Healing After Birth: The Importance of Postpartum Pelvic Floor Therapy

Did you recently have a baby and are now wondering about pelvic floor physical therapy? The postpartum phase is both awe-inspiring and demanding physically and emotionally. It challenges your very being and can leave you yearning to get back to a sense of normalcy. With a little shift in perspective, space to allow healing to occur, and knowledge to understand the recovery process after childbirth, you can get back to your pre-pregnancy activities and goals. Even more importantly, you can keep up with your increasingly growing baby! Pelvic floor therapy will be instrumental in helping you navigate this healing process and you may be amazed at what you’re capable of achieving in this new phase of life.

Let’s get real about postpartum feelings

You just accomplished an enormous feat – bringing a new life into this world and let’s be honest, you’re probably exhausted. Not to mention, if you’re a first-time mom, you are now realizing that sleep as you formerly knew it, is hard to come by, leading to a whole new level of exhaustion. Your body feels different. You may be learning to breastfeed. You’re most likely surprised by how much bleeding and swelling occurs post-birth. You have all sorts of feelings bubbling to the surface. On top of that, you probably have many excited friends and family members eager to meet your new little one. Overwhelming is an understatement. Breathe momma. You can do this! This phase is a mere moment in time and you will be stronger than ever on the other side. In this moment though, you deserve space. Friends and family can wait until you’re feeling ready to step back out into the world.

It is common to have a 6-week postpartum check-up by your doctor or midwife after childbirth since generalized tissue healing occurs in about 6-8 weeks. Before this appointment; however, you may feel a little lost navigating all these new experiences and a healing body, but as long as there are no significant complications, such as heavy blood clots, intense pain, or shortness of breath, then you should absolutely use this time to enter ‘hermit-mode’. Do the necessities to care for your little one, enjoy the precious little moments you have with them, and try your best to rest. Rest is the first stage of any healing process. Make sure that anyone you invite over will help you to rest. It’s not the time to be entertaining others. If you don’t have family or friends willing to help you with chores and meals, then I highly recommend you find a postpartum doula. Not only will they prioritize your needs, but they’re an excellent resource for those initial stages of healing and can help you identify any concerns that may need medical attention.

 

When to seek pelvic floor therapy?

Many postpartum moms call my office to learn how pelvic floor therapy can help at various stages postpartum. They describe heaviness in the lower abdomen, significant abdominal weakness, a lower abdominal “pooch”, difficulty returning to exercise, back pain, urinary leakage, a feeling of something “falling out of their vagina”, pain with intercourse, tailbone pain, and pelvic pain. All of these are reasons to see a pelvic floor therapist.

While I often encourage moms to prioritize rest in the first 6 weeks following childbirth before beginning pelvic floor therapy treatment, there are some reasons to seek pelvic floor therapy care earlier. Consult your doctor or midwife earlier than your 6-week postpartum check-up if you are having difficulty sitting or standing due to pelvic pain or instability, or if you’re experiencing tailbone pain, low back pain, or abdominal pain. If you’re experiencing pain in these areas, or if you’ve suffered a separation of your pubic symphysis or a tailbone injury during childbirth, your provider will most likely refer you to pelvic floor therapy.

However, in most cases, it is best to be evaluated by a pelvic floor therapist after your 6-week check-up when you’re cleared to resume most activities and intercourse. This is because an internal pelvic floor examination is typically part of the evaluation process, as long as you are comfortable with it. If you seek pelvic floor therapy care prior to your 6-week checkup, an internal pelvic floor muscle examination will not be conducted.

 

How can pelvic floor therapy help?

During the initial evaluation, your pelvic floor therapist will:

  • Assess your posture and functional mobility (how you bend/lift/carry/squat/get out of bed).

  • Check for diastasis recti.

  • Assess the bones and joints of your pelvis to determine if your pelvis is still in a position of “birthing.”

  • Assess your breathing as it pertains to intra-abdominal pressure control and pelvic organ prolapse.

  • Perform a pelvic floor muscle examination to assess for weakness, coordination issues, endurance, tissue tension or tightness, and scar tissue mobility of C-Section, perineal, or vaginal tears/scars.

They will also..

