Pelvic Floor PT – The Provider You Should See at Six Weeks Postpartum

By: Rachel Wright, PT, DPT, CSCS

After birth, it is customary to see an OB/GYN 4-8 weeks postpartum. At this visit, individuals who gave birth are cleared to return to all activities including intercourse and all forms of exercise. Yet, the postpartum body is not necessarily ready for all these activities at this time, which is where the pelvic floor PT comes in.

First, we want to think about what has happened to the pregnant individual’s body during pregnancy itself. Relaxin, the hormone that allows for laxity in the ligaments to allow for the baby to travel down the birth canal, causes ligamentous laxity throughout the entire body. Relaxin is still released while women are breastfeeding causing continued laxity throughout the joints of the body in the postpartum phase. Due to relaxin pelvic ligaments loosen and the sacroiliac locking mechanism becomes less effective causing strain on the SI joints. The ribs flare laterally to allow more room for the baby. With a growing belly, the center of mass is translated forward causing increased lumbar lordosis and increased stretch on the abdominals. Increased lumbar lordosis results in increased shearing forces through the lumbar spine as well as increased work of the lumbar extensors. The linea alba stretches causing a separation of the rectus abdominis and by full term, 100% of pregnancies result in diastasis recti abdominis (DRA.) The pelvic floor muscles themselves must work harder than usual to support the weight of the growing baby, setting the stage for pelvic floor dysfunction postpartum. 

Many symptoms can indicate pelvic floor dysfunction during, after, and even years after pregnancy. Urinary leakage, or incontinence, is not normal postpartum, or at any time in life. Due to increased pressure on the pelvic floor during pregnancy, individuals often have decreased strength of the pelvic floor postpartum which can lead to urinary incontinence. Additionally, instrument assistance or tearing of tissue can cause trauma or damage to the pelvic floor muscles also resulting in urinary incontinence or leakage. It is important to remember it takes a full 6 months for connective tissue to restore completely postpartum, which is why it is pertinent that individuals do not rush back into high-impact activities too quickly. In the bigger picture, incontinence is an issue because it impacts an individual’s quality of life and is seen by many as a barrier to returning to exercise postpartum. With proper muscle training (under the guidance and supervision of a pelvic floor PT,) whether it is learning how to contract the pelvic floor properly, or even learning how to relax the pelvic floor muscles, symptoms of incontinence can significantly improve, and individuals can get back to all types of exercise. 

Pelvic organ prolapse (POP) is a downward displacement of the pelvic organs into or through the vaginal or anal canal causing a full, heavy sensation through the vagina or rectum, or even back pain. POP can happen immediately postpartum or several years after childbirth. Compromise to the levator ani muscle complex and collagen weakness increases the risk for pelvic organ prolapse. Pelvic floor muscle training has shown to be an effective way to reduce symptoms of pelvic organ prolapse as well as decrease the stage of pelvic organ prolapse in middle-aged women as they go through menopause when there is an intrinsic weakening of the pelvic floor muscles. Additionally, POP can be caused by muscular tightness and therefore applying myofascial release (by a pelvic PT) to taut tissue has been observed in various studies to improve tissue elasticity and reduce downward pull on the pelvic tissue allowing the pelvic organs to move to their natural position through the course of treatment.

Dyspareunia or painful intercourse is one of the most common, and least talked about, postpartum symptoms, with many potential causes. At 18 months postpartum 24% of individuals reported dyspareunia. Physically there can be scar tissue, poor anatomical reconstruction following perineal trauma, and vaginal dryness due to increased prolactin and decreased estrogen when breastfeeding. Psychological causes include traumatic birth experiences, anxiety, and postpartum depression. Surprisingly, there is an increased risk for dyspareunia following Cesarean birth as compared to vaginal birth. A pelvic floor PT can help address this by working on the coordination of the pelvic floor muscles and the diaphragm to help relax the pelvic floor. Internal manual therapy can be used in conjunction to pinpoint the exact muscle that has increased tension. Pelvic PTs also have various tools such as wands and dilators that they can educate patients on, to assist their treatment while at home.

While these are just a few of the pelvic floor conditions that an individual can present with postpartum, or even if they are not postpartum, it is beneficial to see a pelvic floor physical therapist to assess the pelvic floor postpartum. If you have any of the symptoms discussed above or want to return to exercise and your pre-baby activities, you should consider booking an appointment with a pelvic floor PT.