The Importance of Pelvic Floor Physical Therapy Following Birth

By Dr. Christine Martirez PT, DPT on 7/10/2024

Bringing a new life into the world is a remarkable experience, but it also comes with significant changes and challenges for a woman’s body. Postpartum recovery involves addressing various physical issues that can arise due to pregnancy and childbirth. Pelvic floor physical therapy (PFPT) is an essential component of postpartum care, offering targeted interventions to help women regain strength, function, and comfort. In this blog post, we will explore the postural changes that occur during pregnancy and postpartum, the rehabilitation needed for vaginal vs. c-section births, common postpartum complaints, and how pelvic floor therapy can help.

Postural Changes During Pregnancy and Postpartum

Pregnancy:

• Center of Gravity Shift:

  As the baby grows, a woman’s center of gravity shifts forward, causing an anterior tilt of the pelvis and an increased lumbar lordosis (curvature of the lower back). This shift can lead to back pain and changes in walking patterns.

• Weight Gain:

  The additional weight carried during pregnancy puts extra pressure on the spine, hips, and knees, leading to discomfort and postural imbalances.

• Breast Changes:

  Enlarged breasts can contribute to a rounded shoulder posture and upper back strain.

Postpartum:

• Pelvic Alignment:

  After childbirth, the pelvis can remain misaligned due to the strains of pregnancy and delivery, affecting overall posture and movement.

• Core Weakness:

  The abdominal muscles, particularly the transverse abdominis and rectus abdominis, are often weakened or separated (diastasis recti) postpartum, affecting core stability and posture.

• Pelvic Floor Dysfunction:

  The pelvic floor muscles, which support the bladder, uterus, and rectum, may be weakened or injured during childbirth, leading to various functional issues.

Rehabilitation for Vaginal vs. C-Section Birth

Vaginal Birth:

• Pelvic Floor Recovery:

  Vaginal delivery can cause significant stretching, tearing, or episiotomy of the pelvic floor muscles. PFPT focuses on strengthening and restoring function to these muscles.

• Perineal Care:

  Manual therapy techniques may be used to address scar tissue and improve tissue flexibility.

• Core Strengthening:

  Gentle core exercises are introduced to address diastasis recti and overall core weakness.

C-Section Birth:

• Incision Care:

  The focus is on healing and mobilizing the scar tissue to prevent adhesions and improve tissue movement.

• Core Rehabilitation:

  Exercises are tailored to safely strengthen the core muscles without placing undue strain on the incision site.

• Pelvic Floor Strengthening:

  Despite not delivering vaginally, the pelvic floor muscles can still be affected by pregnancy and the c-section procedure itself, necessitating targeted pelvic floor exercises.

Common Postpartum Complaints and How PFPT Can Help

1. Lower Back Pain:

   • Cause:

     Often due to weakened core and pelvic floor muscles, postural changes, and carrying/lifting the baby.

   • PFPT Solutions:

     Core strengthening exercises, postural training, and manual therapy to alleviate pain and improve stability.

2. Painful Sex (Dyspareunia):

   • Cause:

     Vaginal dryness, pelvic floor muscle tightness, or scar tissue from tears/episiotomy.

   • PFPT Solutions:

     Manual therapy to address scar tissue, pelvic floor relaxation techniques, and education on lubrication and comfortable positions.

3. Urinary Leakage (Incontinence):

   • Cause:

     Weakened pelvic floor muscles may be unable to properly support the bladder, or presence of a pressure management issue through the abdomen and trunk.

   • PFPT Solutions:

     Pelvic floor muscle training, pressure management strategies, biofeedback, and bladder retraining exercises.

4. Pelvic Organ Prolapse:

   • Cause:

     Pelvic floor muscles and ligaments are weakened or damaged, causing pelvic organs to descend into the vaginal canal. Also can be caused by a pressure management issue through the abdomen and trunk.

   • PFPT Solutions:

     Pelvic floor strengthening exercises, postural re-education, use of pessaries, and education on managing symptoms and preventing worsening of the condition.

5. Diastasis Recti:

   • Cause:

     Separation of the rectus abdominis muscles due to the stretching of the linea alba during pregnancy

   • PFPT Solutions:

     Specific exercises to close the gap and strengthen the transverse abdominis, avoiding movements that exacerbate the separation.

The Role of Pelvic Floor Physical Therapy in Postpartum Recovery

Pelvic floor physical therapy offers a comprehensive approach to postpartum recovery, addressing the various physical challenges new mothers face. Here’s how PFPT can help:

Comprehensive Evaluation:

• Assessment:

  A thorough evaluation of the patient’s medical history, pregnancy, and delivery experience, followed by a physical assessment of posture, movement patterns, and pelvic floor muscle function.

Individualized Treatment Plans:

• Pelvic Floor Exercises:

  Tailored exercises to strengthen or relax the pelvic floor muscles, addressing specific dysfunctions and improving overall pelvic health.

• Core Rehabilitation:

  Exercises to safely strengthen the core muscles, including those affected by diastasis recti, enhancing stability and support for the spine and pelvis.

• Manual Therapy:

  Hands-on techniques such as myofascial release, soft tissue mobilization, and scar tissue management to improve tissue flexibility and reduce pain.

• Postural Training:

  Education on proper posture and body mechanics to prevent strain and promote optimal alignment during daily activities and baby care.

• Bladder and Bowel Retraining:

  Strategies to manage incontinence and improve bladder and bowel function.

Education and Support:

• Pain Management:

  Techniques to manage pain and discomfort, including relaxation exercises and supportive devices if necessary.

• Healthy Habits:

  Guidance on nutrition, hydration, and lifestyle modifications to support overall recovery and well-being.

• Labor and Delivery Preparation:

  For future pregnancies, PFPT can provide education and exercises to prepare the body for labor and delivery, potentially reducing the risk of severe pelvic floor trauma.

The postpartum period is a critical time for healing and recovery. Pelvic floor physical therapy offers essential support for new mothers, addressing the physical changes and challenges that arise after childbirth. By focusing on strengthening the pelvic floor and core muscles, improving posture, and managing common postpartum complaints, PFPT helps women regain their strength, function, and confidence. If you’re experiencing postpartum issues, consider consulting a pelvic floor physical therapist to support your recovery journey.

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