The physical therapists in our pelvic floor program recognize that women, in the traditionally defined sense of the word, are not the only people who suffer from pelvic floor dysfunction. We seek to be inclusive, and welcome any person, regardless of how they identify, who presents with pelvic related pain, bowel and bladder dysfunction, sexual dysfunction, and post-surgical scarring.
Specific to women who choose to have children, many will experience pain that begins in pregnancy, which, if not treated early, will continue to persist for years or even decades after child birth. These conditions often include low back, pelvic girdle, and hip pain. Postpartum conditions may include tailbone pain, diastasis rectus abdominis, scar tissue related to C-section or vaginal delivery, bowel and bladder dysfunction, organ prolapse, and sexual dysfunction. Early intervention for these conditions can minimize long-term effects of pregnancy. Our women’s health therapists understand how pregnancy, delivery, and childcare can affect a woman’s body both acutely and in the long term.
Our pelvic floor and women’s health program seeks to treat all people in a compassionate and non-judgmental setting. We are open to treating all people experiencing pelvic floor dysfunction.
5 Things Pelvic Health Physical Therapists Want You to Know About Your Postpartum Body
1. Being pregnant puts a lot of stress on the pelvic floor whether you have a vaginal delivery or cesarean delivery.
The pelvic floor is a hammock of muscles that sits at the bottom of the pelvis. The pelvic floor plays a role in sexual function, assists in continence, stabilization of the pelvis, and the pelvic floor is the support structure for our internal organs against gravity. The pelvic floor supports the bowel, bladder, uterus and other organs in our abdomen. During pregnancy there are a lot of changes happening as the baby grows and the uterus expands. This extra weight and shifting of organs creates extra pressure on the pelvic floor. Pelvic health PT is a specialty physical therapy practice that assesses the strength and function of the muscles of the pelvic floor. A pelvic health therapist checks these muscles with external observation and an internal exam. Keep reading for what to expect following delivery.
2: Leakage of urine, feces, or gas is not normal (although common)
That’s right, leakage after pregnancy and delivery is not normal, but it is common. Leakage during pregnancy is also common. As a pelvic health physical therapist, I hear all the time, “Well I just leak a little, but that’s normal, I mean, I had a baby.” Unfortunately, this message is often supported by the medical community. Leakage of urine, feces, or gas is very common after pregnancy, but it is not normal. A pelvic health physical therapist can assess the muscles of the pelvic floor following pregnancy and determine the best exercises to restore healthy movement and control of the pelvic floor.
3: When can I come to see a physical therapist?
You can come to see a physical therapist at any time during your pregnancy or during your postpartum time. If you are hoping to have your pelvic floor assessed after delivery you will need to wait until after your first postpartum visit with your doctor – usually 6 week after vaginal delivery and 8 weeks after cesarean delivery. However, there are a lot of things a PT can help with in the early phases after delivery, such as body mechanics with lifting, changing, and feeding your baby. Additionally, early activation of the core can be helpful. The pelvic health therapists at Union PT are both orthopedic therapists first. In the early stages of postpartum we can help with all sorts of aches and pains that may be associated with life.
4: What to expect in the first 6 weeks postpartum
The first 6 weeks postpartum can be a bit of a blur. It is a huge change to add a new baby. There will be changes to your body and your sleep schedule. Your core and your pelvic floor is also going through a lot of changes. Much of the items listed below can be addressed during pelvic health PT, but should also be discussed with your OB/GYN or Midwife.
Vaginal tearing and stitches
Pain with urination
Pain with washing
Leaking urine or feces
Separation of the abdominal muscles – Diastasis Recti Abdominis or DRA
Pelvic organ prolapse or POP
Scar pain, persisting pain once scar has healed
Pain with bed mobility
Pain with lifting baby
Leaking of urine or feces
Separation of the abdominal muscles (Diastasis Recti or DRA)
Some women who have a c-section delivery can have pelvic floor trauma from the pregnancy or labor
At the 6-week follow up with your OB/GYN or Midwife they will check for tissue healing, uterus and cervix integrity, and maybe pelvic organ prolapse (POP). There is often no assessment of pelvic floor strength. Your doctor may ask about pain, incontinence (leakage) or difficulty you may be having. They may recommend PT, but they may not. This follow up visit is an excellent time to ask to be referred to physical therapy. Some insurances require a referral or a prescription for PT, but some do not. If you are newly post-partum you should be checked off by your physician prior to having an internal pelvic muscle exam, but as noted above there are many PT interventions that may be helpful in the first weeks of postpartum care to years following pregnancy.
5: What can I expect after the first 6 to 8 weeks and how can a physical therapist help?
Six weeks postpartum is is NOT normal (although common)
To leak urine, gas, or feces when you cough, sneeze, strain, laugh, run, jump, etc.
To have persistent pressure in your vagina or feel like something is “falling out of you”
To have pain when urinating or defecating, with intercourse, with tampon insertion, with OB exam
To have low back pain, buttock pain, or hip pain that persists after delivery
Recovery after delivery may be a slow process, but it should follow a generally upward trend, if you’re getting stuck due to any of the above, time to consult a PT. Working with a physical therapist can help you get you back on track, including getting back to your fitness goals. Even if it has been a number of years since you have had your child it is never too late to start physical therapy to address pelvic health concerns.
Union Physical Therapy has two pelvic health PTs. Sarah Kaiser, PT, and Amanda Benson, PT. Both of our pelvic health therapists are orthopedic therapists first, which means they look at the whole body as part of the assessment process and not just the pelvic floor. Schedule an appointment today at https://www.unionpt.com/schedule/
About the author: About the author: Amanda Benson, PT, DPT, CMPT, OCS has been treating patients in the Seattle area since 2005. She has advanced training in manual therapy, in orthopedics and pelvic health. Amanda has been expanding her women’s health practice over the last year. When Amanda isn’t seeing patients at Union PT you can find her spending time with her husband, daughter, and dog.