Why every birthing person should see a Pelvic Floor Therapist.
Pelvic floor therapy is a vital component of postpartum care, yet many new parents are unaware of its benefits. This blog discusses the prevalence of pelvic floor dysfunction (PFD), its impact on quality of life, and the options available for effective care. Discover why seeing a pelvic floor therapist should be a standard part of postpartum recovery for all birthing persons (vaginal and c-section deliveries).
Pregnancy and childbirth can take a significant toll on your pelvic floor due to compression, stretching, or tearing. This can lead to pelvic floor dysfunction (PFD), making it hard to control and coordinate the muscles that support your uterus, bladder, and rectum. Symptoms might include urinary and/or fecal incontinence (leakage), prolapse (pelvic organs shifting out of normal position), pelvic girdle pain, painful sex, and low back pain (to name just a few).
Many people believe that pelvic issues are just part of the postpartum experience, but that's not the case. According to a recent survey by Orlando Health Advanced Rehabilitation Institute, many Americans mistakenly believe that pelvic pain, pressure, and incontinence are symptoms that a birthing person is expected to simply endure as an expected part of the “normal” postpartum experience (See blog ‘Common vs. Normal’). Although pelvic floor disorders are common - affecting most women late in pregnancy, 75% women one year postpartum, and 33% of women throughout the lifespan, there are treatment options available and symptoms can be significantly improved or resolved with proper care and treatment. Therefore it isn’t necessary to accept PFD after pregnancy as childbirth as a birthing person’s “new normal.”
While some postpartum PFD symptoms might ease over time, many people experience ongoing issues, or even new problems, months or years after childbirth. These issues can affect physical, social, emotional, and sexual well-being. Research in the Archives of Gynecology and Obstetrics from 2019 shows that 48% of pregnant women report psychological stress related to PFD symptoms, and to compound the issue stress can also make PFD symptoms worse. This highlights how significant the impact can be on overall quality of life. The good news is that pelvic floor muscles, like your biceps or any other muscle group, can be strengthened, lengthened, and relaxed with targeted exercises, leading to significant improvements in PFD symptoms. For some women, Kegels can be beneficial, but often a more comprehensive assessment and individualized plan are needed. Kegels primarily address muscles that are too weak, but many women with symptoms of pelvic floor dysfunction (PFD) actually have strong pelvic floor muscles. In these cases, the underlying issues may be related to muscle coordination, structural changes, or other factors - and a pelvic floor therapist can create a personalized treatment plan addresses the underlying cause.
In many countries, such as France, the benefits of such a tailored approach to care are widely acknowledged and therefore postpartum pelvic floor therapy is standard care, with patients receiving prescriptions for multiple physical therapy visits after childbirth. Unfortunately, in the U.S., adopting pelvic floor therapy as a standard practice still faces significant challenges, primarily due to the slow uptake by insurance companies despite abundant supporting data. The consensus among pelvic floor therapists, OB/GYNs, and midwives is that research supports starting therapy 1 to 3 days after delivery and again between two and six weeks postpartum. Shifting to this standard of care would help normalize pelvic health services and promote long-term recovery.
What if I had a C-section, is pelvic floor therapy still recommended for me?
A c-section is a major surgery, no different than a knee or hip replacement, for which the standard of care is immediate follow-up with a physical therapist. A pelvic floor therapist can support your initial healing by teaching you strategies for positions such as getting in and out of bed, guiding you in movements to support core recovery, assisting with body mechanics for activities like pushing a stroller, and even demonstrating scar massage techniques to enhance scar healing.
What if I am not having any symptoms of PFD, should I still get an assessment?
It’s ultimately a personal decision as to what you feel comfortable with. Personally I saw a pelvic floor therapist for evaluation after my first pregnancy even though I wasn’t having any real concerning symptoms for reassurance that everything looked good, there wasn’t any damage from delivery, and that healing was headed in the right direction. She gave me peace of mind as well as some excellent pointers on proper ergonomics during baby care, and personalized exercises to reduce back pain and strengthen my core. Now that I am pregnant with my second child I plan to see a pelvic floor therapist during pregnancy (they can also help with birth preparation) as well as in the postpartum period. I believe they have something to offer everyone.
Conclusion
Pelvic floor dysfunction is common but shouldn't be accepted as a “normal” part of postpartum recovery. With early and appropriate care, including seeing a specialized pelvic floor therapist, many issues can be effectively managed. Most OB/GYNs and midwives aren't trained to assess pelvic floor muscles to the extent that pelvic floor therapists are. If you're experiencing PFD symptoms, seeing a PT or OT with specialized pelvic floor training is recommended. In many states, a referral isn’t necessary to see a pelvic floor therapist, but it’s a good idea to check with your insurance for coverage options. Some therapists also offer sliding scale payments or affordable plans. Prioritizing your pelvic floor health can lead to a more comfortable and fulfilling recovery.
Use the tools below to find a pelvic floor therapist near you today and start improving your postpartum recovery and overall well-being.
https://www.aptapelvichealth.org/ptlocator
https://pelvicglobal.com/directory/
I also recommend this article from the Perinatal Pelvis that includes a questionnaire to help you find a pelvic floor therapist who is a good fit for you: ‘Inform yourself to receive the best care.’
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