Pelvic Floor Health During Pregnancy: What EMS Can and Cannot Do

Introduction: The Pelvic Floor’s Most Demanding Nine Months

Pregnancy is one of the most physiologically extraordinary experiences the human body undergoes — and one of the most demanding for the pelvic floor. Over the course of nine months, the pelvic floor muscles must support a progressively increasing load as the uterus, baby, placenta, and amniotic fluid grow and descend into the pelvis. They must adapt to profound hormonal changes that affect their structure and function. And they must ultimately withstand the extraordinary mechanical demands of labour and vaginal delivery — or adapt to the altered biomechanics of recovery from caesarean section.

Despite the enormous demands that pregnancy places on the pelvic floor, pelvic floor health during pregnancy is frequently overlooked — both by expectant mothers who are focused on the many other aspects of pregnancy preparation, and by healthcare providers who may not routinely assess or address pelvic floor function as part of antenatal care. The consequences of this neglect can be significant: pelvic floor dysfunction during pregnancy is common, distressing, and — with appropriate intervention — largely preventable.

This comprehensive guide covers what happens to the pelvic floor during pregnancy, the common pelvic floor problems that arise during this period, what EMS pelvic floor therapy — using devices like the Riorna EMSlim Pelvic Floor Chair — can and cannot offer during pregnancy, and the evidence-based strategies that support pelvic floor health throughout the antenatal period.

What Happens to the Pelvic Floor During Pregnancy

Increasing Mechanical Load

The pelvic floor is a hammock-like group of muscles, ligaments, and connective tissues that spans the base of the pelvis and supports the pelvic organs — the bladder, uterus, and rectum. During pregnancy, the growing uterus and its contents place a progressively increasing downward load on the pelvic floor — a load that increases from virtually nothing in the first trimester to the equivalent of supporting a 3–4 kilogram baby, placenta, and amniotic fluid by the third trimester.

This sustained mechanical loading stretches and stresses the pelvic floor muscles and their connective tissue supports over months — a process that can lead to progressive weakening, lengthening, and reduced neuromuscular efficiency of the pelvic floor if it is not counteracted by appropriate strengthening and conditioning.

Hormonal Changes: Relaxin and Connective Tissue Laxity

Pregnancy is associated with a dramatic increase in the hormone relaxin — which promotes the laxity and extensibility of connective tissues throughout the body to prepare the pelvis for the passage of the baby during delivery. While this connective tissue laxity is essential for successful vaginal delivery, it also reduces the passive support provided by the ligaments and fascial structures of the pelvic floor — increasing the demand on the pelvic floor muscles to provide active support for the pelvic organs.

The combination of increased mechanical load and reduced passive connective tissue support creates a significant challenge for the pelvic floor muscles during pregnancy — one that is best addressed through proactive pelvic floor strengthening and conditioning throughout the antenatal period.

Postural Changes and Their Effects on Pelvic Floor Function

The progressive growth of the uterus during pregnancy shifts the body’s centre of gravity forward, leading to characteristic postural adaptations — including increased lumbar lordosis (lower back arch), anterior pelvic tilt, and altered hip and knee alignment. These postural changes affect the resting length and tension of the pelvic floor muscles, potentially impairing their ability to generate force effectively and increasing the risk of pelvic floor dysfunction.

Common Pelvic Floor Problems During Pregnancy

The combination of increased mechanical load, hormonal connective tissue laxity, and postural changes makes pelvic floor dysfunction common during pregnancy. The most prevalent pelvic floor problems during pregnancy include stress urinary incontinence (leaking urine with coughing, sneezing, or exercise) — which affects approximately 30–40% of pregnant women, pelvic girdle pain — which affects up to 20% of pregnant women and is associated with pelvic floor dysfunction, pelvic organ prolapse symptoms — including a sensation of heaviness or bulging in the vagina, and pelvic floor overactivity — in which the pelvic floor muscles are too tight rather than too weak, causing pain, difficulty with penetration, and constipation.

What EMS Pelvic Floor Therapy Can and Cannot Do During Pregnancy

The Clear Answer: EMS Pelvic Floor Therapy Is Contraindicated During Pregnancy

It is essential to be completely clear on this point: EMS pelvic floor therapy — including treatment with the Riorna EMSlim Pelvic Floor Chair — is contraindicated during pregnancy. This is an absolute contraindication, not a relative one that can be overridden by clinical judgement or patient preference.

