Pelvic Floor Therapy: The Missing Piece of Childbirth Recovery

When you think about physical therapy, you might associate it with sports injuries, auto accident rehabilitation, or degenerative pain like arthritis. You may not think of childbirth as a reason to visit a physical therapist—but it is.

Pregnancy takes a toll on the core muscles and connective tissue, causing symptoms like:

• SI joint pain or dysfunction
• Urinary incontinence (leaking when you walk, laugh, cough)
• Fecal incontinence
• Difficulty emptying the bladder or rectum
• Painful sex
• Diastasis recti (gaping of the abdomen muscles)
• Feeling of bulging or fullness
• Joints “giving out” or not functioning as they should

One third of women live with a pelvic floor problem, that’s no small number. Pelvic floor therapy is a branch of physical therapy that deals with the muscles inside of the pelvis. As part of our core, these muscles create a support structure for the intra-abdominal organs: sort of like a hammock for the uterus, bladder, and rectum.

Naomi Harris, Ogden Clinic’s Pelvic Floor Therapist, and her assistant, Courtney Wilkins, PA-C discuss how pelvic floor therapy can help pre- and post-partum women manage these symptoms.

How the Pelvic Floor Changes During Pregnancy

Pelvic Floor

Well before labor and delivery, the pelvic floor is already undergoing big changes. “A hormone called relaxin is released when a woman becomes pregnant, causing the connective tissue in the pelvis to relax and make room for a baby,” says Naomi. Courtney adds that joint stability is compromised by relaxin; causing aches in the low back, pelvis, and feet. “Women who work on their feet may start to feel aches and pains before any observable changes to their body—that’s due to the relaxin,” says Courtney. And as the uterus expands with weight gain, it causes more pressure to bear down on the pelvic floor.

Vaginal Birth’s Impact on the Pelvic Floor

When a baby’s head comes through the uterus, the pelvic floor muscles and tissues can overstretch and tear as they’re shoved out of the way. While these tissues usually heal with surgical repair and scar tissue, mothers may be left with nerve damage and muscles may not restore to natural function.

“If you’re injured playing sports or have an accident, you know you’re getting physical therapy after you heal. During pregnancy and childbirth, there are significant, sudden, and sometimes traumatic changes to the pelvic area. We ought to think of the recovery the same way. Healing up is only part of it. We want to help women restore optimal, pain-free strength and function.”

Why Don’t More People Know About Pelvic Floor Therapy?

Pelvic floor therapy is a relatively new branch of physical therapy, says Courtney. “It’s possible this treatment didn’t exist or that generations past never learned about it.” She adds, “We also tend to dismiss pain, leakage, and other symptoms as ‘things new moms need to live with’, and that sentiment gets echoed throughout generations.”

Naomi adds that pelvic/genital health is not discussed enough—although it’s becoming a bigger conversation. “I’m really happy to see more women advocating for their own health, seeking help for these symptoms, and spreading the word about it,” she says.

What is the First Visit with a Pelvic Floor Therapist Like?

Naomi says that it all starts with education about proper body mechanics. “Posture is so important because pregnancy throws us off. Our center of gravity is affected,” she says. In addition to growing a baby, the weight of fuller breasts and proper nursing is a new experience that causes upper back, shoulder, and neck pain. These are just a few of the postural concerns that Naomi discusses with her patients.

From there, Naomi and Courtney will evaluate each patient’s alignment issues and internal laxity with a musculoskeletal and/or pelvic exam. Once they’ve identified the symptoms and concerns, Naomi and Courtney will begin physical therapy and treatment over the course of a few weeks or longer depending on the needs of the patient.

How soon do patients notice changes?

Many postpartum patients leave their first visit feeling equipped to make big changes. Courtney refers to the pelvic floor as ‘invisible muscles’: You can’t see them, but you can feel them. “It’s a new experience to consciously engage and strengthen the pelvic floor. But with education, a light clicks for many of our patients.” Naomi adds that pelvic floor therapy, like any other type of physical therapy, requires patients to work toward their own recovery. “Physical therapy is not a pill or a shot that fix things immediately. But we can educate you on how to begin healing yourself.”

Depending on the needs of each patient, Naomi and Courtney see patients one to two times per week, revisiting symptoms and revising the treatment plan as needed.

What do you want women to know about pelvic floor therapy?

“Advocate for your own health,” says Naomi. Relief is possible and you do not need a doctor’s referral to visit Naomi at Ogden Clinic. Courtney adds that when you are postpartum, you’re always postpartum. “You can visit a pelvic floor therapist 15 years after having your last baby and start working on your symptoms. Patients have done this!”

If pelvic pain, discomfort, or laxity affects your quality of life, contact Ogden Clinic Pelvic Floor Therapy at 801-475-3870 or schedule a visit online. Naomi and Courtney practice at our Professional Center South in Ogden, Utah.