Pelvic Floor Rehab: It’s Time to Treat New Moms Right

In Pregnancy and Postpartum Pelvic Health by Stephanie Prendergast167 Comments

postpartum pain After her first pregnancy, Angela gave birth to a beautiful 7 lb, 3 oz, baby girl. More than six months after leaving the hospital, baby was healthy and thriving, however, the same couldn’t be said for Mom. Mentally, she was full of joy over being a mom, but physically…well, physically, she just didn’t feel right.

For one thing, every time she laughed or coughed, she leaked urine. Her first attempt at going for a run after giving birth had ended in so much leakage, that she was anxious that she might never be able to run again. Before attempting the run, she had told her Ob/Gyn about the leaking issue  at her six-week follow up appointment. Her doctor’s response was she had just had a baby, a little leaking was normal, and to do Kegels.

Then her doctor cleared her for resuming sex and exercise, which brings us to the other reason Angela “wasn’t feeling quite right.” Before baby, she and her husband had had a great sex life, now, however, for Angela sex was painful.

After two more appointments with her doctor, and being told that everything was fine, Angela figured she had better start getting used to her new “normal.” Painful sex, no more running, and “moderate” incontinence. “Oh well, I guess it’s all part of having kids,” she thought.

Angela is one of millions of new moms who believe that postpartum pelvic floor symptoms are all part of a new normal they must learn to live with. And its no wonder as in general, their complaints are dismissed by both the medical community and society.

The reason I decided to write this post is to let you know that Angela’s symptoms and the host of other symptoms new moms can face after pregnancy and delivery are far from “normal!” In fact, the vast majority of common postpartum issues can be helped by a physical therapist who specializes in postpartum and pelvic floor rehabilitation.

Common Postpartum Pelvic Floor Problems

When a woman goes through a pregnancy and delivers a baby, her pelvic floor muscles, fascia, and nerves are put through the wringer. And that’s during an uncomplicated and normal pregnancy and childbirth!

Incontinence, which is basically an involuntary loss of urine, gas, or stool, is one of the more common postpartum issues new moms face. It’s a problem that results from damage to pelvic floor muscles, nerves, and supporting fascia. And, it’s a problem that’s generally widespread in the United States. According to a 2001 to 2008 National Health and Nutrition Examination Survey, more than half of women more than 20 years old in the United States experience some type of incontinence.

But, besides incontinence, there’s a  host of other common symptoms women can experience as a result of pregnancy and childbirth. The list includes: back, groin, hip, vulvovaginal, tailbone or pelvic floor pain; pain during sex, diminished or absent orgasm, urinary frequency, urgency, or retention (retention is difficulty starting your urine stream), constipation and difficulty evacuating your stool, and having a hard time with exercise.

In addition, a very common abdominal issue that arises with pregnancy is something called a “diastasis recti.” A diastasis recti is a separation of the rectus abdominus or “six pack” abs from their central tendon. The ab muscles run down the front of our tummy, and sometimes to accommodate the growing baby, they will separate from their attachment. This causes abdominal weakness, and has been linked to incontinence and back pain in postpartum women.

Plus, if there is any vaginal tearing or there is an episiotomy performed during a vaginal delivery, this can also cause future issues with pelvic floor muscles. From an anatomical standpoint, a third or fourth-degree tear has gone deep enough into the tissue to tear muscles in the pelvic floor. Remember,  these muscles are  important for continence, sexual health, and support of pelvic organs and joints. Just as a hamstring tear or rotator cuff tear needs PT, the pelvic floor muscles also need proper rehabilitation.

Pelvic floor physical therapy can easily treat many of these issues, and it can help even if years have gone by since a woman has given birth. Ideally, however, if a problem has persisted for three months postpartum, it’s time to get help.

But sadly, the majority of new moms have no idea that PT can help them. In fact, most don’t even know what their pelvic floor is or what it does, let alone what it might be doing to cause their problems. In fact, according to one study, 83% of college educated women do not know about the pelvic floor muscles and the role they play in pregnancy and delivery.

The reason new moms are so in the dark about the role their pelvic floors play in postpartum recovery/rehab is that the United States is far behind in it’s postpartum care and treatment. Other countries, like France, Denmark, and the U.K. are much more attune to this health issue.

Let’s take a look at France, which is perhaps the country that’s the most advanced in this area. In France, it’s the standard of care for every new mom to receive PT after she delivers a baby. Specifically, after giving birth, women are prescribed 10 to 20 sessions of la rééducation périnéale. Translation: “PT designed to strengthen and rehabilitate the muscles of the pelvic floor.” Toward that end, physical therapists or as they’re referred to in France, “kinestherapeutes” use both manual internal techniques and biofeedback to strengthen and rehabilitate a new mom’s pelvic floor.

In addition to these initial appointments focused on the pelvic floor, 10 additional visits are prescribed that are primarily aimed at treating the abdominal wall for diastasis recti issues.

The main goal of the program, which was instituted in 1985, and is paid for by French Social Security, is to prevent postpartum incontinence and pelvic organ prolapse, and to restore sexual function—all major factors in a women’s health and well-being. And indeed, the absence of postpartum pelvic floor rehab has been linked to long-term issues, such as incontinence and organ prolapse.

France’s postpartum rehab program is proven. Studies show that la rééducation significantly reduces incontinence and pelvic pain at nine months after giving birth.

Here in the United States, a pelvic floor evaluation and PT postpartum is not part of our labor and delivery culture. Typically, as was the case with Angela, once a new mom has been cleared to begin having sex again after her six-week follow up appointment, she’s instructed to do kegels and sent on her way.(Ironically, studies show that 40% of women who are told to do kegels by their healthcare providers aren’t doing them correctly, so it would seem that verbal instruction isn’t enough, women need someone to show them, not just tell them how to do a kegel.)

However, slowly, slowly slowly inroads are being carved out  in the U.S. as some doctors are starting to prescribe postpartum PT, women are starting to request it, and PTs are starting to offer it. But, there is still much work to be done to get the word out so that adequate recovery/rehabilitation guidance becomes the new norm here in the U.S.

At PHRC, we believe it would be beneficial for all new moms to have their pelvic floor evaluated after they’ve been cleared to resume sex and exercise. This kind of early intervention can help address any concerns, and ultimately enable new moms to return to functional and active lives while possibly preventing future pelvic floor dysfunction.

How PHRC Treats the Postpartum Pelvic Floor

At our clinics we treat not only incontinence, but also the myriad of other postpartum problems that can crop up. So, when we see a patient, whether it’s for incontinence or another postpartum concern, we work to uncover any and all postpartum issues she may be having.

Toward that end, the initial evaluation for the postpartum patient includes:

Musculoskeletal Examination:  This includes an assessment of structure, muscles, tissue, and a manual evaluation of the pelvic floor muscles. We can identify problematic muscles and scar tissue and develop a treatment plan based on our findings.

Diastasis Recti Examination:  Studies show that more than 50% of women have a diastasis recti after pregnancy. Patients with diastasis recti are given specific exercises to correct the problem. Standard exercises, pilates, and yoga can make this problem worse and should only be introduced after the diastasis recti is addressed.

Scar mobilization for Cesarean Section, episiotomy, and other vaginal scars: Scar tissue can cause persistent pain and lead to discomfort and pain with intercourse. That’s because scars from childbirth have the possibility to become adhered to nearby structures due to excessive amounts of disorganized collagen produced during the healing process. Scars from a C-section can contribute to urgency/frequency.

So it’s important to mobilize and stretch these scars to allow the skin, muscle, and other tissues of the body to move freely and without pain. Scar mobilization promotes collagen remodeling to increase pliability of the tissues and reduce uncomfortable sensations, such as itching or sensitivity. It is best to start scar mobilization early in the healing process because the tissues will respond quickest during this period.

Six to eight weeks is the standard for tissue healing, given the incision has closed without any problems or infections. However, scar mobilization can help scar tissue and adhesions that are years old. In addition to helping with the scar itself, scar mobilization desensitizes the area surrounding the scar, which may have become extremely sensitive to touch. As part of our treatment, we show patients how to perform the mobilization at home.

Manual PT for concerns of pain with vaginal intercourse or penetration: Postoperative or post vaginal delivery can result in tissue hypersensitivity around the incision or episiotomy scars as well as create myofascial trigger points or tightness in traumatized muscle in and around the pelvis. We work to  normalize pelvic floor muscle tone, eliminate myofascial trigger points and decrease tissue hypersensitivity with manual techniques that can successfully resolve pain with vaginal intercourse or penetration.

Pelvic Floor Muscle motor control exercises and training to treat Urinary Incontinence: Most women are told about kegel exercises and most women report confusion about how to do them properly or how often. Treating incontinence involves proper kegel instructions as well as training in other key exercises to eliminate the problem.

I hope I have succeeded in my goal of bringing this important women’s health problem to light as well as showing exactly how PT is a viable solution to the problem. As women, we need to make sure we don’t lose sight of how important our own health and happiness is, especially as we set out to undertake one of the most important jobs on the planet!

