Having a baby changes your body in many ways. One change that women tend to joke about is urinary leakage—a small sneeze, laugh or a jump can leave you without control of your bladder. And it’s true that right after giving birth, you might experience a bit of urinary or fecal incontinence. You might also experience pelvic pain, soreness or back pain, especially when trying to get back into a fitness regimen like running.
But while these issues might be considered common for the first six to eight weeks after giving birth, they aren’t issues you should have to deal with for months (or years) after having a baby, as some people do.
“For years, women have been told these issues are normal—they’re almost considered some kind of prize for having a baby, and they shouldn’t be,” says Aparna Rajagopal, PT, MHS, a physical therapist at Henry Ford Health. “You shouldn’t have to live with these issues for the rest of your life.”
How Your Pelvic Floor Is Affected During Pregnancy
Your pelvic floor is a group of layered muscles at the bottom of your pelvis—and they’re often the culprit behind these postpartum issues. “Each layer has a different function. They aid in sexual intercourse, they control the release of urine and fecal matter, and they help to keep your organs supported and lifted,” says Rajagopal.
But during pregnancy and childbirth, your pelvic floor muscles can become weakened: They not only have to support your organs, but also the increased weight of your uterus and baby—and they have to ready themselves to be stretched during labor. “Without trying to scare anyone, it’s fairly common to sustain tears during childbirth,” Rajagopal adds. “All of these factors can contribute to a weakened pelvic floor. Or, in some cases, it can lead to a pelvic floor that becomes too tight, causing pain and spasms.”
It’s also important to note that your pelvic floor can be affected whether you have a vaginal or C-section birth. “Some people think a C-section won’t affect their pelvic floor, but that’s not true,” says Rajagopal. “With a C-section, you’re still carrying an increased load during pregnancy. And sometimes, during labor, you go from an attempted vaginal delivery to a C-section, and that can affect your pelvic floor.”
Getting A Pelvic Floor Evaluation
At your first postpartum appointment (that’s at six weeks if you had a vaginal birth or eight weeks if you had a C-section) tell your doctor if you're still experiencing any symptoms such as:
- Frequent or urgent urination
- Pelvic soreness or pain
- Urinary or fecal incontinence
- Back pain
Your doctor will refer you to a pelvic floor therapist, who will have an in-depth conversation with you about your pregnancy and labor. They’ll ask you questions like: Was your labor prolonged? Was there a lot of pushing? How big was the baby? Did you have an episiotomy (a small incision made between the vaginal opening and anus)?
They’ll also give you an intravaginal examination to assess your pelvic floor muscles. “We’ll check to see if the muscles can contract,” says Rajagopal. “You’d be surprised at the number of postpartum moms who aren’t really aware of whether they’re contracting or relaxing their muscles. We’ll check to see how strong your muscles are, how long you can perform a contraction, whether you’re able to release the contraction.
“And we’ll usually evaluate your lower back and hips, too, because carrying the baby changes your posture and hips and causes you to walk a little differently. Contrary to what we’ve believed for decades—that things just fall back into place after childbirth—we’re realizing there are a lot of changes during pregnancy that don’t go back to being completely normal without some help.”
What Does Pelvic Floor Therapy Consist Of?
A physical therapist will grade your pelvic muscle strength on a scale from 0 to 5. Research shows that it takes anywhere from two to three weeks for it to get stronger by one grade.
“Therapy will take a little bit of time, but it’s a very empowering therapy—we teach patients small activities they can do,” says Rajagopal. “Then they go home, work on it, and come back in two weeks. Then we’ll give them new exercises, and they’ll go home, work on it, and come back in one to two weeks. There are usually eight to 12 sessions spread out over three to four months.”
Rajagopal says it’s important to get a professional assessment, rather than just researching pelvic floor exercises on your own. “Many postpartum mothers can have a variety of pelvic floor issues, and they’re not treated the same way,” says Rajagopal. “You can have the same symptoms—like urinary leakage and pelvic pain—but they can be due to a weakened pelvic floor or tight muscles that can’t relax or contract. That’s why we can’t just hand out a sheet of exercises for everyone to do. One size doesn’t fit all.”
By the time you’re discharged from physical therapy, you’re usually able to resume your pre-pregnancy activity level. And if you have multiple children? It’s a good idea to have pelvic floor therapy more than once. “Multiple births can cause pelvic floor symptoms to become more prominent and prevalent,” says Rajagopal, “so ideally, it would be great if you had pelvic floor therapy after each child.”
To learn more about pelvic floor therapy, visit henryford.com/services/rehabilitation/outpatient/pelvic-floor-therapy or call (586) 285-3884.
Aparna Rajagopal, PT, MHS, WCS, PRPC, is a board-certified clinical specialist in women’s health physical therapy at Henry Ford Health. She is also certified in pelvic rehabilitation and has received advanced training in pregnancy and postpartum physical therapy. She sees patients at the Henry Ford Rehabilitation and Sports Medicine clinics in Clinton Township and Fraser.
