BY PHRC Admin Team
All those who are pregnant and/or postpartum can benefit from pelvic floor physical therapy given the crucial role these muscles play during delivery and how prevalent dysfunction is after birth. Pelvic floor physical therapy reduces the risk of pelvic organ prolapse, urinary, bowel, and sexual dysfunction and pelvic pain. Similar to other diagnoses we treat, many of our patients tell us they wish they knew about us sooner.
The Facts
- 71% of women are unaware that vaginal deliveries increase the risk of pelvic floor disorders
- Up to 70% of women experience stress urinary incontinence in the postpartum period
- Up to 65% of women experience sexual dysfunction 18 months postpartum, regardless of the method of delivery
- 21% of women who undergo vaginal deliveries have Levator Ani Avulsion
- 29% of women undergoing vaginal deliveries have pubic bone fractures
- 77% of postpartum women have low back pain that interferes with daily tasks
- Vaginal deliveries are the number one risk for pelvic organ prolapse
Why Does Postpartum Pain Occur?
There are numerous injuries that are common during labor and birth. These injuries and sources of pain in the postpartum period can be due to:
- The position you labor and push in
- The breathing style you use
- How fast the baby/babies arrive
- Pre existing conditions
- Location of the epidural
Often these changes, pain, or dysfunction may not even arise until months after the birth. Unfortunately, the medical community and society do not talk about these injuries or sources of pain enough and people are made to feel that these changes are just normal, expected and will last throughout the lifespan.
At the 6 week check-up, most physicians will clear patients to return to any activity they like. But we know that many people do not feel ready and even if they do, it may not always be the best advice. Working with a Pelvic Floor PT will help you determine when to rest, when to begin active rest, and when to progress back towards your individualized goals.
When your pelvic floor undergoes a significant amount of pressure and changes during birth, even in the absence of tearing, it can take a long time for the pelvic floor and pelvic girdle muscles to remember exactly what they are supposed to be doing.
Let’s stop normalizing pain and dysfunction as we progress through postpartum recovery. These things are common but not normal. You do not have to put up with pain or dysfunction!
As you read above, there are a lot of reasons why postpartum pain can occur. If your pain is occurring due to any of the above, help is out there! So, how does one recover from perineal tears? The short answer, pelvic floor physical therapy. For the sake of this blog, we’ll give you the long story. Below are some general tips for healing with perineal tears and how to make those first few weeks as smooth as possible for recovery!
Here are some tips to aid your healing within the first two weeks after birth:
Padsicles
A soothing solution for your discomfort. These frozen sanitary pads can provide relief and reduce swelling. Have a padsicle making party ahead of time so you have them stocked in the freezer!
Sitz Bath
A warm, shallow bath that can help alleviate pain, promote healing, and helps soothe the vulvar tissues and pelvic floor muscles. Remember to air dry afterwards for best results.
Peri Bottle
This is a must-have for keeping the area clean without any discomfort. This will help keep your vulvar tissues and any healing wounds clean, instead of wiping which may not feel comfortable initially.
Nourishing Soups/Stews
This will help keep bowel movements well hydrated and soft; which will reduce adverse pressure on the pelvic floor and reduce incidents of unwanted pelvic pain while your body is healing.
Remember, every recovery is unique and it’s okay to take your time. You’re doing an amazing job, mama!
Postpartum Take Home Tips
As a new mom, self-care and appropriate medical attention are critical to ensure you stay as healthy as possible for your little one. While we recommend that all postpartum women see a pelvic floor physical therapist, there are a few things new moms can tackle now to reduce discomfort. Here are some take-home tips:
Lubricants
Using lubricants during sexual activity can reduce dryness and irritation. Look for a water-based lubricant such as Slippery Stuff. Coconut oil is a good alternative.
Scar mobilization
Using the tips of your fingers and a small amount of lotion if needed, move your hand over your scar in all directions with a moderate amount of pressure. Perform this a couple times a day for up to 5 minutes. Scar mobilization helps increase tissue mobility, decrease sensitivity, and realign the scar tissue from a C-Section, episiotomy, or tear. If this causes pain, stop and seek consultation with a medical provider.
Kegels
Proceed with caution as they aren’t appropriate for everyone with pelvic pain or dysfunction, and it is best to be assessed by a PFPT to determine if they’re right for you!
Meditation
Guided meditations can be found on YouTube or through various apps like Headspace, Calm, Simple Habit. Daily medication can help calm the nervous system, decrease tension, and reduce pain.
Foam Rolling
Use a foam roller to self-massage the muscles and connective tissue in your lower back, buttocks, thighs, groin, and hips. Roll for about a minute per area/side. Foam rolling helps to increase blood flow, loosen muscles and connective tissue, and decrease pain.
