We can help with all these postpartum issues:
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Within days following delivery, postpartum women experience
neuromusculoskeletal issues from pelvic floor and abdominal injury.
Obstetricians and Gynecologists recognize pelvic floor issues as being associated with surgical and vaginal birth [source]. Within days following delivery, postpartum women experience neuromusculoskeletal issues from pelvic floor and abdominal injury. Childbirth, vaginal or cesarean section, inevitably causes physical injury to the pelvis. In many countries, therapy evaluations are mandatory in postpartum women to restore full muscular function.
The American College of Obstetricians and Gynecologists (ACOG) recognizes pelvic floor therapy as part of optimal postpartum care [source]. Postpartum rehabilitation dramatically improves recovery time and prevents long-term pelvic dysfunctions. It also screens for vital and mental health issues. When issues are not addressed in the perinatal and postpartum periods, women experience life threatening and/or life-long health risks. Our goal in therapy is to restore full function to the neuromusculoskeletal tissues of the pelvis and prevent future pelvic dysfunctions that plague so many women who did not have access to postpartum rehabilitation.
There is a healthier and kinder way to recover from childbirth, and you deserve it!
(Click each issue to expand and learn more.)
Diastasis recti (the separation of the abdominal muscles) is a leading cause of pelvic floor dysfunction including incontinence, low back and pelvic pain, and prolapsed organs. All pregnant women experience a diastasis by 35 weeks weeks; however, 35-60% do not spontaneously recover [source].
On the internet, women can find a flood of exercise programs to reduce diastasis. Almost all of these, however, fail to consider transference of loads through the core and consequences of repetitive strategies that induce high intra-abdominal pressure.
Therapy utilizes strategies that consider the abdominal wall and its relationship to the rest of the body with emphasis on the pelvic floor and diaphragm. Diastasis recti can be rehabbed at any time, even years after giving birth. Although, the best results are obtained when intervention is provided almost immediately after delivery, before women are taking on loads with their body such as carrying baby.
Early intervention is ideally in the hospital and may include:
Taking the time after delivery to understand how the pelvic floor and abdominal muscles need to coordinate for load transference after pregnancy can reduce the occurrence of pelvic floor issues and provide lifetime benefits.
Mota, P., Pascoal, A. G., Carita, A., Bo, K. (2014). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy. doi:10.1016/j.math.2014.09.002
It is estimated 30% of women experience accidental urine leakage at three months postpartum [source].
Research cites perineal tear, high body mass index, use of forceps, multiple deliveries, and vaginal delivery of an infant over 8.5 pounds as risk factors for postpartum bladder leakage. However, there is no one clear cause [source]. Women who delivered via cesarean experience postpartum bladder leakage and overactive bladder as well (though at lesser rates), which indicates that the stress of pregnancy on the pelvic floor muscles is a large contributor to postpartum bladder issues.
Urogynecologists recognize pelvic floor muscle training as effective to rehabilitate bladder leakage in the immediate postpartum period [source]. Therapy can begin immediately or weeks postpartum with obstetrician clearance. Treatment may include:
Each woman experiences different symptoms, which is why individualized evaluation and care is needed to resolve postpartum bladder issues.
1. Glazener, C. M. A., Herbison, G. P., Wilson, P. D., MacArthur, C., Lang, G. D., Gee, H., & Grant, A. M. (2001, September 15). Conservative management of persistent postnatal urinary and faecal incontinence: randomised controlled trial. The BMJ.
2. Brubaker L. (2002). Postpartum urinary incontinence. BMJ (Clinical research ed.), 324(7348), 1227–1228.
3. Mørkved, S., & Bø, K. (1997). The effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence. International urogynecology journal and pelvic floor dysfunction, 8(4), 217–222.
Postpartum bowel smears and flatulence (accidental gas) are some of the most embarrassing postpartum symptoms women experience. More than 25% of postpartum women report bowel smears at six months postpartum and 40% reporting frequent accidental loss of gas, which almost always occurs during intercourse [source]. Anal sphincter injury from perineal tear is typically the cause of losing anal control.
Pelvic floor rehabilitation is up to 80% effective in the treatment of bowel smears [source].
Treatment may include:
Each woman’s issue is different. Individualized evaluation and care is the key to successful rehabilitation of postpartum bowel issues.
1. Guise, J. M., Morris, C., Osterweil, P., Li, H., Rosenberg, D., & Greenlick, M. (2007). Incidence of fecal incontinence after childbirth. Obstetrics and gynecology, 109(2 Pt 1), 281–288. DOI: 10.1097/01.AOG.0000254164.67182.78
2. Scott KM. Pelvic floor rehabilitation in the treatment of fecal incontinence. Clinics in Colon and Rectal Surgery. 2014 Sep;27(3):99-105. DOI: 10.1055/s-0034-1384662.
Constipation that is developed during the pregnancy is typically caused by dyssynergia, discoordination of the abdomen and pelvic floor muscles. The pelvic floor muscles become hypertonic or tight and have a difficult time releasing a bowel movement.
There are three types of constipation, with the first type being the most common in pregnant and postpartum women.
Treatment may include:
Individualized evaluation and care are successful to rehab constipation developed during pregnancy.
Pelvic floor rehabilitation is up to 80% effective in the treatment of constipation [source].