If you have any questions or would like to share your story with postpartum pelvic floor pain/dysfunction, and/or treatment, please don’t hesitate to write in in the comment section below.

Be well,
Marcy

 

 

 

Comments

  1. I agree that in the uk post natal care is terrible. My life has been a nightmare for 6months. I went running and got uterine rectal abd bladder prolapse. I’m 36 very slim had a 9pound baby 6 years ago and then a 8 pound girl. I must have had a mild prolapse without knowing. I had urine incontinence after William went to see a top gynocologist privately she said to wear a pad when I run didn’t suggest pelvic floor exercise and no one ever told me about prolapse!! I am wearing a ring pessary feel heavy in my pekvic floor area. Also on that run ingot laberal tears of my hips. I am suffering pain with this. Your core strength is shot. After having babies and as the mother you are constantly carrying babies pushchairs strapping kids into cars bending kneeling and no wonder we get weaknesses! I am in a right mess. Apparently I have hip dysplasia which I never knew about but that is 2 issues in a very close area which both affect mobility. I am paying to see A physio gyn now but the horse has already bolted. I am tiny had a 9 pound boy I couldn’t walk for 2 weeks after he was born no healthcare professional gave a monkeys…prolapse affects your self esteem sex life and the hip thing is affecting my kids I can’t run and chase them anymore cant pick them up or bounce on the trampoline I’m heart broken truly.

    Thank you Ruth

    1. Author

      Dear Ruth,

      I’m so sorry about all the trouble you are having! Please don’t give up on PT. The right PT can help you!

      All my best,
      Marcy

  2. Can a stage 2 rectocele and cystocele be reversed back to normal, or to a stage where I can run, jump and row and fully play with my sporty young kids? Samantha

    1. Author

      Dear Samantha,

      The answer to your question is “yes.” There are a number of different treatment options for rectocele and cystocele, and pelvic floor PT might be appropriate for some people with the issue. So with the right treatment, you can resume an active lifestyle with your young ones!

      All my best,
      Stephanie

  3. Hi,
    I am 9mo post c-section and am still having soreness on my right side in my pelvic region. The soreness comes and goes but I notice it more on days I am home lifting my baby a lot. After reading your blog and website on scar tissue I am considering seeing a Pelvic PT. Can you refer a PT near Charlotte, NC? Do I have to be referred by my doctor to see a PT? From your experience, does insurance typically cover this type of service? Thank you!

  4. Hi, I delivered vaginally three weeks back and ended up with fourth degree tear extending from vagina to anus and multiple second degree tears. So far stitches are healing well. But I continue to have soreness and tenderness in the area. The pulling sensation with every movement is very uncomfortable and I just catch a break. I am scared. And don’t want to leave with this pain. I hear it may take months. It may also cause painful sex, incontinence and pelvic organ prolapse. How can I help my body to heal completely and possibly prevent future complications? How can I ease the discomfort ? Are there any activities that i shouldn’t do or should do? Are kegels ok this early on? I live Redmond WA. Do you recommend any pelvic PT/ thank you

    1. Sorry for typos. I meant I can’t catch a break from pain and don’t want to live with this pain forever.

    2. Author

      Dear Ann,

      I’m sorry to hear of your troubles, sounds like you are having a rough time! You had some significant trauma to your perineum, but all hope is not lost. 3 weeks is still so soon post partum to really be able to tell what’s going on. You are still healing, and it takes at least 6-8 weeks for normal tissue healing, anyway. You will feel the tightness in your perineum and at the scar site for some time, but it will get better as you heal. I would say it would be a really good idea to see a pelvic floor physical therapist as soon as you are cleared for internal work. In the meantime, just rest, take it easy, try to sleep as much as you can, and let your body heal. Sometimes sitting on an ice pack helps, and try to avoid pushing or straining to evacuate your bowels. Your MD may recommend a stool softener, so BM’s are a little less painful and easier to manage. Hang in there, and I would say go to PT when you are ready. Below are the PTs who have taken Liz and Steph’s class in WA:

      Costello Kristen PT Federal Way WA (253) 944-4026
      Franklin Elizabeth PT Maple Valley WA (425) 413-4425
      Khadduri Lucie PT Lacey WA (360) 456-3300
      Pazier Shannon PT Tacoma WA (253) 202-4838
      Sieber Carrie PT Seattle WA (206) 354-9590
      Vora Sagira PT Bellevue WA 4256885900
      Gerber Nathan PT Othello WA 7083013102
      Ferguson Carol PT Gig Harbor WA 2539852807
      Wallace Kathe PT Seattle WA 2065272800
      Gaddis Pamela PT Bothell WA 4254834270
      Reicher Rebecca PT Seattle WA 2069859442
      Nelson M. Quinn PT Dupont WA 2532849800
      Wheeler Claudette PT Poulsbo WA 3607793777
      Caples Kathleen PT Seattle WA 2064471570
      Allen Tina PT Seattle WA 2065982889
      Maas Peg PT Seattle WA 2062156596
      Tolcott Jane Vashon WA (206) 744-1675

      All my best,
      Marcy

  5. I just stumbled on this site, and hope you can answer a question. When I was pregnant I had a lot of problems with pelvic pain, mostly right in the middle (pubic bone), and lower back pain. To the point where I couldn’t walk more than 100 meters without having to sit down, couldn’t walk stairs, lift things etc.
    After having given birth it mostly went away. Only my backpain stayed, but I’ve always had a weak back, so not much surprise there.
    I was meaning to start exercise, but first had to recover from a c-section (my little girl was born a bit premature because of pre-eclampsia), and then got really busy with work. in combination with baby, I just couldn’t fit the exercise in. My daughter is 9.5 months now, and for the last few weeks I have noticed that the pelvic pain is back and my backpain is worse again. Thought this might be because she’s getting heavier (almost 10 kg now), and with the lack of exercise my muscles just can’t handle it. I’ve started to do more walking, figuring this would be a low impact way to improve the situation, but it’s only getting worse. I would go to a doctor, but I have no idea which doctor I could go to with this issue. I live in Mozambique, and during my pregnancy was just told it was normal and would go away after giving birth. Sorry for the long story, hope you can give me some tips.

    1. Author

      Dear Eline,

      It sounds like you would benefit from a pelvic floor evaluation from a qualified pelvic floor PT. Without evaluating you myself, it’s impossible for me to know exactly what is going on with your pelvic floor to be causing your symptoms. However, it is possible that you suffered with PGP during your pregnancy: Please read this blog post for more info about PGP: https://pelvicpainrehab.com/451/pt-for-pelvic-girdle-pain-during-pregnancy/, and that may have set you up for the issues you are experiencing now. Two common impairments that cause pelvic pain are hypertonic or tight pelvic floor muscles and/or trigger points.

      Again, it’s impossible to know exactly what is causing your symptoms. My advice to you is to try to get to a qualified pelvic floor PT for an evaluation. One of the populations we treat at PHRC are postpartum women. Take a look at the page on our website about pelvic floor PT for postpartum women like yourself:

      https://pelvicpainrehab.com/pregnancy-postpartum/

      Please let me know if you have any additional questions.

      All my best,
      Stephanie

  6. First of all thank you for this. I am suffering with hyper sensitive nerves for nearly 4 years now. I had a forceps delivery an episiotomy and a tear. I was in pain for months but my doctor just kept telling me it was all fine. It wasn’t until 8 months later that I was scheduled to go in for surgery to tidy up the scar. Still that didn’t help it only made it worse, having intercourse was impossible. No painkillers anaesthetic creams or even injections helped. I was then sent to a psychologist as they thought it was in my head. My psychologist helped me understand the pain cycle but clearly saw that it was physical. I tried dialators and these helped a little after months of trying. I can now have intercourse but its still painful, even touching the area is uncomfortable. Apparently it’s not the scar it’s the tear that has caused nerve hypersensitivity. I am now having another set of injections this time it’s steroids and its supposed to help the nerves. This week I had an appointment and they have pretty much told me that if they don’t help then there’s nothing else I can try. Having another baby can help by stretching but if I tear again then it will make it even worse. I’m looking at a life of pain, an incomplete relationship and no more babies 🙁

    1. Author

      Dear Daniela,

      From your comment, it sounds like you have had a rough time, and I am sorry to hear of your troubles. First thing, women with complicated scars have gone on to have other pregnancies and babies, as well as comfortable sex. All hope is not lost, although I’m sure it seems like a never-ending struggle. It’s hard to say specifically what’s going on since I haven’t evaluated you, but it sounds like you haven’t had pelvic floor physical therapy yet. I am glad to hear you trying dilators, and it helped a little. I think that tells us there is still more progress to be made, and with a trained pelvic floor PT manually working on the scar tissue and the muscles, you might be able to get more relief. I would say you absolutely need to be evaluated by a pelvic floor physical therapist, so she can identify and treat the impairments that are contributing to your pain. This is a difficult thing to experience, but please don’t give up hope yet. Find a PT, and start treatment. Good luck!!

