Congratulations on your new baby! You made it through the 1st, 2nd, and 3rd trimesters….and now welcome to the 4th trimester. Yes you read that correctly, the FOURTH trimester. The term “fourth trimester” has been referred to as the baby’s first three months of life. You can find loads of information on swaddling techniques and sleep advice for the baby during this time, but what about advice regarding recovery for moms?
Women typically see a healthcare provider frequently throughout pregnancy. Once the baby arrives they receive a 6 week postpartum screening and usually no further follow up. New guidelines from the American College of Obstetrics and Gynecology (ACOG) call for improved postnatal care for potential long term changes after pregnancy.
Receiving treatment from a pelvic floor physical therapist can help with challenges that may have developed during or after pregnancy. If you experience any of the following symptoms, pelvic floor physical therapy can help you!
Low back or pelvic girdle pain
Pregnancy related low back pain occurs in 60-70% of pregnancies (Mogren 2005) and can persist after birth. During pregnancy, the growing baby pulls your center of gravity forward and changes your body mechanics. This can place increased pressure on your lumbar spine and result in low back pain. The hormone relaxin can also contribute to laxity in your ligaments which can cause pelvic/low back pain.
Urinary Leakage/Incontinence
The involuntary loss of urine is common in the postpartum population however it should improve over time and does not need to be a symptom you are “stuck with forever” after having a baby. There are two types of incontinence
Stress Incontinence: Typically occurs during coughing, laughing, sneezing, jumping or running.
Urge Incontinence: Sudden urge to urinate and inability to hold urine back while running to the bathroom
Bowel Incontinence/Constipation
Inability to control gas or prevent the leakage of stool could be a flag that your pelvic floor is not working optimally.
Constipation - inability or fear of bearing down to have a bowel movement, heaviness/fullness in the rectum, and the feeling of incomplete emptying.
Pelvic Organ Prolapse (POP)
Pelvic organ prolapse occurs when there is a lack of support of the pelvic organs
Symptoms of POP often include the sensation of “something falling out of the vagina”, pressure, heaviness or fullness in the pelvis that typically gets worse throughout the day
Pelvic floor physical therapists are trained in the assessment and treatment of pelvic organ prolapse
Painful sex
Many women do not feel comfortable returning to sexual activity after their 6 week postpartum check up. If you are having pain with intercourse, there can be many reasons for this including hormonal influences, pelvic muscle tightness, scar sensitivity, etc.
Pelvic floor physical therapists will perform a thorough assessment to determine what is causing the pain and treat accordingly
Scar sensitivity
If you had a c-section, perineal tearing, or an episiotomy, you may have pain and sensitivity surrounding your scar.
Your physical therapist can show you scar mobilization, massage, and desensitization techniques to improve pain and decrease scar tissue adhesions.
Tailbone pain/Pain with sitting
The pressure of your baby passing through the birth canal can bruise, dislocate, or even fracture your coccyx (tailbone). This can cause discomfort, especially with sitting making it difficult to feed your baby or even have a bowel movement.
Diastasis Recti/”Mommy Tummy”
Diastasis recti is a separation of the most superficial abdominal muscles and stretching of the connective tissue called the linea alba. This occurs to make room for the growing baby during pregnancy.
Symptoms:
Discomfort and a feeling of weakness in the abdominals
Doming or tenting in the middle of the stomach when you lift up or roll over
Appearance of a “pouch” in the lower abdomen
Physical therapists can recommend safe exercises, manual therapy and bracing/taping techniques to retrain the abdominal muscles and provide exercise and postural retraining.
Safely return to exercise
Maybe you have no symptoms, but you want to begin to exercise or return to running/sport but are not sure where to begin. Our MomStrong program can help you return to your previous activities in a safe manner and teach you the right exercises to help achieve your goals!
What to expect during the initial evaluation and subsequent treatment sessions:
During your first visit to our clinic, you will meet your physical therapist and be taken to a private treatment room. In the examination room, you will be able to explain your history, symptoms, goals, and what brings you into therapy.
Your therapist may ask you additional questions to further understand what brings you in. They will also explain the components of the examination and explanation of the pelvic floor and its many functions.
Oftentimes an external and/or internal examination will be performed.
For the external examination, your therapist will assess your strength, range of motion, and joints to determine if your hips, back, or core may be contributing to the problem.
For the internal examination, your therapist will leave the room to allow you to undress and give you something to cover yourself. Your therapist may initially perform an observation and ask you to contract your pelvic floor, then bulge. Do not worry if you are unsure how to do this, they will guide you through it. After a visual assessment, they will likely perform a 1 finger pelvic floor muscle exam after obtaining consent from the patient. During the muscle examination, they will ask you to contract, relax, bear down. They will gather information about your strength, coordination, endurance, and ability to relax your muscles.
After the examination, your therapist will discuss their findings and come up with an appropriate and agreeable treatment plan with you. They may assign you a “home program” if they feel it is beneficial.
Follow up visits may include additional external and internal soft tissue releases, muscle re-education strategies, posture and activities of daily living education, and return to safe exercises depending on your current strength, pain level and goals. Your therapist will discuss this with you when determining the treatment plan.
Once postpartum, always postpartum! Even if you had a baby 10 (or more) years ago, you are still postpartum and may find yourself struggling with some of the symptoms listed above. It is never too late to get help! At Zion Physical Therapy, our Doctors of Physical Therapy have special training to help postpartum women with all of the above. If you do not see your particular symptom, please inquire about how we can help! All treatments are conducted in a private treatment room 1-1 for 45 minutes with a pelvic health PT. Call (212) 353-8693, go to our Request Appointment form, or email schedule@zionpt.com to schedule!
Jessica Nielson, DPT
References: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care
Mogren IM, Pohjanen AI. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine . 2005;30(8);983-91. (Evidence level: 2C)
Ostgaard HC, Roos-Hansson E, Zetherstrom G. Regression of back and posterior pelvic pain after pregnancy. Spine (Phila Pa 1976) 1996;21:2777–2780. doi: 10.1097/00007632-199612010-00013.
