The Postpartum Care Dream Team Includes a Physical Therapist!
Whether you gave birth vaginally or had a c-section, every birthing human could benefit from a pelvic PT (pelvic physical therapist). Throughout pregnancy, and especially during the third trimester, your body goes through significant hormonal and physical changes – which don’t just magically disappear or resolve once you have given birth. Your body has gone through significant changes and possibly trauma too during the labor and birthing process. Your tissues need to be given the optimal healing environment, rest, and when ready, the appropriate load, just like you would with another injury or after surgery. You may not need extensive therapy but having the foundations of how to connect with your deep core and pelvic floor as well as how to safely progress exercises, monitor symptoms, and be aware of any “red flags” are great resources to have throughout your postpartum journey.
Every postpartum journey will be different, from person to person as well as between pregnancies of the same person. Exercise history prior to and during pregnancy will have a role in the postpartum journey as well as what your individual goals are.
When Should I See a Pelvic Floor PT Postpartum?
If you have not seen a pelvic floor PT throughout your pregnancy (which we highly encourage you to do) then there is never a soon enough time to seek out one.
You will be given the option for an internal pelvic floor exam however only after you have been cleared by your physician at around the 6-week mark to allow for tissue healing.
Here is where your pelvic floor therapist can and will play a role:
#1 Return to Exercise
Waiting until the 6 weeks “all clear” from your MD may leave you feeling alone, bored, and antsy to get moving. Although we don’t want to dive straight back into our pre-pregnancy exercise routine, there are ways to get moving and exercises that we can begin prior to that 6-week mark.
#2 Resolving pelvic pain with exercise or intercourse
Pelvic pain with intercourse may have a variety of causes and treatment can include learning how to relax the pelvic floor muscles, finding different positions that are less painful, making sure you are using enough lubrication (especially if you are breastfeeding), and using manual techniques to help decrease the tension in the pelvic floor muscles.
Pelvic pain during exercise can also be caused by a multitude of factors and we need to make sure that your hips, core, and low back are all coming to the party to help support your pelvis during exercise and functional activities (like picking up your baby).
#3 Treat common dysfunction seen after birth including incontinence, pelvic organ prolapse, and diastasis recti
Incontinence is important to begin to treat early on. A study by MacArthur et al. found that around 76% of women who had urinary incontinence at 3 months post-partum reported continued incontinence even 12 years later.
Although diastasis (abdominal muscle separation) is normal at the end of all pregnancies to allow for increased space for your baby to grow, ideally it resolves itself within 8 weeks postpartum. If it is not self-resolving it is important to load the rectus abdominus (6-pack muscle) and linea alba (fascia between the two rectus muscles where we see the separation if one has a diastasis) to increase its strength and resiliency again.
Pelvic organ prolapse is more common with vaginal deliveries and according to a 2021 study of primiparous women (the first pregnancy/ delivery) up to 29% reported symptoms of prolapse 6-10 weeks postpartum. Learning how to connect to your pelvic floor (and possibly strengthen it), manage intraabdominal pressure with activity, and minimize constipation/ straining will help with prolapse symptoms. Some mild prolapses may self-resolve, especially once hormones have returned to baseline after breastfeeding, but others may not.
#4 C-section scar mobility/ reduce scar tissue restrictions
We want to make sure that your c-section scar is completely closed and fully healed prior to initiating any mobilization of the area – this is usually around the 6-week mark. We want to ensure that the scar and the surrounding tissues are easy to move and minimize sensitivity to ensure that the abdominal wall can function as efficiently as possible.
#5 Address any other contributing factors
Maybe you had some musculoskeletal pains (hip, low back, neck etc.) that were never addressed prior to your pregnancy, or you now have back pain when breastfeeding or lifting your baby out of their crib. A Pelvic PT will cover good biomechanics for movements that you will be doing over and over again and show you alternative positioning for while you are nursing.
#6 Improve pelvic floor connection and functioning
You just carried a baby for 9 months and there was a significantly increased load placed on the pelvic floor for a period of that time. Therefore, as mentioned above, regardless of your birthing and delivery method, your pelvic floor was impacted. Understanding how the pelvic floor and your breathing work together and good toileting habits will help you not only recover from birth but set you up for future success too.
Now do you understand why having a Pelvic PT on your postpartum team is so crucial?!
The postpartum period can feel lonely – but I want you to know that you are just as important as your baby is. You need to be feeling your best to be able to best care for your child. Caring for a newborn, and possibly other children, with minimal sleep and after major abdominal surgery or a pelvic floor injury is hard work. Oftentimes moms are not given the credit they deserve, and their care takes a backseat to the rest of the family. Well, not anymore! Give us a call at Up and Running PT and know that there is someone in your corner that cares as much about you as the baby.
References
MacArthur C, Wilson D, Herbison P, Lancashire RJ, Hagen S, Toozs-Hobson P, Dean N, Glazener C; Prolong study group. Urinary incontinence persisting after childbirth: extent, delivery history, and effects in a 12-year longitudinal cohort study. BJOG. 2016 May;123(6):1022-9. doi: 10.1111/1471-0528.13395. Epub 2015 Apr 2. PMID: 25846816.
Sigurdardottir T, Bø K, Steingrimsdottir T, Halldorsson TI, Aspelund T, Geirsson RT. Cross-sectional study of early postpartum pelvic floor dysfunction and related bother in primiparous women 6-10 weeks postpartum. Int Urogynecol J. 2021 Jul;32(7):1847-1855. doi: 10.1007/s00192-021-04813-y. Epub 2021 May 3. PMID: 33938963.
https://my.clevelandclinic.
org/health/diseases/22346- diastasis-recti
Thanks for reading! If you’d like to learn more about who we are and what we do, click this link: https://upandrunningpt.com/
This blog was written by Pelvic/Women’s Specialist, Dr. Sam Greig.