      All my best,
      Marcy

  7. I am currently suffering from pelvic problems myself, I was 1st told it was round ligament pain as my pregnancy being my 3rd I was doubtful of what I was told at 6 months pregnant it was pelvic instability and I was taken out of work, by 8 months I fell in a parking lot straight on my bottom, still today I am out of work 9/18/2013. As others I have on & off pain but when its on its awful, a constant pull, nag, burn of just pain. My quality of life really sucks now. I have been prescribed naprelan cr 500 and that does nothing but gives me a headache which makes me more irritable towards my family, been told to use ice but when you have a 3 month old and 2 other children sitting with ice packs sounds more like a dream. I had a MRI done & therapy orders for myalgia & myositis, sacroiliitis, osteitis condensans. Do you have anyone in the Raleigh/Durham, NC area that can please help me?

    1. Author

      Dear Gina,

      I’m so sorry about all that you are going through. I’m glad that you are planning to see a qualified pelvic pain PT, however!

      Below is the PT that we refer to in Raleigh:

      Briggs Jennifer PT Raleigh NC 9195719912

      All my best,
      Stephanie

  8. Hello,
    Thank you for this informative and hopeful site. I wonder if you can answer a question that I have? I am almost 3 months post partum. I had a good pregnancy but a hard birth. My baby was 9lb 9oz and he became stuck so I required forceps and an episiotomy. This was after several hours of trying to get him out by pushing.
    Since his birth I experience daily pain – a sort of heaviness, aching and hypersensitivity in my vaginal area and it is worse when I walk or hold my baby. It’s really starting to get me down. The dr said its normal and early days, but I don’t know anyone else with this kind of pain. do you know what this might be and if it will ever go away?!
    Thank you

    1. Author

      Dear Elizabeth,

      We see patients with your exact story practically on a daily basis. The trauma of your delivery has caused your pelvic floor to be compromised. Your doctor is wrong. While your pain might be COMMON, which it is! It’s NOT NORMAL! You would greatly benefit from seeing a qualified pelvic floor PT. With the right PT and care your pain will go away. Where are you located? Perhaps we can recommend a PT to you in your area.

      All my best,
      Liz

    2. I too had a forcep delivery with tear like Elizabeth above. I pushed for 3.5 hrs and ultimately ended up with a forcep delivery. I am, 8 wks post partum still having pain, aching and hypersensitivity in my vaginal area. I am getting to the point where I am wondering if I will ever be back to myself and be able to have sex with my husband. How long should I wait before requesting an PT order. MD keeps telling me to wait it out and do kegals., which I have done and Kegals are causing pain.
      Can you recommend a therapist in VA?

      Thanks
      Melinda

      1. Hello Melinda,

        Therapists can externally evaluate new mothers 3 weeks after delivery, but cannot do an internal assessement until the patient has been cleared by her gyn/ob. This usually happens at about 6 weeks after delivery. We recommend that you consult with a local pelvic floor physical therapist to begin treatment.

        Regards,

        Stephanie

  9. I am so glad I stumbled upon this site! I am about 7 months postpartum and still experiencing pain that I am assuming could be the pelvic floor muscles as I am having the same troubles others have listed. I have been trying to get back into prepregnancy shape lately, and let’s just say that attempting jumping jacks and running was a disaster! I have been worried that this was just part of having children but I am glad to know that is probably not the case. I plan to make an appointment with my gyno for a referral to PT, but can you recommend a PT in Massachusetts that has taken the class? Thank you!

    1. Author

      Dear Christina,

      That’s great that you’re planning to see a pelvic floor PT. Below is a list of the PTs in Mass that have taken our class. All my best, Liz

      Clarke Anne PT Braintree MA (781)348-2500
      Fonti Hannah PT Danvers MA (978) 304-8701
      Levesque Ann PT Beverly MA (978) 927-7668
      Lewis Elizabeth Burlington MA (978) 761-3149 and (781) 744-8617
      King Linda PT Brauntree MA (781) 519-4756
      Bentley Carolyn PT Amherst MA (413) 253-0413
      Barnicle Katie PT Westwood MA 7814319144
      Cole Elizabeth PT Waltham MA 7814873821
      Gillis Janet PT Dartmouth MA 5089980620
      Machugh Lalla PT Quincy MA (617) 479-8500 x 126
      Perlis Raquel PT Wellesley Hills MA (781) 237-9006
      Herman Holly PT Cambridge MA (617) 576-3204
      Wade Marie PT Framingham MA (207) 779-2256
      Cunningham Patrick Acc Arlington MA (617) 489-2381
      Lewis Elizabeth PT Gloucester MA (978) 761-3149
      Bentley Carolyn PT Northampton MA (413) 582-2113
      Berger Stacey PT Westboro MA (508) 366-7899
      Herlihy Sarah PT Wellesley MA (781) 237-9906

  10. Hi, I am 7 months postpartum. Normal delivery with tear, episiotomy. It look a while to heal as i had extra growth of flesh outward in the perineum, though got it removed with my gyn’s help. It was a mental torture. I am very scared of sex and that its painful. Initially, i had incontinence, which has improved slowly now, but urinary frequency is still there. Whenever i carry my son and walk, bend down and pick him/or do some work, i feel pain in my pubic area. I cant stand for more than 10 mins, severe back pain (spine). My biggest issue is i want to get back to my prepregnancy weight (60 kgs) and breasts are very huge compared to other parts of my body. I want to start working out. What can i do to reduce my breast size and firm them. Also, i would like to know do i have any prolapse as im having pain in my pubic area with bending, carrying, and walking quickly. Is it safe for me to start my workout (i am wanting to do ellipitcal crosstrainer with routine household work). Please help.

    1. Author

      Dear Neha,

      As to your first question regarding your breasts, I’m sorry, but that is not something within our purview. As to your other questions about your pain/whether you have prolapse, and also whether it is safe for you to work out, without examining you, I can not answer them. I recommend that you see a qualified pelvic floor PT in your area. Where are you located; perhaps we could recommend someone.

      Best,
      Liz

  11. I had a fairly easy delivery in August this year, compared to the horror I went through in 09 with my first child. They stitched me up wrong, so I was in severe pain for 6wks, not knowing that it wasn’t normal. I tore in the same place during the 2nd delivery, was stitched properly this time so healing was fantastic in comparison. 4 months postpartum now, I have been sick for about a month. I have started coughing violently, which has lead to leakage. I also do not feel as is if my vaginal area looks the same, what I can only assume is a prolapse. Should this heal itself when Iget over the cold or should I go ahead and seek PT assistance? I live in Virginia Beach, VA and am covered by military insurance so my choives of treatment are limited.

    1. Author

      Dear Heather,

      I would recommend that you not wait and see a PT; below is the name of a PT in your area that has taken our class. Best, Liz

      Brown Carolyn PT Virginia Beach VA 7573742373 cbrown287@cox.net

  12. Hello-
    I took the time to read most of these posts and realized I am not alone in my problems. I would like to find a Pelvic Floor PT location in San Diego. I am almost 4-months post-partum and have not been able to run comfortably anymore. I am used to running hard and long distances and none of that is possible these days. I have been having a dull aching throbbing pain just above the pelvic bone even after a short 3 mile run. I am also sore days after my run. It is as if my uterus is sloshing around freely inside of me without muscles to hold it in place! Am I crazy? What is going on? Please help!

    1. Author

      Hello Jasmine,

      You aren’t crazy! Your symptoms are quite common, particularly in our post partum patients. We recommend Cindy Furey, PT who is located in San Diego. Her contact information is below.

      Cindy Furey, PT
      Comprehesive Therapy
      (858) 457-8419

      Warmly,

      Rachel

  13. My daughter just turned “17 months” and my twin boys are age 5. I have been suffering (unknowingly) from pelvic floor prolapse (rectocele) for almost an entire year! I’ve been misdiagnosed with UTIs, yeast infections, and GI problems trying to figure this out. Finally I was recently diagnosed with rectocele , pelvic floor prolapse. I’m certain even more is going on…I was referred to Rex hospital PT but no one can see me for 6 weeks!!!! Can you please assist me in finding a PT in my area (Raleigh/Wake Forest, NC) who can assist me in relieving this pain? I’ve been proactive watching videos on starting my own PT while waiting but the pain persists every day. I have no family locally that can help & my husband travels ALOT.

  14. Which works better – physical therapy (manual) or pelvic floor rehab (dilator with electric current to relax muscles and then Kegels to retrain)? I have tight muscles and lots of trigger points. I’ve had injections and am taking muscle relaxants. My muscles have shortened and I can sit for only 20-30 minutes at a time. I have nerve hypersensitivity, pressure, and pain that shoots down my legs.

    1. Author

      Dear Brenda,

      We do only manual work for pelvic pain, including pain caused by tight muscles and trigger points. Best, Liz

  15. Hi there,

    I’m 11-months postpartum and still can’t run or jump without having a decent amount of leakage. I’ve had two kids (one via c-section and one VBAC) and we’re considering having a third. I’d like to build up my core muscles and pelvic floor again before we start trying to conceive #3. Can you recommend anyone in the Boston area?

