New Study Emphasizes the Importance of Postpartum Pelvic Care

You may not walk around thinking about your pelvic floor, but these hammock-like muscles are important: They support the bladder, uterus, and rectum in child-bearing women, and when they’re not working properly, they can cause discomfort. Pelvic Floor Dysfunction (PFD) occurs when these muscles can’t contract, relax, or function as they should.

Research suggests that at least one in three people will experience pelvic floor dysfunction in their lifetime. It can occur at any age and can be caused by a variety of factors. Pregnancy and childbirth (whether vaginal or caesarean section) often play a role.

Although the symptoms can be debilitating, a recent survey of more than 600 women by Origin, a pelvic floor physical therapy company with locations across the US, found that there are still major gaps in pelvic floor care.

The survey found that 96% of people with symptoms go undiagnosed. One in three women who give birth within five years will experience pain during intercourse and 67% will experience urinary incontinence. Yet 86% of those surveyed said they received no guidance on how to heal their pelvic floor after giving birth.

Experts stress that this situation needs to change: pelvic floor treatment and rehabilitation are available.

Childbirth and the pelvic floor 

When Mackenzie* was pregnant with her first child, she began experiencing pelvic pain in the middle of her second trimester. The pain was severe and affected her daily life.

“Mostly it’s sex,” the San Francisco mom said, “but sometimes even going to the bathroom really hurts.”

Pregnancy can put a strain on the pelvic floor. “Just the weight gain that comes with pregnancy puts a lot of pressure on the pelvic floor,” says Liz Miracle, MSPT, WCS, physical therapist and director of clinical quality and people at Origin. “To meet that challenge, you need to elevate your pelvic floor.”

Hormonal changes also occur, such as the release of relaxin, which loosens the joints. Pregnancy can also cause constipation, another contributing factor in PFD.

When it comes to childbirth, the pelvic floor muscles are under a lot of strain. PFD is more likely to occur if you give birth vaginally, but it can also occur if you have a C-section. This could be due to the effects of the pregnancy, or pushing before having an emergency C-section. Many people also suffer tears during childbirth, which can also be a contributing factor.

PFD manifests in two ways: “In one sense, the pelvic floor becomes too weak; it becomes like a loose hammock,” Miracle says. “In another sense, your body responds by over-contracting and becoming very stiff in an attempt to hold everything together.”

Symptoms vary, but some common symptoms include:

• constipate
• Urinary incontinence
• Feeling weight around the pelvis 
• Sexual changes (pain, dissatisfaction, inability to reach orgasm)
• Tailbone pain
• lower back pain

Pelvic Floor Therapy May Help

Mackenzie, a certified yoga teacher, began pelvic floor therapy at Origin during her second trimester to loosen her muscles and prepare for birth. Both times, it made her feel better.

In pelvic floor therapy, a trained therapist works on both the external and internal muscles. Therapists often teach patients exercises to do at home. Depending on the patient’s condition, they may recommend using dilators at home to stretch the vaginal tissues. Trigger point injections, dry needling, and biofeedback are other recommended tools.

Mackenzie returned to pelvic floor therapy after a difficult birth. Her daughter was larger than normal, so she had to have a third-degree episiotomy, which resulted in severe urinary incontinence. “Whenever I had a spasm, coughed, jumped or tried to run, I would leak urine,” she says. “It was frustrating having to basically walk around with a change of underwear all the time.”

Weekly pelvic floor therapy, then every two weeks, strengthened and retrained her muscles. “I had the opposite problem when I first started treatment: everything was too loose and not tight enough,” says MacKenzie. She does the recommended exercises at home and also uses vaginal weights.

Bijal Toprani PT, DPT, a pelvic floor physical therapist at Hinge Health, recommends that everyone get a pelvic floor evaluation after giving birth. It usually happens at a consultation with a healthcare provider six weeks after giving birth, but PFD is rarely detected. During that appointment, a healthcare professional will usually examine the tissues to see if any tears from birth have healed or to see the condition of a C-section scar.

“They’re not really looking at the whole picture: can you coordinate your muscles, can you relax your muscles, how strong your muscles are,” she says. “They’re more interested in healing, which is crucial, but it’s a different kind of test than a physical therapist who specializes in pelvic health would do.”

No, you don’t need to be afraid of getting pregnant again. 

Pelvic floor dysfunction can make it difficult to conceive, and Mackenzie was nervous about her current second pregnancy, but sees a silver lining.

“It was good to have had it once, and I feel like I’m more aware of my body and muscles this time around than I was with my first pregnancy,” she says. “I feel more in control.”

Experts agree, pointing to options like pelvic floor therapy during pregnancy. Pelvic floor therapists don’t typically do much internal manipulation during pregnancy, but they will teach patients exercises like lunges, crunches, and diaphragmatic breathing, says Dr. Toplani. (Internal work should be avoided if a patient has issues with the placenta or cervix, or is on bed rest.)

“Many of the movements are gentler and more full-body, which helps your pelvic floor actually give birth and helps you recover better after,” says Dr. Toplani. Aim for 15 to 20 minutes of exercise three days a week to get the most out of your body.

A pelvic floor therapist can also teach you ways to protect your pelvic floor, such as applying warm compresses to prevent perineal tears during childbirth, as recommended by the American College of Obstetricians and Gynecologists (ACOG). Perineal massage can also be helpful in the weeks before giving birth.

Of course, pelvic floor therapy can be done postpartum for those who need it. Recovery time varies depending on the patient and their condition. “People with urinary incontinence, one of the most common pelvic floor disorders, will see improvement in about 90 days,” says Dr. Toplani. Other issues, like pelvic pain, may take longer.

Dr. Toprani cautions that healing can take time, and it’s important to listen to your body and forgive yourself.

“Just because six weeks is a commonly touted number, remember that doesn’t necessarily mean it’s the exact amount of time you need to feel exactly like you did before,” she says. “There’s nothing wrong with you. This is an arbitrary timeline, and you have to follow your own timeline.”

*Last name withheld to protect privacy