Using a Pelvic Floor Trainer in Pregnancy and Postpartum

Monday, February 20, 2023

We get a lot of questions about the efficacy of using Pelvic Floor trainers like the Elvie, EpiNo, or KGoal for birth preparation and postpartum recovery. We turned to our friend Laura Williams, DPT, founder of Hearth Healing for answers...

What's the intention behind pelvic floor trainers, like the Elvie?

Pelvic floor trainers are designed to give biofeedback via visual representation about recruitment and relaxation of pelvic floor muscles. Because these muscles are internal, is often difficult to have good proprioception about what they are really doing, so devices like the Elvie help us visually see our force production, endurance, and relaxation. These can be helpful tools throughout the lifespan, as different life events and hormonal changes impact the function of our pelvic floors.

What about the Epi-No?

The Epi-No is designed as a birth preparation and postpartum recovery tool. To push our babies out, we need good pelvic floor strength and length! The Epi-No promotes strength throughout pregnancy and optimizes length in late-stage pregnancy. As our muscles lengthen during pregnancy, they weaken and become less responsive to pressure changes. Keeping them strong and more importantly well-coordinated, can optimize force production, and improve postpartum recovery. However, in late-stage pregnancy we need to condition our perineal tissue to lengthen in preparation for delivery.

What are some indications for their use?

The beauty of these tools is that they offer an extrinsic feedback system to help guide our efforts. The caveat is that not everyone needs pelvic floor strength, per se. We need balance in these muscles. 70% of the muscle fibers of the pelvic floor are tonic, or endurance muscles, so we need good endurance (e.g. to be able to run without leakage or hold a full bladder). 30% are phasic, or fast twitch, and we need our muscles to also be quickly responsive to pressure changes (e.g. sneezing our jumping). We can have just as much dysfunction and weakness if our muscles are too tight or short, in which case we may need emphasis on relaxation and length rather than strength.

Should they be working with a pelvic health provider when utilizing these?

Because our pelvic floors are complex and impacted by so many variables (trauma, previous pregnancies and modes of delivery, pathology, our nervous systems, etc.) it is crucial to have a pelvic floor assessment performed by a pelvic health provider prior to using a pelvic floor trainer. Once you know what your unique pelvic floor needs, then a pelvic floor trainer is a great way to progress independently. These tools can be very motivating and help with accountability.

When would someone consider using a pelvic floor trainer in pregnancy or postpartum?

A pelvic floor trainer may be a helpful way to maintain good pelvic floor coordination during pregnancy whether symptoms are present or not. Some good indications for use during pregnancy or postpartum may be a feeling of heaviness or openness in the vagina, urinary leakage, significant urgency or frequency, or low back pain. No matter how babies are delivered, the lengthening that occurs in our pelvic floor and tonic core during gestation warrants re-coordination after delivery.

When tissue trauma happens to the pelvic floor during delivery, often muscles respond by being very tight and painful, and pelvic floor trainers can help us understand how to release the tension. Again, these tools should always be used following a pelvic floor analysis by a professional. It is generally safe to have a pelvic floor examination performed by a pelvic health physical therapist (PT) during pregnancy, after the first trimester. This should always be done with absolute patient comfort and consent, and physician clearance.

Just remember that a gentle and specific pelvic floor exam, performed with one gloved and lubricated finger, is less invasive than penile penetration. This allows you and your provider to have a clear understanding of how your pelvic floor is working, so they can give you individualized guidance. This would then be performed again after 6-weeks postpartum to assess your new baseline, and new guidelines would be given per tolerance.

Should they be working with a pelvic health provider when utilizing these?

Ongoing work with a pelvic health specialist when using a pelvic floor trainer is recommended. They can give you feedback on your progress and advance your exercises. We need our pelvic floors to work well in a variety of conditions and positions, and under different forces, not just sitting or lying down. Pelvic health PTs are experts at helping you integrate the skills you master from your pelvic floor trainer into functional activities, so you can get back to carrying your kids, running, jumping, sneezing, and living, without pelvic floor dysfunction.

Anything else you want to add?

Pelvic floor trainers can be a great tool but should be considered one element of a cohesive individualized treatment plan. That plan should consider how all your systems work together and help you meet your overarching goals.

Bio: Laura Williams is a Doctor of Physical Therapy (DPT) and Board-Certified Women’s Health Clinical Specialist. She lives and practices in Salida, CO with her husband, 3-year-old daughter, and second child on the way. Laura founded Hearth Healing, offering 100% virtual postpartum healing consultation, in 2022, as a pelvic health consultant. Though not a substitute for in-person healthcare, postpartum healing consultation should be viewed as a vital way to bridge the gap in maternal care. People deserve information about how to improve symptoms that impact their quality of life after childbirth, without having to wait months, or feel limited by lack of childcare or transportation. At Hearth, Laura provides individualized answers to postpartum healing questions, early healing strategies, self-management advice, and guidance on appropriate resources, products, and providers.

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