"Expecting more from your postpartum care” Pelvic Floor Physical Therapy during pregnancy and postpartum
The journey into motherhood is a beautiful one packed with surprises and new experiences. There’s a lot of questions when it comes to caring for Baby… but what about when it comes to caring for Mom? Have you asked any of the following:
“Is it normal to leak when I sneeze or laugh now?”
“Will I ever run or jump on a trampoline again?”
“I feel pressure down there… is something falling out?!”
“Sex doesn’t feel the same as before. Is it going to hurt from now on?”
I’ve heard this story time and time again. Mom is at her 6 week check-up with her OBGYN, expressing concerns about all the above.
What answers does she frequently get?
“Have a glass of wine before sex it’ll be fine”
“Don’t worry about it.”
“It will resolve itself.”
What happens when it doesn’t resolve itself? It’s unlikely that true musculoskeletal dysfunction will just go away. I can’t imagine an orthopedic surgeon telling a patient with a torn rotator cuff that “it will resolve itself.” These concerns are so often disregarded. As long as baby is healthy and the tissue down below has healed, the doctor has done his/her job. This is no knock on any medical doctors, they are often not exposed to or educated on Pelvic Floor Physical Therapy as part of their training.
Yes, it is common to leak or experience painful sex after baby. Yes, it is common to feel pressure down there especially after a long active labor. Yes, it is common to feel apprehensive about getting back to running or your exercise routine postpartum. Yes, it is common to feel like your core is weak or that something is just “off”.
Just because these symptoms are COMMON does not mean they are NORMAL.
Pelvic Floor Physical Therapy is a specialty that focuses on everything new moms are encouraged to accept as their “new norm”: leaking, painful sex, pelvic pain/pressure, general aches and pains. We treat all things pee, poop, sex, pregnancy and postpartum. Pelvic PT is not a hot new trend, in fact, France mandates 20 sessions of pelvic floor PT 6-8 weeks postpartum and has been doing so since 1985; their rates of urinary incontinence and postpartum depression (PPD) are a fraction of ours in the United States. This makes sense as incontinence and PPD are highly correlated.
The pelvic floor consists of three layers of muscles that sit at the base of the pelvis like a bowl. They SUPPORT our pelvic organs (bladder, uterus, rectum), aid in continence through SPHINCTERIC control and play a role in SEXUAL pleasure. The pelvic floor works with the diaphragm (breathing muscle), deep abdominals (transversus abdominis) and low back extensors to comprise the deep core. Just like any other muscle in the body, it can be weak, tight, uncoordinated and/or have trigger points. Muscles that are too lengthened or are too tight cannot function effectively. The pelvic floor can be tight AND weak.
“Isn’t it just doing kegels?”
NO! Being able to contract the pelvic floor is just one piece of the puzzle.
We need to be able to both CONTRACT and RELAX the pelvic floor. Peeing, pooping, childbirth and sex requires the pelvic floor to drop and lengthen. More often than not, this is a skill many patients have to learn. How do we teach our patients? Believe it or not, the gold standard to assess pelvic floor muscles is an internal exam. This is typically done vaginally, but occasionally a rectal exam is warranted. A pelvic PT will use gloves and lubrication to assess tone, tenderness, strength, coordination and motor control. If you are uncomfortable with an internal exam, there’s plenty of other pieces of the puzzle to work with; posture, breathing, visceral or organ mobility, muscle restrictions, and strengthening just to name a few.
I am thrilled to offer my first 4-week “Heal Your Pelvic Floor with Dr. Carly” in partnership with The Nesting Place. In addition to learning pelvic floor anatomy and basics, we will be going through core progressions and pelvic floor relaxation techniques. Hope to see you there!
Health & Happiness,