Restore Your Pelvic Floor After Childbirth

By Melissa Ho, PT, DPT

The pelvic floor is a group of muscles and tissues that form a hammock-like structure at the base of the pelvis. This structure supports the bladder, intestines, and, for women, the uterus.

It also plays a key role in urinary and bowel control and in sexual function.

During pregnancy, the pelvic floor endures significant changes and stress, which can lead to various conditions, including incontinence, pelvic pain and pelvic organ prolapse.

The Center for Pelvic Wellness at Penn Medicine Princeton Medical Center (PMC) provides highly specialized treatment for a wide range of pelvic disorders and offers physical therapy to help new moms restore their pelvic floor after childbirth.

Common Postpartum Pelvic Floor Conditions

Pelvic floor changes are a normal part of having a baby. The pelvic floor muscles help support the developing baby as it grows, which can cause them to weaken under the added workload.

During childbirth, the muscles and tissues stretch and thin to allow the baby to come out. Perineal tears (tears in the tissue between the vagina and the anus) can also occur.

As a result, many women experience postpartum pelvic floor dysfunction and may suffer from one of more of these common conditions:

• Urinary incontinence. The increased weight of the uterus on the bladder and the hormonal changes during pregnancy can lead to stress urinary incontinence. This condition involves unintentional leakage of urine during activities that increase abdominal pressure, such as coughing, sneezing, or exercising.

• Fecal incontinence. Less often discussed but equally significant is fecal incontinence, which involves the involuntary release of stool or gas. This can occur due to damage to the anal sphincter during childbirth, especially with a perineal tear or episiotomy, when an incision is made toward the anus.

• Pelvic organ prolapse. Pelvic organ prolapse occurs when one or more of the pelvic organs (bladder, uterus, rectum) descends into or outside of the vaginal canal. This condition is often due to the weakening of the pelvic floor muscles and connective tissues under the pressure of a growing fetus and the strain of labor and delivery.

• Pelvic pain. Pregnancy can cause pelvic girdle pain due to the loosening of ligaments and joints in preparation for childbirth. This pain can extend to the lower back, hips, and thighs, making everyday activities challenging. Pelvic pain can also interfere with sexual function.

Physical Therapy Can Help

Pelvic floor physical therapy can help treat postpartum pelvic floor disorders and enable women to return to feeling like themselves again. Pelvic floor physical therapy involves a range of exercises and techniques designed to target the pelvic floor muscles, improve their function, and alleviate pain.

At the Center for Pelvic Wellness, pelvic floor physical therapy begins with a thorough evaluation and assessment of the pelvic floor function. Therapy depends on the condition, but typically involves:

• Targeted exercises aimed at strengthening and/or lengthening the pelvic floor and helping improve muscle tone and urinary control.

• Education and behavioral strategies. Therapists educate patients about proper body mechanics, bladder and bowel habits, and lifestyle modifications to support pelvic floor health. This may include advice on posture, proper lifting, and dietary adjustments to prevent constipation as well as techniques to return to healthy sexual function.

• Real-time ultrasound imaging, biofeedback, and other modalities. Real-time ultrasound imaging as well as biofeedback can help improve muscular awareness in the pelvic floor and core, helping women learn how to control and strengthen these muscles effectively. Light therapy can assist in healing after an episiotomy and can help reduce scarring from a cesarean section. Electrical stimulation of the pelvic floor muscles (e-stim) can also aid in neuro-muscular retraining and strengthening to reduce pain.

• Manual therapy. Pelvic floor therapists may use hands-on techniques to release muscle tension, improve blood flow, and reduce pain. Physical therapists at the Center for Pelvic Wellness coordinate with your physician and other healthcare provider as needed to provide collaborated care. Prescriptions for pelvic floor physical therapy are required and most major insurance plans are accepted.

Women are generally able to begin pelvic floor physical therapy three to six weeks after childbirth, depending on clearance from their doctor.

Tips to Keep Your Pelvic Floor Strong

Whether you are thinking of having a baby, already pregnant or just want to keep your pelvic floor strong, here are a few tips:

• Avoid straining during bowel movements. Prevent constipation by staying hydrated and eating enough fiber. Positioning a stool under your feet combined with belly breathing can decrease straining.

• Use proper lifting techniques. When you lift an object try to have it directly in front of you and as close to you as possible. Exhale as you lift and engage your pelvic floor. Keep your ribs lifted away from your pelvis. Store heavier objects on a shelf, so you are not lifting them from the ground.

• Maintain a healthy weight. Maintaining a healthy weight by eating a healthy diet and exercising can reduce strain on the pelvic floor.

• Practice breathing techniques and mindfulness. Practicing deep breathing from your diaphragm and incorporating mindfulness exercises into your day can help you reduce stress and tension in the pelvic area.

• Exercise. Certain exercises can help strengthen and lengthen the pelvic floor. Consistent practice can help improve muscle tone and bladder and bowel function. A pelvic floor physical therapist can provide personalized exercises and techniques for pelvic floor health.

To find a physician affiliated with Penn Medicine Princeton Health or for more information about the Center for Pelvic Wellness at Penn Medicine Princeton Medical Center call (888) 742-7496 or visit www.princetonhcs.org, 

Melissa Ho, PT, DPT is a pelvic floor physical therapist at the Center for Pelvic Wellness at Penn Medicine Princeton Medical Center.