Benefits of pelvic floor physical therapy during postpartum
Why you should see a Pelvic Floor Physical Therapist in Postpartum
When I had my first child, I had been a Physical Therapist for about two years at that point. I worked exclusively in a hospital setting, that did not see “female” conditions. No OB-GYN, no pregnancies, no patients early postpartum. During my outpatient rotation, I was introduced to pelvic health, and I saw clients who came in during their pregnancy, but I didn’t see any coming in during postpartum.
When women who have had kids, talked about symptoms they were experiencing, the rhetoric heard was “that’s just the way it is”. “I leak a little when I sneeze or laugh”, “I feel like a tampon is inside of me, but there isn’t”, “I have this low back pain that started during my pregnancy and it hasn’t gone away”. The list goes on.
My first son had just turned two when I went to my first pelvic floor continuing education course. The course started off with anatomy, physiology, and then quickly jumped into conditions of pelvic floor dysfunction. I heard these conditions, and I heard all the statements that I had heard before, and I heard solutions to those conditions. Why are women not informed about how they can be helped? Why are they being told this is normal, or their new life? Why am I complaining about my cesarean scar two years later, when there is help?
Before I jump into all the ways Pelvic Floor Physical Therapy can help you Postpartum, I’d like to say, it’s never too early to seek help, and it’s also never too late. Postpartum is for life, why should you suffer in silence?
During delivery, if you had a vaginal delivery, your uterus was contracting to help guide baby down through the vaginal canal, through the pelvic floor muscles. Depending on how you pushed, the integrity of your muscles and fascia prior to pregnancy and delivery, and how long you pushed, you may have a little or lot of work to do to help restore balance in this region.
If you had a cesarean delivery, you had 7 layers of tissue cut through to get your baby out: skin, fat, fascia, abdominal muscle (but they try to go though the fascia of the muscle and not the belly of the muscle), peritoneum, pull the bladder down to cut the uterus (another muscle), and finally the amniotic sac. All of these layers have mini layers of fascia in-between and therefore you have multiple layers of what can develop into scar tissue that can restrict organ mobility, muscle mobility, skin mobility, and cause pain. Not to mention, you also had persistent pressure on your pelvic floor throughout the pregnancy, and for some moms, they push for a while before they end up having a cesarean.
Therefore, any type of childbirth is going to require reconnection to the pelvic floor afterwards. The best way to establish this is with breath.
A properly functioning pelvic floor needs to be in sync with our breath system. Our pressure system is intertwined in our breath system, like a canister. Our diaphragm is at the top, deep abdominals are in the front, multifidi are in the back, and our pelvic floor is at the bottom. When we inhale our lungs fill with air and expand. This expansion of our lungs should cause our rib cage to expand out and up, like a bucket handle, and it pushes our diaphragm down. Since our diaphragm goes down, that creates increased intraabdominal pressure that can expand the belly and/ or back outwards, and pushes the pelvic floor down. When we exhale, our pelvic floor and deep abdominal muscles should contract in (towards the center) and up. This pushes the pressure up towards the diaphragm to bring it up and therefore push the air out of the lungs.
If this is out of sync for you, seek help.
What might you experience during postpartum?
Pain with sex. Pain in any part of your back. Pain in your hips or pelvis. Pain with insertion of anything. Abdominal separation (feeling like your core just can’t engage). New apron-like shelf months after your cesarean. If you had a cesarean at all. Leakage with laughing, jumping, sneezing, coughing. Leakage after you already went, and now you’re up and it’s dribbling down your leg. Not leaking, but feeling like you constantly need to go. Discomfort before you go, or after you go. Increased feeling of pressure in your vagina, or feeling like there’s something in it, when you know there isn’t. Constipation, straining, decreased frequency of bowel movements. Leaking stool. Desire to return to pre-pregnancy activities. These are all signs that there is dysfunction in the pelvic floor, and you should get some help.
Remember, postpartum is for life, so at any point, you begin to feel any symptoms, it’s time to get help.
