2009 Sep;22(6):706-11. doi: 10.1002/ca.20836.
  7. Boissonnault J.S., Blaschak M.J. Incidence of diastasis recti abdominis during the childbearing year. Physical Therapy. 1988; Jul;68(7):1082-6. doi: 10.1093/ptj/68.7.1082.
  8. Rath A.M., Attali P., Dumas J.L., et al. The abdominal linea alba: an anatomo-radiologic and biomechanical study. Surg Radiol Anat. 1996;18doi: 10.1007/BF01627606.

If you want to get your baseline or if you have never included a pelvic floor physiotherapist in your healthcare team, it might be the next step to helping you recover.

Book Now to see Leona Ham BSc. P.T,  Pelvic Floor Physiotherapist.