Why pelvic floor therapy is needed after giving birth

Feb 14, 2023 • 7 min read

Benefits of Pelvic Floor Therapy

The pelvic floor consists of muscles, ligaments, tendons, and nerves connected to the pubic bone and pelvic girdle. Combined, it is often considered a sling or hammock. The pelvic floor supports the bladder, bowel, rectum, uterus, and vagina.

Risk factors for pelvic floor issues include the number of childbirths, traumatic childbirth, age, obesity, trauma such as a car accident or pelvic surgery, and chronic straining or lifting. In 30% of women, injury or damage to the pelvic floor results in pelvic organ prolapse (POP) while others experience milder symptoms such as pressure and urinary incontinence.

The main way to help prevent or alleviate these issues is pelvic floor therapy.

Pelvic floor therapy consists of a variety of technologies and practices that can help women preserve the nerves and muscles that support the region. It can be used preventatively before childbirth or once the problem presents itself.

This guide goes over the benefits of pelvic floor therapy and what to expect in pelvic floor therapy so you can decide if it’s right for you.

Benefits of pelvic floor therapy

Prevention of pelvic floor damage is often overlooked because most women are not aware that being proactive may decrease the severity of the damage attributed to childbirth.

The stronger the muscles are before childbirth, the less chance of severe damage that could lead to prolapse and incontinence.

It is especially helpful to perform pelvic floor therapy during pregnancy. There are many types of pelvic floor exercises that can be done, but Kegels can be done at any time and anywhere unless you are using a device to help isolate the right muscles. The key is repetition.

Pelvic floor therapy can increase control of your pelvic muscles, improve contraction and relaxation of the muscles, decrease pain and symptoms of pelvic floor dysfunction, and improve sexual pleasure.

Let’s take a closer look at the benefits of pelvic floor therapy:

1) Reduce urinary incontinence

Stress Urinary incontinence (SUI) and to a lesser extent, urge incontinence, can be reduced with pelvic floor therapy.

SUI occurs when the neck of the bladder collapses into the vagina when there is increased abdominal pressure such as sneezing.

By strengthening the pelvic floor, the amount of urine loss can be lessened.

2) Help overactive bladder

Like with SUI, studies have demonstrated the benefit of pelvic floor therapy in reducing the degree of symptoms associated with an overactive or unstable bladder, commonly referred to as urge incontinence or detrusor instability.

The detrusor muscle is the internal bladder muscle that will contract unexpectedly and cause leakage. Pelvic floor therapy can strengthen the nerves that supply the destroyer, thus reducing the nerve firings that trigger the contraction.

It is estimated that 25% to 45% of all women suffer from involuntary urine loss at some stage in their lives, thus making early intervention essential.

3) Reduce fecal incontinence

There are many reasons for fecal incontinence (FI), but traumatic childbirth leads the way unless there is an underlying nerve problem or paralysis.

In many cases, pelvic floor therapy in combination with dietary changes can reduce the incidence of FI. The nerves must be stimulated to control the muscles surrounding the rectum and pelvic floor therapy accomplishes both actions.

4) Reduce constipation

Constipation can be due to a combination of diet, activity levels, and nerve dysfunction in the large colon. Pelvic floor therapy with biofeedback can strengthen the muscles and help relieve constipation.

In one study, 80% of people undergoing biofeedback improved their constipation compared to 22% in the laxative group.

Chronic constipation and straining must be controlled, or the risk of pelvic floor damage increases, and a rectocele could form. Rectoceles occur when the top wall of the rectum pushes into the vagina, narrowing it.

5) Reduce vaginismus

Vaginismus is a condition that occurs when the muscles around the opening of the vagina tighten up like in a clenched jaw due to actual or anticipated pain.

Any time something is about to be put in the vagina, such as a finger, penis, tampon, or a medical device like a speculum, the woman experiences pain. Vaginismus often prevents women from having sex or causes pain during sex.

Pelvic floor therapy helps the woman learn to relax the muscles that prevent penetration.

6) Alleviate pain from intercourse

Pain during intercourse can be due to a variety of reasons, but retraining the nerves that supply the nerves to the vagina and pelvis is one modality that can be accomplished with pelvic floor therapy.

It increases blood flow, releases nerve entrapment, decreases sensitivity, and relaxes the vaginal muscles.

7) Reduce symptoms of prolapse

Prolapse (a displacement of an organ downward) of the bladder or rectum can be treated with surgery and support devices, such as pessaries.

The symptoms of prolapse (pressure and urinary leakage) can be reduced through pelvic floor therapy by increasing blood flow and stabilizing the nerves and muscles.

8) Improve general pelvic pain

Pelvic pain can arise from many organs in the pelvis or near the pelvis. Prolapse, endometriosis, scar tissue, and vaginal atrophy are common reasons for general pelvic pain.

Pelvic floor therapy can stimulate the nerves, relax the muscles, and increase blood flow to the region, all of which may reduce pelvic pain.

9) Improve Vulvodynia/Vestibulitis

Vulvodynia/vestibulitis is a disorder of the external vulva and perineum that is poorly understood but leads to severe discomfort and impacts all aspects of daily life, including sexual intercourse.

Pelvic floor therapy can help desensitize the nerves so that there is less pain.

