By Alexa Savitz, DPT, PHRC Pasadena
Meet Jackie!
Jackie, six months postpartum, came to PHRC experiencing heaviness, pressure, muscle spasms around the rectum, and pelvic pain near her right hamstring and sit bone. She had a vacuum-assisted vaginal birth and a Grade Two Perineal Tear. Despite being ‘cleared for activity’ at her six-week check-up, her pain persisted. After consulting a urogynecologist, she was diagnosed with Grade One Uterine Prolapse. Jackie mentioned that she tended to tighten her pelvic floor out of fear of prolapse symptoms. During our treatment, she was fitted for a pessary, which she rarely wore due to discomfort caused by the device. Before pregnancy, she was active in hiking and weightlifting. Now, she struggled to walk a mile without symptoms, experienced pelvic pain while lifting her baby, and found it difficult to stand and cook dinner at the end of the day.
Goals for Pelvic Floor Physical Therapy
Jackie aimed to return to hiking with her baby, resume general exercise, and eliminate pain while standing and cooking.
Physical Examination
The physical exam revealed the following impairments:
- Reduced coordination of her deep core muscles and mild diastasis recti
- Increased pelvic floor muscle tension with painful palpation of the transverse perineal and levator ani muscles
- Reduced pelvic floor muscle strength and poor neuromuscular coordination
- Myofascial trigger points in the pelvic girdle and weakness in her gluteal muscles
- Vulvar tissue dryness, which is now called the GenitoUrinary Syndrome of Lactation* and is treated with topical vulvar estrogen
*A groundbreaking study has revealed that high prolactin levels during lactation can cause genitourinary symptoms like vaginal dryness and urinary incontinence in those postpartum. This research sheds light on the under-recognized “Genitourinary Syndrome of Lactation” and underscores the importance of better screening and care for new moms.
Suspected Causes and Treatment Approach
I suspected her pelvic floor muscle tension stemmed from childbirth-related perineal injury and her body’s natural tendency to tighten due to fear of prolapse. This tension likely contributed to her pelvic floor pain.
We began with techniques to relax her pelvic floor muscles, including breathing exercises and internal pelvic floor muscle release, and down-training the soft and connective tissues of the pelvic girdle with mobilization techniques. Jackie was given home exercises to relax her pelvic floor through breathing, stretches, and foam rolling. We later incorporated self-symptom management using a pelvic wand to help release her pelvic floor tension. Additionally, we focused on deep core activation and diaphragmatic breathing to support her pelvic floor muscles and alleviate the heaviness and pressure. Proper breathing patterns are crucial to managing pelvic floor pressure and prolapse symptoms, especially during lifting and other daily activities. We also worked on lifting mechanics and carrying postures to help manage pressure, and included hip strengthening exercises to support her pelvic floor muscles and improve pelvic stability.
Achieving Goals!
By the fourth visit, Jackie was able to go cross-country skiing without experiencing heaviness or pelvic pain. By the sixth visit, her daily pelvic pain had resolved, with only intermittent pain during higher-level activities. We progressed her exercises, incorporating hip hinging, lunging, and hip stability with increased loads as tolerated, to mimic her daily activities and goals.
Although we planned for 12 visits, I saw Jackie for nine due to her moving from the area. By the ninth visit, she could hike one mile while carrying her baby, go on three-mile hikes without pelvic pain, and squat and lift her baby without pain. She was mostly symptom-free! Both of us were confident that she could manage any occasional postpartum symptoms independently with her home exercise program.
Why Every New Mom Deserves To See a Pelvic Floor Physical Therapist
Whether you are pregnant or postpartum, pelvic floor therapy can be a great resource! Pelvic floor dysfunction and/or pelvic floor disorders can be treated by seeing a pelvic floor physical therapist! Postpartum pelvic floor recovery can seem intense, but your pelvic health is crucial for a variety of basic bodily functions. Your well being is important, especially when experiencing postpartum issues. Regardless of the pelvic floor issues you are experiencing, we hope referrals to see a pelvic floor therapist becomes more common practice to all those postpartum.
All pregnant and postpartum women 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.
Postpartum pelvic floor therapy can help with pelvic floor disorders such as:
- Urinary retention, urgency, frequency, hesitancy, pain and incontinence (leaking)
- Constipation, difficulty with bowel movement, fecal incontinence
- Painful sex, diminished or absent orgasm
- Diastasis Rectus Abdominis
- Restoring core function and strength: abdominals and pelvic floor muscles
- Pelvic floor and pelvic girdle, low back, and hip pain
- Cesarean section and episiotomy scar tissue and pain
- Pelvic organ prolapse prevention and/or treatment
- Eliminate perineal pain and/or levator ani trauma
- Reduce pain from pelvic neuralgias
What to Expect from Postpartum Physical Therapy
Education
Information about your pelvic floor and girdle muscles, diastasis recti, pelvic organ prolapse and your strength, endurance, and motor control. We want you to know about your pelvic floor anatomy!
Manual Therapy
In the clinic to reduce impairments (whether that was a vaginal delivery or not). Your pelvic floor therapist will create an individualized treatment plan.
Guidance
On how to reduce pain, return to exercise/physical activity, sexual intercourse (reducing painful sex) and proper mechanics to keep you comfortable while caring for your baby. You will receive a home exercise program with pelvic floor exercises geared towards your specific needs.
The Facts
- Up to 70% of women experience stress urinary incontinence in the postpartum period
- 36% of women have persistent Diastasis Rectus Abdominis after giving birth
- 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
- Vaginal deliveries are the number one risk for pelvic organ prolapse
- 77% of postpartum women have low back pain that interferes with daily tasks
- 51% of women can not perform a kegel with verbal cuing alone, 25% of women perform the exercise in a manner that promotes further (pelvic floor) dysfunction
Additional Resources from our PHRC Blog:
Diastasis Recti: What is it and who can it affect?
Moisturize My Vagina?! What you need to know
Top 5 Stretches to Relax the Pelvic Floor Muscles
Foam Rolling for your Pelvic Floor
Pain Interventions for Labor and Birth With a Partner
Other Postpartum Success Stories:
Postpartum Urinary Incontinence is Common: Here’s How We Can Help
Pain in your tailbone? You are not alone: Michelle’s Success Story
Success Story: Pelvic Floor PT Helped Charli Resolve Postpartum Pain
Success Story Jamie: Pushing Back Against Postpartum Prolapse
Source
Perelmuter, S., Burns, R., Shearer, K., Grant, R., Soogoor, A., Jun, S., Meurer, J. A., Krapf, J., & Rubin, R. (2024). Genitourinary syndrome of lactation: a new perspective on postpartum and lactation-related genitourinary symptoms. Sexual medicine reviews, qeae034. Advance online publication. https://doi.org/10.1093/sxmrev/qeae034
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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.
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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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