5 Signs Your Body Needs Postpartum Physical Therapy

Pelvic floor physical therapy is the highest standard of care for moms after having a baby- yet so many moms don’t receive referrals. Why is that? I don’t have a great answer for you unfortunately. What I do have, however, is a solution. The great state of Wisconsin has direct access for physical therapy! That means that you don’t have to wait or even ask a physician or PCP for a referral- you can just take yourself right to the pelvic floor physical therapist of your choice. Here are 5 sure signs that your body needs postpartum physical therapy:

Leaking Urine

Leaking urine is never normal, even after having a baby. Pelvic floor physical therapists are sounding the alarm on this problem the world over. In my own clinical experience, I've seen the far end of the spectrum and what happens to women as they age where their leaking issues weren't addressed. Common complications of unresolved leaking (aka incontinence) are: 

• UTIs (urinary tract infections)

• Vulvar skin irritation and infections

• Falls resulting in bone fractures and death.

  
  

These complications may show up right away,or they may take years and decades to develop. From my clinical experience, these are supremely unpleasant things to be dealing with at any stage of life. I’ll just say that seeing older ladies fall and break hips because they were incontinent and trying to get to the bathroom is one of the most heart breaking things I’ve ever seen in the hospital. The death rate within a year after a hip fracture is 20-30%, and for those that survive their quality of life significantly declines. Many women experience life long hip pain and significantly impaired mobility. All because they have been leaking urine since they were young mothers and didn’t get the pelvic floor care they deserved. 

Pelvic Heaviness

Feeling heaviness in the pelvic floor is often a sign of pelvic organ prolapse (POP). This is when the tissues of the abdominal cavity start to descend into the vaginal space and sometimes out through the vaginal opening. There can be descent of the bladder, cervix/uterus, and/or of the rectum. Prolapse is typically diagnosed via a vaginal exam. The heaviness often happens at predictable times and scenarios: 

• End of the day

• Extended time standing or walking

• Carrying heavy objects or baby wearing 

• Impact activity such as running or jumping

• Using the toilet

  
  

Proper rest in the first 2-3 weeks postpartum coupled with early postpartum physical therapy that starts around 2-3 weeks postpartum can make a huge impact on how you recover. Moms at our Waukesha clinic who start PT early postpartum report rapid resolution of any pelvic heaviness they experienced after delivery. 

Back Pain

Pain is a sign that something is wrong. Yet many moms ignore their back pain and never seek an assessment for it. Pain is not something to be ignored. Common reasons for postpartum back pain include: 

• Epidural site scarring

• Poor spinal mobility

• Pelvic bone position changes

• Weak abdominal muscles

• Weak glute muscles

• Tense pelvic floor

• C-section scars

• Forward head posture

  
  

All of these causes for back pain can be addressed with a course of postpartum physical therapy. Without addressing these issues, subsequent pregnancies will be more painful and challenging, and being an active mom becomes significantly harder. Early intervention for back pain is one of the best ways to stay off of pain medication and out from under a spine surgeon’s knife. 

Diastasis recti

Diastasis recti (DRA) is a separation of the rectus abdominis muscle, which is the muscle that gives you a “six pack.” Nearly every woman who makes it to full term with her pregnancy will have this separation. When assessing for DRA, a pelvic floor physical therapist will look at both how wide and how deep the gap is to determine how best to treat you. While this separation is normal in pregnancy, we do want to see that gap come back to normal, which is approximately 1 finger width wide. We also shouldn’t be able to press our fingers down deep between the two sides of the muscle. When I am assessing a woman with DRA, here are the main things I am looking for:

• Rib cage angle

• Rib flare to the front

• Back tension

• Trunk posture

• Oblique muscle tension and mobility 

• Fascial restrictions through the abdomen

• Small intestine mobility

• Breathing mechanics

• Muscle activation of all three muscle layers of the abdomen

• Glute mobility and strength

  
  

All of these items are readily addressed with pelvic floor physical therapy via manual techniques and targeted corrective exercise. It’s also been my clinical experience that women who start their rehab early (2-3 weeks postpartum) will have closed their abdominal separation by 3 months postpartum. Women who wait until they are several months postpartum and only start physical therapy because they feel like they still look pregnant will have a longer road to closing their gap. 

Pain with sex

Painful sex is tough on a relationship. So many moms in my clinic are so scared to have intercourse again after birth because they are extremely worried about the pain. While some discomfort is to be expected after everything the vagina went through in birth and being off limits for 6 weeks, experiencing pain with sex is a different story. Pain during sex can manifest in different ways, and they can all be treated with pelvic floor therapy:

• Stinging pain with insertion

• Sharp pain that does not resolve with foreplay, adequate lubricant, or increased arousal

• Deep thrusting pain

• Feeling like your partner is running into something hard

• Lower abdominal pain

• Lingering pain or soreness that lasts more than 2-3 hours after intercourse.

When treating women who are having painful intercourse, we do a full body assessment and aim to get to the root of why her pelvic floor is experiencing pain. We then will do manual therapy, targeted exercise and stretches, and often some mindset and emotional work to help you get back to enjoying being with your spouse again. 

Postpartum physical therapy is life changing when moms take the time to take care of themselves. At Foundation Physical Therapy we actively support moms getting the care they need, when they need it. We offer in-person appointments for early postpartum recovery (not just virtual) in addition to group classes for postpartum recovery to help moms build strength, confidence, and community.

Looking for a pelvic floor physical therapist to help you recover postpartum? Our Waukesha, WI clinic is actively accepting new patients. You can click here to learn more and schedule online or give us a call at 262-627-0425. 

FAQ

When should I start physical therapy postpartum? 

2-3 weeks postpartum is ideal. There is a great deal of healing that is taking place during the early postpartum time. Taking advantage of this healing window by having targeting manual therapy and participating in targeted exercises helps moms recover quickly. 

When is it too late to get physical therapy for these postpartum problems? 

Never! You can always start physical therapy. But it is important to know that if you’ve had any of these problems for an extended period of time, it will take time to heal them. It’s not going to be a quick fix. 

How do I find a good pelvic floor physical therapist? 

Word of mouth is your friend here! Local Facebook groups are a wealth of recommendations for all things mom and baby related, including provider recommendations. What I would not recommend is just choosing someone because they are in-network with your insurance plan. You deserve the best, and the best are going have their praises shouted from the rooftops. It’s a challenge to vet providers off an insurance company list. Go with someone local moms like you have seen and trust.

Dr. Sabrina Thorpe is a Doctor of Physical Therapy with a decade of clinic experience. She specializes in treating pregnant and postpartum women and their infants at Foundation Physical Therapy in Waukesha, WI.