Postpartum
Healing, Strength & Wellness
The pelvic floor muscles play a tremendous role in pregnancy and childbirth. They help stabilize the pelvic girdle while supporting the growing uterus and baby. During childbirth, these muscles undergo additional changes, whether delivery is vaginal or by cesarean section.
Postpartum, the pelvic floor muscles are often a combination of weak and tight, which can contribute to pelvic and abdominal pain, urinary leakage, and poor stability.
The abdominal muscles are also lengthened and weakened during pregnancy. Often times this results in diastasis, low back pain, tailbone or pubic pain.
Postural changes during pregnancy can contribute to tightness in the muscles at the front of the hips and shoulders, rounded shoulders, and increased lumbar lordosis. There are also changes to our breathing patterns and coordination.
These changes, combined with the care of a newborn can create pain and difficulties with childcare, daily chores, walking and returning your normal routine or fitness goals.
Diastasis Recti (DR)
Studies have shown that 100% of women will have a diastasis recti. This is a split along anywhere in the rectus abdominals, above or below the umbilicus. It can range from significant doming to barely noticeable.
This is measured by finger width and depth. The biggest factor with healing a DR is the strength of transverse abdominus below, and proper activation between that muscle group and the pelvic floor.
Urinary Incontinence and Leakage
It can happen (and be very scary!) that you leak urine after childbirth.
Some women will stand and feel like urine pours out. A lot of times this naturally resolves in the first 7-10 days, but it should not persist. But it should not persist as you get back to running and fitness, laughing and coughing.
Neck and Back Pain
You should never have pain with childcare – whether lifting the carrier, prolonged feeding postures or carrying your baby. The changes to the core and pelvic floor from pregnancy and then delivery, combined with the increased demand of infant care can cause neck, upper or lower back pain.
Physical therapy helps to identify and improve postural changes from pregnancy and child care. Restoring core and pelvic floor strength improves stability to the lumbar spine. Soft tissue techniques help to reduce tension in shoulders, back and hips, allowing for more mobility and better muscle function.
Painful Intercourse
You will not be cleared for intercourse for at least 6 weeks, to allow for healing from delivery.
Due to the trauma of the pelvic floor muscles from delivery (even with a cesarean) it is typically painful for the first time. It should be tolerable, and resolve after the first 1-3 times.
Pelvic floor physical therapy uses massage and myofascial release techniques to the superficial and deep layers of the pelvic floor muscles to resolve pain.
Perineal Tears & Scar Tissue
Our bodies allow for natural tearing during a vaginal delivery. In very rare cases (this used to be common practice) will there be an episiotomy.
Depending on the delivery, how long you are pushing, how fast (or slow) your baby comes out, and whether or not there was any assistance will effect how significant the tear is. Initially the scar tissue from the tearing can be painful to touch and stretch.
Sometimes it does require pelvic floor physical therapy for scar massage techniques to improve mobility and reduce pain.
Cesarean Section Recovery and C-Section Scars
C-section childbirth creates additional trauma to the abdominals and uterus, and layers of fascia and muscle in between. This is in addition to the changes during pregnancy, and can also be compounded with labor and pushing if it was unplanned. Initially
Physical therapy can be helpful for safely returning to lifting and childcare.
Manual therapy is important for:
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Scar tissue and fascia restrictions to reduce pain and scaring
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Smoothing and eliminating the shelf like appearance
Neuromuscular re-education is important to restore normal breathing patterns, and to address core and pelvic floor muscle strength for returning to fitness.