My first trimester tips as a pelvic health PT
My top 5 tips as a pelvic health PT to help optimize your health during your first trimester.
As a pelvic health specialist, my approach to pregnancy might look a little different than the average person. Here are my top 5 tips [as a PFPT] for what to do during the first trimester.
Exercise has been my number one priority throughout my trying to conceive journey and my pregnancy. Prepare yourself for a long explanation on why exercise is so important to me as a PFPT. Exercising in the first trimester is challenging (that’s an understatement). Fatigue, nausea, and anxiety can really get in the way of physical activity. Most days between weeks 6 and 12 were spent working, napping, and snacking on whatever food sounded good to me. My approach was to exercise every day that I felt physically capable. I have to admit that I always felt better after I did even if dragging myself off the couch felt impossible in the moment.
For the non-pregnant person, exercise has shown to have numerous health benefits: strong muscles and bones, reduced risk of heart disease and diabetes, improved quality of sleep, and decreased anxiety and depression (1). As a physical therapist, exercise has always been a priority in my lifestyle as well as a main goal I create for most of my patients.
During pregnancy, exercise continues to demonstrate health benefits for both mom and baby. Women who exercise during pregnancy report less back pain, improved mental state, reduced risk of gestational diabetes and high blood pressure, and limited weight gain (2, 3). I have witnessed these benefits first-hand through the patients I have treated.
My focus in the first trimester was low-impact cardio and strength training (I had much success with the Juna Moms app for at-home, COVID-friendly workouts). During the first trimester your musculoskeletal system is physically functioning in about the same way as it was prior to pregnancy. In the first 13 weeks, there are slight changes in the abdominal and pelvic floor muscles as relaxin begins to create soft tissue laxity throughout these areas to allow for your growing uterus and baby but the actual length and strength of these muscles does not really change. Strength-based, resistance exercise and low-impact cardio are my recommended exercises to maximize your core, upper body, and lower body strength.
What this meant to me was that I had about 12-13 weeks where I could continue to use and strengthen my core muscles before they began to make changes that were out of my control. As the abdomen expands and the baby gets heavier, the core muscles have a much harder time working and strength training becomes [to some degree] more about maintaining what you have and less about making gains. I will discuss this more in my tips for the 2nd trimester.
All this being said, it is important to know when NOT to exercise. I encourage each and every person to discuss their exercise plan and goals with their obstetrician as soon as they can during their pregnancy to make sure it is safe and appropriate. There are certain conditions where exercise is not recommended.
Signs to stop exercise include:
- Vaginal bleeding
- Regular, painful contractions
- Shortness of breath prior to exercising
- Chest pain
- Muscle weakness
- Calf pain or swelling
- Amniotic fluid leakage
2. Manage constipation
Unfortunately I suffered from constipation pretty soon after finding out I was pregnant. I do NOT typically have issues with constipation so tackling this early was a major priority for me. If you are like me and struggling with constipation as well… here are some tips for you.
The reason it is important to manage constipation (especially during pregnancy) is because constipation impacts the pelvis and pelvic floor muscles in a big way. Stool built up in the rectum puts unwanted pressure and stress on the pelvic floor muscles. Over time this can lead to an overactive or hypertonic pelvic floor along with hemorrhoids, anal fissures, and painful bowel movements. Since 25-35% of women will experience hemorrhoids in their pregnancies (4) due to pressures from a growing uterus and baby, this is not something we want to exacerbate with constipation.
As soon as I began to notice a change in the ease and frequency of my bowel movements, I moved in the troops.
Fiber intake: fiber is what bulks our stool to help completely pass it in one sitting. With an overactive pelvic floor, you might actually have more difficulty passing soft stool which is a little counterintuitive. Aim to eat 25-35 grams of dietary fiber per day to help improve bowel movements (5).
**My focus was dark leafy greens like spinach (great source of insoluble fiber) since these greens are also rich in magnesium (another important micronutrient that aids in digestion). Since all I really wanted to eat in the first trimester was bagels, bread, and cheese, I mixed spinach into smoothies and incorporated a lot of high-fiber fruits (i.e. kiwi, raspberries, apples). Oatmeal and chia seeds are another healthy source of soluble fiber!
Water intake: while fiber bulks the stool, water balances the consistency to prevent it from being too hard to pass. When you are eating a high fiber diet, water is KEY. The recommendations on water intake during pregnancy vary depending on your source. I recommend aiming to drink 80-100 ounces of water per day. Following the “thirst rule” works best for me since I get well over my recommendation of daily water intake just based on how thirsty I am (especially while pregnant!).
Natural Calm: this is a powder magnesium supplement you can mix with cold or warm water. There is a disclaimer on the product to talk to your provider if you are pregnant or breastfeeding. I will give the same disclaimer: talk to your provider before using a new product like this. I typically turned to Natural Calm if I had not had a complete bowel movement in 2-3 days and it usually worked like a charm!