  • Help you regain awareness and activation of your deeper core muscles, particularly the deep abdominals and pelvic floor.

  • Educate you on proper ways to lift, hold, and carry your baby.

  • Educate on appropriate exercise progressions to safely return to your desired routine.

 

Following the initial exam, your therapist will explain how the findings relate to any symptoms you are experiencing, such as pelvic pain, urinary incontinence, bulging of your abdomen with sit-up movements, urinary leakage, heaviness in the lower abdomen or vagina, pain with intercourse, low back pain, and even hip pain. This information will guide your treatment and the timeframe to achieve your therapy goals. While the plan of care is different for everyone, in my practice, you can typically expect to see me for 4-6 follow up treatment sessions after the initial evaluation.

 

The reality of the postpartum body and healing

It is so important to understand that postpartum healing takes time. Your body sustained A LOT of change in a relatively short period of time. Not only this, but taking care of a newborn doesn’t exactly allow you the actual rest you need for healing your body between lack of quality sleep and the physical demands of holding and carrying your little one. Additionally, if you are breastfeeding, your body is releasing the same hormones it did during pregnancy that cause ligamentous laxity. This may extend the time it takes to heal from C-section incisions, perineal tears, and diastasis recti. Even if you are not breastfeeding, Relaxin stays present in your body for up to 12 months postpartum(1). Just as during pregnancy, this hormone can cause pubic symphysis pain, sacroiliac joint (SIJ) pain, and pelvic pain.

When it comes to getting back into exercise, progressing slowly is key! By 6-weeks postpartum, 83% of women will present with some level of pelvic organ prolapse (descent of one or more of the pelvic organs into the vaginal canal) and 60% will present with diastasis recti (separation at midline of the outer layer of abdominal muscles)(1). These conditions may worsen if activity is progressed beyond the capabilities of your healing body. About 32% of women will continue to have diastasis recti by 12 months postpartum(1). A pelvic floor therapist will help you to identify simple changes in posture and positioning, as well as, safe exercise progressions to ensure proper healing.

 

What can you do before pelvic floor therapy?

Aside from rest, there are some things you can do before seeing a pelvic floor therapist that will put you on the right track in the healing process. Check out my Prenatal Blog Post for a list of safe exercises to begin as early as 3-4 weeks postpartum to start regaining core awareness and strength. You will need this strength to keep up with the demands of holding, carrying, and rocking your baby. Even as a physical therapist working with the postnatal population for years, I was thoroughly surprised by the demands of lifting and carrying that a newborn required when I experienced it for myself. It reasserted the importance of keeping your upper body strong and developing good postural habits early on with lifting and carrying your little one.

Pay attention to your posture when you are holding your little one. Do you find yourself in any of these poor postures?

Are you a Bum-Tucker?

Do you tuck your bottom under when you’re holding your little one and press your pelvis forward?

Are you a Hip-Hiker?

Do you create a “shelf” by hiking one hip up for your baby to sit on?

Are you a Rib-Shifter?

Do you thrust your ribs forward and lean into your lower back?

How to correct:

I always say that a little awareness goes a long way. Identifying a poor postural habit and making a conscious effort to correct it will make a tremendous difference in your postpartum recovery. Especially as your baby grows and gets heavier, you may develop back pain or pelvic heaviness if you continue poor postural habits. With any of these postural habits, the correction involves lengthening your spine (growing a little taller) and feeling a gentle activation of your deep abdominals. The first video in the Prenatal Blog Post will help you identify the deep abdominal muscles. Our bodies are meant to move in dynamic ways, so rigidifying your posture (or overcorrecting) is not the answer. Employ these small changes (lengthening your spine and recruiting your deep abdominals) and you will feel the difference in your ability to get out of pain (if you’re already experiencing it) and feel stronger.

Written by: Lindsay Hall, PT, DPT

 

I would love to help you on the journey of postpartum healing and rekindling joy with your body. Please reach out with any questions!

 

References:

  1. Matejka, A. (2023). Guidelines for Prenatal and Postpartum Resistance Training. IntechOpen. doi: 10.5772/intechopen.109230

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Empowered Motherhood: Pilates for a Healthy Pregnancy & Birth