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When immersed in the fog of new motherhood, adding one more item to the list can seem daunting, but if there’s one appointment that every mother should attend after giving birth, it’s an assessment with a pelvic health physiotherapist or pelvic health physical therapist (PHPT).
Many women are surprised to hear that this specialty of physical therapy exists, and unfortunately, often don’t learn of it until they’re experiencing a pelvic floor issue like incontinence or pelvic organ prolapse. Pelvic health physical therapists are PTs who receive additional education and training in managing conditions related to the pelvis. They have the ability to perform external and internal exams and treatment and are therefore able to provide clearer insight to the function of the pelvic floor, which is critical for any woman recovering from pregnancy and delivery.
A PHPT typically sees women who are dealing with:
Pregnancy and birth, are stressful on the body. During pregnancy, the weight of a growing baby places pressure on the pelvic floor musculature and connective tissue, and hormonal changes throughout pregnancy result in softening pelvic support to prepare for birth. These changes alone can lead to a pelvic floor that is more vulnerable to dysfunction.
In the event of a vaginal birth, the pelvic floor has had to accommodate the exit of a baby, and frequently, some degree of muscle tearing and nerve damage results. In the case of a C-section, while the muscles of the abdominal wall are not incised, the fascia, nerves, and skin are, which can contribute to symptoms postpartum.
If muscle tearing, nerve damage, and major surgery in any other region of the body were to occur, physical therapy would likely be included in the recommended treatment plan. The recovery from pregnancy and birth is just as deserving of targeted care!
An assessment with a PHPT empowers a woman to learn more about her body’s function, and equips her with a teammate and the tools to recover efficiently and effectively so that she can return to the activities she loves in daily life and in fitness. Without this assessment, it’s difficult to know why she is leaking, or why she’s experiencing pain during sex, or whether her symptoms are “normal.”
Without an awareness of the function of one’s pelvic floor, it’s possible that a new mother will engage in activities that put her a greater risk of developing dysfunction, even if she isn’t currently experiencing symptoms.
“Most clients I see in my physiotherapy practice (whether expecting, new, or seasoned moms) don’t have an awareness of what is happening with their pelvic floor muscles until after an assessment,” notes Anita Lambert, a physiotherapist with a focus on working with women before, during, and after birth. “An individual assessment can greatly benefit a mom’s confidence in their own body during a time where there is so much change happening physically, mentally and emotionally during postpartum healing.”
If a woman (or her support team) is on the fence about the value of seeing a pelvic health physical therapist, here are six more reasons for why every new mother should see a PHPT.
Generally, women attend a postpartum check-up with their OB-GYN or midwife around six weeks postpartum. Unfortunately, most care providers are not evaluating pelvic floor strength and function (even if an internal exam is performed!) and infrequently test for diastasis recti.
Even though most doctors and midwives are not performing an assessment that fully addresses the strength and function of the pelvic floor, more often than not, women will be given the “green light” to resume exercise. Without more specific instruction, mothers may jump back into exercise that their bodies aren’t yet prepared to manage, and could introduce greater risk of becoming injured or worsening symptoms.
The experts in this area are the PHPTs! After attending the six-week postpartum visit with a doctor or midwife, I strongly encourage women to schedule an appointment with a PHPT to receive a comprehensive evaluation of all of the structures most impacted by their pregnancy and birth experience.
While issues like incontinence, pain, and prolapse are common, they aren’t normal and shouldn’t be considered inevitable consequences of becoming a mother. Working with a pelvic health physical therapist can alleviate symptoms and treat the origin of dysfunction, meaning women do not have to put up with bothersome symptoms!
A PHPT will provide a thorough assessment of the body, focusing close attention to the abdominal wall, and the structures within the pelvis. After performing an external assessment that includes a diastasis recti check, a PHPT can then perform an internal assessment.
The pelvic floor runs through the opening of the urethra, vagina (in women), and rectum, so internal palpation allows for the most thorough assessment. The internal exam a PHPT performs is generally much more comfortable than an annual pelvic exam and is usually much less uncomfortable and awkward than many women anticipate!
It’s worth noting that a PHPT will only perform an internal assessment after gaining consent and making sure the patient is comfortable. If an internal exam is something that one is not comfortable receiving, PHPTs can still gain valuable insight from an external assessment.
An assessment with a PHPT provides feedback on the functioning of one’s pelvic floor, as well as the rest of the core system. Pelvic floor dysfunction is often due to a myriad of causes and is not always related to muscle weakness. A PHPT can identify the origin of any symptoms a new mother may be experiencing, as well as address anything that is currently asymptomatic but may eventually present a problem.
PHPTs can make recommendations on lifestyle factors (bowel habits, breath, alignment) that may be increasing one’s risk of developing pelvic floor dysfunction, and will work to develop a plan to facilitate recovery from birth and a return to one’s chosen activities.