Sitz bath: when my constipation would really act up, I would often suffer from fissures.. Not fun! A warm bath with epsom salts helped to ease any discomfort I had from an especially difficult bowel movement and helped with tissue healing. Fissures are tricky because once they start, they can be difficult to stop. A sitz bath helps the fissure to heal so that it does not reopen on your next bowel movement. Sitz baths also help with pelvic floor tension and hemorrhoids associated with pregnancy and constipation.
3. Begin to change your sleeping positions
Finding your optimal sleeping position is important even from the very beginning of pregnancy. As our ligaments become lax, the joints have less built-in stability and need more support; especially in resting positions when our muscles are also relaxed and not providing support.
If you are lying on your back, I suggest trying pillows under your knees. This alleviates stress from the joints of the lower back. Experts recommend avoiding sleeping on your back after 20 weeks of pregnancy.
If you are lying on your side, I suggest trying a pillow(s) between your knees. This places the pelvis in a symmetrical position which alleviates stress from the joints of the pelvis, hips, and back.
I have invested in two positioning pillows since finding out I was pregnant. Every person will have different preferences but this is what worked for me.
- C-pillow: I have to admit, this pillow did not work for me. I was sad initially because this is the first pillow I tried and I was really looking forward to a comfy night’s sleep. I liked the support it provided to my lower back and knees, but you have to use this as your head pillow too and my neck was not happy with this change.
- Body pillow: My sister-in-law said she used a straight body pillow while she was pregnant. I figured I would give it a go and it totally worked for me! I was able to use my usual pillow for my head and use this pillow to support my body and knees when on my side.
Update at 26 weeks pregnant: I am still using the body pillow! I alternate having it placed in front of my body supporting my belly and knees and behind my body supporting my back and knees.
4. Learn more about and become aware of your pelvic floor
As a pelvic floor physical therapist, I am very aware of my pelvic floor muscles and I truly believe this will help me throughout my entire pregnancy. Understanding your pelvic floor can help combat incontinence, back and pelvic pain, and improve your activity and exercise tolerance. I also strongly believe having this awareness will help with labor and delivery.
You can get a better understanding of your pelvic floor muscles with a simple at-home assessment. First start by taking a mirror (this can be combined with tip #5 below) to inspect the outside of the vagina and anus. Try to do a kegel by squeezing your pelvic floor like you are stopping urine or gas. If you see the vagina and anus tighten and lift up into your body, you have found your pelvic floor! If you do not see any movement around the openings, you may not be contracting the right muscles.
Taking things a step further, you can insert your finger (thumb or index finger - washed and clean please) into your vagina. As you squeeze your pelvic floor to perform a kegel, you should feel these muscles tighten and squeeze around your finger. If you feel this, then congrats again! You have found your pelvic floor muscles.
To work on maintaining the function of your pelvic floor and improving strength throughout your pregnancy, in general, kegel exercises are recommended for women during their first and second trimester of pregnancy. But fair warning: kegels are not a one size fits all exercise! Kegels are not right for everyone as some people may have “tight” or short pelvic floor muscles and need to work on lengthening before they are ready for kegels.
For this reason, I recommend seeking an evaluation with a PFPT once you have reached the second trimester. This way you can collect a baseline of where your pelvic floor muscles are and how they work prior to delivery. Unsurprisingly, vaginal deliveries change the way the pelvic floor rests and functions in a major way! It’s much harder to have awareness of your pelvic floor after delivery if you were not even aware of these muscles before delivery.
5. Look at your vulva!
I cannot stress this enough. Many women are concerned about the way their vulvas (the external, female genitalia) and vaginas look and feel, especially postpartum. After having a baby (particularly a vaginal delivery), many suddenly become aware that they have a vulva, vagina, and pelvic floor. Most often this is because new symptoms arise. By the time they came in to see me for an evaluation, they have looked at their vulvas and are concerned that the appearance has changed. Unfortunately, I can never really confirm this because I don’t know what it looked like before! But I can at least explain the anatomy and what about the appearance is normal versus what is not “normal”.
My advice is… look at your vulva! Take a picture, get to know your anatomy before delivery, learn about your pelvic floor and pelvic organs so that after delivery you can compare the look, feel, and function with a little more clarity.
Congratulations on your baby!! If you have any questions about these tips or symptoms you are feeling during your pregnancy, email me at email@example.com. Stay tuned for my tips throughout the second, third, and fourth trimesters!
“Benefits of Physical Activity.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 7 Oct. 2020, www.cdc.gov/physicalactivity/basics/pa-health/index.htm.
Montoya et al. (2010). Aerobic exercise during pregnancy improves health-related quality of life: a randomised trial. J Physiother. 56(4): 253-258.
Clapp et al. (2002). Continuing regular exercise during pregnancy: effect of exercise volume on fetoplacental growth. Am J Obstet Gynecol. 186(1): 142-147.
Staroselsky, et al. (2008). Hemorrhoids in pregnancy. Can Fam Physician. 54(2): 189-190.
Hajhoseini, L. (2013). Importance of optimal fiber consumption during pregnancy. Intl J Women’s Health Reproduction Sci. 1(3): 76-79.