Most people are aware that they need to see a physical therapist after a knee surgery or an ankle sprain to optimize healing and improve function but what about pelvic floor physical therapy after child birth? It’s often assumed that since child birth is a natural process that our bodies just go back to how they were before.
Unfortunately, there is no bounce back. It can take months for our bodies to heal postpartum and shift back to place – and sometimes they don’t without assistance. Our pelvis and rib cage expand during pregnancy. Our pelvic bones continue to shift during vaginal birth. Muscles and ligaments can get damaged during the birthing process with sprains, strains and tearing common and cesarean births are a major abdominal surgery.
To top it off and as a clear sign that we simply do not bounce back after child birth is the high prevalence of pelvic floor dysfunction postpartum. A 2023 Japanese study reported that 73.6% of participates experienced some type of pelvic floor dysfunction between 6 and 15 months postpartum.
What’s your pelvic floor and how does it change in pregnancy
Your pelvic floor is really more of a pelvic hammock or trampoline. Instead of being solid and rigid like a floor, there is give and movement. Your pelvic floor is a group of muscles and ligaments in 3 layers that are located at the bottom of the pelvis and act as the foundation of your core. They support your pelvic organs, are important for bowel and bladder continence and sexual function. They also help ensure optimal posture and movement patterns and force production.
During pregnancy you produce the hormone relaxin which helps with ligament laxity allowing the pelvis to shift and widen to make room for baby. This widening that occurs causes the pelvic floor muscles to stretch as the pelvis expands. This continues to happen during the pushing phase when the levator muscles (part of the pelvic floor group) stretch on average 200%. During this stretching there is a chance of damage to muscles, nerves and soft tissue in the area.
In the event of a c-section the amount of additional stretching will be related to if any pushing that might have also occurred. The initial stretching from pregnancy is still present regardless of pushing and delivery method. C-section births pose there own challenges to the pelvic floor as they are major abdominal surgeries. Scar tissue can cause issues down the road as it can cause adhesions.
What is pelvic floor physical therapy?
Pelvic floor PT is physical therapy that focuses on the pelvis and pelvic floor. Great but what exactly is physical therapy you ask? Well in short it is a branch of rehabilitative health that uses exercise and other modalities to decrease pain, improve function, obtain physical goals and ultimately improve quality of life. Physical therapy is very patient/client focused and should always be a team approach between therapist and said client. Pelvic PT is no different.
Pelvic floor physical therapy is the evaluation, assessment and treatment of individuals experiencing pelvic floor dysfunction or orthopedic conditions which involve the pelvis. While the pelvis might be the focus of the visit, it is usually not the only area addressed. Our bodies function best when the whole system is working together and generally benefits from a full system approach.
Reasons to see a pelvic floor PT postpartum
As previously stated our bodies go through a huge transformation during pregnancy from increased weight on our joints, to ligament laxity, to postural changes all of which can have an impact on how our bodies move, feel and perform. That alone is reason enough to schedule some time with a PT postpartum.
Now tack onto that the birthing experience and the drastic changes that our bodies undergo during delivery. This can lead to a number of reasons to see a pelvic PT postpartum with the first and most obvious one being that you are postpartum. Yes, that alone is reason enough to see a PT to allow for proper healing and recovery and to move through realistic timeframes to return to specific activities. Unlike what you might have heard the 6 week mark is not the green light for everything. Higher impact activities and heavier lifting are best to wait until closer to 12 weeks (or even later) and require signs of readiness.
Additional reasons to see a pelvic floor PT postpartum are
- urinary incontinence, urgency or frequency
- constipation
- bowel incontinence, or difficulty wiping clean
- pain with bowel movements or painful urination
- feelings of pelvic heaviness
- pelvic organ prolapse
- sexual dysfunction including pain or decreased pleasure, inability to orgasm
- back or hip pain
- you want to get back to higher level activities such as running
- this is not an exhaustive list
Benefits of pelvic floor pt
Pelvic floor physical therapy will help you restore proper muscle balance, improve length tension relationship of pelvic floor muscles and improve muscle coordination postpartum. Proper pelvic PT will also address return to pre-pregnancy posture and improve alignment while also addressing breathing and pressure management. Pelvic floor PT can improve and often eliminate many of the symptoms that brought one to seek care in the first place as well as act as a prevention for dysfunction from developing when seen postpartum.
Is there a time frame?
The good thing is it is never too late and it definitely isn’t too early. Early intervention can help prevent issues from arising and ensure a smoother (and more comfortable) transition into motherhood.
Ideally you will want to schedule an appointment prior to experiencing any dysfunction. Typically, if preventative, you will be seen after your 6 week visit with your physician. However if issues are arising or you are experiencing pain prior to your 6 week visit, you should call and make an earlier appointment and discuss PT as part of your plan of care.
What to expect in your appointment?
Your first visit will be your initial evaluation and assessment. Your therapist will take a thorough history which will include your medical history, history of your pregnancy and birth process as well as the symptoms that you are noticing.
During your first visit your posture and breathing patterns will be assessed, movement patterns and body mechanics will be looked at as well as range of motion, muscle strength, balance and coordination. This will be done through observation as well as hands on assessment and palpation.
If it is warranted and if you are feeling ready you will also have an internal examination. This can help to better assess the pelvic floor muscles. No worries though this does not have to occur on the first visit, if at all. While an internal examination is the gold standard, there is a lot that can still be achieved without it. Rest assured you are in charge here and the visit will go at your pace. If you do have an internal examination know that there is no speculum involved, only a gloved finger.
Following your evaluation, your physical therapist will go over their findings and discuss your plan keeping in mind your goals and what you hope to get out of your sessions. Your PT will also provide you with some homework it might be in the form of exercises or lifestyle modifications or an ongoing assessment such as a bladder diary.
Follow up visits
Each follow up visit will be set up to address any issues found during the initial assessment and also review how you are feeling with any homework that you were provided. Your visit will be a mix of the following.
- breathing exercises
- education and awareness
- bladder retraining
- postural re-education
- manual therapy – both internal and external
- mobility work
- strengthening exercises
- additional treatments and modalities such as cupping, dry needling, bio-feedback, electrical stimulation etc.
How long will you have to go to physical therapy?
You can expect to be seen 1 to 2 times a week either in person or virtually. The length of time you will need to see a physical therapist will depend on several factors. Severity and complexity of symptoms, what your goals are, and time since onset of symptoms all play into duration. Although a good guess is 6 weeks this can be longer or shorter based on the above. Typically the longer you have been dealing with something the longer it takes to resolve. This is especially true for chronic pain and pain will often benefit from a multidisciplinary approach. This means you, your PT, your physician and any other careers should be working closely together.
How to get started?
If you are in the US most states have direct access to physical therapy meaning you do not need a script from your physician to be seen for your first visit. Each state does have different rules and policies in place around this. That being said speaking with your birthing provider is a good place to get referrals.
I like to advise speaking with a pelvic floor physical therapist prior to birth of your baby, if possible. The time prior to the birth of your baby is the optimal time to start looking into your postpartum care team. That should include having numbers for mental health support and physical support on hand for when needed. The next best time is now. As stated before it is never too early to plan for postpartum recovery and it is never too late to seek the care you deserve.
If you are local to me, living in the North Shore MA area and are in need of services contact me directly. I offer in-home concierge physical therapy and postpartum wellness coaching for a smoother postpartum journey.