Every woman deserves pelvic floor physical therapy postpartum, no matter if she delivered vaginally or by cesarean section. Pregnancy and childbirth change our bodies in miraculous and tremendous ways and I believe we as a society could honor those changes more by making rehabilitation after childbirth standard care.
However, that is not yet the case so for now I would like to shed light on some postpartum experiences that definitely call for pelvic floor physical therapy.
● Stress Urinary Incontinence.
○ What it is: Leaking urine with coughing, sneezing, laughing, or physical activity.
○ Whether you leak a few drops when you sneeze or require a full pants change when you laugh, stress incontinence is not an inevitable product of having children. (See my blog post on Stress Urinary Incontinence for more details).
● Urge Urinary Incontinence
○ What it is: Leaking urine with strong, sudden urges that seem to come without warning. These urges can also happen without leaking urine, which is referred to as urinary urgency and is also a condition pelvic floor PT can help with.
● Urinary Frequency
○ What it is: Urinating more frequently than 5-7 times per day and waking more than 1 time per night to void. This tends to go along with other urinary dysfunctions as a product of either trying to keep the bladder empty to avoid leaking or as a product of urinary urgency.
● Perineal Laceration:
○ What it is: Cutting or tearing of the perineum (tissue between the vagina and anus) as a result of natural tearing or receiving an episiotomy during a vaginal delivery.
○ This is especially important for those graded 2 or higher, meaning that muscle was involved. PT can help with scar tissue management, painful intercourse, or any urinary/bowel dysfunctions that may be related to the tearing. **Having a perineal laceration does not mean that you will definitely have incontinence or painful intercourse.
● Diastasis Recti
○ What it is: A separation of the rectus abdominis muscle. This separation can lead to core weakness, back pain and other conditions.
○ Diastasis Recti or DRA has gained a lot of attention in recent years and many postpartum women are aware of its existence, but may be unsure how to determine if they have a separation. One way to self-assess is to lie on your back and lift your neck and shoulders. Notice if you see any “doming” or “bulging” along the midline of your abdomen. If you are still unsure, your OB/GYN can assess you at your 6 month visit. Either way, pelvic floor PT is a good idea for rehabilitating your abdomen and other core muscles.
● Fecal Incontinence
○ What it is: involuntary leaking or loss of stool.
○ Though this is less common than urinary incontinence postpartum, it is something that women face postpartum and may have difficulty seeking treatment due to feelings of embarrassment or shame.
● Low Back Pain/ Pelvic Pain/ Hip Pain
○ Often times, this pain begins during pregnancy and often times, it subsides after childbirth. If the pain persists or if new pain develops after delivery, pelvic floor PT can help!
● Pain with Intercourse
○ What it is: Pain felt during sexual intercourse. Sometimes, this pain is felt with other forms of vaginal penetration as well such as when inserting a tampon or when a speculum is inserted during a GYN examination.
● Caesarean section Delivery
○ What it is: Abdominal surgery in order to deliver a baby, often performed if vaginal delivery will put the mother or baby at risk.
○ C-sections are a major abdominal surgery, yet the mother is given minimal time to heal before being sent home with her newborn. This recovery can be especially difficult because the mother still has to perform all of her child care duties (i.e lifting her baby, carrying the infant carrier & diaper bag) with a compromised core. To top it all off, she often is not getting adequate sleep, a major factor in healing.
○ Pelvic floor PT helps mothers who have had c-sections retrain and strengthen the abdominal muscles that were affected by the surgery. It can also help with scar tissue management.
Though I’ve put these conditions in a bulleted format, they don’t always occur in isolation and often women have a blend of these symptoms. Your pelvic floor therapist will consider all of your symptoms and create a program tailored to meet your specific needs.
● Be your own Advocate: Doctors are amazing, but they are not mind-readers so be vocal about what you are experiencing and ask about pelvic floor therapy specifically if you think it is the right treatment for you.
● Pelvic Floor PT is not the same as an OB/GYN visit. OB/GYNs assess pregnant and postpartum women for numerous medical conditions to ensure maternal and fetal safety. This does not always include a musculoskeletal examination that would be included in a physical therapy visit, helping shed light on the troubling, yet not medically dangerous, conditions listed above.
● You probably do not need a referral Many states are Direct Access (including Vermont) meaning that you are not required to see a doctor to obtain a referral for physical therapy. This can get confusing with different health insurances, so if you are confused, call a clinic that offers pelvic floor physical therapy, they will help you get set up and let you know if you need specific authorization or referral.
● It doesn’t matter how long ago you had your baby. If you are experiencing any of these conditions, whether your children are newborns or in their 40s, you can still benefit from PT treatment. Often, women feel they missed the window of opportunity or waited too long to seek treatment. This is not the case, though sooner is usually better pelvic floor PT can still help.