Hi friends! Happy Tuesday!
Before we get started with the blog of the day, I just wanted to do a couple postpartum updates! Unfortunately, my women’s health physical therapist had something come up…and my appointment is pushed back a week. I’m waiting to run until then, to make sure everything is looking well enough to sustain the high impact that running has on our pelvic floors.
I’ve been weighing myself on Thursday mornings to get an idea of where I am. My 40 pound pregnancy weight gain with Maxwell has been coming off pretty steadily…until this point. Thursday marked the first time I hadn’t lost weight for the week. I came back into our bedroom + told Drew in a somewhat disappointed voice. EVEN though this is how I feel about weight + letting scales determine your health, I still have my moments too. My husband said, “Amy, you are beautiful. You just had a baby 7 weeks ago! You know you are going to hold onto some weight while breastfeeding!” I’m telling you, he came this sweet! It has been SO nice that he educated himself on pregnancy + breastfeeding and can support me through moments like this. I’m still holding on to 10 pounds, we’ll see if that sticks around until I’m done breastfeeding…which would be just fine, even if I need reminders. ?
Onto the blog of the day! To give you a brief background, Lauren + I played soccer together in middle school. Of course Facebook has a fantastic way of letting us stay connected. She is now a women’s health physical therapist. She reached out with a sweet message complimenting me on being an advocate for women’s health physical therapy + for letting women know that they are able to get help for issues they experience prior to or after birth. She also praised the fact that I wasn’t in a rush to “bounce back” after baby (another great reminder for me to NOT be in a rush or worry about those last 10 pounds). I thanked Lauren for the message, but also roped her into coming onto the blog! 😉 She was more than happy to answer questions for us, as she is passionate about helping women too!
I set this post up in a question + answer format. I tried to ask common questions + questions that I had coming into the postpartum period. Huge thanks to Lauren for taking time to educate us!
Here is a picture of the female pelvic floor for everyone. I don’t want to just assume everyone knows what we’re talking about! The pelvic floor muscles have lots of jobs. Specifically: “Pelvic floor (PF) muscles function to support pelvic floor organs, assist in urinary and fecal continence, aid in sexual performance (orgasm), stabilize connecting joints, and act as a venous and lymphatic pump for the pelvis.” -Beyond Basics Physical Therapy
Ames: Introduce yourself for us Lauren!
Lauren: First off, I just wanted to say how great it is to reconnect with you, and I thank you for being an advocate and positive voice for women as they journey through motherhood. I have really enjoyed your blog posts!
I work at a hospital-based outpatient physical therapy clinic called Honor Health in Scottsdale, Arizona. I have been a physical therapist for 5 years and specialize in women and men’s pelvic health. Arizona is a very active state, so outside of work I enjoy running, hiking, hot yoga and spending time with my husband and two dogs. We love to travel and explore new cities and visit friends around the country.
Ames: Can you explain the role of a women’s health physical therapist before and after birth?
Lauren: I hope that it becomes standard of care for women to meet with a women’s health physical therapist before, during and after pregnancy. Ames: As Lauren + I discussed, it is in other countries! Also, do not be afraid to ask your OB for a referral. Mine was happy to write one because I advocated for myself! Our profession strives on preventative care and women can learn about the musculoskeletal/postural changes that will occur through pregnancy. In the pre-partum phase, women can learn about proper body mechanics and posture, breathing mechanics for delivery, pelvic stabilization exercises, stretching, supportive bracing, and balance training. They also can benefit from pelvic floor muscle training in preparation for pregnancy and delivery. Often times, I treat women once they have developed symptoms and the opportunity was lost to treat them proactively. In the post-partum phase (usually after 6 weeks of pelvic rest), a pelvic health therapist will assess the patient’s pelvic floor muscle strength, coordination, and if there are any areas of pain related to pelvic floor dysfunction. The therapist will also check diaphragmatic breathing mechanics, if the patient developed a diastasis recti, scarring from perineal tear or c-section scar, or any other pelvic dysfunction related to pain or incontinence.
Ames: Explain for us pelvic floor dysfunction in regard to the postpartum period. What increases a women’s chances of experiencing these problems?
Lauren: This is directly from one of my patient handouts: Pelvic Floor Dysfunction (PFD) is an umbrella term used to encompass several different bowel, bladder, and sexual disorders, and chronic pelvic pain syndromes, that affect or are caused by the pelvic floor muscles inability to contract, relax, and/or bulge effectively. These conditions may or may not have pain associated with them.
Typically, we find that most women have some sort of dysfunction, especially after being awesome and carrying a baby for 9 months! Everything is so thrown off mechanically, and it takes time to heal to resume prior activities. Women who tend to be at risk for PFD had theses issues with previous pregnancies, had any of the above issues in the pre-partum period, or return to prior activities too quickly and don’t allow enough time for healing.
What are signs + symptoms that it is time to see a women’s health physical therapist after birth?
Lauren: It is common to give yourself 6 weeks of pelvic rest following delivery. It is never normal to leak or have pelvic floor pain that is lingering in the post-partum phase. I often hear patients say they leak urine when they return to running, crossfit, or high-impact activities and are told that this is “normal” or “that’s the way it’s going to be and just deal with it.” THIS IS NOT TRUE. Leaking is a symptom of pelvic floor dysfunction. If you leak, stop the offending activity and see a therapist. Pelvic/perineal pain is also not normal and can be a sign of hypertonicity (spasm) of the pelvic floor, which can be addressed with PT. I have treated many women who have leaking, pain with intercourse or prolapse (falling out feeling) after delivery, which are common complaints.
Ames: Is urinary incontinence ever normal after birth? What about pain during sex?
Lauren: As I mentioned above, there will be a period of time (usually within the first 6-12 weeks) where you may experience incontinence and discomfort while you are healing. I never want to suggest that it is “normal,” but “expected” might be a better word. If these symptoms linger, then it’s time to see your therapist. Many patients report that sex is different after baby and it will take time to regain strength and muscle function to find sex pleasurable. Persistent pain during arousal, penetration, or that lingers after sex is not normal and is a sign of dysfunction.
Ames: What issues are you most commonly seeing women for?
Lauren: Incontinence is the most common followed by pelvic pain. Ames: As Lauren mentioned above, if you continue to experience these issues…get yourself into a women’s health physical therapist!
Ames: As with many new mommas, I was super excited to get back to exercise. How long do you recommend waiting after baby to get back into exercise? What should women stay away from early on?
Lauren: When your pelvic PT says it’s okay! (haha, just kidding!) Pregnancy followed by delivery is like recovering from a sports injury or surgery, it is crucial to give yourself enough time to heal. You don’t want to cheat yourself. I typically tell my patients when they consistently don’t have symptoms of pain or leaking during exercise, then it’s safe to gradually get back into their workout routine. Before getting back into any core strengthening, get assessed for diastasis recti (splitting/gapping of the rectus abdominis muscle). I would make sure that you never hold your breath during a high impact activity such as lifting, as this will place unnecessary pressure on your pelvic floor. The timeline differs patient to patient. Bottom line: listen to your body, it will tell you what it needs.
Thank you, thank you, thank you Lauren! Incredible information for women that want to become pregnant, are pregnant, or are postpartum. If you guys have any additional questions, drop them in the comments or email me + I’ll get them answered for you.
Have a great day! -Ames