    Many thanks,
    Ann

  16. Hi can you recommend anyone in Austin, TX and do u need RX?

    1. Author

      Hi Jennifer,

      Below is the name of a great PT in Austin. I do not know if an Rx is required as it differs from state to state. Best, Liz

      Sauder Sara PT Austin TX (512) 335-9300 sara@sullivanphysicaltherapy.com Sullivan Physical Therapy

  17. Hello,
    I am 15 weeks postpartum and still experiencing pelvic pain. The pain intensifies with activity so I am staying off my feet as much as possible, and am still out of work on a medical leave. I had a vaginal delivery of an 8lb baby after 3.5 hrs of pushing. I have an appt to begin PT in 2 weeks, but I am wondering if there’s anything I can do to ease the pain in the meantime besides taking medication. Should I be concerned about prolapse or incontinence (right now I do have leakage from running and jumping)? What should I expect from PT? Is it ok to resume sexual activity or should I continue to hold off?

    1. Author

      Dear Lauren,

      I’m so sorry about what you are going through, but it sounds like you are on the right track with an appointment with a pelvic floor PT. As for what you can be doing in the meantime to ease the pain besides medication, hot baths and ice are two options. It sounds like you are having some stress urinary incontinence (leaking from running and jumping); this is something your PT can help you with. Check out this page on postpartum PT on our website (scroll down to the “Evaluation and Treatment” section) for an idea of what you should expect from PT.

      Lastly, since I have not evaluated you, I can not say whether it’s okay for you to resume sexual activity; that’s a question that’s best asked of your PT.

      All my best,
      Stephanie

  18. Hello! I am now 8 weeks postpartum, I had a vaginal delivery of a 10 lbs 1 oz 22.5 in baby girl. I had no tears or anything, except the fact that as the weeks go by the pain gets worse. The pain started early around 16 weeks and got worse and worse even after delivery. Unfortunately I go to a military Dr. From my experience (the past 6yrs and 2 children) they either don’t know anything, or don’t care. My whole pregnancy they just brushed it off as normal and at my 6 week apt I was told that the pain would go away if I exercise. Well I tried running and the pain in my pelvis was unbearable, I actually cried and I was also soaked as if I peed myself but didn’t feel it. I was to not to go to physical therapy if not properly diagnosed but no one seems to care enough to diagnose me. What do I do now, my career depends on my running and physical health?

    1. Author

      Dear Toni,

      I’m sorry about all that you are going through. I know how frustrating it can be finding answers from the medical community when it comes to pregnancy/postpartum pelvic pain. The best advice I can give you is to make an appointment with a qualified pelvic floor PT. In most states you do not need a prescription or referral from a physician to visit a PT. Where do you live; perhaps we can give you the name of a pelvic floor PT in your area.

      Best,
      Stephanie

  19. I delivered 3.4kg baby through episiotomy 6months back. now my gynec found that I am having gross rectocele and minor cystocele. and suggested me for KEGEL or pelvic floor exercise. will you guide me that I can be ok without surgery or need surgery for correction

    1. Author

      Dear Tanu,

      Yes, sometimes pelvic exercises will prevent further complications with rectoceles and cystoceles. However, surgery cannot be ruled out until you are examined by a pelvic pt. I would recommend seeing a pelvic therapist in your area.

      Best,

      Malinda

  20. Hi there! Wow I am so happy I stumbled upon this site!!! Like all of the woman here I too suffer from pelvic girdle pain 4 months postpartum. Anytime I do any form of exercise it flares up and is really painful and frustrating. I’ve been doing Levels but that doesn’t seem to be nearly enough. Can you recommend a pelvic floor pain PT around the Danbury, CT area??? Thank you SO much for this post!!! I finally have some hope that perhaps I can start feeling better!

    Thanks,
    Heather

    1. Author

      Dear Heather,

      Below is a list of the therapists we refer to in CT.

      Barbara Cooper, PT Trumbull, CT (203)445-0845
      Anna Marotti, PT Norwalk, CT (203)855-3564
      Peter Philip, PT New Canaan, CT (203)966-3076
      Jillian Beaulieu, PT Meriden, CT (203) 630-3939

      All my best,

      Casie

  21. I have been diagnosed with diastasis recti yet I also suffer with back pain, severe hip pain, painful intercourse. I am 15 months postpartum with 3 children. My doctor just keeps saying it will pass and I need to lose weight. It’s hard to workout when I can barely walk some days. Is there a PT in Greenville, NC?

    1. Author

      Hi Vonda,

      Unfortuantely, a diastasis is not like the common cold, and it will not just “pass.” Although a healthy weight can greatly reduce the level of discomfort that you are experiencing, weight loss alone will not eliminate any pelvic dysfuntion caused by connective tissue restrictions, trigger points, or muscle spasms. We do not have a referral for a therapist in Greenville, NC but I can refer you to a therapist in Raleigh, NC.

      Best,

      Rachel

      Emily Wegmann, PT
      Raleigh NC
      (919) 571-9912
      Carolina Pelvic Health Center

      Jennifer Briggs, PT
      C.A.W.H. Rehab
      (919) 571-9912

  22. Hi,

    I delivered a baby weighing 7lbs about 3.5 months ago. I used to find it difficult to walk during the last trimester of my pregnancy, due to severe pain at the pubic area.
    Now 3.5 months postpartum, I have been diagnosed with a cystocele and am having sharp shooting pains at my pelvic, groin and pubic area. What can i to do ease this pain?
    Thanks!

    1. Author

      Hello Pooja,

      A pelvic physical therapist can treat your pubic symphysis pain in order to decrease your discomfort. In regards to the cystocele, a PF therapist can help you to prevent further decension of the organs. I would recommend that you schedule an evaluation with a pelvic floor therapist in your area.

      Best,

      Malinda

  23. Hi, thank you for taking the time to respond to all of the questions here! I was wondering if you have a recommendation for someone in memphis, tn. I have had three children in the last four years and am having major pelvic and back pain after attempting to run, walk longer distances or carry any of my children for a period of time. I am currently one year out from my last pregnancy but have had this problem since I was pregnant the first time. I have been to see a PT that my OB recommended but after a few weeks she told me that there was nothing else she could do for me (we worked on doing kegels properly). I’m still having a lot of pain and not really sure where to turn. Thanks!

    1. Author

      Hello Molly,

      Thank you for sharing your information. Did your therapist specialize in pelvic floor PT, and was she/he able to do internal work with you? Often times, our postpartum patients need helps releasing tightness and restrictions, rather than simply kegel exercises. We have therapist recommendations in Chattanooga, TN, but we do not have a therapist recommendation in Memphis.

      Best,

      Malinda

      1. Who do you recommend in Chattanooga, TN? I’ve been having pain in my pelvis, RLQ,and radiating down my inner thigh for over a year. I have Crohn’s and it was very bad a couple years ago. My OB/GYN thinks possible endometriosis and my GI thinks scar tissue from where my colon was so bad. My GI wants to avoid surgery at all costs because it can cause the formation of new scar tissue. She put me on medicine for neuropathic pain which has helped some, but I still struggle at times. Any help is appreciated. By the way I have no kids or anything, so no damage from pregnancy or childbirth.

        1. Hello Rachel,

          Melissa Kubic, PT is located in Chattanooga, TN. Here is her information:

          Melissa Kubic, PT
          Chattanooga, TN
          (423)778-8660

          Regards,

          Liz

  24. Hi there,

    I am 6 weeks post partum and have been diagnosed with a 2nd stage cystocele and a mild rectocele. I live in Chicago… can you recommend any good PF therapists in my area?

    Thank you so much!

  25. I am 11 months post partum with baby #2 and I have been experiencing pelvic floor problems with no help from my ob/gyn. Can you recommend some PT’s in New Hampshire. Thank you!

    1. Author

      Hello Shelly,

      Below are therapist recommendations near New Hampshire. In addition, our Boston office will open April 2015.

      Regards,

      Malinda

      Marie Wade, PT
      Franklin Memorial Hospital
      Framingham, MA
      (207) 779-2256

      Elizabeth Lewis, PT
      Lewis Physical Therapy and Lahey Clinic
      Gloucester, MA
      (978) 761-3149

  26. So glad I came upon this site! I am 6 weeks postpartum with our first child. We had a good pregnancy ( some pelvic pain and mild incotenence). Delivery/ labor was rough and long. We were induced and would not dilate past 9 centimeters. Suction and forceps were necessary to get my precious 8 llb 2 oz baby out. I am suffering from incontenence and pain. I was given instruction on now to do kegal exercises and can tell that the muscles are very weak. I am unable to stop my urine flow once it had begun. I have made an appointment with a therapist in Blackburg Virginia ( blacksburg physical therapy associates) as it is the closest large town. I am told it can take up to 6 months to heal but am very concerned about my future. Can you recommend some therapists in southwest Virginia or Winston Salem area of NC? I will likely also ask to be referred to a urology clinic who has someone who is more educated on this matter. Thank you!

