Pelvic Floor Physical Therapy Part 2: Post-Partum Rehab

At Foundational Concepts, we love working with clients to rehabilitate after delivery! 6 weeks, 6 months or 6 years, there is always so much to teach, so much progress to be made, and so many women who look at you with eyes welling up in gratitude for the words you’ve just said, “This can get better.”  To expect that after delivery women should accept things like urinary incontinence, pain, or pelvic organ prolapse as if there is no hope for these ever returning to any kind of normal, is disheartening.  Many times we hear “Give it time” or “You did just deliver a baby”.  The truth is giving it time won’t take care of your pelvic symptoms. Pelvic floor physical therapy can help you heal and thrive after baby. .

Let’s begin with the trauma of giving birth.  Give yourself some serious points here, as this process is truly amazing, but at the same time horrifying for those poor tissues and muscles within the pelvis.  Their ability to stretch is on level with some super-human abilities, if only the recovery were as easy.  We can compare delivery to a whip-lash injury in a car accident. Those pelvic muscles are stretched to their max in a short amount of time, often with tearing of the fascia and connective tissue and/or nerve tissue aggravation. Or we have the reverse, where a woman is asked to push for 2-3 hours, which is darn near the time it takes to run a marathon!  We expect that people after whiplash or after running a marathon will have full recovery and return to their normal activities, so why not after baby?  Well, for years women were just accustomed to the problems that bearing children left them. Thank heaven for modern progress and for pelvic PT’s everywhere!   We are working hard to get the information out, educate people and providers so that we can live happy healthy and active lives, laugh with our friends without leaking, and enjoy sex with our spouses!

What exactly do we do at Foundational Concepts? As Pelvic Physical Therapists we start with a very thorough musculoskeletal evaluation. We rule out the lumbar spine, sacroiliac joint, pubic symphysis joint, hip joint, and the abdominal wall as a source of the problem.  We will examine your abdominal, pelvic floor and spinal musculature to determine weakness, poor coordination, muscle imbalance, and dysfunction. These joints, connective tissues, and muscles must all work together, in a coordinated manner, or symptoms such as urinary incontinence, pelvic organ prolapse,  constipation, coccydynia (tailbone pain), pain with sex, or vaginal or pelvic pain with other activities will appear.

The trouble with “just giving it time” is, it won’t generally work itself out on it’s own. You will heed the advice of the media or other fitness gurus who will work your abs, gluteal, hamstrings, and quads until they are so sore you can’t get out of a chair, but you won’t see the pelvic symptoms resolve. This is because strengthening these big, global muscle groups will only mask or worsen your problem. You have to get to the source of the problem and physical therapists, namely pelvic floor physical therapists, are the only specialists who truly know how to examine the many muscles that make up the pelvic girdle, while also examining the spine, SI joint and hips and put it all together to develop an individualized program to help you reach your goals.   Pelvic Physical Therapists will take the time to find the source of your problem, devise a treatment plan that will work for you, and spend countless hours educating you so that you can continue to maintain a healthy pelvis after you are no longer seeing us.

It is important to determine what your pelvic floor muscle strength & coordination are. Often in early post partum there is generalized weakness and laxity of supportive tissues. But in later post partum we might find muscle over activity. These two situations are very different and require a different approach to rehabilitation. It is also important to screen for pelvic organ prolapse. This is important to address before returning to exercise. Screening for Diastasis Rectus Abdominus is also an important factor in rehabilitation. This condition is a laxity in the connective tissues of the abdominal wall and must be addressed individually to reach the optimal function and safely get back to exercise and activity. All of these conditions can exist with bladder or bowel leakage, pelvic pain or other joint pain.

So ladies, please hear what I am saying!  You are not alone, we see these pelvic symptoms often, even years after the last baby.  You can stop hurting and enjoy sex again. You can sneeze, cough, and laugh hysterically and not leak. You can return to activities and exercise you love and see your abdominal wall get stronger.  We can help you do it!  Our clinic was founded for this purpose!  Foundational Concepts focuses primarily on pelvic dysfunction, and we want to help you feel better. We offer a free 15 minute phone consultation to answer any questions. Dont wait to come in to see us and see what we can do to help! It is worth your time, money and effort.

–Sarah Dominguez, PT, MSPT, CLT, WCS

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at foundationalconcepts.net for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Instagram @foundationalconcepts and like us on Facebook at Foundational Concepts for updates.