Monday Medical: Pelvic floor health after pregnancy
For Steamboat Pilot & Today
Pregnancy affects a woman’s body in a variety of ways. But there’s one change women may not consider: the impact to the pelvic floor.
The pelvic floor muscles sit within the pelvis and support a woman’s bladder, rectum and reproductive organs. They play an important role in core stability, bladder function and more.
While the strain of pregnancy and delivery may cause issues in the pelvic floor, the good news is that most of those issues can be resolved.
“A lot of women assume that things will never feel the same after pregnancy, but pelvic physical therapists do not agree,” said Cheryl Tenpas, a physical therapist specializing in pelvic health at UCHealth SportsMed Clinic in Steamboat Springs. “There are a lot of things we can do with exercise, posture and body mechanics that can make a big difference in how you feel and function.”
Below, Tenpas outlines the most common post-partum pelvic floor issues she sees.
Low back pain
About 40% of women report low back pain even six months post-partum. Often, that pain is due to a weakness in the abdominal muscles and pelvic floor.
“The abdominal muscles and muscles along the spine are antagonists to each other,” Tenpas said. “If you’re weak anteriorly, this can translate to dysfunction posteriorly. The body works as a unit, and we need to think about the pelvic floor when we think about strengthening the core.”
Along with core strength, Tenpas works with patients on improving posture and body mechanics when doing everyday activities, such as lifting and carrying a baby.
Pelvic floor weakness
This condition is often described as a feeling of heaviness in the pelvis. “Some women feel that after using the bathroom, things don’t return to where they should be,” Tenpas said. “Or during intercourse, they may feel pain or that something just isn’t right.”
This weakness may impact the bladder, causing leaking or frequent urination at night.
As with low back pain, the appropriate exercises can help rebuild strength in the pelvic floor.
Separation of abdominal muscles
Also known as diastasis recti, this issue may result from mechanical stresses in the body during pregnancy, including the widening of the pelvis, stretching of ligaments and the change to the center of gravity.
“You could see coning of the skin between the edges of your abdominals or an issue with more tissue around the naval that you didn’t notice before,” Tenpas said.
The issue makes it difficult to manage pressure within the abdomen, which can cause leaking of urine, as well as bowel issues.
Though the condition impacts about a third of women up to one year after childbirth, it can be addressed with specific exercises. Tenpas advises skipping the planks and crunches, which should be avoided until the muscles have approximated, or come closer together.
Pelvic floor pain
Pregnancy and delivery can result in scar tissue and overactive pelvic floor muscles and may damage nerves in the pelvic floor, all of which may result in pain.
“Some women think this pain is just something they have to live with,” Tenpas said. “But over time, it can affect how the whole body functions and can keep you from participating in activities you want to do.”
Specific movements and exercises can help relax overactive muscles and decrease scar tissue, helping to reduce symptoms.
For any pelvic floor issue, a pelvic physical therapist can help create an individualized exercise plan.
“A specific pelvic floor muscle assessment is so important in determining which exercises are the right ones for each patient,” Tenpas said.
Tenpas likes to remind patients that it’s never too late to work on the pelvic floor, no problem is too small and taking care of yourself is also a way to care for your baby.
“You can be years post-partum and exercise can still make a big difference in function,” Tenpas said. “And if something is bothering you, it’s worth addressing.
“Remember that you’re doing something for your baby, too,” Tenpas said. “You’ll be more able to be active in your child’s life if you spend a little time on yourself.”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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