Postpartum Pelvic Floor Rehabilitation

Postpartum Pelvic Floor Rehabilitation

The postpartum period is a transformative time in a person’s life, filled with joy, challenges, and adjustments. Amidst the excitement of welcoming a new baby, it’s easy to overlook the physical toll pregnancy and childbirth take on the body. One crucial aspect of recovery often underestimated is pelvic floor health. Pelvic floor rehabilitation postpartum is not just beneficial—it’s essential for long-term well-being.

What is the pelvic floor?

The pelvic floor is a group of muscles and connective tissues between the tailbone and pubic bone that support vital organs such as the bladder, uterus, and rectum. These muscles play a critical role in core stability, urinary and bowel control, and sexual function. Pregnancy and childbirth, whether vaginal or cesarean, can weaken or damage the pelvic floor, leading to a variety of issues if left unaddressed.

Common Postpartum Pelvic Floor Issues

Postpartum individuals may experience a range of pelvic floor-related concerns, including:

1. Urinary Incontinence

Leaking urine during activities like coughing, sneezing, or exercising is a common postpartum issue (stress incontinence). Another form is urge incontinence when urine is leaked during a strong urge.

2. Pelvic Organ Prolapse

This occurs when pelvic organs shift downward due to inadequate support, often resulting in pressure or discomfort.

3. Pain and Discomfort

Pain during intercourse, lower back or SIJ pain, or a sensation of heaviness in the pelvic area can stem from pelvic floor dysfunction.

4. Diastasis Recti

A separation of the abdominal muscles, which often coincides with weakened pelvic floor muscles and affects core stability.

The Importance of Rehabilitation

Pelvic floor rehabilitation focuses on restoring strength, flexibility, and function to the pelvic muscles. Here’s why it’s crucial:

1. Improved Bladder and Bowel Control

Strengthening and improving the coordination of the pelvic floor can alleviate or prevent incontinence and improve overall quality of life.

2. Prevention of Long-Term Issues

Addressing pelvic floor dysfunction early can reduce the risk of chronic pain, pelvic organ prolapse, urinary incontinence and other complications later in life.

3. Enhanced Core Stability

A strong pelvic floor contributes to overall core strength, which supports posture and reduces the risk of injury.

4. Better Sexual Health

Rehabilitation can address pain or discomfort during intimacy and improve sexual satisfaction.

Tips for Initial Healing of Perineal Tearing

Over 85% of women who deliver vaginally will have some degree of perineal tearing, and proper care is essential for healing. Here are some tips to promote recovery:

1. Practice Good Hygiene

Keep the area clean by using warm water to rinse the perineal area after using the bathroom. Use a peri bottle for gentle cleansing.

2. Apply Cold Compresses

Ice packs or chilled pads (padsicles) can reduce swelling and provide pain relief in the initial days postpartum.

3. Use Pain Relief Options

Over-the-counter pain relievers, as recommended by your healthcare provider, can help manage discomfort. Topical anesthetics may also be beneficial.

4. Rest and Avoid Strain

Minimize activities that put pressure on the perineal area, such as heavy lifting or prolonged sitting.

5. Consider Sitz Baths

Soaking in a warm, shallow bath can soothe the area and promote healing. Add Epsom salt for added relief if approved by your provider.

6. Stay Hydrated and Eat Fiber-Rich Foods

Prevent constipation by drinking plenty of water and consuming a high-fiber diet. Straining during bowel movements can worsen discomfort.

7. Consult Your Healthcare Provider

Follow up with your healthcare provider to monitor healing and address any concerns, such as signs of infection or severe pain.

What Does Pelvic Floor Rehabilitation Involve?

Rehabilitation typically begins with an assessment by a specialized physical therapist who can tailor a program to your specific needs. Common elements include:

• Pelvic Floor Exercises: Are kegels right for you? Learning how to coordinate the pelvic floor with breathing and functional activities is key and often involves learning how to lengthen and relax your pelvic floor first.Your PT will help determine if pelvic floor contractions, also known as Kegels, will be a part of your plan of care.

