When to Start Pelvic Floor Therapy During Pregnancy
- Nicole Cozean
- 3 days ago
- 5 min read
The short answer? As early as possible. In an ideal world, we would begin pelvic floor therapy around 12 weeks — at the end of the first trimester and start of the second — even if you don’t have symptoms. Our goal is to help you have a comfortable, healthy pregnancy, prepare for a smooth delivery, and prevent postpartum complications.
Introduction
Most people come to pelvic floor physical therapy during pregnancy because something hurts.
Pubic symphysis pain. Painful intercourse. Urinary leakage. Low back pain. Hip or groin pain. “Lightning crotch.” Wrist, hand, or foot pain. Or just a general sense that their body doesn’t feel right anymore.
These symptoms are incredibly common. And unfortunately, many expecting mothers are told by their OB that discomfort is simply “part of pregnancy” and that it will magically resolve after giving birth — the most physically demanding event the human body can go through.
Pelvic floor physical therapy can absolutely mitigate or resolve these symptoms. But it can do so much more than symptom management. We believe every pregnant person deserves proactive support and care throughout pregnancy. Your baby has a team checking in constantly — but who is checking in on you?
Pelvic Floor PT During Pregnancy
In an ideal world, pregnant moms would receive as much structured support as we offer their unborn children.
Even if you are not experiencing pain or symptoms, there is so much that can be optimized throughout pregnancy. Your body is undergoing massive hormonal shifts, ligament changes, weight redistribution, and changes in breathing and posture. These adaptations happen quickly — and often silently — before symptoms ever appear.
A comprehensive pregnancy program focuses on:
Helping you feel confident and safe with exercise
Modifying workouts appropriately as your body changes
Optimizing nutrition and hydration for pelvic and bowel health
Improving sleep strategies
Supporting stress management and nervous system regulation
We also work to prevent common pregnancy symptoms — including pubic symphysis pain, low back pain, painful intercourse, and urinary incontinence — before they become disruptive.
And beyond the more serious issues, we help mitigate the “standard” aches and pains that many women are told they just have to accept. Low and mid-back discomfort. Hip pain. Joint pain in the feet or hands. None of these should be brushed off as inevitable.
Pregnancy is natural. But unnecessary suffering is not.
How Often Should I Be Coming to Pelvic Floor Physical Therapy When Pregnant?
If you are not currently experiencing symptoms, our Pregnancy Program at PelvicSanity mirrors the cadence of your OB visits.
In early pregnancy — typically starting around 12 weeks — we often see patients once per month. These visits focus on:
Monitoring how your body is adapting
Adjusting exercise and movement
Addressing small issues before they become big ones
Preparing you for the next stage of pregnancy
As you move closer to your due date, just like with OB care, the frequency of visits often increases. Your body is changing more rapidly, and we work with you to stay ahead of those changes.
In the third trimester, we actively shift toward birth preparation. We help the pelvic floor muscles learn to relax. We teach you about labor positions that may best support your specific body. We introduce perineal massage to reduce tearing risk. And we begin push-prep training — learning how to breathe and coordinate pushing during labor.
If at any point you are experiencing pain or discomfort, we increase frequency as needed to resolve those symptoms and keep you comfortable.
How Pelvic Floor Physical Therapy Helps Prepare Your Body for Delivery
There is so much that can be done to prepare for a smoother delivery — and unfortunately, most women never get the opportunity.
We work with many postpartum moms who say, “I wish I had known this during pregnancy.”
Birth is not about strengthening the pelvic floor. In fact, the pelvic floor’s primary role during labor is to relax, stretch, and get out of the way so the uterus can push the baby out.
If those muscles are overly tight — which often happens when compensating for low back pain, hip pain, or pelvic instability — they can be much more difficult to relax during labor.
A key part of prenatal pelvic floor therapy is ensuring these muscles are supple and prepared to lengthen.
We teach:
Perineal massage (for you or your partner) to prepare the tissues and reduce tearing risk
Labor positions that naturally relax your pelvic floor
Push preparation techniques to coordinate breathing and effort
What to expect during different stages of labor
We also help you think through birth options, communicate confidently with your OB or midwife, and feel empowered rather than anxious heading into delivery.
Preparation changes everything.
Early Postpartum Care for New Moms
One of the greatest benefits of starting pelvic floor therapy during pregnancy is that you’ve already established care with an expert who knows you and your body.
No matter how birth unfolds — vaginal delivery or C-section — it is a profound physical event. Your body transitions rapidly from 40 weeks pregnant to postpartum, and that shift can be overwhelming.
Having a trusted pelvic floor therapist in your corner means:
You know exactly who to call if symptoms arise
You receive guidance on that first postpartum bowel movement
You understand what is normal and what is not
You get early intervention for incontinence, painful intercourse, back pain, or pelvic pain
Pelvic floor therapy can be critical for optimizing recovery and helping you return to the activities you love.
By starting care during pregnancy, you are not scrambling postpartum. You are supported.
How to Find a Pelvic Floor Therapist When Pregnant
Not all pelvic floor therapy is created equal.
When searching for a provider during pregnancy, look for someone who:
Specializes exclusively in pelvic floor therapy — not someone who “dabbles”
Is trained in both orthopedic and pelvic assessment
Can address issues beyond just the pelvic floor itself
Has a structured pregnancy and postpartum program
You want someone who understands the full spectrum of pregnancy changes — from joint pain to pelvic symptoms to labor prep — and who can guide you confidently through each stage.
At PelvicSanity, our comprehensive Pregnancy Program is designed to:
Keep you comfortable and active during pregnancy
Prepare you for a smoother delivery
Support you through postpartum recovery
If you are local to Orange County, California, we would absolutely love to work with you.
👉Learn More about our Pregnancy Program or Request an Appointment to begin your pregnancy care with our pelvic health specialists.
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Who are We at PelvicSanity?
At PelvicSanity, it's our mission to support patients with pelvic pain and pelvic floor symptoms, regardless of where you live. We can help with:
In-person treatment for those in Southern California at the PelvicSanity clinic
Immersive Out-of-Town program for those able to travel
Remote Consultations to get you expert 1:1 help, advice and an action plan
Online patient courses on Interstitial Cystitis and Movement for Pelvic Health
A Facebook support group for patients called Finding Pelvic Sanity.
Dr. Nicole Cozean is the founder of PelvicSanity Physical Therapy in Orange County, CA. PelvicSanity treats patients from all over the world with remote consultations and the Immersive Out of Town Program. She also runs Pelvic PT Rising, training other pelvic PTs to better serve patients.
Named Physical Therapist of the Year, Dr. Nicole is author of the award-winning book The Interstitial Cystitis Solution and the first PT to serve on the ICA Board of Directors, Her passion is helping those with pelvic health issues - regardless of where they live - find lasting relief.
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