The reasons for this contraindication are straightforward and compelling. The electromagnetic field generated by HIFEM pelvic floor devices penetrates into the pelvic cavity and stimulates the pelvic floor muscles through intense electromagnetic stimulation. During pregnancy, the developing fetus is located within the pelvic cavity — directly within the treatment field. The effects of HIFEM electromagnetic stimulation on fetal development are unknown, and in the absence of evidence of safety, the precautionary principle requires that EMS pelvic floor therapy not be used during pregnancy under any circumstances.

Additionally, the intense pelvic floor contractions produced by EMS pelvic floor therapy could theoretically stimulate uterine contractions — a risk that is unacceptable during pregnancy regardless of gestational age. No reputable EMS pelvic floor device manufacturer recommends the use of their devices during pregnancy, and practitioners who offer EMS pelvic floor therapy should screen all female clients of reproductive age for pregnancy before each treatment session.

What EMS Can Offer: Postpartum Pelvic Floor Rehabilitation

While EMS pelvic floor therapy is contraindicated during pregnancy, it is one of the most effective interventions available for postpartum pelvic floor rehabilitation — the period after delivery when the pelvic floor needs to recover from the demands of pregnancy and childbirth. For a complete guide to postpartum EMS pelvic floor therapy, see our article on Postpartum Recovery Timeline: When Is It Safe to Start Pelvic EMS Therapy?

Evidence-Based Strategies for Pelvic Floor Health During Pregnancy

While EMS pelvic floor therapy is not available during pregnancy, there are several evidence-based strategies that effectively support pelvic floor health throughout the antenatal period.

Pelvic Floor Exercises (Kegel Exercises)

Voluntary pelvic floor exercises — commonly known as Kegel exercises — are the cornerstone of antenatal pelvic floor conditioning. Regular pelvic floor exercises during pregnancy strengthen the pelvic floor muscles, improve neuromuscular control, and reduce the risk of stress urinary incontinence and pelvic organ prolapse during and after pregnancy. The evidence base for antenatal pelvic floor exercises is strong — multiple systematic reviews have demonstrated that regular pelvic floor exercises during pregnancy significantly reduce the risk of urinary incontinence both during pregnancy and in the postpartum period.

However, as discussed in our article on Why Kegel Exercises Alone Are Not Enough, voluntary pelvic floor exercises have significant limitations — including the difficulty of correctly identifying and activating the pelvic floor muscles, the tendency to perform exercises incorrectly, and the limited intensity of the voluntary contraction compared to the supramaximal stimulus of EMS. These limitations mean that many pregnant women do not achieve the full benefit of pelvic floor exercises despite their best efforts.

Pelvic Floor Physiotherapy

Assessment and treatment by a pelvic floor physiotherapist is the gold standard for antenatal pelvic floor care. A pelvic floor physiotherapist can assess the function of the pelvic floor muscles — identifying weakness, overactivity, or coordination problems — and provide individualised exercise programs, manual therapy, and education that address the specific pelvic floor needs of each pregnant woman. Referral to a pelvic floor physiotherapist is recommended for all pregnant women, and is particularly important for those with a history of pelvic floor dysfunction, previous difficult deliveries, or current pelvic floor symptoms.

Load Management and Activity Modification

Managing the mechanical load on the pelvic floor during pregnancy — by modifying activities that place excessive downward pressure on the pelvic floor — is an important component of antenatal pelvic floor care. High-impact activities (running, jumping, heavy lifting) place significant downward pressure on the pelvic floor and should be modified or avoided if pelvic floor symptoms develop. Swimming and cycling are generally well-tolerated alternatives that maintain cardiovascular fitness without excessive pelvic floor loading.

Posture and Core Conditioning

Maintaining good posture and core conditioning during pregnancy supports pelvic floor function by reducing the anterior pelvic tilt and lumbar lordosis that impair pelvic floor muscle mechanics. Antenatal yoga, Pilates, and specific core conditioning programs designed for pregnancy can help maintain the postural alignment and core strength that support pelvic floor function throughout the antenatal period.

Perineal Massage

Perineal massage — gentle massage of the perineum (the area between the vagina and anus) in the final weeks of pregnancy — has been shown to reduce the risk of perineal trauma during vaginal delivery and to reduce the severity of postpartum perineal pain. It is typically recommended from 34–36 weeks of pregnancy and can be performed by the pregnant woman herself or with the assistance of a partner.

