Physical Therapy Can Help with THAT? Part 2a: Postpartum
Here is the second post in the series PT Can Help with That? Today we’ll be discussing how PT can help postpartum.
Postpartum care in the US is sorely lacking compared to other countries in the world. In the US, new moms are usually given 1 visit, 6 weeks postpartum, to clear them to return to exercise, sex, and basically everything else at full steam. However, many women aren’t necessarily ready to return to their regular tasks and exercise at that point. And when they start resuming their high stress jobs, high intensity exercise, plus full-time parenting tasks...etc, it can take a toll on their bodies in a big way. (side note: I don’t blame the OBs for this, it’s a much larger problem involving our healthcare situation in the US, but I won’t get into that now. Just know that they are TRYING to change the way postpartum care is done as we speak, but systemic change like this takes time. Anyway...back to the post)
Here is a short list of everything Physical Therapy can help you with postpartum:
Returning to exercise safely
Painful sex after baby
C-section scar pain
Pelvic Organ Prolapse
Back pain (or any other musculoskeletal pain)
This list is by no means exhaustive, but it covers the most common things I help moms (new and not so new) with. Next, I’ll go into the basics of how I help women solve these issues. This post will contain the first 4 on the list (DRA through painful sex) and the next post will cover c-section through back pain.
Just know that there is help out there! You don’t have to suffer with these issues “just because you’ve had a baby”.
DRA (Diastasis Rectus Abdominis, or Abdominal Separation, Mommy Tummy, Mommy Pooch)
Now, I could write several posts on just DRA alone, so today will just cover the basics. DRA is a very common and normal part of pregnancy where the connective tissue between your six-pack muscles stretches to allow for the baby to grow. Studies estimate that between 75-100% of pregnant women will have a DRA during their pregnancy.(1) However, if that connective tissue is still loose after you have delivered, it makes activating your core muscles during normal tasks or exercise very difficult. Having a DRA may lead to pelvic organ prolapse and may be associated with severity of low back pain and urinary incontinence (2) because your core isn’t functioning properly. This is also the reason why women can “still look pregnant” months postpartum because the loose connective tissue is not allowing for muscle tension to flow across it and hold the abdominal contents in place.
How can PT help?:
Physical Therapists can accurately measure and track your DRA. The new research is showing that we are looking for improved tension in the connective tissue more so than the width of the separation, which can be hard to feel on yourself. PTs also will help you retrain your deep core muscles, pelvic floor muscles, and breathing strategies to ensure proper and timely rehab. Your PT will give you exercises to do at home for sure, but it is also important to regularly check in with your PT to make sure you are performing the exercises properly and so she can continue to make the exercises harder as you progress! These exercises may look easy and boring, but are essential to proper healing. When talking about DRA, I always say that you have to build the foundation before the house, or eventually, it will all fall down. When done correctly, these “easy” exercises, aren’t so easy at all in fact.
Returning to Exercise Safely:
Related to DRA rehab is returning to exercise safely postpartum. Like I mentioned earlier in the post, most moms are given the “all clear” to resume their regular exercise at around 6 weeks postpartum, sometimes earlier! This can be misleading. Your OB is looking to make sure your stitches and tears (if any) have healed, your bleeding has stopped and, nothing major is going wrong. These are all good things to check obviously, however, your OB is not necessarily looking at your pelvic floor and other muscle strength, asking what your perferred form of exercise is, or giving you any tips for resuming these tasks. This is the job for your physical therapist. Because, even if your OB gives you the “all clear”, your pelvic floor muscles could still be weak, you could have a DRA, you could be at risk for a prolapse and all of these things are exacerbated when you return to exercise too soon or without knowledge of how to modify properly.
How PT can help?:
I WANT my patients to return to exercising, but, remember the foundation before the house part? That’s what I do here as well. A PT will assess your pelvic floor, core, and other muscle strengths, look at your breathing technique, and watch you as you do the exercises you want to return to, so she can give you tips on what to avoid or what to modify. That way, when you return to that barre, pilates, yoga, or crossfit class, you will be prepared and successful.