    1. Author

      Hello Beth,

      Your treatment duration will depend on your findings and overall history. Thus, it’s difficult to predict. Yes, I can recommend PF therapists in NC. It would be best to ask their office for Urologist recommendations.

      Regards,

      Casie

      Emily Wegmann, PT and Jennifer Briggs, PT
      Carolina Pelvic Health Center
      Raleigh NC
      (919) 571-9912

      Wilda Young, PT
      Greensboro, NC
      (336) 275-6380

    2. Hi,
      I have the exact same issues as mentioned here. I was wondering how you feel now – and how long did you end up doing PT.

  27. I just have to say thank you for your website. I can’t believe how alone I felt the past month, but so many woman have the same issues. I’m 6 months postpartum and I delivered a 7lb baby via vbac (my first 3 1/2 years ago was a csection). I’ve been diagnosed with a thin posterior wall which I’m guessing is the same as a rectocele, after a month of pelvic pressure and discomfort. After starting pelvic exercises the pressure has gotten better, but now I’m having severe constipation despite treatment can PT help?

    1. Author

      Hi Laura,

      Absolutely, pelvic PT can also help to address your constipation. I would recommend that you see a local therapist if you have not already done so.

      All my best,

      Casie

  28. Like all other women here, i am 5 months post partum and i still feel pain in my pubic symphisis, groin, inguinal area, taolbone and sometimes in my hamstring all the way at the back of my knee. I involuntary pass gas whoch i dont do before i had my baby. I feel like so,ething is going to fall from my pelvis. I cant walk as normal as i used to. My doctor says it will go awy nuy its beem 5 months. Pls help me find a pelvic PT here in seattle, wa. My zipcode is 98036. Thank u so much! Im so miserable.

    1. Author

      Hello Charlaine

      Here are our Seattle recommendations:

      Tina Allen, PT
      University of Washington-Roosevelt
      Seattle WA
      (206) 598-2889

      Sagira Vora, PT
      Overlake Hospital Medical Center
      Bellevue, WA
      (425)688-5900

      Best,

      Melinda

  29. Hi there
    Thank you for this website and dedication.
    I’m now 8 month postpartum and I have been suffering from sharp pain in my pelvic bones (both sides at the same time) specially after waking up / getting up or going for a short walk for the past month. It feels like muscles pain as if I had an intense workout.
    I give a vaginal birth to 7lb 11 oz baby .. I was suffering from this ( but only one side at a time) the last 2 month of my pregnancy ..I didn’t experience this pain again until a month ago. Please guide
    Thank you

    1. Author

      Hello Nana,

      I’d like to recommend a local therapist. Where are you located?

      Regards,

      Allison

  30. Hi – I am 4 months post partum and like most women in this thread I tore and had an episiotomy while delivering my 8lb 3 oz baby girl. I also had part of my stitches pull open only a week after delivery but was told that I had to just let that heal and it was too late for it to be stitched back. It has been near impossible for me to sit for longer than 10 minutes due to the pulling sensation that just makes me feel like it may be tearing all over again. Anytime I try to have any type of range of motion for example if I try to bend over and pick up a diaper that I may have dropped I feel a sharp pain which I can deal with but what is scary is the pulling and almost tearing sensation which then continues for days or even weeks after such a small movement as to bending over. Often times I even get some spotting from certain movements. I have been to several OBGYNs and have been told everything from – just give it more time but continue all normal activities to stop doing everything and try to go on bed rest for several months …the directions of the OBGYNs are all over the map and at this point I just see a very sad future as I am scared to try anytype of physical activity and anytime I even have an exam it seems I am in pain just from the dr. touching my vaginal area so to say the least I can only do my job now from home and I am terrified to attempt to have any sort of sex life …. Can PT possibly help not only to lessen the pain and tearing/pulling sensation but can it give me the confidence to be able to resume my life knowing that I am not going to continue to tear?

    1. Author

      Hello Stephanie,

      Yes it can! Physical therapy works on your pelvic floor to minimize the risk of tearing once again, and will help you in countless of other ways. I would like to offer you a therapist recommendation. Where are you located?

      All my best,

      Melinda

      1. Hi Melinda,

        Thank you so much for your response and please let me know of a therapist in my area. I live in south Florida the major cities near me are Boca Raton, West Palm Beach and Ft. Lauderdale.

        I thank you again 🙂

        1. Author

          Hello Stephanie,

          Below are therapist recommendations in Florida. We do not have recommendations near Boca Raton, West Palm Beach and Ft. Lauderdale:

          Ashley Arango, PT and Katherine Marsh, PT
          Florida Hospital Pelvic Health Rehab
          Orlando FL
          (407) 303-8280

          Tracy Sher, PT
          Florida Hospital
          Altamonte Springs
          (407)257-1403

          Pamela Downey, PT
          Miami FL
          (305) 666-3232

          Regards,

          Melinda

  31. I have stage 2-3 Uterine Prolapse I was just told. Dr suggested immediate Hysterectomy, since I am young and the recovery is quicker. I’m 58. Can PT help me at this point? I am an avid gardener and I want to enjoy all life. I’m so bummed out. I need PT in San Diego please. Thanks.

    1. Author

      Hello Andrea,

      Cindy Furey is located in San Diego. Here is her information:

      Comprehensive Therapy
      San Diego, CA
      (858) 457-8419

      Regards,

      Allison

  32. Hi,
    I hope you can help me because I am worried my life will always be like this. I delivered a healthy baby girl 7.3 lbs and got a 2nd degree tear. I am only 6 days postpartum but still have no control over my bladder. I stand up and just pee. I feel great but this peeing thing is making me so depressed. I’m only 31 and did not experience anything like this with my first baby. Will I be wearing depends forever?

    1. Author

      Hello Angela,

      Physical therapy will help tremendously. However, therapists usually see post partum patients at 4-6 weeks after delivery, and only after an Obstetrician has cleared a patient for internal treatment. I can offer you therapist recommendations for your area. Where are you located?

      All my best,

      Liz

      1. I live in Chico Ca and pray there is a therapist near by. My OB placed a Foley catheter on Monday and the plan is to leave it in for a week to rest my bladder. He seems pretty confident it will be better after the foley comes out. Is this a reasonable expectation?

        1. Author

          Hello Angela,

          Risa MacDonald is located in Sacramento. Unfortunately I do not have a recommendation for Chico at this time:

          Risa MacDonald, PT
          East Sacramento Physical Therapy
          Sacramento CA
          (916) 457-8802

          Regards,

          Liz

      2. Angela, I am exactly in the same space as you. Can you please tell me what worked for you? I’m am 12 days postpartum and gushing as soon as I stand or move around. I have no feeling of fullness and no control over my urine stream.

  33. Hi, please could you answer a question for me. I had a third degree tear four months ago. I have since seen a consultant and Physio and have been advised that I have healed well. I am not in pain but still feel like I recently gave birth, often feel very achey and struggle to walk very far and feel sore if I over do it. Please can you tell me if this is fairly normal considering what had happened and if in time I will be able to walk long distances again? I am worried I am never going to get back to normal. Many thanks

    1. Author

      Hello Lisa,

      Feeling achy, and having difficulty walking for longer distances may be signaling an underlying issue. I would recommend that you consult with a pelvic floor therapist who can evaluate you.

      Regards,

      Liz

      1. Thank you for your reply Liz I am seeing a women’s Heath Physio on the NHS but my next appointment isn’t for another 6 weeks. When I last saw them I was advised that it could take a long time to recover but I too am wondering if there is an under lying issue as I would have expected to be able to walk further by now. I’ll contact them to have a chat. I also had / still have issues with my piriformis muscle too so I am wondering if this could be contributing to the problems I am experiencing as I know this forms part of the pelvic floor support. Could this potentially contribute to the achiness I am experiencing? Many thanks for your time.

        1. Author

          Hello Lisa,

          It may be possible that all of your impairments may be contributing to your symptoms but without evaluating you, it is difficult to say. I suggest that you consult with your therapist, and seek a second opinion if necessary.

          Regards,

          Liz

          1. Thank you Liz I’ll give them a call to discuss it further. Lisa

  34. i really enjoyed reading this article. I have been having similar issues to a lot of these women, i had a 7lb 3 oz baby in November 2014, third degree tear, that did not take properly. had to have an episotomy repair in january ’15 and havwe been having pain ever since. skin is tight and so sensitive! finally was able to see a specialist yesterday and she recommended pelvic floor rehab! she said that my hip flexors and SI joints are all out of whack and that’s what’s causing such painful intercourse, as well as the tight skin for the repair, for which i will likely need to work with dilators. Can’t wait to see a PT, but in the meantime, i will also work with yoga and different SI stretches. Anyone else out there having these issues, I get so stiff in my hips if i lay on my stomach that i cannot move when i wake up to turn onto my stomach. It all made sense to me when my GYN explained it all….everything’s connected and works together unfortunately against me right now. I can say if you can try to laugh about it, it makes coping better….i say i can either laugh or cry, so i choose to laugh! i’m confident i will get better and train myself to relax my muscles and my PT wil help me get everything back into the correct place! Hope everyone else gets better!!!

