Pelvic Floor Physio in Pregnancy: When Should You Start?

After two pregnancies of my own — and many years of caring for pregnant patients — I’ve learned that pregnancy has a way of making you suddenly very curious about parts of your body you hadn’t given much thought to before.

The pelvic floor is usually one of them.

I regularly co-manage pregnant patients with our pelvic floor physiotherapist. My role as a chiropractor is to support a body that is changing quickly: keeping it moving comfortably, adapting to changes in posture and load, addressing areas of tension or restriction, and helping prepare for the physical demands of delivery.

Pelvic floor physiotherapy complements that beautifully.

So, if you’re pregnant and wondering when to see a pelvic floor physio, what happens when you get there, or whether you need one at all, here’s what I want you to know.

When should I start pelvic floor physio during pregnancy?

There isn’t one magic week.

If you’re experiencing pelvic pressure or heaviness, leaking, pelvic pain, pain with intercourse or difficulty exercising comfortably, you don’t need to wait to have it assessed.

But you also don’t need to have a problem.

One of my favourite reasons to see a pelvic floor physiotherapist during pregnancy is to establish a baseline. How well can you contract your pelvic floor? Just as importantly, can you relax it? How does it coordinate with your breathing and core?

Knowing where you started can also give your physiotherapist valuable information when you return postpartum.

What actually happens at a prenatal pelvic floor physio appointment?

This is often the question patients really want answered.

Your physiotherapist will talk to you about your pregnancy, activity, bladder and bowel function, any pain or pressure, your goals and your birth plans. Depending on your stage of pregnancy and what’s appropriate for you, your assessment may also look at breathing, core function, movement and pelvic floor muscle function.

And pelvic floor physio is not just about doing Kegels.

Some pelvic floors need strengthening. Others need help relaxing. Many need better coordination between the pelvic floor, diaphragm and abdominal muscles.

The goal is to understand your body rather than give every pregnant person the same exercises.

Can pelvic floor physio help me prepare for delivery?

Yes — and this is one of the reasons I love incorporating it into prenatal care.

Birth isn’t only about having a “strong” pelvic floor. During a vaginal delivery, your pelvic floor also needs to be able to lengthen and relax.

A pelvic floor physiotherapist can help with awareness of these muscles, relaxation and breathing strategies, pushing positions and, when appropriate, techniques such as perineal massage.

From my side of care, we’re also thinking about the body as a whole: pelvic mobility, hip mobility, breathing, comfort and giving your body as many options as possible heading into delivery.

No practitioner can promise a particular birth experience. But we can help you feel more connected to your body and prepared for the physical demands ahead.

Do I still need pelvic floor physio if I’m having a C-section?

I would still recommend a postpartum check-in.

A C-section changes how your baby is delivered, but it doesn’t erase the nine months that came before it.

Your pelvic floor has still spent pregnancy adapting to increased load and pressure. After delivery, your abdominal wall is also recovering from surgery, and your breathing, core and pelvic floor need to learn to work together again.

Your pelvic floor was part of your pregnancy regardless of how your baby entered the world.

When should I go back postpartum?

There isn’t a universal date. Your delivery, healing, symptoms and medical history all matter.

What I don’t love is the idea of waiting until you’re struggling.

Leaking, heaviness, pelvic pain, painful intercourse or difficulty returning to exercise are all reasons to seek care — but you can also book a postpartum assessment simply because you want to understand how you’re recovering.

And if you had a prenatal assessment, now you have a baseline to compare to.

If I feel fine, is all of this really necessary?

This might be the most important takeaway:

Pregnancy care doesn’t have to be problem-based.

You don’t have to wait until your body hurts or something stops working the way you expect it to.

Some of my favourite prenatal visits are with patients who are doing really well. We can focus on keeping them comfortable, helping their body adapt, preparing for delivery and making sure they have the right support if something changes.

Pregnancy asks an incredible amount of your body. You don’t have to navigate all of those changes on your own.

At Urban Health Group, our approach to prenatal and postpartum care is simple: support the body that’s carrying you through all of it.

Looking for prenatal chiropractic or pelvic floor physiotherapy in Toronto? Our Midtown Toronto team provides collaborative care throughout pregnancy and postpartum.

Dr. Christina Mallinos
Chiropractor & Owner of Urban Health Group