Diaphragmatic Breathing
Lie on your back in a comfortable position. Place one hand on your belly and one hand on your chest. As you inhale, the hand on your belly should rise first and much more than the hand on your chest. As you exhale, the hand on your belly should fall. Repeat. Perform this at least one time a day for 3-5 minutes.
✅ POSTPARTUM CHECKLIST ✅⠀
It’s important to have the right essentials to help you heal, bond, and recover as comfortably and practically as possible during postpartum. Here are some items we recommend for your recovery journey:
- Check in with a pelvic floor PT for a 6 week follow-up. During this visit, a basic pelvic muscle assessment takes place. ⠀
- Comfort is a priority during recovery! Some pieces include comfy pants/leggings, loose shirt dresses, loose nursing tops, and recovery-stretchy underwear. ⠀
- Maternity pads for a few weeks until post-natal bleeding lets up. ⠀
- Ice your perineum every couple of hours for the first 24 hours post-birth.⠀
- Yoga mat for yoga and pilates exercises. Check out our YouTube for more videos! ⠀
- Organic coconut oil for moisturizing and soothing skin that is healing from the pregnancy stress and strain.⠀
- “Reviving Your Sex Life After Childbirth” is a must-read for new moms and partners. It provides strategies to help restore normal pelvic floor sensation and tone, which is key for pleasurable sex.⠀
Remember that you went through a lot of changes during those 9 months! Be patient with your body and give it the time it deserves to bounce back and recover.⠀
Common Postpartum Complaints
When it comes to being postpartum, you’re not alone if you are feeling a bit uncomfortable. That is normal! You just gave birth and your body is adjusting to no longer being pregnant. These are the most common postpartum complaints we hear from our postpartum patients:
Urinary difficulties- Those with urinary incontinence leak urine when they sneeze, cough, or run. Some feel a frequent or sudden urge to urinate, even when their bladder isn’t full. Others are unable to start the flow of urine at will or empty their bladder completely when urinating.
Fecal incontinence- Many postpartum patients have difficulty controlling gas or bowel movements.
Perineal pain- This symptom is common in postpartum patients, especially those who tore during childbirth or are recovering from an episiotomy. (The perineum is the area of skin between the vagina and the anus.) In addition, tight pelvic floor muscles cause some to experience persistent perineal pain, even after their wound heals.
Pelvic pain- Some patients have pain during sex for many months or even years after childbirth. And some have chronic vulvar pain, burning or itching. Others have pain during bowel movements. These symptoms are often caused by tight pelvic floor muscles, which can lead to inflamed tissue and nerves.
Pelvic organ prolapse. When pregnancy and childbirth weaken the pelvic floor muscles the uterus, bladder, and/or bowel can slip out of place. Rehabilitating these muscles can help prevent or improve this condition.
Frequently Asked Questions
As a PR Would you recommend any courses or for example becoming a doula?
Absolutely! This might be the best and most specific related to what we already do as PTs.
Are there studies connecting these positions to lower tear risk? Also I love the visuals! (Only asking for sharing with my med friends who are hesitant to do anything majority docs veto, and a lot of docs aren’t trained to deliver a baby unless mom is on her back).
Yes! If you review this blog of ours, our author did a great job providing all the research/studies linked down at the bottom of the page!
Resources:
What to Expect at a Prepartum/Postpartum Evaluation
Pain in your tailbone? You are not alone: Michelle’s Success Story
Postpartum Urinary Incontinence is Common: Here’s How We Can Help
Success Story! Jackie’s Postpartum Recovery at PHRC
Success Story: From Birth Prep to Birth Success at PHRC
How We Can Help
Prenatal and postnatal pelvic floor physical therapy begins with an evaluation with your physical therapist. During the evaluation, the physical therapist reviews your history with you, your current symptoms and functional challenges, and discusses your birth plan if you are peripartum and if postpartum, how your delivery went. Importantly, we understand the challenges of pregnancy and the postpartum period.
During the physical examination the physical therapist examines muscles, tissues, joints, nerves, and movement patterns. Once your physical therapist completes the examination they review your findings with you. The physical therapist creates an assessment and short and long-term goals for your treatment plan. Typically, the frequency of physical therapy treatment is one time per week but this can vary greatly depending on the physical findings. You are given a home exercise program to complement your in-person sessions, and your physical therapist will help to coordinate your recovery with your Obstetrician and the other members of your treatment team. We are here to help you recover and live your best life!
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Check out our recently published e-book titled “Vulvodynia, Vestibulodynia, and Vaginismus,” designed to empower and inform individuals on their journey towards healing and understanding.
Did you know we opened our 11th location in Columbus, OH? Now scheduling new patients- call (510) 922-9836 to book!
Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical therapy appointments too!
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
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