When to Start Pelvic Floor Therapy During Pregnancy

Mar 18

Many women don’t know that you can receive pelvic floor therapy during pregnancy–but it can be a game changer. Some may have heard of pelvic floor therapy for postpartum or even think that you have to wait until you are completely done having kids to benefit. However, this definitely isn’t the case!

Pelvic floor therapy during pregnancy can decrease discomfort and improve strength, improve your birth outcomes and make postpartum easier! So the question is–when to start pelvic floor therapy during pregnancy?

What Is Pelvic Floor Therapy?

First, let’s answer the question of what is pelvic floor therapy! Pelvic floor therapy is provided by a skilled rehab provider, either occupational or physical therapist who specializes in the pelvic floor. The pelvic floor is the group of muscles in your pelvis that help to stabilize the spine and pelvis. They also create a sling for your pelvic organs: uterus, bladder and rectum.

As you might imagine, pregnancy can put a strain on the pelvic floor muscles. As the uterus grows to accommodate the growing baby, the pelvic floor muscles have to work hard to do their job (help keep in bowel/bladder, contract/relax with movement).

A pelvic floor therapist helps to assess your:

current pelvic floor strength and coordination, as well as
breathing mechanics
core strength and coordination
hip mobility and strength
spinal range of motion

in order to ensure that your body is working as efficiently as it can to support you as it changes and grows during pregnancy.

Why Timing Matters

As I mentioned above, your pelvic floor muscles are doing a lot of work throughout the pregnancy. Even at the beginning of your pregnancy, the pelvic floor is under increasing physical demand.

First trimester: Hormonal changes (especially the rise of relaxin) begin loosening the ligaments and connective tissue that support the pelvic floor. The uterus is still small, but the foundation is already shifting. Some women notice increased urinary frequency or mild pelvic heaviness even this early.
Second trimester: The uterus grows significantly and begins pressing down on the bladder and rectum. The pelvic floor muscles work harder to support the added weight, and your center of gravity starts to shift — changing how load is distributed through the hips, spine, and pelvis. This is when diastasis recti (abdominal separation) often becomes noticeable, which directly affects how the pelvic floor functions.
Third trimester: The baby drops lower into the pelvis in preparation for birth, placing increased pressure on the pelvic floor. Muscles that were already fatigued from months of extra load are now being stretched and compressed simultaneously. Pelvic girdle pain, symphysis pubis dysfunction (SPD), and stress incontinence are all common at this stage.

The Case for Being Proactive vs. Reactive

Most women only seek pelvic floor therapy when something goes wrong — pain becomes unbearable, leaking becomes embarrassing or pelvic heaviness is overwhelming. However, this doesn’t have to be the case!

Starting therapy proactively — ideally in the second trimester — means:

You learn how your pelvic floor actually functions before dysfunction sets in, rather than trying to correct problems later
You're coached on birth preparation — pushing techniques, breathing strategies, and perineal massage — which research suggests can reduce the risk of tearing and the need for episiotomy.
Small issues get caught early, when they're far easier to address

Think of it like going to the dentist before you have a toothache. Proactive care is almost always faster, cheaper, and less invasive than reactive care.

Common Issues That Arise From Waiting Too Long

When pelvic floor dysfunction goes unaddressed during pregnancy, it rarely resolves on its own — and it often compounds:

Stress urinary incontinence: Leaking urine when sneezing, laughing, or exercising is common but not normal. Small leaks are typically easier and quicker to resolve than waiting until you have full bladder loss.
Pelvic organ prolapse: When the pelvic floor is weakened or overstretched without proper support–the bladder, uterus, or rectum can descend into or beyond the vaginal canal. This can feel like pelvic heaviness. Strengthening, pressure management and wearing external supports can all help to decrease prolapse symptoms.
Chronic pelvic pain: Unaddressed muscle tension, nerve irritation, or ligament strain during pregnancy can develop into conditions like vaginismus, vulvodynia, or coccyx pain that persist well into the postpartum period.
Diastasis recti complications: Without guidance on managing intra-abdominal pressure, abdominal separation can widen, leading to core instability, back pain, and a "coning" effect during exercise that strains healing tissue.
Longer postpartum recovery: Women who enter birth with a well-coordinated and strong pelvic floor tend to recover faster. Waiting until after delivery means starting from a more compromised baseline.

The Best Time to Start: A Trimester-by-Trimester Guide

First Trimester (Weeks 1–12)

Not every patient needs treatment during the first trimester. Of course, it is never too early, many women are dealing with morning sickness and fatigue during the early weeks or pregnancy. However, if you are a patient who has a history of pelvic pain, prior birth injuries or hypermobility, you would benefit from starting pelvic floor therapy early. This gives your body more time to adapt to changes and start strengthening sooner.

Early education on breathing, posture, and pressure management are all things that you are taught to help you establish a good base of support during pregnancy.

Second Trimester (Weeks 13–26) — The Sweet Spot

This is the ideal time for most women to start pelvic floor therapy as they are typically over any morning sickness and fatigue. The uterus is growing and the body is changing but it is also still highly responsive to treatment. We can also begin to address any aches and growing pains such as round ligament pain, SI joint pain and bladder urgency/leaking. It is also a great time to make sure you are maintaining coordination with the deep core and pelvic floor muscles.

Third Trimester (Weeks 27–40)

Although the second trimester is the most ideal time to start pelvic floor therapy, you can still benefit if you are already in the third trimester. It’s not too late!

We can still address any aches or pains during pregnancy mentioned above as well as pubic symphysis pain and pelvic girdle pain.

We will also begin to go over birth prep:

perineal massage
pushing techniques
labor positions.
Early postpartum recovery strategies

As you can see, it can be very beneficial to seek pelvic floor therapy during pregnancy. While the second trimester is the “sweet spot”, any trimester is a good trimester to begin care! Pelvic floor health should be a part of prenatal care!

If you’re interested in working with me, you can schedule with me below to create a personalized plan that supports you through your pregnancy and beyond!