    1. Hi Sarah,

      We have offices in San Francisco, Berkeley and Los Gatos. Please contact your preferred location for more information.

      Regards,

      Rachel

  35. Hi there,
    I had tailbone pain throughout my two pregnancies. I’m 3.5 months post-pardon after my 2nd child, and I continue to have pain in my left hip/tailbone area. It hurts to lie on my back, especially on a hard surface when my hip/pelvis/tailbone area are touching the floor. There have been times that it is so painful it hurts to walk or pick up my baby. When I try to exercise, it’s very sore and painful during and afterwards. I love running, and I feel like I’ll never be able to run again. Can you suggest anyone in the Detroit area? Thanks

    1. Hello Melissa,

      It sounds like pelvic physical therapy would be beneficial for you. Unfortunately we dont have a therapist recommendation in Detroit but we can recommend an excellent therapy practice in Chicago. The information is below:

      Kotarino’s Physical Therapy
      Main Clinic
      1 TransAm Plaza Drive
      Suite 170
      Oakbrook Terrace, IL 60181

      Regards,

      Liz

  36. Hi,

    I live in France and have a 4 month old daughter. Ive just finished my ten sessions for the ‘rééducation de périnéale’ nothing has happened for me. My midwife has now given me a device to use at home to try and retrain my muscles. I am giving myself electric shocks down there as I type this lol. She told me to do it a couple of times a day but I’m doing more. I’m desperate to get back to normal. I can’t hold in my pee, I’m constipated, sex is painful and I can’t orgasm. I’m lucky I’m in a country that helps this stuff. I never knew about it until my midwife explained to me what she was about to do. However they leave you in labour longer here. Mine was 33 hours and it’s probably the reason why I’m so messed up down there now.

    1. Hello Sunny,

      You may require internal manual therapy if you are having pain. Often the tens/e-stim only provide relief but cannot properly treat the root of your symptoms. Maria Elliott is located in London. If you are able to travel I recommend you consult with her.

      http://www.simplywomenshealth.co.uk/

      All my best,

      Liz

  37. Hi,
    I gave birth 3 mo back in april to a 6.4lb baby boy. He is my second child. I was getting better day by day. And by 6 wk there was no pain at all.
    I was given all clear from my midwife so i started to work out. All of a sudden for last 2 wk or so ( after working out for almost 2 mo) i am feeling pelvic pressure down there. The occurrences are more towards the evening or when i chase my toddler boy. Goes away after some time of rest. Also when i press that area it feels really better. Need help in deciding if i shld wait for sometime and try to slowdown or take some help and what kind of help.
    Thanks,
    Priyanka.

    1. Hello Pryanka,

      It is difficult to know without evaluating you. When it comes to your health, it is always best to have preventative checkups rather than waiting for a problem to arise. We recommend that you consult with a local pelvic floor therapist for more information.

      All my best,

      Casie

  38. I have a 3-year-old daughter and am pregnant with my 2nd. I had a forceps delivery with an episiotomy and 4th degree tear with my first. I was discharged after the standard 48 hours and healed pretty well, although I wasn’t really informed on how serious a 4th degree tear is. When I started to have my period again, I would experience intense pressure the first 24-48 hours of my cycle. It was a sensation like all my insides might fall out. My doctor said that was not uncommon after childbirth, and a nurse said she has the same experience. I am now having that same sensation in this pregnancy if I am on my feet for more than a few hours. Just this week, I began to have some vaginal bleeding. I saw my doctor and after ruling out the usual causes, he determined it was caused by pressure and irritation at the sight of my episiotomy. Is it possible for me to pursue pelvic floor therapy while pregnant? I’m very anxious now about the rest of my pregnancy (I’m only 6 months along) and very nervous about delivery.

    1. Hello Jennifer,

      Yes! As long as you are cleared for intercourse, internal manual therapy is ok. A therapist can also continue working extrernally as you approach delivery, in order to ensure you are as comfortable and prepared for delivery as possible.

      All my best,

      Liz

  39. I am 3 months postpartum and would like to get evaluated to make sure I am okay given lots of soreness in my abs when I run. What record do you have for cincinnati Ohio?

    1. Hello Annette,

      Unfortunately we do not have a therapist recommendation in Ohio at this time, but perhaps the Cleveland Clinic will be able to assist you. We also recommend the APTA wesbite for more provider research tools.

      Best,

      Liz

  40. Hi. I’m 4 weeks post partum with a grade 1 cystocele. My ob said not to worry as it’s still to early to say it won’t get better but I’m concerned and would love to see a pelvic floor pt who specializes in woman’s health. Is it possible for a cystocele bulge to get smaller or go away? Why recommendations in the philly area of some place I can go? Thanks in and advance.

    1. Hello Lindsay,

      We recommend Hina Sheth, PT in Philadelphia, PA. She will be able to evaluate you, and begin treatment.

      Hina Sheth, PT
      Rebalance Physical Therapy
      267-282-1301
      hinashethpt@gmail.com

      Best,

      Liz

  41. I am desperately searching for best recommendation near Boone, NC (accustomed to traveling for good medical care), Winston Salem, Charlotte, Greensboro, Raleigh, Hickory NC are all considerable areas. Also Johnson City, TN. Really need EXPERIENCED PT to find treatment options for diastesis recti and associated pelvic floor dysfunctions. Thanks!

    1. Hello Tammie,

      Here are our therapist recommendations near Boone, NC:

      Talley, Sarah DPT Raleigh NC (919) 571-9912 Carolina Pelvic Health Center
      Wegmann, Emily PT Raleigh NC (919) 571-9912 Carolina Pelvic Health Center
      Young, Wilda PT Greensboro NC (336) 275-6380
      Briggs, Jennifer PT Raleigh NC (919)571-9912 C.A.W.H. Rehab

      Best,

      Stephanie:

    1. Hello Kate,

      We are located in Los Angeles CA. We do not have a therapist recommendation in Thousand Oaks at this time.

      Best,

      Liz

    1. Hello Jane,

      We do not have a therapist recommendation located in the Clear Lake/Houston area, but we can recommend a few therapists in Austin and Waco. Below is their information:

      Walker Carolyn PT Waco TX 2544055203 Premiere Physical Therapy
      Basler Colleen PT Austin TX (512) 219-5377 PT Specialty Clinic

      McGee Christina PT Austin TX (512) 335-9300 Sullivan Physical Therapy

      Regards,

      Liz

  42. Hi,

    I’m in the UK and am now 6 months postpartum and have very weak pelvic floor still with moderate cystocoele and mild rectocoele. Baby was 9lb 4oz (4.2kg) with induced labour and ventouse delivery. I experience aching from the prolapses along with some stress and urgency incontinence. The latter is improving slowly with bladder training recommended to me by my PT. I’ve been using the kegel tight and tone once daily for 8 weeks now with some improvement in pf strength I think but still experience symptoms. Feel I’ve never get back to running again! Or even playing properly with the little one.

    Is there benefit/necessity in strengthening the core/gluteal muscles that support the pf as well as exercising the pf. I’ve been swimming once a week and am about to get a personalised trading programme at the gym.

    Starting to feel rather despondent about it all! I still find it very difficult to squeeze the pf without using the kegel machine. Will this get easier as the muscle gains strength? I’m worried I’m just not able to connect my brain to do it properly without the machine! Is that possible/can that happen?

    Your thoughts would be greatly appreciated!

    Thanks!

  43. Hello,

    Can kegels make pelvic pain worse? Since seeing PT my pain has been escalating. She says all part of retraining muscles but it really is so sore. Have nerve pain which feels better when PT massages internally. Also pain after sex etc, 4 months postpartum. PT recommendations in Jacksonville, FL? I am seeing one but interested in your recommendation! Thank you.

    1. Hello Zoe,

      Yes they can if a patient’s symptoms are due to pelvic floor tension and musculature restrictions rather than a weakness. Unfortunately we do not have a therapist recommendation located in Jacksonville, but we can recommend Pamela Downey, DPT in Miami. Below is her information:

      (305) 666-3232

      Best,

      Liz

  44. Dear Liz,

    Do you have recommendations for a pelvic floor PT in the New Haven area of CT? I am 2 weeks post Partum and had severe pubis symphysis (PS) and pelvic girdle (PG) pain during both my pregnancies. My second pregnancy was particularly painful and difficult because I also experienced sciatica pain in my right leg. The only relief I got from the PS and PG pain was through physical therapy. However the therapist I used to go to during my first pregnancy moved out of state. He was very good and familiar with this type of pain and relevant exercises. I struggled to find a similar good fit for a PT during my second pregnancy. I plan to resume PT after the initial 6-week recovery period or even sooner (because the pain in my back is too much right now). It would be great to get a recommendation from you.

    Many thanks.

