Postpartum Physical Therapy

Being pregnant and giving birth can be a beautiful and emotionally fulfilling time in the life of a mother. That said, this time period can also be physically daunting.

On top of caring for a newborn while operating on little to no sleep, many women are left with one or several musculoskeletal conditions as a result of the pregnancy and birthing process.

Fortunately, however, there may be an effective solution. Many postpartum diagnoses can be successfully managed or treated with the help of a physical therapist.

This article discusses postpartum conditions, physical therapy options, and treatment options.

Postpartum Conditions

Over the course of a pregnancy, a woman’s body is subjected to many different stresses. This includes:

• Weight gain: The progressive weight gain that occurs over nine months places increased amounts of load through the joints in your spine, pelvis, and legs. It also significantly alters your posture and places new stresses on the muscles in these regions.
• Changes in ligaments: In addition, the body’s ligaments are also frequently affected by pregnancy. This is because a person's body secretes hormones designed to make your ligaments more stretchy and lax in preparation for giving birth.
• Pelvic issues: Significant amounts of trauma can occur in the pelvic or reproductive regions during the birthing process itself. This is because a child’s head and torso must exit the mother’s body through a relatively small anatomical space.

Some of the most frequently seen diagnoses in postpartum women are listed below:

Urinary Incontinence

Urinary incontinence or leakage is a common issue that many women deal with during and after pregnancy. In fact, some estimates suggest that up to 30% of females experience this condition at the six-month postpartum mark.

This problem is thought to occur because the muscles of the pelvic floor get weak during pregnancy, and even when the uterus shrinks back to its normal size, the muscles are still weak from when it was larger.

Low Back Pain

As a baby grows within your body and your stomach increases in size, your abdominal muscles stretch out and become less and less effective. At the same time, the curve (also known as lordosis) in your lumbar spine becomes more pronounced, causing your low back muscles to shorten.

These changes make your core muscles less able to support the spine and can lead to back pain during pregnancy and after birth.

Diastasis Recti

As your abdominal muscles (specifically the rectus abdominis) stretch out during the second and third trimester, the tendinous structure that runs down the middle of this muscle (called the linea alba) can start to widen and separate.

This condition, called diastasis recti, is estimated to be present in up to 59% of women immediately after labor. As this fibrous area thins and widens, it also becomes weaker and may even tear. When this occurs, a palpable lump is often present in the middle of the abdomen, especially when your stomach muscles contract.

Pelvic Pain or Dysfunction

The pelvic floor is a group of important muscles that line the bottom of a woman’s pelvis and provide support to the bowels, bladder, and uterus.

During pregnancy, the weight of a growing child can place excessive pressure on these muscles and cause them to become lax and ineffective. The trauma associated with childbirth can also cause further laxity or tearing in these structures.

After your baby is born, pregnancy or birth-related damage to the pelvic floor muscles can lead to a variety of conditions. Potential issues include pain during sex or sexual dysfunction, pelvic pain, separation of the pubic symphysis bone, or even the prolapse or bulging of the pelvic organs through the vagina.

Physical Therapy Options

If you are dealing with any of the pregnancy-related conditions listed above, pelvic floor physical therapy (PT) may be an effective treatment option. The first step is speaking to your physician about your symptoms. If your doctor feels therapy is appropriate, they can help you find a PT who is certified in women’s health.

Physical therapists with this specialization are trained to help you relearn to utilize your pelvic floor muscles appropriately and to regain any strength that was lost during pregnancy or birth. Because each woman’s postpartum condition is unique, they are also skilled in developing an individualized treatment plan based on the details you share and the findings of their examination.

When to Seek Care

If you are experiencing pain in the pelvic, groin, hip, or low back region after the birth of your child, you should speak to your doctor about whether postnatal physical therapy is appropriate.

The same is true if you are dealing with incontinence of the bowel or bladder, a palpable bump over your stomach (especially when you clench your abdominal muscles), or pain or difficulty during sexual activity. Finally, women who feel a full or heavy sensation in the pelvis or a bulging in the vaginal area should also seek the care of their physician.

Frequently Asked Questions:

What can you expect at a physical therapy session?

The first visit with your therapist is typically a comprehensive evaluation. They will ask you for details about your symptoms and will also assess how effectively your abdominal, core, and pelvic floor muscles are functioning. Following this examination, your PT will work hand in hand with you to create an effective and individualized treatment plan.

After your evaluation, a home program is typically created that focuses on improving strength and coordination in the muscles listed above. This program is typically progressed in subsequent therapy visits as you gain strength and coordination. Manual techniques may also be utilized to help reduce pain and teach you to properly activate these muscles.

What exercises help treat pelvic floor dysfunction (PFD)?

Physical therapy exercises that focus on training the pelvic floor muscles can help treat many different symptoms of PFD, including urinary incontinence, sexual pain or difficulty, and pelvic pain.

This type of training typically revolves around Kegel exercises, which teach you to activate and strengthen the important muscles located under your bladder, large intestine, and uterus. Your physical therapist may also utilize a biofeedback machine to help you visualize your muscle contractions and better learn to turn on these structures.

Pelvic floor therapy often focuses on structures that are too tight/constantly contracted in the pelvic floor as well, so it's not always about contracting the muscles. Sometimes it's about learning how to relax the muscles.

How long should postpartum physical therapy last?

Depending on the severity of your symptoms, it may take some time before your postpartum condition begins to improve. That said, physical therapy has been shown to begin helping with some issues like pelvic pain in as little as five weeks of treatment. Other issues, like urinary incontinence or pelvic floor prolapse, may take several months or longer before significant improvement is noted.

After a thorough evaluation, your PT will be able to provide you with a more accurate estimate of your recovery timeline.

A Word From Verywell

The first three months after the birth of your child is frequently referred to as the fourth trimester of pregnancy. During this time, it is important to focus some of your energy on letting your own body heal. Postpartum conditions, like the ones discussed above, are extremely common and most are well-managed with conservative measures like physical therapy.

With this in mind, it is crucial to speak to your OB-GYN about any symptoms you are feeling. While it may be tempting to focus on your child’s needs and to ignore your own, working hand in hand with your doctor will help set you on the road to recovery.