Transform your Postpartum Recovery with Pelvic Floor Therapy
If you’ve ever been pregnant, you’ve probably heard of the pelvic floor – and as a pelvic floor physical therapist, I can’t tell you how blessed we are to live in an era where that’s true. But while you may have heard of the pelvic floor, there still tends to be a pretty considerable barrier between understanding that you have one and understanding how it affects you.
So let’s dive in. What is the pelvic floor?
The pelvic floor is a series of muscles and ligaments that exists at the bottom of your pelvis. It exists in both men and women, and functions to support the bladder, urethra, bowels, uterus, and vagina. The pelvic floor is imperative to allow for normal functions including peeing, pooping, having sex, and having normal hip and spine mobility.
During pregnancy, the muscles of the pelvic floor, like many others in the body, are in a stretched position for a prolonged period, experiencing an enormous challenge. It’s crucial to maintain good strength and mobility during this phase to prepare for labor and delivery. Aside from contrary belief, strengthening your pelvic floor actually leads to reduced time spent in active labor.
Childbirth, the culmination of months of challenge to the pelvic floor, can often cause injury to these already stressed tissues. Vaginal delivery can cause tearing in 90% of first-time mothers, with a slight reduction in this rate for subsequent deliveries. Like any muscle injury, this tearing and the inevitable formation of scar tissue can cause pain and dysfunction long-term. While many assume the pelvic floor would be safe for those undergoing c- section, many women labor for hours and even push prior to surgery, increasing the risk of tissue injury.
Common issues postpartum moms face include:
· Incontinence: often referred to as “leaking,” this is the loss of control of urine when you don’t intend it – like peeing when you laugh, sneeze, cough, jump, run, or lift weights
· Urgency: many moms don’t realize that they have urgency! A person typically pees 6-7 times per day, including up to once at night. If you find that you’re going more than that, or feeling a strong urge with certain triggers, you may have urgency.
· Prolapse: this is a feeling of heaviness in your pelvic floor. It describes a descent of your bladder (cystocele), rectum (rectocele), or uterus, often made worse with stress on the pelvic floor.
· Painful sex: this is pretty self-explanatory, but I’ve seen patients who’ve been told to try more lube, drink a glass of wine, and “just relax” – often the muscles of their pelvic floor are spasmed and that is causing all of their symptoms! Weakness of the pelvic floor can also cause a release of air from the vagina during or after sex.
· Constipation: defined as passing fewer than 3 stools per week or having painful bowel movements, this can often be caused by tightness to the muscles of the pelvic floor.
· Frequent UTIs: spasm of the pelvic floor musculature can cause referred pain, including symptoms masking as UTI
· Diastasis recti: this is a separation of the muscles of your anterior abdominal wall. It is characterized by “coning” or “doming” – your belly coming to a small peak with abdominal work. This can cause inefficient transfer of load on your core from one side of your body to the other and result in pain.
· Low back and hip pain: this can be caused by pain referral from spasming muscles and by inefficient load transfer due to a diastasis recti gap.
How can pelvic floor physical therapy help?
Your course of physical therapy will be as unique as your body. Every person has a different set of symptoms at baseline and especially after pregnancy and delivery. The first step in physical therapy will be your evaluation – what feels like a very invasive line of questioning followed by a gentle assessment of the pelvic floor. This exam may include an internal assessment of strength and the presence of triggerpoints (knots) but will never include a speculum. If this makes you uncomfortable, talk about options with your pelvic floor PT!
I have seen so many women that come to me after years of trying to get better on their own. It’s so common to feel embarrassed or alone in the symptoms that you’re feeling. Many wonder whether pelvic floor physical therapy can even help. That indecision and isolation so often causes years of suffering in silence, avoiding higher intensity activities, and requiring expensive pads just to live a normal life.
If this sounds familiar, my message to you is this: it doesn’t have to be this way! I’ve seen women years and even decades out from childbirth resolve their leaks, learn to take control of their abdominal separation, and enjoy sex again.
After pregnancy and delivery, it’s very common to put yourself and your health last. One thing I like to stress in pelvic floor physical therapy is that common does not equal normal. For generations, women have been told to change their lives, interests, and expectations of their bodies because they became a mother. I’m here to tell you: you don’t have to change! Pelvic floor physical therapy can be the first step in feeling like yourself again.
Signs that you may need pelvic floor physical therapy:
· Leaks of urine with or without triggers
· Bladder urgency
· Constipation
· Pain during sex
· Lack of sensation during sex
· Heaviness in pelvic floor
· Pain in the back
· Pain in the hip
· Doming or coning (a bulge in the abdomen with challenge to the muscles)
· Passing stool or gas without control
· Inability to use a tampon due to pain or falling out
· Pain in your c-section scar
You’ve probably seen loads of blogs and articles teaching you how to strengthen your pelvic floor. What I’ve found is that although strength improves some conditions, overuse of these muscles can worsen other conditions – and it’s really difficult to tell whether your symptoms are being caused by weakness or overuse. With that in mind, here are some safe exercises for anyone to get started with!
1. Diaphragmatic breathing. Place one hand on your chest and one on your abdomen. Breathe deeply, trying to move only the hand on your abdomen. The pelvic floor and diaphragm should work in tandem, so deep breathing is a good way to mobilize the pelvic floor.
2. Deep core (transverse abdominis) engagement and activation. Place your fingertips on your hip points, then roll inwards slightly. Cough to feel the muscles bulge into your fingers. This is the muscle that we’re trying to target! Engage by pulling your bellybutton to your spine and holding (while breathing), aiming for 10 rounds of 10 seconds. If you have a hard time targeting this muscle or you feel heaviness in your pelvic floor, you can elevate your hips on a pillow.
3. Stretching: happy baby, child’s pose, adductor stretch. Complete 3 rounds of 30 seconds for each stretch.
I hope this helps clear up some of the mystery, stigma, and confusion that still surrounds the pelvic floor. Enjoy the exercises, and if you’re still feeling held back by your symptoms, book a session to start your journey towards getting your life back!
