Healthy Pelvic Floor For A Healthy Life: The Importance Of Healing After Birth
The biggest issues I see with moms and women, at my practice, stem from improper healing and lack of restoring deep core muscles after childbirth.
Most women get cleared by their MD, midwife or OB at 6 to 8 weeks postpartum. As long as the uterus is done “bleeding” they get cleared to go back to exercise, return to intercourse, advised to “just ease back” into everything they were doing prior to pregnancy.
THIS IS A HUGE PROBLEM.
The body is still healing at this point. No matter how the baby came out of your body: be that vaginal or cesarean birth, it is a massive event.
The muscles, the skin, the fascia and the organs all stretched out over 10 months. So to think that you will be back to “normal” or ready to hit the gym at 6 to 8 weeks would be pretty impressive.
So I tend to see women after they have injured themselves attempting to get back to a routine or after they have over exerted themselves; most commonly around the 4 month, 7 month and 18 month postpartum mark. At 18 months many of the moms I treat are either pregnant again or are worried about conceiving again because things never felt normal after their last pregnancy.
These injuries stem from the body not being ready for whatever activity the mom has returned to doing.
Common injuries that were not necessarily present or at least symptomatic after birth but occurred within the first 1-3 years after birth are:
Where organs protrude/fall into the vaginal canal. Either the front wall (bladder falls in), uterus descends, urethra protrudes down, rectum bulges into the back wall of the vagina. Now some decent of these organs into the vaginal canal occurs after pushing a baby out or carrying a baby for 10 months. Hence we need to support these organs recoiling and shrinking back into the body after childbirth, let me tell you crunches are not the answer for this!
This is where the two “6 pack ab” muscles separate and the linea alba which is tissue between those ab muscles stretch and thins out. You may feel like you have a hole in your stomach.
Other common things that bring women in the door include discomfort when returning to sex, peeing their pants when they exercise, constipation and trouble fully passing the stool stiff. Add to the list achy joints: mid back, ankle, hips, SI pain, neck.
These are the most common things I see and by no way am I saying they are normal. Common does not equal normal.
Common does not equal normal
The standard of practice in America is to be cleared for everything even though the body has not been guided to heal, this is wrong and leads to issues that can be prevented if proper care is taken.When you have a baby you have scar tissue either in your perineum, right where the baby came out of the vaginal canal or across your stomach if you had a birth by cesarean section. Please don’t be fooled, if you had a c-section your pelvic floor is absolutely affected too.
There are fascial connections between abdominal fascia and pelvic floor fascia. This means that being cut open in one place can make tightness and pain in another. So having scars can be painful, numbing and irritating and therefore you probably don’t want anyone near them. A lot of times we ignore them or don’t touch them because they are scary, hurt and have a lot of emotion that is wrapped up in the scars.
Why scars are important
The reason scars are so important to address is because birth scars are directly at the area of the pelvic floor and deep core muscles, known as the transverse abdominals, if there is scar tissue present then the muscles can’t fully contract. And I am going to say something fairly controversial but as a baby descends through the birth canal, there are micro tears that occur. These are not the tears that are traditionally needing stitching. But they are important to note because they are also scars and can contribute to a weakened core. The core is the most important force absorber in your body. If your core is weak you will wear out all your other joints faster. So you may have little niggly aches and pains or wake up with perpetual stiffness.
Often times what I see in my practice in older women that could have be prevented, is simply the fact that they never rebuilt their core. So older women typically show up with achy hips, backs and knees. Possibly leaking pee with exercise or racing home to use the toilet.
And then when they get to their late 50s and into their 60s they are thinking about joint replacements, maybe bladder slings. This is all because their cores were never restored after having babies.
I have seen this even further down the line in 80-100 year olds who are all in diapers and in wheelchairs. And often this causes skin break down and ulcers and eventually is a large contributor to death. I don’t say this to completely scare you. I say this because we all want to remain independent and have a good quality of life, we don’t really think of the direct influence our actions today will have on our life as we become older.
My advice is for women to advocate for themselves and even if they are cleared by a OB, midwife or physician at 6 to 8 weeks, request a referral to a specialized physical therapist to rehabilitate your pelvic floor and abdominal wall. This is standard practice in France and my hope is America follows suite and prioritizes women’s postpartum health. No matter when you had your baby, be it 6 months or 16 years ago, getting an evaluation by a Pelvic Expert Physical Therapist will give you the tools to know how to effectively build and use your core.
Pelvic Party: Pelvic Floor Workshop
Join us March 13th at 11am for a Pelvic Party at Allison’s clinic in Edmonds! Tickets & registration can be found here! She will be sharing “everything you wish your mom had told you!”
About the Event:
About The Author:
My name is Doctor Allison Feldt, Women’s Health Physical Therapist and Owner of Body Motion Physical Therapy. We are a specialty clinic helping women through pregnancy and beyond so they can live active, confidence and healthy lives. I am a pelvic expert physical therapist and have been for 8 years now. I am also a mom of a 1 and 3 year old. My passion for helping moms came from seeing women across the life span struggle with issues that could have been prevented if they had the guidance and help to heal after birth.