    1. Hello Maryam,

      We do not have a therapist recommendation in CT however, I can give the names of a few pelvic floor therapists who have taken our course, and are in the CT area. Below is their information:

      Cooper Barbara PT Trumbull CT 2034450845 bbcooper123@yahoo.com Physical Therapy For Women
      Marotti Anna PT Norwalk CT 2038553564 anna.marotti@norwalkhealth.org Norwalk Hospital Outpatient Rehab
      Philip Peter PT New Canaan CT 2039663076 pphilip@optonline.net Philip Physical Therapy
      Beaulieu Jillian Meriden CT (203) 630-3939 jillian.beaulieu@flhosp.org Florida Hospital Pelvic Health Rehabilitation
      Levine Ellen PT Wilmington DE 3029952100 back_clinic@comcast.net The Back Clinic

      Best,

      Liz

  45. Thank you for this blog. It has given me some hope. I am almost 6 months post-partum after having an 8 lb 14 oz VBAC delivery (C-Section was 18 months prior with no complications). I had a 2nd degree tear that was sutured but also had a “raw piece of skin” (vaginal mucosa) in between my vaginal opening and anus that the delivering midwife said was “un-sutterable” and “would go away/heal itself.” It never went away and it caused severe burning every time I urinated as well as chaffing every time I moved. At 10 weeks postpartum, I had this piece of vaginal mucosa surgically removed through perineoplasty. I have a feeling of heaviness/pressure in my pelvic area, worse at the surgical site. It feels better when I lay in bed and worsens when I lift my kids, laugh, cough, sneeze, jump or do any exercise. It feels better when I put pressure on the outside of my vaginal opening. I also queef a lot and feel “bubbles” that I have to reposition myself in order for them to go away. I went to a prolapse specialist because I thought maybe I had a prolapse but she said that if was “borderline” prolapse and not significant. …I used to be an avid runner and loved to exercise, but now, since I can’t do anything without feeling this heaviness/pressure, I’m feeling so upset because I’m wondering if this will ever go away. Will pelvic rehab help and who do you recommend in Michigan? (I live near Lansing, but am willing to go anywhere to make this better). Thank you.

    1. Hello Torey,

      I am sorry to hear about your situation. Below are two great therapists near you. I would recommend calling them for an evaluation:

      Miles Kristen PT Royal Oak MI (248) 655-3011 kmaike@beaumont.edu Women’s Urology Center
      Veeser Catherine PT Ferndale MI (248) 655-3000 catherineveeser@gmail.com William Beaumont Hospital

      Best,

      Elizabeth

    1. Hello Katy,

      I apologize for the delayed response. We have received a high volume of inquiries, and have been unable to attend to them in a timely manner. Below are therapist recommendations in the Colorado area:

      Neujahr Hollie PT Denver CO (303) 260-5092
      Byrne Laurie PT Ft. Collins CO 9702211201
      Gerig Nel MD Denver CO (303)388-9321
      Woodward Margaret PT Littleton CO 3037970988
      Nishimoto Terri PT Denver CO 7204023801

      All my best,

      Stephanie

  46. Thank you for this information. I have rectocele, cystocele, front pelvic pain and tailbone pain (I keep my butt tight and tucked so my pelvis and tailbone don’t hurt so much but then have low back pain).
    There are other problems too. This is making me extremely depressed, I feel like I am no longer alive.
    Two questions: 1. Can you recommend a PT who has taken your class for southern MN or northern IA?
    2. In your experience, do you see women who get surgical rectocele/cystocele repair end up with good results? Like being able to move without pain, run, jump and have a great sex life? Or are they permanently impaired after it? I keep reading how many women end up worse than before the surgery. It has been very difficult to find good, positive, insightful info.
    Thanks so much.
    Thanks so much!

    1. Hi Mia,

      Multiple factors can affect a surgical outcome including the severity and chronicity of the problem, the skill of the surgeon, and the before-care and post-surgical rehabilitation. The best outcomes come when an interdisciplinary approach is used that includes physicians and physical therapists. It is best to manage the pain as much as possible before entering surgery.

      Best,
      Stephanie

  47. Hi there, Thanks so much for this information. I am nearly four weeks postpartum with my fourth child. This was my second c section (twins first, vica section, then vbac, then another section after 28 hrs of labor), and recovery has been very difficult this time. No infections and incision is healing well, and pain at the incision site is finally minimal. However, my groin on the right side near when my pelvis meets my right leg hurts fairly constantly, especially when I’m standing for too long. It feels achy or like a bruise. I will ask my ob about it at my six week checkup, but wondered if I can expect this to resolve or if I might need to seek pt? If the latter, do you have recs for the DC/Northern VA are? Thank you!

  48. Please help. Do you have any recommendations for a PT in Virginia Beach, Va? My twins (babies 3 and 4) are 14 months old. I am in great shape, but my tummy is still round. My ob diagnosed me with DR and said only surgery would fix it. That is obviously my LAST resort. I would love to see a PT. Thank you!

  49. Can you recommend anyone in Houston, TX?

    I have a very high pain tolerance but I’ve been dealing with hip/pelvic/leg/lower back pain for 3yrs, including 2 pergnancies and it’s getting to the point where I question, each morning, if I going to be able to walk.

  50. Hello, I am 8.5 months post partum and I have noticed that if I walk a lot, exercise or lift heavy weights, i.e. my baby in stroller, car seat etc. my entire pelvic floor hurts, a throbbing pain like it would fall apart. Then I’m not able to walk properly. I also have severe back pain daily.. Do you know of these symptoms and if so what can I do to aid in healing my body better?
    Thank you

    1. Just a little more info. This is my first baby and I had vaginal birth no tears.

  51. Hello,

    I am 4 months postpartum after an uncomplicated delivery of a 7 lb 14 oz baby girl. I just went to the doctor again today to have an examination because I have had pain and a feeling of pressure/like something is falling from my vagina since my daughter was born. I’m a runner and I have also had problems with incontinence when running. It’s very discouraging because I was active throughout pregnancy and did lots of exercises right up until I delivered including tons of kegels. Now I am having difficulty with kegels because I cannot isolate those muscles very easily. The doctor I saw today thinks I have a cystocele and wants to send me to a urogyn and for an ultrasound. I do not want surgery. I would rather work to improve this problem with physical therapy. Do you have a pelvic floor PT you can recommend near San Diego California? Thank you!

  52. Hello
    Iam 6weeks pp and stumbled across what I thought was a uterine prolapse at 2 weeks pp
    Absolutely devastated I dove right into a depressive state (on top of all my other hormonal issues!)
    I feel utterly broken, I have seen my gp and nurse (who described my problem as having considerable movement in my uterus when I cough sneeze etc and that it is low-visible within my privates)
    I have stumbled across you site whilst in urge of finding hope!
    Iam awaiting referral for pt however the wait is terrible in the uk!
    Also I have started the Hab it did.
    My main question really if you can help me Is will my uterus ever “return to its original position”
    And will I ever be able to cough with out feeling like one of my organs is trying to wriggle out?
    I want to enjoy my baby not have this worry constantly 24-7

  53. Hello,
    I’m 19 mths postpartum and still having pelvic pains when i walk or stand for awhile. Over a mth now i was frightened by a lizard and jumped away at that moment the pain has gotten so severe i can’t even turn in bed without feeling severe pain. I can barely stand or walk its so frustrated I’m just 30 yrs old. I feel like 80yrs old. Was told by doc to do kegel, having problem to stop control urine. I’m so depress .i live in Kingston Jamaica i don’t know if you are able to recommend me a pt
    .

  54. Hi
    I had a 2nd normal labour & episiotomy 4 y. Now , my 1st normal labour & episiotomy were 6years ago, 1 year following my 2nd labour i had experienced heaviness in the perineal region on the same side of the episiotomy specially after sex , but pain relieved spontaneoysly after about an hour .
    my last menses about 2 weaks ago
    i experienced that heaviness since 1st day of menses till now
    any recommendations ?

  55. I have seen a pelvic floor pt for vulvodynia which it helped a fair deal and it rehab me from a c section. The side of my vagina most sore is left side and I sometimes also have burning in bottom of left foot, so it seems something nerve related.

    I gave birth five months ago, vbac, healthy but long delivery, 57 hours with 3.5 hours of pushing. She said I had a tiny half degree tear on left side and I healed well. I am feeling well and healed. But recently I have been getting intermittent waves of heat down mostly my left leg. Is that something my pelvic floor pt would address??

    1. Hi Angeline,
      Thank you for your comment. The waves of heat may be coming from your low back or your pelvis. I recommend having a work up from a physician to rule out anything menacing. If your physician deems PT appropriate, then an evaluation with a pelvic floor PT or an orthopedic PT is a good idea.
      Kindly,
      -Malinda

  56. Hi,
    I am 34 and almost 8wks. pp with my first baby, I have sustained a uterine, cystocele and rectocele prolapse (all stage 2). Can they be reversed with PT so they are not symptomatic? And can I still carry my baby and push her in the stroller? Also, can you recommend someone in the Silver Spring, MD area?

