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Twin Pregnancy & Pelvic Health

My Friend is pregnant with twins and finding out that you’re carrying more than one baby can be both exciting and overwhelming. So today lets talk about how carrying twins may affect your pregnancy and how to ensure the best possible outcome for you and the little ones.

How are twins different from singleton pregnancies?

Multiple pregnancies are generally considered higher risk than singleton pregnancies, however, monochorionic pregnancies do have a higher risk for complications due to the sharing of one placenta. If you have a monochorionic pregnancy you can expect more appointments and more ultrasounds to monitor your little ones’ growth, which is great – you get to see them way more often!

During pregnancy the pelvic floor muscles are working harder to support the weight of a growing baby – now times that weight by two if you have twins!

Relaxin and Pelvic/Hip/Back Pain

The pregnancy hormone “relaxin” as it sounds, has a softening effect on connective tissue which makes the pelvic floor muscles work harder to provide support while compensating for the relaxed ligaments. Women carrying twins have been shown to carry higher levels of pregnancy hormones compared to singletons.

The pelvic floor muscles are further stretched during a vaginal delivery, allowing the safe passage of the babies through the birth canal.

C-sections are major abdominal surgery that significantly the abdominal wall. The pelvic floor muscles have to compensate for the loss of stability around the pelvis and therefore have to work much harder.

Get to know your pelvic floor:

The pelvic floor muscles create a supportive hammock at the base of your pelvis, extending from your tailbone to your pubic bone. Functions include supporting your abdominal organs and maintaining urine and fecal continence. Pregnancy and birthing often weaken the pelvic floor muscles, resulting in ongoing incontinence, prolapse, and ongoing postpartum pain.

Pelvic floor muscle exercises are very effective in preventing and managing pelvic floor dysfunction and are recommended to commence antenatally. Pelvic floor exercises can be extremely helpful, but if done incorrectly harmful. For patients with a hyperactive and tight pelvic floor, further strengthening the pelvic floor may exacerbate symptoms.

Harmony Physiotherapy Ottawa are Experts in managing pelvic floor conditions. Our Expert Physiotherapists can assess the pelvic muscles and tailor an treatment and exercise program customized to each patient to address any tone, strength, endurance, or functional deficits. Just like every pregnancy is unique, every pelvic floor is unique. This is why a proper assessment and individualized program is most effective.

Diastasis Recti (RAD)

Women with twins or higher-order multiples have a higher risk for developing a rectus abdominis diastasis and umbilical hernia, primarily due to the increased stretch on the abdominal wall to accommodate multiple babies. A rectus diastasis is described as abdominal muscle separation and relates to an impairment of the linea alba, which is the fibrous connective tissue between the rectus abdominis muscles that widens and thins during pregnancy to accommodate your growing babies. The diastasis often resolves naturally within the fourth trimester when the body is undergoing most healing. However, sometimes at times, diastasis recti if severe can persist and may be associated with pelvic floor dysfunction including incontinence pelvic pain, or back and hip pain.

Harmony Physiotherapy Ottawa can assess for diastasis recti and prescribe appropriate exercise progressions to help you safely return to the exercise you want to do. So it does not mean you have to avoid heavy exercise forever!

Prenatal and Postpartum Pain

As the pregnancy hormone “relaxin’s” levels are higher for women with twins, the softening effect it has on connective tissue increases the likelihood of developing pregnancy-related pelvic girdle pain (PGP). Furthermore, the anatomical changes associated with pregnancy are more pronounced in a twin pregnancy due to the increased size and weight of the uterus. PGP may be felt at the very bottom of your spine at the sacroiliac joints at the buttock, at the pubic symphysis at the front of your pubic bone, or in both areas. Rolling over in bed, climbing stairs, getting in and out of the car and walking longer distances are common aggravating activities for PGP. Harmony Pelvic Physiotherapy Experts can effectively help you prevent and manage PGP.

At Harmony Physiotherapy we are Experts in Pelvic Physiotherapy. We work with and coordinate all patient care with your obstetrician, midwife, physician, and other health care professionals to maximize results and effectiveness. Harmony Physiotherapy Ottawa will assist you in achieving a full and healthy recovery. Book an appointment with our Harmony Pelvic Physiotherapy Experts today. We can help get you back on your path of recovery!


Dr. Richa Rehan

Harmony Physiotherapy

"We Help Women Through Pelvic Pain, Pregnancy, Postpartum And Beyond So They Can Live Active, Confident, And Healthy Lives With The Help Of Conservative Management."