Updated: Dec 2, 2021
Some of the challenges that come with bringing home a new baby are expected, such as sleepless nights and endless diaper changes. But it is the unexpected problems that can be especially distressing for a new mom:
difficulty with that first bowel movement
leakage with sneezing or lifting your baby
difficulty controlling gas
perineal pain with sitting
back and shoulder pain with breastfeeding and holding your baby
pain with intercourse
vaginal pressure towards the end of the day
Where was all of this in the pregnancy books?!
Pregnancy and the process of giving birth, whether vaginally or via C-section, can mean a 1-2 punch to our core: overstretched and weakened abdominal muscles, along with traumatized and struggling pelvic floor muscles. This means that these 2 powerful muscle groups which help make up our core are often not up to the task of keeping us dry, protecting our backs, or supporting our perineum and pelvic organs.
But here is what is important to know: while these problems are common, they are not "normal", and there are steps you can take to get your pelvic floor and abdominal muscles back on track. Pelvic floor physical therapy can help get a new mom on the path to a quicker recovery, while respecting the healing process of the precious perineal tissue, and help to prevent problems in the future.
Having a baby the French Way
Did you know that in France, all new moms receive pelvic floor therapy, automatically? After giving birth, women are prescribed 10 sessions of rééducation périnéale, in the form of pelvic floor exercises by manual therapy techniques, biofeedback, and electrical stimulation. These services are routinely provided, regardless of symptoms, and the sessions are covered as part of the country's government health care plan.
The main goal of the French program, which was instituted in 1985, is to "prevent postpartum incontinence and pelvic organ prolapse, and to restore sexual function, all major factors in a women's health and well-being."
Wouldn't it be great to actually prevent pelvic problems, instead of waiting for calamity to strike and then getting treatment? We could learn a thing or two from our French friends in this regard, and it is this standard of care which we in the United States need to strive towards, because healing our pelvic floor and core muscles are just as important to our quality of life as the healing of our uterus.
This requires a major paradigm shift. Childbirth is one of the primary risk factors for pelvic floor dysfunction, so it makes sense to address it head on, shortly after the main event, instead of waiting until a woman has had problems for years before starting treatment. One wouldn't think of foregoing physical therapy after having a knee replacement, for example, so let's start viewing childbirth for the major health event that it is!
What is postpartum pelvic floor therapy?
Every new mom's needs are different after giving birth, which means each mom needs her own personalized exercise plan to address any pelvic floor concerns. Did you deliver vaginally or by C-section? Were you able to exercise during pregnancy, or were you too sick? Did you push for 4 hours, or 4 minutes? Are you anxious about getting back to exercising? Do you have other medical problems or challenges?
Given so many variables, there isn't a one-size-fits-all program that will meet every person's individual needs. That is where postpartum pelvic floor therapy comes in; as muscle specialists, pelvic PT's are uniquely positioned to help uncover which exercises are perfect for you and your specific situation following the birth of your baby.
The goals of pelvic floor rehab are to address whatever current pelvic problems and complaints you are experiencing, as well as help prevent future pelvic floor problems from occurring by teaching mom lifelong healthy pelvic habits and exercises.
Pelvic floor therapy in the postpartum period commonly encompasses the following components:
Exercises to gently and safely rebuild the strength and coordination of abdominal and pelvic floor muscles
Learning how to protect your vulnerable pelvic floor and abdomen while they heal and minimize downward pelvic pressure as you do things such as lifting, sneezing, carrying baby, and exercising
Instruction in healthy bowel and bladder habits to help minimize straining, which can tax the tender perineal muscles
Addressing any pain complaints, such as back, shoulder, hip, pelvic, or perineal pain, scar pain, or pain with intercourse that can occur when a new mom first resumes sexual activity
What happens during a typical pelvic floor therapy visit?
Your first pelvic floor physical therapy visit can be done virtually or in person, and will typically include three parts:
Detailed history—your therapist will ask you questions about your pregnancy and delivery, bowel and bladder function, any problem or pain you might be having and when it occurs, questions about your general medical history, and your goals for therapy.
Movement exam—the therapist will ask you to do certain movements to measure your muscle strength, mobility, endurance and coordination. This might include things such as moving your back and hips; walking; balancing on one leg; squatting; and demonstrating how you hold your baby, and how you lift. Usually a pelvic floor muscle exam, if necessary, is not done until after your six-week postpartum visit with your doctor.
Home program—this is where the magic is! Based on the findings from parts 1 and 2 of your visit, your therapist will teach you the specific exercises and strategies you'll need to do at home to help restore the strength and coordination to your pelvic floor and abdominals, as well as address any other musculoskeletal problems you've discussed.
If you have no persisting or bothersome symptoms and the exercises are go well, this one visit may be all the therapy you need. If you are struggling with things such as bladder leakage, back pain, vaginal pressure, pain with intercourse, or perineal pain, then your therapist may recommend additional sessions.
Every woman deserves to have a safe postpartum recovery
But unless you live in France, you will need to advocate for yourself and search out this service! You can find a qualified pelvic floor therapist by asking your doctor, consulting national directories, such as the ones at PelvicRehab.com or American Physical Therapy Association, or by calling your local physical therapy providers and inquiring if they provide pelvic floor therapy.
It may be helpful to do this research before baby arrives, so you are all ready to go once the baby comes. Telehealth can be an especially convenient option, as you don't have to leave home or find a babysitter to see your therapist. Whether you see a pelvic floor therapist virtually or in person, or find a different type of healthcare provider to help you, be sure to save some time and energy for yourself so your pelvic floor and core can fully heal.
Feel better in your body after baby
If you have just had a baby, or if you are having any symptoms of pelvic floor or core muscle dysfunction, you can schedule a free virtual consultation with me here.
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About the Author:
Angela is the owner of My Pelvic Therapy, PLLC and a licensed physical therapist. Prior to starting her telehealth private practice, she worked as a senior physical therapist for 17 years at Advocate Lutheran General Hospital in Park Ridge, IL, specializing in helping both women and men overcome their pelvic floor challenges. She received her physical therapy degree from Duke University, biology degree from University of Illinois, and is a lifelong learner of all things PT.