    1. Hi Lynette,
      Thank you for your comment. Pelvic floor PT can help with easing the prolapse symptoms and also help with preventing the prolapse from worsening. I highly recommend you see a pelvic floor PT. The therapist should go over body mechanics with carrying, lifting, and pushing the stroller.
      Kindly,
      -Malinda

      1. Hi Malinda,

        Do you know of a good womens physio therapist on Silver Spring MD?

  57. Hi Marcy!
    Thank you so much for posting this extremely important topic. I am 7 months postpartum and am experiencing incontinence, pain where my scar tissue is from a 2nd degree tear and pain in my pubic bone after sex and when I go for long walks. Oy. I was very active before my son was born but with all of these new and often annoying challenges I don’t feel like myself and am scared to exercise as I often did 3 or 4 cycling classes a week before baby. I live in Rochester NY, are there any PT’s that you know of that specializes in postpartum treatment? Thanks do much for your help! -Sara

  58. Thank for posting!! I’m having pain 6 months post partum. Doctor cleared me and told me to keep doing kegels but I still have pain during sex, urine leakage, pain during certain exercises (barre/yoga) and tailbone pain. I would love to see someone about it. I live in Spokane but am not sure how to go about asking for what I need. Thanks for advice

  59. Hello. I have had 4 children via c section. My last being 13 months ago. With my 3rd, I had scar tissue built up that attached my uterus to my bladder. The Dr. had to cut my bladder away in order to deliver my baby. With my 4th, there was quite a bit more scar tissue and combined with my growing uterus, it had pushed some some of my organs out of place. My bladder had also attached to my stomach wall which when pulled on, from delivering my baby, it tore. My external scar is keloid as it has with every delivery but this time I can also feel that it is raised internally as well. I haven’t had any sort of exam because I don’t have any pain caused by it but I was wondering if this therapy would be of any help to avoid having the previous problems with scar tissue attaching organs and possibly causing trauma to them if I were to conceive again? If so, do you have any recommendations in the Mesa, AZ area? Thank you!

  60. Thank you so much for posting this! I am 11 months post Partum and had painful sex up to 8 months postpartum and severe back pain and still have slight pelvic floor pain. I’ve gone to the doctor and they told me the painful sex was just bc I wasn’t “wet” enough (don’t mean to be crude) and scare tissue but never gave me a resolution to my problem except lube which didn’t really help that much. Also have had pee during running and physical activities now i wear a pad and have heard I should do kegels but now after reading your article I am more motivated than ever and will definitely add it to my routine. Thanks again!!!

  61. After a long and hard delivery (a beautiful, almost 8 pound baby girl), I am suffering from incontinence – gushing urine every time I stand up and often while moving around. This is my third child, and experienced no incontinence issues with previous births. I am terrified that I will be unable to engage with my older children and live my normal, active lifestyle. I am so embarrassed and so upset about all of this, and don’t feel like my concerns are being taken seriously. Can you recommend a therapist in the Atlanta area? Thank you.

    1. Hi Jessica,

      Please use the link below to find a pelvic floor physical therapist in your area.

      Regards,
      Admin

  62. What a relief to find this site! I’d love if you could refer me to someone in Oklahoma to help me with my problem. Prior to becoming pregnant and giving birth last year, I was VERY petite (5’0, 100 lbs). After being induced at 38 weeks because of low fetal growth, I gave birth within 3 hours of induction to a small, but healthy (5lb 11 oz) baby boy. In my opinion I experienced a very traumatic birth- after pushing for about an hour, my baby’s head got “stuck” in my pelvis, I was catheterized, had an episiotomy, tore, and I was seconds away from a vacuum extraction (luckily I was able to get him out with one final, gut wrenching push). I even passed out after delivery from the intense pain. My OB was very perplexed with how difficult it was for me to get him out, as he was soo small. A few days after birth I started experiencing severe pelvic/pubic pain. When I saw my OB (who delivered my baby) about a week postpartum she told me I had pubic symphysis diastasis, and that if I ever wanted another child I would have to have a cesarean due to my difficulties delivering vaginally. Since then she has sent a referral to the only place she in Oklahoma she thought could help. The diagnosis on the referral was “pelvic pain” and “pelvic girdle disorder”. Several weeks have passed now, and they are still “reviewing” my referral, and don’t seem to want to give me an appointment because they mostly treat women’s postmenopausal symptoms and they lead me to believe they are not well versed in how to treat my disorder. I am now 11 weeks postpartum, still dealing with moderate to severe pain daily which greatly reduces and inhibits my activities of daily living (I am unable to go to work or attend school). I cannot even walk without a walker. On top of that i have not been intimate since giving birth because I’m soo afraid of the pain and discomfort it will cause. I would really like to get back to normal activities, and to living a normal life. I would greatly appreciate if you could refer me to somewhere in Oklahoma (or even Texas) that could possibly help me. Thank you in advance.

  63. Hi there. I delivered my 8lb 9oz baby almost 6 months ago via unplanned c-section. Baby was breeched and they attempted a version before the section but that attempt failed. About a week after the baby came I felt as though I had a UTI coming on. Within days of that feeling I came down with the burning sensation while urinating. Where I was breastfeeding they put me on a 7 day script of a low dose antibiotic. About 3 days fter finishing it came back. This time it was worse and the pain was in my abdomen. I was given a different antibiotic to take for 7 days. Within days of finishing the antibiotic the burning returned so bad that I went straight to emerge. Another antibiotic script but this time for 10 days. And again..days after finishing the pain came back. I was convinced that the cathiter from the surgery did damage. Went back to emerge and told them I wasn’t leaving until something was done. I had x-rays and blood work and was referred to a urologist. I saw my OB/GYN after this and she did a scope on my urethra and bladder and said everything was fine. Saw the urologist and he said from all the tests I had done he said he really didn’t know what the issue was but that it could likely be caused by nerve sensitivity from the surgery. He prescribed me a med to help with nerve pain. Meanwhile my GPA referred me to a Pelvic Specialist which apparently takes years to get an appointment but I was made one for a few months down the road. I haven’t had any stinging or burning pain since, but every now and then….and maybe for a couple days together it feels like my vagina aches on the front areas. Almost as if when I do kegals I can feel that area being flexed. I see the pelvic specialist next month. I have yet to find anyone who has had the same issue as me. Wondering if anyone here could shed some light – be greatly appreciated.

    1. Hi Melissa,

      It sounds like you may have a pelvic floor disorder. Unfortunately we cannot make specific recommendations without evaluating you. We would be happy to evaluate you in one of our locations or you can use our website to find a pelvic floor physical therapist in your area that can help.

      Regards,
      Admin

  64. my daughter suffers from this. her son is now 4 years old and still has no relief. there must be something else she can do besides trying almost everything. She is in pain all the time. Medications don’t work..she has had botox shots, is allergic to some of the Rx creams/gels and latex. She has tried different exercises to no avail. what is left for her. She lives in Seattle…where can she turn to? thank you for helping.

  65. Hi. I am 6 weeks pp and am recovering from a 4th degree tear that had to be repaired at 10 days pp due to an infection that made tear open up. So basically im 4 weeks po and I know its still to soon for pt I was wondering if you could recommend anyone in Houston Texas or near. I seem to have some fecal leakage after a bm. I also want to know if I will be able to hold it (a bowel movement) for more than a minute if im too far from a restroom.

  66. Is there any hope for grade 3 cystocele besides surgery? My understanding is that PT is for minor prolapse issues. I’m 10 weeks postpartum and was completely incontinent for the first month so that I had to wear adult diapers all the time. I’m no longer wearing adult diapers but I still have a huge bulge at my vaginal opening, have to urinate frequently but have trouble emptying my bladder, feel a lot of discomfort and pressure when walking or standing for too long, and have a hard time lifting things, especially while going up stairs. I just want to get back to normal and would love nothing more than to exercise. I haven’t had sex yet because I’m too scared and bothered by this bulge. 🙁

    1. Author Stephanie Prendergast says:

      Hi Elizabeth,

      Pelvic floor physical therapy is helpful to improve pelvic floor muscle function and this can help with prolapse of any size. However, it may not be able to reduce or eliminate your bulge or symptoms sufficiently because your prolapse is considered more significant. In addition to seeing a pelvic floor physical therapist it makes sense to consult with a urogynecologist to determine if a pessary may help.

  67. I’m researching pelvic floor disorders as I believe I may have something going on. I’m only 1 week postpartum so I understand things can change in the next 5weeks of healing. This is my 5th baby in 7 years. I suffered with horrible pelvic pain, sciatic pain during this pregnancy. My chiropractor said my pelvis was twisted throughout my pregnancy. I had a normal fast vaginal delivery. However, through the pregnancy I leaked urine like crazy, had horrible constipation and pain with intercourse. I’m just wondering when I should seek assessment for this? Currently I’m having bowel issues with soft stools that are hard to excrete and feeling incomplete, urinary start and stop/hard to relax to start urinating. I know I’m all over the place with this post but just want to see if this could be my issue. And if you know of a good therapy center in Minneapolis area. Thank you

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