Rao, S. S., & Patcharatrakul, T. (2016). Diagnosis and Treatment of Dyssynergic Defecation. Journal of neurogastroenterology and motility, 22(3), 423–435. DOI: 10.5056/jnm16060
When left untreated it causes chronic lower back and pelvic pain. This pain is difficult to resolve with traditional physical therapy because the muscles are best accessed via the pelvic floor. A key symptom of coccyx dysfunction is pain and intolerance of sitting.
There are many structures that attach onto the small surface area on the coccyx. The coccyx also provides support to important organs, such as the rectum and anus.
The position of the coccyx will affect everything that attaches to it, which is why pelvic floor therapists are uniquely qualified to treat coccydynia. In fact, medical research cites therapy to be 90% effective in treating coccydynia [source].
Therapeutic treatment modalities can include:
The goal for each patient with tail bone pain is to be pain free.
As a new mom, looking down at baby for extended periods of time puts incredible pressure on the shoulders and neck. Couple this with the likelihood that a new mom has weakened core stabilizer muscles to support her upper body (abdominal and pelvic floor muscles), and it becomes clear why nearly 75% of new moms experience shoulder and neck pain [source].
Preventing postpartum shoulder and neck pain via ergonomic education and postpartum pelvic floor therapy is the best plan of action. However, shoulder and neck pain can be treated at any time. The goal for each patient is to be pain free while caring for their infant.
New moms are often back to work and unable to take time to find comfortable positions. Therapy for postpartum upper back and shoulder pain can include:
Koyasu, K., Kinkawa, M., Ueyama, N., Tanikawa, Y., Adachi, K., & Matsuo, H. (2015). The prevalence of primary neck and shoulder pain, and its related factors in Japanese postpartum women. Clinical and Experimental Obstetrics & Gynecology, 42(1), 5–10.
Pregnancy and both vaginal and cesarean delivery changes things. The transition into parenthood should not be at the cost of a woman’s sexual satisfaction. However, it is estimated that 83% of women experience a sexual health issue at three months postpartum and 62% at six months [source]. When these issues go untreated, they can have lifetime consequences to a woman’s quality of life.
Common postpartum sexual health symptoms include:
There are many reasons women can experience decreased sexual satisfaction or pain.
Treatment options can include:
Each woman has a unique set of symptoms, which is why an individualized treatment plan is necessary to resolve postpartum sexual issues. Goals are specifically designed to address each individual woman’s preference of sexual satisfaction.
1. Barrett, G., Pendry, E., Peacock, J., Victor, C., Thakar, R., & Manyonda, I. (2000). Women’s sexual health after childbirth. BJOG : An International Journal of Obstetrics and Gynaecology, 107(2), 186–195.
2. Barrett G, Pendry E, Peacock J, Victor C, Thakar R, Manyonda I. Women’s Sexuality After Childbirth: A Pilot Study. Archives of Sexual Behavior. 1999 Apr;28(2):179-91. doi: 10.1023/a:1018771906780. PMID: 10483509.
Many women experience chronic pelvic pain after pregnancy. The pelvic floor muscles are intricately involved in pregnancy. They also support the internal organs, spine, and pelvic girdle.
When the pelvic floor muscles are unable to relax or tissues of the pelvis are scarred from laceration or microtears, it can produce imbalance in the pelvic area and result in chronic pelvic pain.
Illustration of the pelvis and pelvic floor muscles.
Nonrelaxing pelvic floor dysfunction is often unrecognized by providers and instead treated as low back pain or other common orthopedic impairments [source]. Many women suffer a lifetime of pelvic pain from pregnancy that did not get resolved in the postpartum period.
Another cause of pelvic pain after pregnancy is the changed position of the uterus. When the uterus descends or shifts after pregnancy, it can create painful tension on the uterine ligaments that attach to the pelvic bones.
Treatment for pelvic pain can include:
Our goal for each patient is to be pain free.
Faubion, S. S., Shuster, L. T., & Bharucha, A. E. (2012). Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clinic Proceedings, 87(2), 187–193. DOI: 10.1016/j.mayocp.2011.09.004
Pelvic organ prolapse is where the muscles and supporting structures of the pelvis become weak and loosened, allowing one or more of the pelvic organs to collapse or fall into the vagina. In severe cases, the pelvic organs will protrude outside of the vaginal entrance.
Pelvic organ prolapse is a significant health risk for postpartum women. Nearly 50% of women having prolapse six months after both vaginal and cesarean delivery [source]. Symptoms include a heavy pressure in the pelvis or feeling like something is falling out. Other symptoms may include bladder leakage, constipation, pain with sex, and/or lower back or pelvic pain.
Strengthening the pelvic floor muscles is effective to support and recede prolapse. In some cases, especially women who are high impact athletes, we will recommend being fit for pessary to provide additional support. Each prolapse is different and many are not detected unless being displaced by gravity in a standing position or impact with exercise.
Treatment for prolapse may include:
It is estimated that 1 in 5 women will have surgery to correct prolapse, which is why we highly recommend pelvic floor therapy for all postpartum women to manage and prevent pelvic organ prolapse [source]. Rehabilitation can begin almost immediately after delivery, if not contraindicated by tear.
1. Hagen, S., & Stark, D. (2011). Conservative prevention and management of pelvic organ prolapse in women. The Cochrane Database of Systematic Reviews, (12), CD003882. DOI: 10.1002/14651858.CD003882.pub4
2. Hallock, J. L., & Handa, V. L. (2016). The Epidemiology of Pelvic Floor Disorders and Childbirth: An Update. Obstetrics and gynecology clinics of North America, 43(1), 1–13. DOI: 10.1016/j.ogc.2015.10.008
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