Pelvic Floor Physiotherapy Matters in Pregnancy and Postpartum

An interview with Courtney and Apaarna from Cornerstone Physiotherapy

On EP65 of My Fertility Podcast, we are joined by Courtney and Apaarna, two highly skilled pelvic health physiotherapists from Cornerstone Physiotherapy in Richmond Hill. They first joined us to discuss vaginismus and fertility, and now they’re back to explore pregnancy, postpartum recovery, and how pelvic floor physiotherapy can support patients through every stage of the perinatal journey.

Welcome back!

Courtney and Apaarna: Thank you so much for having us! We’re thrilled to be back and to talk about this really important topic.

What Is Pelvic Floor Physiotherapy?

For listeners who are new, let’s start with the basics. What is pelvic floor physiotherapy, and why does it matter?

Courtney and Apaarna: Pelvic floor physiotherapy is a specialized branch of physiotherapy that focuses on assessing and treating the muscles of the pelvic floor — the group of muscles that support the bladder, bowel, uterus, and play a role in sexual function. Unlike standard physiotherapy, pelvic floor physiotherapy requires additional post-graduate training because it involves an internal examination, which is considered the gold standard for assessment.

Instead of using instruments like a speculum (as in a Pap test), we use our fingers to feel the muscle tone, check for tightness, and assess strength, asking patients to squeeze and lift so we can feel whether the pelvic floor is functioning optimally. This hands-on approach allows us to create a tailored treatment plan.

At Cornerstone, all our pelvic health physiotherapists are also orthopedic physios, which means we consider the whole picture — hips, lower back, and core, because all of these areas are interconnected with the pelvic floor.

Common Bodily Concerns During Pregnancy

Pregnancy brings many physical changes. What are the most common concerns you see in your practice from pregnant patients?

Courtney and Apaarna: The most common issues we see include:

Low Back Pain

Definition: Low back pain is discomfort or pain felt anywhere between the lower ribcage and the gluteal folds. During pregnancy, hormonal changes (e.g., increased relaxin) and shifting posture can lead to instability in the spine and pelvis, causing pain.

How Pelvic Floor Physiotherapy Helps: By strengthening and coordinating the pelvic floor (an integral part of the core system) along with deep abdominal and hip muscles, pelvic physio improves core stability and reduces strain on the lumbar spine, alleviating back pain and improving mobility.

Pelvic Girdle Pain

Definition: Pelvic girdle pain (PGP) refers to pain in the joints and soft tissues of the pelvis, often affecting the pubic symphysis, sacroiliac joints (SIJs), groin, hips, or tailbone. It is reported by up to 50% of pregnant individuals at some stage of pregnancy.

How Pelvic Floor Physiotherapy Helps: A pelvic physio can assess joint alignment, provide manual therapy, teach stabilization exercises, and offer support strategies (like SIJ belts and posture modifications) to reduce pain, improve pelvic alignment, and restore normal movement patterns.

Urinary Incontinence

Definition: Urinary incontinence is the involuntary leakage of urine. During pregnancy, increased uterine weight and hormonal changes weaken pelvic floor support, leading to stress incontinence (leakage during coughing, sneezing, laughing, or exercise).

How Pelvic Floor Physiotherapy Helps: Through individualized pelvic floor muscle training, biofeedback, and bladder retraining strategies, physiotherapy can improve muscle tone and coordination, helping to prevent or stop leakage both during and after pregnancy.

Pelvic Organ Prolapse

Definition: Pelvic organ prolapse occurs when the bladder, uterus, or rectum descends into the vaginal canal due to weakened support structures, often presenting as a sensation of heaviness, bulging, or pressure.

How Pelvic Floor Physiotherapy Helps: Pelvic physios teach evidence-based exercises to improve pelvic floor strength and endurance, use breathing techniques to reduce downward pressure, and provide education on lifting mechanics and posture to prevent further descent.

Exercise and Activity Concerns

Definition: Many pregnant patients are unsure what exercises are safe, how hard they should work out, or whether certain movements could harm the baby or themselves — leading to unnecessary inactivity.

How Pelvic Floor Physiotherapy Helps: Pelvic physios assess each patient’s stage of pregnancy, fitness level, and symptoms to create a safe, personalized exercise plan, teaching modifications and strategies that keep patients active while protecting the pelvic floor and core.