Urinary and/or Fecal Incontinence:
Incontinence of all sorts is common postpartum because your pelvic floor muscles have endured so much during pregnancy and delivery. However, this does not make it normal, or something to be ignored. In a recent study, about 50% of women reported urinary incontinence during pregnancy; at 1 year postpartum, about 13% of these women still reported urinary incontinence!(3) You don’t want to be leaking still a year later! It drives me nuts when I see posts on social media about how it’s funny that we leak a little if we jump or sneeze, and, oh, that’s just how it is now! No!!!! It’s not! Leaking is NEVER normal and shouldn’t be endured for no reason. Incontinence can resolve on its own in some cases, but, in other cases, more help is needed.
How can PT help?
A physical therapist will perform an internal examination of your pelvic floor muscles to check for any scar tissue, pelvic floor strength/endurance/coordination/ and control, as well as your ability to relax your pelvic floor muscles. Depending on what you specifically need to work on, your PT will give you a tailored exercise plan to perform at home. She will also teach you how to activate your PFMs during your daily tasks like lifting the baby, sneezing, squatting down...etc or any other aggravating activity. You will learn how to perform a kegel properly, but other strengthening exercises will also be performed to ensure your entire body is functioning well together.
Painful Sex After Baby:
Sex shouldn’t be painful. Period. After delivery, you are usually cleared for sex at that 6 week visit and I have found that most women don’t feel like they are ready. And that’s ok! Again, your doctor is just saying that from a medical standpoint, you are cleared, not from a muscular/emotional/mental/personal standpoint. Sex could be painful after delivery for multiple reasons: you could have a painful scar where you tore, your vaginal tissues could be drier than usual because of breastfeeding, your pelvic floor muscles could be in shock from a traumatic birth, you could have delivered a very large baby, you could have pushed for several hours...etc the list goes on! All of these are valid and all of these are treatable.
How can PT help?
Again, an internal examination of your pelvic floor muscles will be performed. Your PT will be looking for tender scar tissue, tightness in the pelvic floor muscles, ability to relax the pelvic floor muscles, tissue fragility, tender spots in the pelvic floor muscles. Treatment may include manual work to the area to help the pelvic floor muscles relax again and to reduce tenderness of the scar tissue. Vaginal dilators may be prescribed to be performed at home. The use of lube is usually highly recommended for breastfeeding mothers and other education about different sexual positions and foreplay can also be discussed.
This is just half of the list of how PT can help postpartum. Stay tuned for the next post that will cover C-section scar pain, pelvic organ prolapse, Mommy Thumb, and Back (and other) pain. Follow us on Instagram & Facebook @glowptandwellness to stay updated! And as always, email, DM, call, or text me with any questions or for your FREE 15 minute consult!
Mota, P., Pascoal, A., Carita, A. and Bø, K. (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy, [online] 20(1), pp.200-205. Available at: https://www.sciencedirect.com/science/article/abs/pii/S1356689X14001817 [Accessed 14 Jan. 2019].
Benjamin, D., Frawley, H., Shields, N., van de Water, A. and Taylor, N. (2018). Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy. [online] Available at: https://www.sciencedirect.com/science/article/abs/pii/S0031940618301329 [Accessed 14 Jan. 2019].
Lin, Y., Chang, S., Hsieh, W., Chang, Y., Chueh, H., Chao, A. and Liang, C. (2018). Persistent stress urinary incontinence during pregnancy and one year after delivery; its prevalence, risk factors and impact on quality of life in Taiwanese women: An observational cohort study. Taiwanese Journal of Obstetrics and Gynecology, [online] 57(3), pp.340-345. Available at: https://www.sciencedirect.com/science/article/pii/S102845591830069X [Accessed 14 Jan. 2019].