The natural changes of both pregnancy and delivery (either vaginal or C-section) impact the pelvic floor muscles and connective tissue, often causing discomfort and pain for women either during pregnancy (prepartum) or after delivery (postpartum).
Research surrounding the impact of pregnancy and delivery on the pelvic floor provides a snapshot of the issue:
- 45% of pregnant women experience pelvic girdle pain (PGP, in 25% of these women it is severe and for an estimated 7% to 8%, it results in disability).
- Incidences of stress urinary incontinence during pregnancy have been reported to range from 19.9% to 70%.
- 35% of new moms experience stress urinary incontinence in the postpartum period.
- More than 50% of women have a diastatis rectus abdominis after pregnancy. (A diastatis rectus abdominis is the separation of the abs from their central tendon and is a leading cause of low back pain, stress urinary incontinence and pelvic organ prolapse.)
- 20% of first-time moms show severe pelvic floor muscle injury after a normal pregnancy/delivery.
- 25% of women with pregnancy-related pelvic girdle pain during pregnancy remain in pain after delivery.
The good news is the therapists at the Pelvic Health and Rehabilitation Center can easily treat both pregnancy or postpartum-related symptoms with manual, hands-on techniques and individualized home exercise programs.
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Prepartum Physical Therapy
Pelvic floor PT during pregnancy can treat any pregnancy pain or discomfort as well as optimize delivery and prevent perineal tearing and other postpartum dysfunctions.
Common Prepartum Symptoms:
- Swelling secondary to increases in blood volume
- Foot and back pain due to hormonal changes
- Low back pain. Studies have shown the 40% to 60% of women will experience back pain during pregnancy and as many as 25% experience temporarily disabling pain.
- Neck pain and headaches due to changes in posture
- Tightness and pain in the legs due to the flattening of the feet
- Arm pain or tingling caused by nerve compression associated with an increased chest diameter
- Sciatic, hip, sacral, pubic symphysis a.k.a pelvic girdle pain and tailbone pain
- Urine leakage due to strained pelvic muscles
Other prepartum issues PT addresses:
- Perineal massage and partner training for perineal massage. Perineal massage is the practice of massaging a pregnant woman’s perineum around the vagina in preparation for childbirth. The intention is to prevent tearing of the perineum during birth or to prevent the need for an episiotomy or tearing during an instrument (forceps or vacuum extraction) delivery.
- Preparation of pelvic floor muscles for childbirth. The pelvic floor muscles and core stabilizing muscles are intimately involved in the childbirth process. These muscles function at their maximum potential when they are lengthened, strengthened, and free of myofascial trigger points. Impaired muscles are not always symptomatic. A physical therapist can individually examine each muscle internally and externally. If impairments are found the physical therapist can treat the problems with manual therapy and exercise resulting in improved function. In addition, treatment will increase the potential for successful vaginal deliveries with less pelvic floor muscle injury and postpartum pain and dysfunction.
Postpartum Physical Therapy
It is beneficial for all new moms to have their pelvic floor evaluated by a physical therapist 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.
Common postpartum complaints:
- Urinary difficulties. Women with urinary incontinence leak urine when they sneeze, cough, or run. Some women feel a frequent or sudden, urge to urinate, even when their bladder isn’t full. Others are unable to start the flow of urine at will or empty their bladder completely when urinating.
- Anal incontinence. Many postpartum women have difficulty controlling gas or bowel movements.
- Perineal pain. This symptom is common in postpartum women, especially those who tore during childbirth or are recovering from an episiotomy. (The perineum is the area of skin between the vagina and the anus.) In addition, tight pelvic floor muscles cause some to experience persistent perineal pain, even after their wound heals.
- Pelvic pain. Some women have pain during sex for many months or even years after childbirth. And some have chronic vulvar pain, burning or itching. Others have pain during bowel movements. These symptoms are often caused by tight pelvic floor muscles, which can lead to inflamed tissue and nerves.
- Pelvic organ prolapse. When pregnancy and childbirth weaken the pelvic floor muscles the uterus, bladder, and/or bowel can slip out of place. Rehabilitating these muscles can help prevent or improve this condition.
If you are suffering from chronic pelvic pain, PHRC is going to be an essential part of your recovery. They have been for me.
Evaluation and Treatment
During a prepartum or postpartum patient’s first appointment at PHRC a.k.a. the “evaluation appointment,” a physical therapist will take an extensive medical history. Following the history, the physical therapist will perform a thorough external and internal musculoskeletal examination. You are always welcome to have another individual in the room during evaluation and/or treatment.
Your evaluation may include:
- 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: Patients with a 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. In addition, scars from a C-section can contribute to urgency/frequency. The reason scars from childbirth can cause problems is that they can become adhered to nearby structures due to excessive amounts of disorganized collagen produced during the healing process.
- 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; however, most women report confusion about how to do them properly or how often. In fact, according to recent research, 51% of women could not perform a Kegel properly with verbal cueing alone. And 25% of the women in the study were actually performing the attempted Kegel in a manner that could promote incontinence. Treating incontinence requires proper Kegel instruction as well as training in other key exercises to eliminate the problem.