When to Avoid Pelvic Floor Physiotherapy

Are there any cases where someone should not see a pelvic floor physiotherapist during pregnancy?

Courtney and Apaarna: There are some rare situations — such as high-risk pregnancies or when someone has been told to abstain from intercourse or remain on strict bed rest — when we would avoid internal assessment. Otherwise, pelvic floor exams are very gentle and safe. We don’t go as far as the cervix, and our assessments are far less invasive than many routine medical exams.

Who Can Benefit from Pelvic Floor Physiotherapy?

What about pregnant patients who don’t have symptoms — should they still see a pelvic floor physio?

Courtney and Apaarna: Absolutely. Even if you don’t have pain, leakage, or other symptoms, pregnancy puts significant pressure on the pelvic floor muscles for nine months. We know that after pregnancy, the muscles will have reduced function — sometimes due to tearing, episiotomy, or simply intense stretching during delivery. Preparing these muscles beforehand helps build resilience and lowers the chance of problems after birth.

Many people don’t know how strong their pelvic floor is, whether they are doing Kegels correctly, or how much strength they need to safely return to activities like running. Pelvic floor physiotherapy gives them this information and helps prevent issues before they start.

Are you wondering: Where is there pelvic floor physiotherapy near me?

Add Cornerstone website/ locations/ image, contact for Courtney and Apaarna.

Debunking C-Section Myths

Many people believe that having a C-section protects the pelvic floor. Is that true?

Courtney and Apaarna: Not entirely. You still carry a baby for nine months, so your pelvic floor is under strain regardless of the delivery method. And for those who go through labor before an emergency C-section, the pelvic floor may have already stretched significantly. C-sections also involve major abdominal surgery, which means the core muscles must be rehabilitated — the pelvic floor is part of that core system.

We educate patients about scar treatment timelines and help them gradually return to activity, starting with gentle movements and progressing safely.

Preparing for Labor and Delivery

Can pelvic floor physiotherapy reduce the chance of needing a C-section, vacuum, or forceps delivery?

Courtney and Apaarna: While there are no guarantees, research and clinical experience suggest that proper preparation can lower the risk of interventions. Starting around 35 weeks, we focus on:

Perineal stretching: To help tissues become more flexible and get the brain used to the sensation of stretch.

Breathing techniques: Diaphragmatic breathing to manage pain during contractions and help relax the pelvic floor — which is necessary for the baby’s descent.

Pushing practice: We teach patients effective pushing techniques so they know how to work with their body’s natural reflexes. This can make pushing shorter and more efficient, which reduces maternal exhaustion — a common reason for assisted deliveries.

Labor positions: We recommend upright or forward-leaning positions (if possible) to use gravity to aid baby’s descent.

Preparing physically and mentally is key. Labor is like running a marathon; it requires endurance, strength, and mindset strategies to keep going when exhaustion hits.

Exercise During Pregnancy

Some people believe they should avoid exercise entirely during pregnancy. What do you recommend?

Courtney and Apaarna: For most people with low-risk pregnancies, staying active is very beneficial. We generally recommend 150 minutes of moderate-intensity exercise per week, including strength training, walking, swimming, or prenatal yoga. The “talk test” is helpful — you should be able to carry on a conversation during exercise.

Exercise improves energy, reduces pregnancy discomfort, prepares the body for postpartum tasks (like lifting a car seat or pushing a stroller), and benefits mental health. Safety considerations include staying hydrated, avoiding overheating (especially in the first trimester), and modifying activities that carry a fall risk in the third trimester.

Pelvic Floor Physiotherapy Postpartum Rehabilitation

What about after delivery?

Courtney and Apaarna: Pelvic floor physiotherapy is just as important postpartum, regardless of delivery method. We assess muscle function, teach proper Kegel technique, guide safe return to exercise and intercourse, and help with scar management after C-sections or perineal tears. Addressing these issues early can prevent long-term complications like incontinence or prolapse.

Free Prenatal Education Talk

You also offer a free virtual prenatal talk, right?

Courtney and Apaarna: Yes! Once a month, we host a virtual session open to anyone — patients or not. We cover pregnancy and postpartum concerns, prevention strategies, exercise guidelines, safe return to activity, and labor preparation. It’s a great way to learn what to expect and ask questions.