Planning for Postpartum Pelvic Floor Recovery

One of the most valuable things a pregnant woman can do for her pelvic floor health is to plan for postpartum recovery before delivery. This includes identifying a pelvic floor physiotherapist for postpartum assessment, understanding the timeline for safe return to exercise and EMS pelvic floor therapy after delivery, and setting realistic expectations for the postpartum recovery process.

EMS pelvic floor therapy is typically safe to begin 6–8 weeks after vaginal delivery and 3–6 months after caesarean section, subject to medical clearance. Planning to begin EMS pelvic floor therapy at the appropriate postpartum time — rather than waiting until symptoms become severe — gives the pelvic floor the best possible chance of full recovery. For a complete guide to postpartum EMS timing, see our article on Postpartum Recovery Timeline: When Is It Safe to Start Pelvic EMS Therapy?

Key Takeaways

Frequently Asked Questions

Can I use the EMS pelvic floor chair if I am pregnant?

No — absolutely not. EMS pelvic floor therapy is an absolute contraindication during pregnancy. The electromagnetic field penetrates into the pelvic cavity where the developing fetus is located, and the effects on fetal development are unknown. Additionally, the intense pelvic floor contractions could theoretically stimulate uterine contractions. There are no circumstances under which EMS pelvic floor therapy is appropriate during pregnancy.

I am trying to conceive. Can I still do EMS pelvic floor therapy?

EMS pelvic floor therapy is appropriate for women who are trying to conceive but have not yet confirmed pregnancy. However, because the early weeks of pregnancy may not yet be confirmed by a pregnancy test, women who are actively trying to conceive should discuss this with their EMS practitioner. Many practitioners recommend avoiding EMS pelvic floor treatment in the two-week window between ovulation and a pregnancy test result, as a precautionary measure.

I had a miscarriage. When can I resume EMS pelvic floor therapy?

Following a miscarriage, EMS pelvic floor therapy should be postponed until the miscarriage is complete, any bleeding has resolved, and medical clearance has been obtained from your physician or gynaecologist. The appropriate waiting period varies depending on the gestational age at the time of miscarriage and the nature of the miscarriage (spontaneous vs medically managed). Consult with your healthcare provider for specific guidance.

My pelvic floor is very weak during pregnancy. What can I do right now?

The most effective immediate interventions for pelvic floor weakness during pregnancy are referral to a pelvic floor physiotherapist for assessment and individualised treatment, regular voluntary pelvic floor exercises (Kegel exercises) performed correctly — ideally with physiotherapist guidance, activity modification to reduce high-impact loading on the pelvic floor, and postural correction to support pelvic floor muscle mechanics. These interventions can produce meaningful improvements in pelvic floor strength and function during pregnancy and reduce the risk of postpartum pelvic floor dysfunction.

Will having a caesarean section protect my pelvic floor?

Caesarean section reduces the risk of some types of pelvic floor injury — particularly the levator ani muscle avulsion that can occur during difficult vaginal deliveries. However, it does not fully protect the pelvic floor from the effects of pregnancy itself — the nine months of increasing mechanical load and hormonal connective tissue laxity affect the pelvic floor regardless of the mode of delivery. Women who deliver by caesarean section still benefit from antenatal pelvic floor conditioning and postpartum pelvic floor rehabilitation.

When can I start EMS pelvic floor therapy after my baby is born?

EMS pelvic floor therapy is typically safe to begin 6–8 weeks after uncomplicated vaginal delivery and 3–6 months after caesarean section, subject to medical clearance from your obstetrician or midwife. For a complete guide to postpartum EMS timing and what to expect, see our article on Postpartum Recovery Timeline: When Is It Safe to Start Pelvic EMS Therapy?

Conclusion

Pelvic floor health during pregnancy is one of the most important and most overlooked aspects of antenatal care. While EMS pelvic floor therapy is absolutely contraindicated during pregnancy, the evidence-based strategies of pelvic floor physiotherapy, voluntary exercises, load management, and postural conditioning can effectively support pelvic floor health throughout the antenatal period — reducing the risk of pelvic floor dysfunction during pregnancy and setting the foundation for successful postpartum recovery.

Planning for postpartum EMS pelvic floor therapy before delivery — and beginning treatment at the appropriate time after birth — gives the pelvic floor the best possible chance of full recovery and long-term health. The Riorna EMSlim Pelvic Floor Chair is ready to support that recovery when the time is right.

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