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3 Post-Partum Concerns for your Pelvic Floor

Any pelvic floor physical therapist will tell you that pelvic floor physical therapy should be mandatory after childbirth. And in fact, in some countries it is – just not here in the US. Because of the location and function of the pelvic floor, these muscles work extra hard during pregnancy, labor, and childbirth. These muscles span the base of the pelvis, and are stretched to allow for changes in the hip girdle, but also work extra hard to support the hip girdle and lower spine during the changes of the growing uterus and baby. After more than 9 months of changes in pregnancy, and then labor and childbirth as well, these muscles are can be weakened, strained and tight. This is what creates symptoms of urinary (and sometimes stool) leakage, pain in tailbone, pubic bone, hip, or low back and also pain with intercourse in the post-partum period.

1. Incontinence is the involuntary leakage of urine or stool. It is common to experience this during the end of pregnancy (especially if it is not your first time) and in the post-partum time period. This occurs due from weakness in the muscles of the pelvic floor, and also because of coordination deficits with breathing. The pelvic floor should contract on your exhale, which helps to push air up and out. This is important for sneezing, coughing, and laughing. It should go away completely, regardless of age or number of pregnancies.

2. Dyspareunia is pain with intercourse, and can occur with the superficial layer or deep layer. It is common to have increased sensitivity at the scar tissue from natural tearing or after an episiotomy. The length of labor, size of the baby and any assistance (forceps, vacuum) needed during childbirth can all affect the trauma to the vulvar tissue and pelvic floor. While this usually resolves on its own after the first 2-3 times, persisting tightness can be improved with myofascial release and soft tissue massage to improve scar mobility and gentle lengthen tightened muscles.

3. Pelvic Organ Prolapse is common after childbirth, and can increase with multiple vaginal deliveries. If occurs when there is a loss of support to the organs in the pelvis. This can be due to weakness in the pelvic floor muscles, but also can be from changes to ligamentous or myofascial support. Studies report anywhere from 25-65% of women post-partum will have pelvic organ prolapse. Symptoms of prolapse include pelvic heaviness, low back pain, pressure in vaginal canal or feeling like a tampon is falling out. Pelvic floor physical therapy can improve symptoms with strength training of pelvic floor, core and hip girdle. As well as education on postures, toileting and childcare to reduce strain to pelvic floor.

As a Pelvic Health PT, I feel strongly that every woman should have a complete pelvic floor and orthopedic post-partum exam.This helps to address muscles imbalances, to address or prevent any of the above concerns with return to activity and fitness, or even to help prevent them with future pregnancies!


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