Patients can sign up through the Cornerstone Physiotherapy website by scanning a QR code or selecting a date that works best for them.

Final Thoughts

Thank you both for such a comprehensive discussion. Any final thoughts for listeners?

Courtney and Apaarna: Our message is simple: everyone can benefit from pelvic floor physiotherapy: during pregnancy, postpartum, or even years later. Don’t wait until problems arise to get help. Education and proactive care can make pregnancy, birth, and recovery smoother and set you up for long-term pelvic health.

Pelvic floor physiotherapy is more than just treatment, it’s about prevention, preparation, and empowerment. Whether you’re pregnant, planning to be, or recovering postpartum, physiotherapists like Courtney and Apaarna are there to guide you every step of the way.

FAQ about pelvic floor physiotherapy 

Below are answers to your questions about pelvic floor physiotherapy in Ontario, with sources only from Ontario or Canadian evidence and policy documents.

How does pelvic floor physiotherapy work?

Mechanisms & Process:

Pelvic floor physiotherapy (PFPT) uses various techniques to assess and rehabilitate the pelvic floor muscles, connective tissue, alignment, and associated structures. The goal is to restore strength, flexibility, coordination, and function, reduce symptoms, and improve quality of life. Some components include:

Assessment: including external and often internal exams (vaginal or anal) to check muscle strength/tone, coordination, gaps, tears, alignment, presence of pain, how well the patient can contract and relax the muscles. (Cornerstone notes over 30% of women cannot properly contract pelvic floor muscles without assessment.) (Source: Cornerstone Physiotherapy)

Pelvic Floor Muscle Training (PFMT): tailored exercises to strengthen pelvic floor muscles, improve endurance, coordination. These may include contracting (“squeezing”) and lifting the pelvic floor muscles, gradually increasing workloads. (Source: Cornerstone Physiotherapy)

• Other techniques include: stretching, manual therapy, myofascial release, biofeedback, breathing work, alignment corrections, functional movement re-training, scar or perineal tissue work postpartum, etc. (Source: Bloom Integrative Health)
  
• Education: guiding patients on lifestyle adjustments (bladder habits, bowel habits, posture, lifting mechanics), proper technique, home exercises, and empowering patients to self-manage. (Source: Cornerstone Physiotherapy)
  
• Monitoring & follow-up: regularly checking progress, adjusting program intensity, frequency, type of interventions as needed. Typical courses may involve several visits over weeks or months. (Source: Bloom Integrative Health)

How improvement happens:

• Strengthened and coordinated pelvic floor muscles better support pelvic organs, bladder, bowel.
• Improved control over muscle contractions helps reduce leakage, urgency, or pain.
• Through stretching and relaxation techniques, tight or hypertonic muscles or scar tissues can be eased, reducing pain or discomfort.
• Improved awareness and neuromuscular control help patients use their pelvic floor appropriately (e.g. during coughing, lifting, or during pregnancy / postpartum periods).
  

Is pelvic floor physiotherapy covered by OHIP?

Yes, for certain groups: those 65 or older, 19 or younger, people who have been hospitalized overnight for a condition needing physiotherapy, or who are recipients of ODSP or Ontario Works. In those cases, pelvic floor physiotherapy may be covered under OHIP. (Source: Cornerstone Physiotherapy)

No, for the general adult population outside those criteria — particularly if you attend a private clinic not funded by OHIP, or you don’t meet the specific eligibility criteria. Private pay or private insurance is usually required. (Source: Cornerstone Physiotherapy)

Summary Table

Question	Answer (Ontario-specific)
Does OHIP cover pelvic floor physiotherapy?	Only in specific eligibility cases (age groups, hospital stays, social assistance programs). Otherwise, usually not.
Does pelvic floor physiotherapy work?	Yes, strong evidence for improving urinary incontinence, pelvic pain, prolapse, etc. PFMT & supervised programs are effective.
How does it work?	Assessment (often internal), tailored exercises, manual therapy, education, lifestyle work, follow-up.
Is PF physio covered by OHIP?	Covered only under certain eligibility criteria; otherwise, costs are out of pocket or via insurance.