• Breathing Techniques: Proper breathing can help coordinate the diaphragm and pelvic floor, enhancing muscle function.

• Whole body strengthening and improving posture: Your PT will guide you on returning to exercise which may include a return to running program. Generally your medical provider will clear you for all activity at 6 weeks postpartum which you may not be ready for. PT will include integrating core and pelvic floor with your entire system in order to prepare your body for higher impact activities like running or HIIT exercise. Running is not typically recommended until 12 weeks postpartum.

• Manual Therapy: Hands-on techniques may be employed to release tension or address scar tissue from tears, cesarean section scars or episiotomies. Dry needling may also be used.

When to Start Rehabilitation

If you are having pain or would like to have guidance on exercise in the first few weeks after having a baby, you can start any time postpartum- even before 6 weeks! An internal pelvic exam would be held until 6 weeks so that a medical provider can provide clearance that tissues have healed. It is never too late to seek help. Even years after giving birth, addressing pelvic floor health can yield significant benefits.

Conclusion

Pelvic floor rehabilitation is an investment in your health, enabling you to recover fully and enjoy your postpartum journey without unnecessary discomfort or limitations. Prioritize this aspect of self-care—your body will thank you for it. All of our therapists at Klein Physical Therapy specialize in postpartum rehabilitation. We offer hour-long sessions to have time to address your entire body and provide one-on-one care. Book your appointment today!

Male Pelvic Health

Chronic Nonbacterial Prostatitis

Chronic nonbacterial prostatitis is a common referral to pelvic floor physical therapy clinics. Yet, the journey to find physical therapy, and to learn that your symptoms aren’t related to a UTI or STI, can be a long and frustrating process. There’s a common misconception that pelvic floor physical therapy is only appropriate for women, particularly related to pregnancy, postpartum care, or in relation to sexual dysfunction. Awareness that males, too, can struggle with pelvic floor dysfunction is improving, albeit slowly.

Males dealing with urinary issues report first seeing their general practitioner, a urologist, or sometimes even gastroenterology, but after a few negative tests, are likely sent on their way with medication(s). Most patients report that this process is repeated multiple times, prior to pelvic floor physical therapy being brought up at all. This can take consulting with multiple providers prior to finding a provider familiar with the connection to our pelvic musculature. It is a frustrating and drawn-out process for many.

If we dive a little deeper into why physical therapy can help, we can look to the muscles in our pelvis specifically. The muscles in the pelvic floor help us retain as well as release urine at the appropriate times. We get into “dysfunction” when these muscles are chronically tight, have poor coordination, or cause pain with urination or bowel movements due to an upregulated nervous system.

Chronic nonbacterial prostatitis, or chronic pelvic pain syndrome, accounts for almost 90% of individuals with a diagnosis of prostatitis according to NIH. Symptoms that you may be experiencing include frequency of urination (<3 hours between voids), a small amount of leakage or dribbling after urination, burning or pain during/after urination, or waking at night >1x to urinate. It is common, as was mentioned before, for these patients to be put through a number of tests, given a few medications that may mildly improve their symptoms, but truly find minimal to no real relief. Symptoms can come and go related to stress, changes in your diet, increase in activity, or may increase with prolonged pressure at the pelvic floor (ie. biking, sitting for extended periods, or chronic constipation/straining for bowel movements).

Pelvic floor physical therapy can help with your symptoms by teaching you to relax and stretch these muscles, improve your body awareness of how you manifest stress or anxiety, change urinary habits, improve coordination of the pelvic floor muscles, and improve your body’s ability to fully void as well as hold in urine with improved control. Additional symptoms may include difficulty with achieving erections, difficulty with ejaculation, low back or hip pain, testicular pain, pain to the tip of the penis, or pain at the groin line and abdomen.

If any of these symptoms sound familiar to you or someone you know, seek out a consultation with a pelvic floor physical therapist to start your journey towards an improved quality of life and reducing painful symptoms.