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  • Writer's pictureLila Abbate, PT, DPT, MS, OCS, WCS

The Highs and Lows of Pregnancy and Post-Partum

Updated: Jan 10, 2021

Becoming pregnant is an amazing process. The body is an incredible machine where at the successful end of the better part of a year, you have made a human being. For the woman and her body, it is a fantastic journey. It can also be incredibly nauseating, incredibly sweaty, incredibly uncomfortable and maybe even down-right painful. Painful from a musculoskeletal point of view.

PT for pregnancy and post-partum

From the point of view of a pelvic health physical therapist, every pregnant woman should be seen by a pelvic health PT for at least 4 visits post-partum to help correct the body and normalize its state after the journey of pregnancy. Nothing is “normal” or “easy” about being pregnant. A baby grows inside your body moving your organs all around and mainly upward, your ribs expand significantly, your breasts engorge, your upper body posture changes. Not to mention what is happening down below to our pelvis. With pelvic organ descent, low back and sciatica pain along with hip and knee alignment changes and swelling feet are all potentially painful effects.

There’s no doubt, it is all 100% worth it. However, the lack of information guiding the pregnant and post-partum woman on how to take care of her own body is understandable. How to get rid of that rib flaring or normalize and return yourself to your old bra size? What to do about that chronic neck and low back pain that improves as you move around during the day, but seems to be chronically part of your life? What about potential hip, knee and foot pain? And not to mention, your pelvic floor muscles. Who is rehabbing those? It’s not happening in your spinning, Pilates or yoga class. Bo, et al, in 2015 determined that the only exercise that can get your pelvic floor stronger is specific pelvic floor exercises. There is some carryover when going to the gym, but you can’t be sure if you are strengthening your vaginal pelvic floor or maybe your rectal pelvic floor muscles, as it’s difficult to feel the difference or separateness of each compartment. The muscles traverse from one opening to the other but the “compartments” (anterior for vaginal and posterior for rectal) have different purposes and each may function independent or compensate for the other. I have patients who have had a long birthing process, or a lot of stitching, or a tender episiotomy tear and their rectal pelvic floor muscles are the only muscles contracting. You won’t know what is going on until you see a pelvic health therapist. Pelvic health therapists specialize and take extra continuing education about special conditions along with pelvic muscle training (up- or down-training). Some gynecologists are assessing pelvic floor muscle activity, but for the most part they are looking for pathology/disease/infections, as well as birthing babies and/or performing surgery. The majority of doctors are not sending their female patients to a pelvic health physical therapist (at least not here in the United States), which is why I am so passionate about educating women about pelvic health.

With so much information on blogs, magazine articles and books that touch on different physical changes that a pregnant or post-partum woman could be going through, it is becoming more evident that women need this type of musculoskeletal intervention. An article was making its way around Facebook that every pregnant woman in France gets in-home pelvic floor strength training education by a physical therapist starting at the 4th week post-partum. Women need to be aware of where their pelvic floor muscles are and how to either strengthen or relax them.

Urinary incontinence is one of the most common complaints of post-partum women. Whether it resolves within a few weeks or months, some women are resigned to live with these symptoms. Urinary incontinence is not a normal part of being post-partum, nor is it a normal part of the aging process. Currently, the women’s feminine hygiene industry has invented a smaller type of tampon to be used to prevent leakage. The physical therapy industry just doesn’t have the same type of financial support to have campaigns on Lifetime, Hallmark or HGTV channels to talk about the benefits of pelvic floor muscle training so women flock to buy these products instead of correcting the causes of the problem.

Seeking the care of the women’s health or pelvic health physical therapist can be of great benefit in your life. Several visits can make a huge change in how you feel, can reactivate muscles that forgot how to work and can change compensations of inappropriate muscle firing throughout your body. You are worth the investment!

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