The 4th Trimester: Navigating Postpartum Pain

By Courtney Edgecomb, DPT

In Part 2 of my 2-part post I will cover different therapeutic strategies for postpartum pain.

As a new mom, self-care and appropriate medical attention is critical to ensure you stay as healthy as possible for your little one. I am sure it is daunting to find time for yourself at the moment, but it will help you adjust to a pain-free life with a newborn. Finding a way to incorporate self-care into or around attending for your newborn can help you check it off the list! So, where do you start with self-care as a mother?

All new moms should have an evaluation with a pelvic floor physical therapist within a year of delivering. However, if you have pain we recommend seeing a pelvic floor physical therapist sooner, as early as 6 weeks. In Part 1 of this series, we covered the drastic ways your body changes throughout pregnancy and childbirth, and sometimes the body doesn’t always magically heal on its own. A pelvic floor physical therapist will perform an evaluation to determine which muscles, connective tissue, scar tissue, nerves, joints, or movement patterns are contributing to your pain. Your PT can also assess for diastasis recti and pelvic floor motor control (correctly moving your pelvic floor muscles on your own). By talking about how and your pain bothers you, your PT will uncover the specific motions, activities, positions, and postures that are the underlying factors. From there, various physical therapy treatments for postpartum women can include:

Manual therapy and nerve glides
Therapeutic exercise (and no, not everyone needs to do Kegels!!)
Neuromuscular re-education to address movement patterns and control over your muscles
Body mechanics (especially with a growing baby on your hands)
Postural re-education
Guided and progessive diastasis correction exercises
Self care strategies
Coordination of care with your other medical care providers (when needed)

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:

Topical hormonal creams
- Seek consultation from an OB/GYN for guidance on topical hormone treatments that may be right for you. This will help vulvar tissue healing which can be perpetuated by the lack of circulating estrogen if you are breastfeeding.

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 you 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.

Proceed with caution when it comes to Kegels
- Kegels are not appropriate for everyone with pelvic pain or dysfunction, and it is best to be assessed by a pelvic floor physical therapist to determine if they are right for you!

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. Diaphragmatic breathing helps to calm the nervous system, stretch the pelvic floor muscles, and decrease tension.

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.

As you have seen through Part 1 and 2 of this blog, postpartum pain is common, but not natural. At PHRC, we have a team of therapists who are ready to help you through the postpartum journey! A pelvic floor physical therapist will be able to adapt your treatment for appropriate postpartum care and the lifestyle changes that come along with caring for a newborn. A PT will guide you towards safe and effective exercises that won’t aggravate your pain or increase strain to your pelvic floor. Postpartum yoga and pilates isn’t always the best place to start, especially when any of the symptoms in Part 1 are relevant. Typically it is best to calm those symptoms, reduce tissue dysfunctions, improve motor control, and restore pain-free activity. Whether your goal is to return to exercise or sit on the ground to play with your baby, a PT will help you reach your goals with a tailored plan of care. At PHRC, we also help manage your team of medical providers so that all angles of your needs are met! And if you wish, your bundle of joy can tag along to appointments at PHRC!

______________________________________________________________________________________________________________________________________

Are you unable to come see us in person? We offer virtual appointments!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. The cost for this service is $75.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.

Resources

FAQ

What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.