The stress that pregnancy puts on a woman’s body and mental health is well documented. But only recently in the United States has the pelvic floor started to receive the attention it deserves.
The pelvic floor consists of organs and connective tissues that lie within a woman’s pelvis but are affected by musculature and nerves going up to her diaphragm. So why does it merit more attention?
The pelvic floor is essential in bladder control. One of the most common pelvic floor dysfunctions in postpartum women is urinary incontinence, or the leaking and loss of urine. There is a spectrum of urinary incontinence, ranging from minor leaking with laughing or jumping to full loss of bladder or bowel control, all of which should be evaluated and treated with input from a health care provider.
Other examples of pelvic floor dysfunction in pregnancy and postpartum is prolapse and diastasis. Pelvic prolapse is when the tissue that supports the abdomen relaxes, dropping the organs in the abdomen so they fall into the vaginal wall, causing a bulge. Symptoms of prolapse include fullness or pressure in the vagina, aching of the pelvis, a bulge coming down into the vagina, and urinary leakage. Diastisis, also known as diastasis recti, is when the abdominal muscle separates at its connection point, creating a gap. A large separation in this musculature causes dysfunction in the core and your ability to transfer your weight load appropriately. This can result in chronic back pain and SI joint instability.
The good news is that there are ways to prevent these pelvic floor issues and there are treatment options if you have been suffering from these symptoms. Even women who have had these issues for years have options for treatment and improvement in pelvic floor function. In fact, in France every postpartum woman goes to three months of pelvic floor therapy postpartum for every child that she births.
Currently in Jackson there is a pre/post-natal Pilates class at Medicine Wheel that is led by Kim Armington, who is a physical therapist and certified Pilates instructor. This class focuses on pelvic floor conditioning and core strength to support expecting and postpartum mothers with their changing bodies. Here they can learn about and work on the body mechanics of motherhood (things like picking up a 20-pound carrier) to not only prevent pelvic floor dysfunction but also improve existing problems.
This class also provides labor support by boosting stamina and working with expecting mothers on breathing exercises to prepare for delivering a baby. One key component is education and awareness. It is especially important for women to get the approval of their health care provider at their 6-week postpartum check up that they are ready to participate in these classes.
I also recommend that women make a prenatal appointment with a pelvic floor physical therapist for assessment. The therapist will assess each individual on their current breathing pattern and techniques. They will assess their mechanics and alignment while showing them how to prevent back pain and SI joint pain. This preparation can be part of a comprehensive labor support plan to promote proper breathing and reduce pain during labor. After the baby is born, I recommend a follow up for pelvic physical therapy after a normal 6-week postpartum visit. In this appointment a woman can expect an assessment of the pelvic floor contraction, posture and breathing pattern.
The postpartum pelvic physical therapy assessment is important because women are ready to go back to their prepregnancy intensive exercise routines. Whether it is Orangetheory, BeachBody or Crossfit, these can wreak havoc on a pelvic floor that has not been strengthened postpartum. These assessments are crucial to understanding your daily mechanics and strengthening the pelvic floor to increase success in getting back to intensive cardio and interval training.
If you are experiencing any of the above symptoms or discomforts, call your health care provider and make an appointment for an assessment. Discuss your concerns and keep a journal of your symptoms to review during your appointment. Record what is the most painful, when, what are you doing when the pain or symptoms occur or worsen. Look into your insurance on which pelvic floor therapists are in your network and ask about it at your appointment.
Even though these are common discomforts and symptoms for women, they do not have to be your new normal.