Should pelvic floor therapy be a part of your postpartum care?

The answer to that question is probably YES! If you had a vaginal delivery or even a cesarean birth then your pelvic floor muscles are likely in need of some rehabilitation. You might be asking yourself what is the pelvic floor and why would it need rehab? Great questions.

The pelvic floor is the sling of muscles located at the bottom of your pelvic outlet. There are openings that pierce completely through these muscles. These openings include the urethra, the vaginal opening, and the anus. The pelvic floor muscles encircle these openings and when contracted hold back urine, feces, and gas. The pelvic floor also provides support to our pelvic organs. So that means our bladder, rectum, and uterus are all being held in place by these muscles. Without them our organs would obey the laws of gravity and fall out of the vagina. This is called pelvic organ prolapse and it’s a real issue.

Lastly, the pelvic floor provides stability to our trunk. Along with the diaphragm, abdominal wall, and muscles in our back called multifidi, the pelvic floor contracts during functional movements becoming a sturdy canister for the rest of our body to move off of. It’s pretty amazing that such a small group of muscles can provide so many important functions.

Here’s the important part for you postpartum ladies out there: Because the pelvic floor can experience massive stretch, tearing, and incisions called episiotomies, during childbirth they can lose their ability to function properly. This means that postpartum women are more likely to experience urinary leakage, pelvic organ prolapse, and pelvic pain. In fact, one study found that 92% of postpartum women report urinary leakage 12 weeks after delivery. When these same women were asked again 5 years later 92% of them continued to experience leakage (Viktrup et al 2000). As for pelvic organ prolapse, 50% of women who have experienced childbirth have some degree of prolapse (Hagen & Stark 2001). Prolapse can be accompanied with symptoms of pelvic heaviness, backache, and vaginal bulging.

So what is pelvic floor therapy and how can it help?

As pelvic floor therapists we have special training to assess the pelvic floor through an internal vaginal assessment, or if someone is not comfortable with this then we can assess their pelvic floor with external techniques. We assess the pelvic floor for strength, coordination, and endurance. This helps us figure out why someone might be experiencing leakage, pain, or prolapse. Often times we find that a woman is doing a pelvic floor contraction (A.K.A “kegel”) incorrectly. An incorrect contraction can look differently depending on the person. Some women squeeze accessory muscles in their butt, thighs, and abdomen instead of the pelvic floor. Other women actually bear down utilizing a valsalva movement instead of doing a kegel. This can actually worsen symptoms like prolapse and urinary incontinence. In these cases, we teach them how to do a kegel the correct way so that they can strengthen their pelvic floor in isolation. We then teach them how to coordinate the pelvic floor muscles with activities such as sneezing, coughing, jumping, running, etc. so that they don’t experience leakage or prolapse during these activities.

Thankfully in the US, pelvic floor therapy is becoming more recognized however this modality is still underutilized in postpartum care compared to other countries. Often times medication and surgery are the first line of treatment for these issues, which is unfortunate when a more conservative and effective treatment exists.

The pelvic floor therapists at Alpine Physical Therapy are hopeful of a future where pelvic floor therapy becomes a cornerstone in every woman’s postpartum care. If you are a postpartum woman in any stage, whether you had a baby 6 weeks ago or 6 years ago, you could benefit from this form of physical therapy for prevention and treatment of pelvic floor issues.

If you have any further questions or inquiries call Alpine at 541-382-5500 or email emily@alpinephysicaltherapy.com

References

1. Viktrup L, Lose G. Lower urinary tract symptoms 5 years after the first delivery. Int Urogynecol J Pelvic Floor Dysfunct 2000;11:336–40.
2. Hagen, S. and Stark, D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane database of systematic reviews, 2011, 12, CD003882