Pregnancy / Postpartum

The entire body is affected by pregnancy, delivery and breastfeeding.

• During pregnancy, the pelvic width increases by 10-15%:
  • Changes in hip muscles
  • Increased strain on knees
  • Decreased connection between deep abdominal and the pelvic floor muscles
  • Increased low back pain
• During delivery, there is a tremendous stretch on muscles, tendons, ligaments and connective tissue of the pelvic organs. This is especially true with episiotomy, tearing, incisions, cesarean section. Scar tissue may permanently impair muscle connections without skillful rehabilitation. Cesarean section is a major abdominal surgery.
  • Increased intra-abdominal pressures during delivery can increase the risk of prolapsed bladder, uterus, rectum
  • Reduced muscle integrity increases risk of incontinence.
  • Abdominal muscle injury affects posture and core strength
  • Increased risk of musculoskeletal pain which can include pain with intercourse
• Hormonal changes persist up to 6 months postpartum
  • Pregnancy requires increased progesterone
  • Increased progesterone and thyroid changes may slow digestion and are associated with constipation
• Pregnancy requires increased Relaxin/Elastin hormones
  • Required during pregnancy and at high levels up to 6 months postpartum
  • Increases flexibility of ligaments, which increases risk for sprains, strains and even dislocations as well as increased shoe size
• Breastfeeding requires reduced estrogen
• Low estrogen is associated with pelvic and perineal pain and increased bladder sensitivity

And many more!

PREVENTION and Treatment of Pregnancy and Pospartum-related musculoskeletal injury and pelvic floor dysfunction is possible!

• Following just one single pregnancy women are 3x more likely to develop urinary incontinence1 and 2x as likely to develop prolapse².
• Women that participate in pelvic floor PT during pregnancy can reduce their risk of incontinence by 62%³ and waiting until after delivery, but still participating in pelvic floor retraining can decrease the risk of incontinence by 40%⁴. Current research is still lacking in specifically tracking prevention percentages for prolapse in women that proactively participating in pelvic floor therapy. However, medical consensus agrees that maintaining proper strength in the pelvic floor, in addition to avoiding weight gain, not smoking, avoiding constipation, and strain with heavy lifting all assist with the prevention of prolapse⁵.

What is the "Fourth Trimester"?

• Postpartum weeks and months of significant hormonal, musculoskeletal and emotional change as the uterus shrinks, internal organs return to their pre-pregnancy position, emotional and physiologic bonding with baby continues and breastmilk is produced.
• These body changes continue for a minimum of 12 weeks following delivery with several important hormonal factors persisting until 6 months postpartum
• To "bounce back" is a cultural myth and a physical impossibility.
• Recovering your strength and vitality takes time, but it is a crucially important process in order to care for your baby and your family.

Common, but not inevitable, post-partum physical complaints include:

• Bladder or Bowel Incontinence
• Prolapse or "Falling Out Feeling"
• Musculoskeletal Pain
  • Back, Neck or Joint pain
  • Tendonitis, especially of wrist or thumb
  • Scar or incisional pain
  • Painful penetration including intercourse, pelvic exams or tampons
• Diastasis Recti
  • Persistent abdominal separation reduces core strength and may increase back pain or incontinence

How can your specialist Pelvic Health Physical Therapist help?

• Re-train core muscle coordination of abdominals, hips, spinal muscles and the pelvic floor.
• Safely and progressively strengthen abdominals, hips, spinal muscles and the pelvic floor.
• Teach ergonomic posture and body mechanics for squatting, lifting and even breastfeeding.
• Reduce pain through gentle stretching, progressive strengthening, teaching body mechanics as well as manual therapy, massage and scar tissue reduction.
• Prevent further and future injury to abdominals, the pelvic floor and pelvic organs.

You deserve to feel confident about your body again.

You deserve support and encouragement in your postpartum recovery journey.

References:

1. Hansen, BB, Svare, J, Viktrup, L, Jørgensen, T, Lose, G. Urinary incontinence during pregnancy and 1 year after delivery in primiparous women compared with a control group of nulliparous women. Neurourol. Urodyn. 31(4), 475-480 (2012).
2. Kudish, BI, Iglesia, CB, Gutman, RE, Sokol, AI, Rodgers, AK, Gass, M. Risk factors for prolapse development in white, black, and Hispanic women. Female Pelvic Med. Reconstr. Surg. 17(2), 80-90 (2011).
3. Woodley, Stephanie J, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews: 06 May 2020 in Issue 5, 2020.
4. Boyle R, Hay-Smith EJ, Cody JD, Morkved S. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. The Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.:CD007471. DOI: 10.1002/14651858.CD007471.pub2.
5. www.MayoClinic.org