Why pelvic floor therapy is needed after giving birth

The vagina and uterus undergo dramatic changes during pregnancy and postpartum. The vagina returns to its normal size after vaginal birth, and depending on whether there has been trauma to the vagina or perineum during childbirth determines how well and fast this happens.

Added to that is the lowered estrogen levels when breastfeeding. Lowered estrogen decreases blood flow to the vagina. Pelvic floor therapy increases blood flow, which enhances healing. Faster and better healing means the tissue’s strength is restored.

Healing restores the muscles to their proper function and interactions with nerves. Healthy nerves and muscles mean a healthy pelvic floor.

When to see a pelvic floor therapist

A pelvic floor therapist should be visited if any of the problems listed above occur, either before or after vaginal birth.

The sooner the intervention, the higher the chance of success. Early intervention with a pelvic floor specialist can reduce problems down the road because the longer the nerves and muscles are weak, the less chance of rehabilitation.

A pelvic floor therapist is a specialized type of physical therapist (PT) who is trained for all types of pelvic floor disorders, rather than a PT that addresses other areas of the body that might need help after an injury or stroke.

Pelvic floor therapists must have received a CAPP or WCS certificate.

If you’re looking for help, we can connect you with a pelvic floor therapist who is in our network here at Zaya Care. You can browse through therapists, learn about their backgrounds, and choose the one that works best for you.

You should see a pelvic floor therapist if:

You have pelvic or vaginal pain that persists and no underlying pelvic pathology is identified such as an infection or endometriosis.
You develop urinary or fecal incontinence.
If you have the urge to urinate all the time.
Constipation starts after childbirth or for unknown reasons.
If you notice uncontrolled postpartum gas/flatus.
You cannot tolerate vaginal penetration.
After childbirth even if it was uncomplicated or nontraumatic.
If you have continued pelvic pressure.
If you have pain externally (vulva and perineum) that is not due to an infection or other pathology.
If you notice the symptoms above getting worse as you approach menopause.
After any trauma, such as a car accident or fall, that may affect your pelvis.

What to expect at pelvic floor therapy

First of all, the pelvic floor therapist will ask you questions about your medical, surgical, and obstetrical history. They will take a survey of your symptoms or the reason for your visit. They will focus on urinary, sexual, and bowel symptoms, including an assessment of your level of distress or pain.

Then they will conduct an exam of your vagina/pelvis. Diagnostic tests made be performed, such as anal manometry or nerve conduction studies.

The following are some activities you can expect:

Education about your anatomy and how things work
Best toilet habits
May give you a urinary diary to record how often you urinate
Education about exercises you can do at home and what activities to avoid
Pelvic massage to reduce scar tissue, loosen up muscles, and stimulate blood flow
Devices may be suggested
Pelvic floor biofeedback to help you assess which muscles do what. This requires small probes to be placed on your abdomen, in your vagina, and rectum to monitor contractions of the pelvic muscles
Electrical stimulation with electrodes outside of your body sends gentle pulses to the nerves and muscles

References

Cook MS, Bou-Malham L, Esparza MC, Alperin M. Age-related alterations in female obturator internus muscle. Int Urogynecol J. 2017 May;28(5):729-734. doi: 10.1007/s00192-016-3167-5. Epub 2016 Oct 4. PMID: 27704154; PMCID: PMC5450648.
Berghmans B. Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. Int Urogynecol J. 2018 May;29(5):631-638. doi: 10.1007/s00192-017-3536-8. Epub 2018 Jan 9. PMID: 29318334; PMCID: PMC5913379.
Berghmans B. Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. Int Urogynecol J. 2018 May;29(5):631-638. doi: 10.1007/s00192-017-3536-8. Epub 2018 Jan 9. PMID: 29318334; PMCID: PMC5913379.
Alouini S, Memic S, Couillandre A. Pelvic Floor Muscle Training for Urinary Incontinence with or without Biofeedback or Electrostimulation in Women: A Systematic Review. Int J Environ Res Public Health. 2022 Feb 27;19(5):2789. doi: 10.3390/ijerph19052789. PMID: 35270480; PMCID: PMC8910078.
Pereira V.S., De Melo M.V., Correia G.N., Driusso P. Long-term effects of pelvic floor muscle training with vaginal cone in post-menopausal women with urinary incontinence: A randomized controlled trial. Neurourol. Urodyn. 2012;32:48–52. doi: 10.1002/nau.22271.
Freeman A, Menees S. Fecal Incontinence and Pelvic Floor Dysfunction in Women: A Review. Gastroenterol Clin North Am. 2016 Jun;45(2):217-37. doi: 10.1016/j.gtc.2016.02.002. PMID: 27261895.
Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006 Mar;130(3):657-64. doi: 10.1053/j.gastro.2005.11.014. PMID: 16530506.
Binik YM. The DSM diagnostic criteria for vaginismus. Arch Sex Behav 2010; 39:278.
Tommola, P. (2017). Etiopathogenesis and treatment of localized provoked vulvodynia. [P. Tommola].

By Kim Langdon, MD

Kimberly Langdon M.D. is a retired, board-certified obstetrician/gynecologist with 19 years of clinical experience. She graduated from The Ohio State University College of Medicine, earning Honors in many rotations. She then completed her OB/GYN residency program at The Ohio State University Medical Center. After clinical practice, she founded a medical device company where she invented six patented medical devices for both life-threatening and non-life-threatening conditions.