Unfortunately, recommendations for addressing common postpartum concerns have almost exclusively focused on Kegel exercises. While Kegel exercises (pelvic floor contractions that are typically recommended in isolation) can be a helpful tool, they aren’t the end-all-be-all when it comes to one’s pelvic floor functioning well. Not only that, but some women have pelvic floors that are over-recruited, often called “hypertonic”, which means that the pelvic floor is spending more time in an overly-contracted state, instead of dynamically moving through its range of motion (a functional pelvic floor is just like any other muscle system: it should move and not just statically hold!).
Despite popular opinion, a too-“tight” pelvic floor is not a functional pelvic floor and can lead to symptoms like incontinence, painful sex, a sensation of pressure, or the inability to feel the performance of a pelvic floor contraction. These symptoms may lead a woman to believe her pelvic floor is too “weak” and she may begin a regimen of Kegel exercises in hopes of addressing her concern without realizing that this could exacerbate, or lead to new, symptoms. A PHPT can identify an over-recruitment issue and can help to facilitate relaxation and more appropriate function.
Even if kegels are an appropriate exercise for a woman to include in her postpartum recovery plan, there is research to suggest that some women may be performing kegel exercises in a way that could actually lead to worsening symptoms with one study citing that 25 percent of the women in their sample performed Kegel exercises in such a way that could promote incontinence . Individualized assessment and treatment with a PHPT ensures that a new mother receives the most appropriate guidance that is specific to her body and her needs.
Pelvic floor physical therapy involves more than kegels!
PHPTs use biofeedback, manual therapy, lifestyle modifications, exercise prescription, and more to address the concerns specific to each woman. As Anita Lambert wisely stated, “There is no one-size-fits-all and every mom I see has different needs postpartum.”
The pelvic floor is the base of our core. Together with its teammates (the diaphragm, the transversus abdominis, and multifidus), the pelvic floor aids in stabilizing the body from the inside out. Whether lifting a baby in a car seat, or a barbell at the gym, the pelvic floor responds to stabilize and provide support.
Without adequate rehabilitation post-birth, the body may be susceptible to injury and pain, with the pelvic floor being particularly vulnerable. Many new moms will find that they end up leaking or experiencing pain or pressure if they try to rush back into levels of fitness that they did previous to giving birth.
A PHPT can identify the body’s current capabilities, teach strategies that promote full-body functioning while emphasizing healing of the pelvic floor and abdominal wall, and can implement both targeted and generalized exercise that take into consideration each woman’s stage of healing, existing issues, and the many demands of new motherhood. They can also collaborate with fitness professionals, building a cohesive team to support the bodies of new mothers.
“I love collaborating with other health, birth, and fitness professionals to help a mom return to activities they love postpartum, in a smart and efficient way without pain, pelvic floor or core symptoms,” mentions Anita Lambert.
As a mother with pelvic floor dysfunction, I’m grateful for the personal care I’ve received that has enabled me to return to high levels of athleticism, and as a fitness professional working exclusively with mothers, I’m so appreciative of the professional guidance PHPTs have provided for our shared clients that gives me a fuller picture of the clients’ capabilities and needs.
A common misconception is that C-sections remove the risk of pelvic floor dysfunction. This may lead women to believe that working with a PHPT is only necessary for women who have given birth vaginally. Women who birth by C-section, however, are still susceptible to pelvic floor dysfunction, pain, and diastasis recti and can benefit from seeing a PHPT just as much as women who give birth vaginally. The method of birth is only one factor among many that can influence the function of the pelvic floor: pregnancy, fitness and daily life activities, constipation, and genetic predisposition can all contribute to pelvic floor concerns.
Additionally, as their name implies, C-sections involve an incision in a woman’s abdominal wall and uterus, which then forms a scar as part of the normal healing process. Keep in mind that the external scar is only the most superficial layer of scar tissue and what’s happening below the surface can lead to painful and bothersome symptoms. Working with a PHPT after a C-section birth can help minimize the adhesions that frequently occur as scar tissue forms, and that could contribute to pain, discomfort, as well as other symptoms such as urinary urgency and incontinence.
So often, as soon as a woman gives birth, their focus shifts to caring for the new baby and mothers frequently find themselves at the bottom of the list. Prioritizing the new mother’s physical and emotional wellness is just as important as celebrating her new baby. Emphasizing recovery and function postpartum not only benefits the new mother, but encourages a cultural shift in the way we view and treat motherhood.
Working with a PHPT can empower women to participate in a self-care regimen that supports them in the initial phases of postpartum recovery, and beyond.
If you are an expecting, new, or veteran mother who is looking to book an assessment with a pelvic health physical therapist in your area, you can find one by searching on the following websites: