Pregnancy and childbirth cause many dramatic changes in your life and body. Some changes may be expected and exciting, while others are less so. If you are pregnant or have given birth and notice changes such as stress incontinence (urine leakage when laughing, coughing, sneezing, jumping, or squatting), pain in your pelvis, or not making it to the bathroom in time, you are not alone. It may be time to consider pelvic floor therapy.
These are not embarrassing or inconvenient parts of pregnancy or life after childbirth. These are symptoms of pelvic floor dysfunction caused by weakened or injured pelvic floor muscles, a common and treatable condition.1 If you are suffering from these symptoms, postpartum pelvic floor therapy guided by a pelvic floor therapist can significantly improve your quality of life. Take the time to learn more and to take care of yourself.
What is the Pelvic Floor?
Your pelvic floor is a supportive hammock-like structure made of a group of muscles.2 These muscles keep the organs in your pelvis, such as your bladder, uterus, ovaries, and rectum, in place. They also facilitate urine and bowel control in coordination with other pelvic structures like the urethra and the anus.3 To locate your pelvic floor muscles, take a moment to imagine you are trying to stop the flow of urine while you pee. The muscles you would squeeze to do this are your pelvic floor muscles.4
How Your Pelvic Floor is Affected During Pregnancy
During pregnancy, your pelvic floor supports your baby as your uterus grows and your placenta, and an increased blood supply to nourish your baby.5 This increased weight causes stretching and potentially weakening pelvic floor muscles.6 This is why some women experience pelvic floor weakness symptoms during pregnancy.2 Constipation during pregnancy and straining to pass a bowel movement can also cause the pelvic floor muscles to weaken.5
For a vaginal delivery, the pelvic floor muscles must stretch even further, up to three times their original length. This allows your body to accommodate your baby’s descent down the birth canal, particularly during pushing.13 In addition to pelvic floor muscles experiencing trauma, nerves can be stretched, causing postpartum pelvic pain, which may happen with or without sex. If forceps or a vacuum are used to help deliver your baby, the risk of pelvic floor injury increases. In addition to urine or bowel incontinence, weakening of the pelvic floor muscles can impact their ability to support other pelvic organs later in life.7 This can lead to a condition known as pelvic organ prolapse, as the organs that the pelvic floor is designed to support (the uterus, bladder, and rectum) drop down into the vaginal canal.8
Some women’s bodies recover more quickly and completely after giving birth, while others may take longer or need additional restorative support. It is essential to pay attention and listen to your body. If you are experiencing symptoms that are negatively impacting your quality of life, it is best to seek resources from your OB provider, such as referral for rehabilitation through pelvic floor therapy (or postpartum physical therapy) specifically aimed at restoring strength in the muscles of your pelvic floor.5
How Can a Pelvic Floor Therapist Help?
Pelvic floor therapy is a specialized physical therapy to restore strength in the pelvic floor muscles. The goal is to help resolve symptoms of pelvic floor dysfunction through various exercises and strengthening techniques.9 A pelvic floor therapist is a physical therapist who has additional training to identify and treat pelvic floor disorders.11
Pelvic floor physical therapy treatment can also focus on strengthening the abdominal muscles for mothers who have diastasis recti or a separation of the abdominal muscles that can happen during pregnancy and delivery.6
Pelvic Floor Therapy: What To Expect
Effective pelvic floor physical therapy begins with your therapist discussing your medical history, what symptoms you are experiencing, and what goals you would like to achieve through therapy.9 Your therapist can teach you about the anatomy of the pelvic floor using a model of a pelvis or pictures to explain how the weakening of specific pelvic floor muscles may cause your symptoms.12
Your therapist will perform a physical exam, including an assessment of your hips, spine, and pelvic floor muscles, to assess which muscles need strengthening.11 The pelvic floor muscles are during a pelvic exam similar to the one you get during a pap smear, but there is no need for a speculum or stirrups. The therapist inserts a gloved finger into your vagina to determine the specific muscles contributing to your symptoms. You may be asked to squeeze and relax your pelvic floor with instruction from your therapist. Be sure to communicate with your therapist if you are not comfortable at any point.9
Next, your therapist will discuss your treatment plan to meet your individual needs and how to prevent worsening dysfunction as you age.2,6 Techniques include exercises, biofeedback therapy, and stretches you can do to strengthen your pelvic floor muscles.2 You may also receive recommendations on lifestyle changes to help improve pelvic floor function and prevent things that may worsen your condition, like constipation.9
Does Insurance Cover Pelvic Floor Therapy?
Many insurance companies that cover physical therapy will cover pelvic floor therapy. It is best to verify with your insurance provider beforehand to find out if it will cover your treatment and if you’ll need a referral from your doctor.10
Do I Need to See a Therapist? Can’t I Do Kegel Exercises?
It is a common misconception that doing Kegel exercises alone at home can help all pelvic floor issues.11 Also, many people do them incorrectly initially; for example, they may hold their breath or tighten their thigh or buttocks muscles.7 This could do nothing to help your symptoms or may make them worse. A pelvic floor therapist can determine if Kegels are right for you and, if so, teach you the proper techniques so they are effective. They can also answer any questions you may have.11
Kegel exercises are one of the many forms of pelvic floor muscle strengthening. You can do them by squeezing and holding your pelvic floor muscles for three seconds and then relaxing in sets of 10 three times a day. Each week, as your muscles strengthen, you can increase the hold by one second and eventually achieve the goal of a 10-second hold.7
Can You Do These Exercises During Pregnancy?
Kegel exercises are safe during pregnancy; however, if you have symptoms such as pain or urine leakage before delivery, talk with your OB provider.4 You may get relief with formal pelvic floor physical therapy. Your pelvic floor therapist can teach you exercises for your specific needs and continue or modify treatment as needed after delivery.12
When To Start Pelvic Floor Therapy After Birth
As your body recovers from giving birth, your muscles undergo further physical changes. This is why some symptoms of pelvic floor weakness resolve on their own with time. However, if you have symptoms at your six-week postpartum follow-up appointment, talk to your provider about what you are experiencing. Your provider can give you a referral to a pelvic floor therapist. If you haven’t made it to six weeks and your symptoms are negatively impacting your quality of life, you may want to seek treatment sooner.14
Your body can do amazing things: growing your baby, giving birth, and, in the case of pelvic floor weakness, healing itself with the proper therapeutic guidance. Although symptoms of pelvic floor dysfunction occur frequently in motherhood, they have a treatable cause, which means you do not have to suffer. If you are experiencing urine or bowel incontinence or pelvic pain, be your own advocate and find a pelvic floor therapist. Take care of your body and seek help. You’ll be glad you did, now and for years to come.