My second trimester tips as a pelvic health PT
My top 4 tips as a pelvic health PT to optimize your health in your second trimester.
The second trimester. The golden trimester. When the negative symptoms of pregnancy begin to wear off a tiny bit and we are able to enjoy food, exercise, and life again.
The second trimester was definitely when I felt my best. My fatigue had subsided and my belly was still cute and light enough for me to be active. My desire and energy to exercise returned which was a wonderful feeling for me!
This is also when I started to notice my expanding belly was making it harder for me to engage my core. I saw abdominal coning (or doming; associated with diastasis rectus abdominis) with certain movements and noticed that getting up from the couch, getting out of bed, and rolling were suddenly much harder to do. This made exercise even more important for me.
Let’s dive into my top tips as a pelvic floor physical therapy in the second trimester.
1. Participate in focused, intentional exercise: core strengthening
I talked a lot about the importance of exercise in my first trimester tips (also refer back to learn when NOT to exercise). For the second trimester, there are specific types of exercise that are important to focus on.
During the second trimester it is important to focus on core and resistance exercises.
Strengthening your core will help reduce the risk of diastasis rectus abdominis and improve your stability throughout the remainder of your pregnancy. A weak core is associated with increased pelvic pain, SIJ dysfunction, and lower back pain. The changes your core goes through during pregnancy makes the core muscles innately weaker. This is why there is a higher incidence of pelvic and lower back pain when compared to the nonpregnant population.
Core strengthening should include proper engagement of the pelvic floor, transverse abdominis, and multifidus muscles. This is also known as a “pelvic brace”. When coordinating your pelvic brace with breathing, you will notice the following benefits:
- Better stability and balance when performing exercises like lunges, planks, dead bugs, and bird dogs
- Improved tolerance to low-impact cardio exercise and upper/lower body strength training
- Improved strength and endurance during labor and delivery (maybe the most important benefit!)
- Quicker postpartum recovery and return to activity
**I highly recommend learning the pelvic brace with a skilled physical therapist or personal trainer.**
**Instructions on how to perform a pelvic brace are in the Core Restore program in the Juna app [for which I am the PT advisor]**
2. Focused, intentional exercise: upper and lower body strengthening
One of the most beneficial types of exercise throughout your pregnancy is walking. However, you will need upper and lower body strength and power for labor and delivery. The second trimester is the optimal time to focus on this because you likely have the energy and have not put on too much weight. Also you should still be able to active your core well!
There are tremendous benefits to be able to move and sustain different positions during labor. The hands and knees, deep squat, and the standing “dance” positions all can help alleviate pain and improve the efficiency of your contractions. Imagine holding these positions in 10-15 minute increments for 20+ hours with an added 30 lbs on your body. This is why strengthening is so important.
I highly recommend finding exercise routines specifically created for pregnancy. These routines keep in mind your growing belly, core, and balance. They are safer for and more applicable to your pregnant body than other exercise routines. I used the Juna app because, as their PT advisor, I had reviewed all of the exercises and agreed that they were completely safe and appropriate for pregnant women! But feel free to shop around.
3. Focused, intentional exercise: upper and lower body strengthening
This is important for two reasons:
1) The second trimester is often when pelvic pain symptoms arise.
2) The pelvic floor is also likely in good shape during this time.
Pregnancy-related lower back pain and pelvic girdle pain occurs in 56-72% of the antepartum population (JWHPT Clinical Guidelines) who are between 20-30 weeks pregnant. This is pain involving the lower back, SI joints, and pubic region. There is evidence to support that manual therapy and exercise prescription by a pelvic health PT can help with this type of pain! Being evaluated early will help improve your outcomes and reduce pain throughout the rest of your pregnancy.
The second reason to see a PFPT during this time is that you can establish a baseline of your pelvic floor. This is the earliest time you can see a PFPT (unless you see one before getting pregnant). During this appointment, you can learn about the type of control you have over your pelvic floor, your strength, your endurance, and how the integrity of the muscles may impact your likelihood of tearing. This data can be used to guide your control during L&D and to establish your goals after baby arrives.
4. Have sex!
This is the sweet spot for having sex while you are pregnant. With first trimester symptoms [hopefully] behind you, you may be more interested. Your sex drive may likely be up because of those wonderful pregnancy hormones. And there are so many benefits to having sex during pregnancy (unless contraindicated). Sex can improve mood, intimacy with your partner, and help with headaches.
As a pelvic floor PT, this is on the list because the pelvic floor muscles benefit from sex! With stimulation and sensations of pleasure in the pelvic area, you are increasing blood flow to your pelvic floor. With climax/orgasm, you are strengthening your pelvic floor muscles. To some degree (take this with a grain of salt) the pelvic floor is a “use it or lose it” type of muscle. The more frequently you use it, the better the muscle can perform!
Stay tuned for my tips as a PFPT in the third and fourth trimester!