When to see a pelvic floor PT postpartum

Welcoming a new life into the world is an incredible experience. It can also bring a host of physical changes and challenges, and working with a pelvic floor physical therapist (PT) can be crucial to optimizing your recovery.

Why should I see a pelvic floor PT postpartum?

For 9-10 months of pregnancy, there is increased demand on the body to support the growing fetus. This demand is especially apparent for the pelvic floor muscles which support the uterus, bladder, and rectum. There are also significant changes that occur in posture and the abdominal muscles as your body accommodates a growing belly.

During vaginal deliveries, the pelvic floor muscles undergo significant stretch and may become weakened or damaged. Mothers that undergo a c-section may still experience pelvic floor symptoms due to the physical stress of pregnancy and incision recovery.

Because of these changes, it is not uncommon for postpartum women to experience symptoms such as urinary incontinence, pelvic pain, or prolapse. While these issues are common, they should not be ignored. Seeking the help of a pelvic floor physical therapist can be a game-changer in your postpartum journey.

What can a pelvic floor PT help with?

There are a multitude of conditions that a pelvic floor PT can treat postpartum. A few of the most common reasons women seek out help include:

1. Persistent pelvic pain
   During pregnancy and after childbirth, it's not uncommon for women to experience pelvic pain. This pain may be due to the strain on the pelvic floor muscles or other factors such as scar tissue from perineal tearing, episiotomy, or c-section. If you're experiencing persistent pelvic pain that interferes with daily activities or intimacy, it's time to see a pelvic floor physical therapist.

2. Urinary and fecal incontinence
   Postpartum urinary incontinence (such as leakage when coughing, sneezing, or laughing, or urgency) is a common issue that affects many women. While many mothers do experience leaking postpartum, it does not mean that you have to accept it as a new normal! Research has shown that pelvic floor PT is very effective in treating urinary leakage. While less common, fecal or gas incontinence may also arise. Women who experience more significant perineal tearing are at higher risk and should work with pelvic floor therapist to ensure proper recovery.

3. Pelvic organ prolapse
   Pelvic organ prolapse occurs when one or more pelvic organs, such as the bladder, uterus, or rectum, descend or bulge into the vagina. Symptoms may include a sensation of heaviness or pressure in the pelvis or difficulty emptying the bladder or bowels. If you suspect you have prolapse, seek the expertise of a pelvic floor physical therapist who can provide guidance on lifestyle modifications and recommend appropriate exercises.

4. Diastasis recti
   Diastasis rectus abdominis (often referred to as DRA) is the separation of the abdominal muscles that commonly occurs during pregnancy. While this condition may resolve on its own for some women, others may require targeted exercises and physical therapy to restore muscle tone and core strength. A pelvic floor physical therapist can assess the severity of the DRA and create a customized exercise program to promote healing.

5. After a difficult or traumatic delivery
   If you experienced a difficult or traumatic delivery, such as a long labor, forceps or vacuum extraction, or an emergency c-section, your pelvic floor muscles may have endured excessive stress. These events can contribute to muscle tears, pelvic pain, or pelvic floor dysfunction. Consulting a pelvic floor physical therapist can help assess any potential issues and guide you on the road to recovery.

Can I come in for a postpartum check-up if I don’t have any symptoms?

Absolutely! Pregnancy and childbirth is demanding on the body and this comes with many physical changes (whether or not you’re experiencing symptoms).

Physical therapists can perform a thorough assessment to evaluate your posture, mobility, and strength to identify any deficits or areas for improvement. Your therapist can then help design an individualized program to optimize your recovery postpartum and decrease your risk of pelvic floor dysfunction down the road!

How soon should I start pelvic floor PT postpartum?

Most women enter the postpartum period with very little guidance on recovery. There are so many changes happening in those early weeks, and it can be hard to know how much or little you can or should be doing to promote recovery. At your 6-week postpartum check-up, your provider will usually clear you to resume exercise but does not typically give guidelines on how to do this safely.

Because there is typically little to no guidance from the delivery provider, I recommend following up with a pelvic floor therapist within the first 3-6 weeks postpartum.

During these early weeks, your therapist can provide tips on how to manage common symptoms like urinary leakage, constipation, hemorrhoids, scar pain, etc. They can also teach you ways to manage movements like bending and lifting to protect your pelvic floor and abdominals while they recover.

In many states like California, you can start seeing a pelvic floor PT without needing a referral. If your state does require a referral, your birth provider should be able to provide this for you.

Despite significant research on the benefits of pelvic floor PT postpartum, some providers tend to brush off symptoms considering them a normal part of the postpartum experience. While it is unfortunate for many women to feel dismissed during this period, it is important to know that you can always advocate for yourself or seek a referral from a different provider.

Work with Remedy!

Erin Rahter is a doctor of physical therapy and is board certified in women’s health through the American Board of Physical Therapy Specialties (ABPTS). She is the owner and founder of Remedy Pelvic Health and provides physical therapy services in the San Diego area. Virtual services are also available throughout California. She specializes in women’s health, prenatal, and postpartum care.

Want to learn more or ready to schedule? Click the link below to schedule a free 15-minute phone consultation!