Urogynecological physiotherapy during pregnancy - what is safe and what to avoid

This is specialized care focused on the lesser pelvis area, which combines the assessment of pelvic floor function, learning conscious contraction and relaxation, working with breath, and education regarding daily loads. Intensive hormonal changes – especially the action of relaxin – make joints and ligaments more flexible, preparing the body for childbirth. Regular visits to the therapist teach how to respond to the body's needs.

Professional support includes the following elements:

• Body signals: learning to read signals coming from the body,
• Posture: ongoing body posture correction,
• Pelvic floor: regaining full control over the pelvic floor muscles,
• Education: education on lifting, coughing, and sneezing,
• Training: personalized medical training,
• Manual techniques: safe therapy methods.

Close cooperation between the physiotherapist and the gynecologist ensures safety. A good consultation checks whether the patient can activate the pelvic floor and relax it just as consciously.

Preparation for childbirth is based on learning conscious body relaxation and working with breath, and not on the promise of a faster or painless delivery. Mastering diaphragmatic breathing allows for better oxygenation of the baby and effective use of the abdominal press. Around the 34th week of pregnancy, unless the gynecologist recommends otherwise, it is worth taking care of making soft tissues more elastic.

Preparation under the guidance of a specialist begins with learning conscious relaxation of tension and training the correct breathing technique, which together give control over the work of the abdominal press. In the third trimester, this is accompanied by perineal massage protecting against incision and learning active vertical positions, which support childbirth. The whole is complemented by pelvic exercises facilitating its course. Learning vertical positions relieves pain and facilitates subsequent stages of labor. This is a real investment in comfort, although no exercise program replaces the obstetric decisions of the attending team.

During pregnancy, most physical treatments based on heat, electric current, and magnetic fields are excluded because their safety for the child's development is not confirmed.

Methods that should be avoided include:

• Laser therapy: absolutely excluded during pregnancy,
• Ultrasound: therapeutic – safety not established,
• Magnetic field: without confirmed safety for the fetus,
• Cryotherapy and currents: excluded during the entire pregnancy,
• Sauna: and intensely warming treatments.

Exercise special caution with intense manual techniques, such as dry needling or pinotherapy – each time requires a doctor's confirmation. In your daily routine, avoid overexertion and “coning” of the abdomen, lifting heavy objects, and interrupting the flow of urine in the toilet. After about the 16th week, replace lying flat on your back with a side or supported position if it causes discomfort.

A vaginal examination in a normally progressing pregnancy is safe and constitutes the foundation of pelvic floor assessment – provided that the gynecologist rules out contraindications.

During such an examination, a specialist assesses muscle strength and tension as well as the tissue response to loads, and then corrects exercise errors and prepares a work plan for delivery. Professional support primarily brings peace of mind and teaches mindful listening to the body's signals. A good consultation starts with a functional assessment, not with a list of exercises – it is this conversation that determines the plan.

Take care of your pelvic floor consciously, not by guesswork – book a consultation, undergo a functional assessment, and enter childbirth with a plan tailored to you, not to an online exercise list!