Physiotherapy in pregnancy and after birth: back pain, pelvic floor and getting active again

Pregnancy and birth bring big changes to the body: to posture, joints, the pelvic floor and the tummy muscles. Some discomfort is common, but many problems that women are told to simply put up with can be helped by physiotherapy.

During pregnancy

Back and pelvic pain

As the baby grows, the body's posture and loading change, and hormones make ligaments more flexible. Lower back pain and pain at the front or back of the pelvis are common. Physiotherapy can help with:

• advice on posture, lifting, sleeping and getting in and out of bed

• exercises to support the back and pelvis

• hands-on treatment where suitable

• advice on support belts, if helpful

Staying active

For most women with a healthy pregnancy, regular moderate activity such as walking, swimming and pregnancy exercise classes is good for both mother and baby. Check with your doctor before starting, particularly if you have any complications.

Pelvic floor exercises

Strengthening the pelvic floor muscles during pregnancy can help prevent leaking urine during and after pregnancy. To find the muscles, imagine stopping yourself passing wind and urine at the same time. Squeeze and lift, hold for a few seconds, then relax fully. Do a few sets a day. A physiotherapist can check you are doing them correctly.

After birth

The first weeks

• Pelvic floor exercises can usually start gently soon after birth, when comfortable.

• Gentle walking helps circulation and recovery.

• Look after your back when feeding, lifting and bathing the baby: bring the baby to you rather than leaning over.

After a caesarean

A caesarean is major surgery. Support your wound when coughing, get in and out of bed by rolling to your side, avoid heavy lifting at first, and follow your doctor's advice on when to return to driving and exercise.

Tummy muscle separation

The tummy muscles often separate a little during pregnancy. In many women this improves on its own in the months after birth. A physiotherapist can check it and suggest suitable exercises to rebuild strength.

Leaking, heaviness or pain

Leaking urine when coughing, sneezing or exercising, a feeling of heaviness in the vagina, or pain during intercourse are common after birth, but they are not things you have to accept. A physiotherapist with experience in women's health can assess and help.

Getting back to exercise

Return gradually, building up from walking and pelvic floor work to core strengthening and then higher-impact exercise such as running, usually over a few months. Your physiotherapist can help you plan it.

See a doctor promptly if

• you have bleeding, fluid leaking or reduced baby movements in pregnancy

• you have pain in the calf, chest pain or breathlessness

• a wound becomes red, hot or leaks, or you have a fever

• you have severe pain or feel very unwell

Find a physiotherapist

Search for physiotherapists who offer women's health physiotherapy on PhysioDesk Reach and contact them directly. Some offer home visits, which can help in the early weeks after birth.

This article is general information, not medical advice. Always follow the advice of your doctor and midwife.