New Study Highlights Need for Postpartum Pelvic Care

You likely don’t walk around thinking about your pelvic floor but these hammock-like muscles are important. They support the bladder, uterus, and rectum in those that give birth and can cause unpleasant symptoms when they aren’t functioning properly. Pelvic floor dysfunction (PFD) occurs when these muscles can’t contract, relax, or engage the way they are supposed to. 

Research shows at least 1 in 3 will have a pelvic floor disorder in their lifetime. These can happen at any age and various factors can lead to them. It’s not unusual for pregnancy and/or childbirth—whether vaginally or via C-section—to be a trigger.

The symptoms can feel debilitating but there are significant gaps in pelvic care, according to a new survey of more than 600 women from Origin, a pelvic floor physical therapy company with locations around the country. 

The survey found that 96% of people with symptoms have not been diagnosed. One in three who had a baby within five years experience pain with sex, while 67% have bladder leaks. But 86% of those surveyed say they didn’t receive any guidance on healing their pelvic floor after childbirth.

Experts stress that this needs to change. Pelvic floor treatment is available and recovery is possible.

Childbirth and the Pelvic Floor 

When McKenzie* was pregnant with her first child, she began experiencing pelvic pain around the middle of her second trimester. It was intense and was impacting her daily life. 

“Mostly with sex,” shares the San Francisco-based mom. “But also, sometimes, even just going to the bathroom was really quite painful.” 

Pregnancy can be hard on the pelvic floor. “Even just gaining the weight that you need to gain to carry a baby in your body puts a lot of extra pressure onto the pelvic floor,” says Liz Miracle, MSPT, WCS, a physical therapist and Head of Clinical Quality and Talent at Origin. “The pelvic floor has to kind of rise to meet that challenge.”

Hormonal changes are also taking place, such as release of relaxin, which is creating more laxity in the joints. Pregnancy can also cause constipation, another factor contributing to PFD.

As for childbirth, it can put a significant strain on the pelvic floor muscles. While vaginal deliveries may be more likely to cause PFD, those who undergo C-sections can also experience symptoms. That can be due to the impact of carrying the baby or cases of pushing before undergoing an emergency C-section. Many people also experience tearing from childbirth, another factor.

PFD can present in two ways. “In some ways, the pelvic floor will just be too weak—it’ll be kind of like a loose hammock,” says Miracle. “In other ways, people’s body respond by over contracting and becoming very tight to try to hold it all together.”

Symptoms can be vast, but common ones include:

• Constipation
• Leaking urine
• Heaviness in the pelvic area 
• Changes in sex (pain, not as satisfying, unable to reach orgasm)
• Tailbone pain
• Lower back pain

Pelvic Floor Therapy Can Help

McKenzie, a certified yoga teacher, started pelvic floor therapy at Origin in her second trimester to help loosen her muscles, and later for labor prep. It helped her feel better in both instances.

During pelvic floor therapy, a trained therapist typically works on your muscles externally and internally. A therapist often also gives a patient exercises to do at home. Depending on a person’s condition, they may recommend using dilators at home to stretch vaginal tissue. Trigger point injections, dry needling, and biofeedback are some other tools that might be recommended.

McKenzie returned to pelvic floor therapy after giving birth due to a challenging delivery. Her daughter was larger than average and she suffered a third-degree episiotomy. It led to severe urinary incontinence. “Anytime I seized or coughed or tried to jump up and down or run, I peed my pants,” she says. “It was very frustrating to basically always have to travel around with an extra pair of underwear.”

Pelvic floor therapy weekly, and then biweekly, helped to strengthen and retrain her muscles. “I had the opposite problem than I had when I originally went to treatment, which was everything was too loose and not tight enough,” says McKenzie, who also performed suggested exercises at home and used vaginal weights. 

Bijal Toprani, PT, DPT, a pelvic floor physical therapist at Hinge Health, recommends everyone gets a pelvic floor evaluation following childbirth. While there’s typically a six-week postpartum appointment with a health care provider, PFD is rarely detected. During that visit, a health care provider usually examines the tissue, whether a tear from birth has healed, or the condition of a C-section scar.

“They’re not really looking at the integrity of whether you can coordinate your muscles or relax your muscles or how strong they are,” she says. “They’re more looking for healing, which is super important, but it’s just a different type of checkup than a pelvic health PT would do.”

No, You Shouldn’t Fear a Subsequent Pregnancy 

Pelvic floor dysfunction can make conceiving again feel scary. McKenzie felt that fear before her current second pregnancy but she’s looking at the silver lining. 

“It was very encouraging to know that I’d already worked through it once and I feel like I have a lot more body awareness and muscle awareness going into this pregnancy than I did with the first one,” she says. “I feel much more in control.”

Experts agree, pointing to options, such as pelvic floor therapy during pregnancy. Dr. Toprani says pelvic floor therapists generally do less internal work during pregnancy, but will guide patients through exercises, such as lunges and mini squats, and diaphragmatic breathing. (Internal work is avoided if a patient has placental or cervix issues or is on bedrest.)

“A lot more gentle, full body types of moves, which is helpful for their pelvic floor for actually giving birth and then also how well they can kind of bounce back after they give birth,” says Dr. Toprani. Carving out 15 to 20 minutes of exercises, three days a week, can be beneficial.

Pelvic floor therapists can also offer guidance on protecting the area, including applying a warm compress to the perineum during the pushing phase of labor to prevent tearing, which the American College of Obstetricians and Gynecologists (ACOG) advises. Perineal massage can also be helpful in the weeks leading up to labor.

Of course, pelvic floor therapy can be performed after birth for those who need it. How long it takes to get better depends on the patient and their symptoms. “People that have urine leakage, which is one of the most common pelvic floor conditions, can see improvements in like 90 days,” says Dr. Toprani. For other issues, such as pelvic pain, it can take longer.

Dr. Toprani reminds that treatment can take time and it’s important for people to listen to their bodies and give themselves grace.

“Just kind of remembering that just because that six-week number has been thrown around a lot doesn’t necessarily mean that it’s the perfect amount of time where you should just feel right back to the way you were before,” she says. “There’s nothing wrong with you. It’s kind of an arbitrary timeline, and so you have to go on your own timeline.”

*Last names withheld for privacy