June 20, 2024

Pulse Bliss

most important health challenges

Postpartum Pelvic Floor Therapy: How It Works

After giving birth, some new parents think they’ll bounce back to regular activity quickly—but that’s usually not the case. Many postpartum people experience issues related to the pelvis, ranging from pain to urinary incontinence, and they sometimes need help addressing them. Enter a pelvic floor therapist.

These specialists “accentuate the natural healing capacity of the body” by strengthening and relaxing the pelvic floor muscles, says Tami Kent, MSPT, a physical therapist in Portland, Oregon, and author of the books Wild Feminine and Mothering From Your Center. Keep reading to learn more about postpartum physical therapy related to the pelvic floor.

What Is Pelvic Floor Therapy?

Pelvic floor therapy focuses on the group of muscles that stretch like a hammock from the pubic bone to the tailbone. These muscles often become strained during pregnancy due to hormonal changes and your baby’s weight. Childbirth may also stretch and weaken the pelvic floor muscles, whether you had a vaginal delivery or C-section.

In the postpartum period, pelvic floor issues can manifest as pelvic pain, bowel or bladder incontinence, pelvic organ prolapse, uncomfortable sex, and more. Research shows that physical therapy can address these concerns by strengthening a weak pelvic floor and relaxing tight muscles.

In some countries, like France, pelvic physical therapy is the standard postpartum care. While it’s still considered a new practice in the U.S., many American experts believe pelvic physical therapy can benefit all new birthing parents.

What Is the Pelvic Floor?

The pelvic floor muscles stretch like a hammock from the pubic bone to the tailbone. They support your bowel, bladder, and uterus, and they’re also important for sexual function. Pregnancy and childbirth can weaken the pelvic floor, leading to pain, incontinence, and other postpartum problems.

Benefits of Pelvic Floor Physical Therapy

This therapy addresses pelvic floor dysfunction, which happens when the pelvic floor muscles don’t function properly due to weakness or looseness. Research estimates about 24% of American women suffer from pelvic floor disorders.

Pelvic floor therapy might help treat the following symptoms after childbirth.

  • Urinary incontinence
  • Bowel incontinence
  • Pelvic pain or pressure
  • Pain in the vagina, lower back, hips, pubic symphysis joint, and more
  • Pelvic organ prolapse (when the pelvic organs drop out of place from weakness)
  • Diastasis recti (separation of the abdominal muscles after childbirth)
  • Painful sex

Still, not all pelvic floor therapy patients need a definitive physical symptom. “They could just be aware of not feeling like themselves in their bodies anymore,” notes Ann Udofia, PT, DPT, co-founder of Body Connect Health & Wellness in Washington, D.C. “They just feel weaker, they’re having problems connecting with their pelvic floor muscles, and they want to get a sense of what they need to be doing to reintegrate that.”

Pregnancy and childbirth are transformative experiences, adds Udofia, and “being empowered about the changes that are happening in your pregnancy—especially when it’s a first-time pregnancy—and understanding how to safely and effectively take care of yourself is important.”

Finding a Pelvic Floor Therapist

If you’re looking for a pelvic floor physical therapist, your OB-GYN, midwife, or other health care provider is a great place to start. The Academy of the American Physical Therapy Association also has a locator tool on its website to help find a therapist in your area.

What To Expect With Pelvic Floor Physical Therapy

During your first appointment, the therapist will probably conduct an evaluation. Udofia shares that whenever she meets a new patient, she does an extensive intake, in which she learns about their symptoms, their level of physical activity prior to pregnancy, their birth experience, and what they’re hoping to accomplish.” Then you’ll work to decide on a treatment plan.

Here’s what to expect during your postpartum pelvic floor therapy session.

Manual Therapy (Internal and External)

Your therapy sessions will likely include internal and external therapies. Internal therapy might be similar to an OB or midwifery appointment. Your therapist will assess the strength, tenderness, and endurance of your pelvic floor muscles (using a gloved finger inside of your vagina), and they’ll massage any trigger points.

“There are some women who are just not comfortable with [internal work] in the beginning,” acknowledges. Udofia “But there’s no pressure that that has to be done the first time that you see a pelvic physical therapist.”

A session may also include external work on the abdominal muscles, spine, hips, rib cage, and lower or upper body. Imbalances in these areas can throw pelvic alignment off. Scar tissue assessment might also be conducted (for C-section scars and perineal tears).

Strengthening Exercises

Treatment will also involve core strengthening and pelvic stabilization, relying on exercises to target the appropriate muscles. Some exercises will be completed during the therapy session, while others should be done at home.

Your therapist may also teach you how to do Kegels correctly (though it’s important to note that Kegels can worsen certain postpartum symptoms, so they’re not always recommended for treatment).

Other Techniques

Depending on your circumstances, the pelvic floor therapy sessions might involve yoga, ultrasound, biofeedback, electrical stimulation, and other tactics. Breathing techniques can also help the process sometimes. “If I’m finding that a patient’s breathing mechanics are off, that can change how they’re stabilizing through their core and pelvic floor muscles,” says Udofia.

The Bottom Line

Birthing people should prioritize their own rest and physical recovery, especially in the first few months after delivery. Pelvic floor physical therapy is one major way of doing that, and it offers a bevy of benefits—in both the short and long term. Regular sessions can help alleviate symptoms by strengthening and relaxing the pelvic floor muscles.