01.26.22 4 min read

Physical Therapy and Postpartum Care

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Pregnancy and birth take a toll on the pelvic floor, contributing to pelvic floor dysfunction (PFD). Pelvic floor dysfunction refers to conditions that occur because of problems in the muscles of the pelvic floor, and includes urinary and fecal incontinence, pelvic organ prolapse, and pelvic pain conditions (1, 2). 

Approximately 20% of people will have at least one pelvic floor disorder in their life. These disorders occur more frequently with age and this rate may be even higher depending on how urinary incontinence is defined (1). When left untreated, PFD may negatively affect wellbeing and quality of life (3). Although common after pregnancy and childbirth, pelvic floor dysfunction should not be accepted as a given.

Pelvic floor physical therapy (PFPT) is an effective treatment for PFD, but is underutilized in the United States (4). Providers who care for people with disorders related to pelvic floor dysfunction should educate themselves on the benefits of PFPT (3).

If you care for people through reproductive life changes like pregnancy or postpartum, you know that these can be trying transitions that impact physical and emotional health. Obstetricians and gynecologists, midwives, lactation consultants, and family practice providers caring for people’s reproductive health can all benefit from digging into the importance of pelvic floor physical therapy.

Pelvic floor physical therapy can help pregnant and postpartum patients

Pelvic floor physical therapy, is performed by pelvic floor physical therapists who have specialized training and certification. PFPT works to restore normal resting tone, improve muscle strength, and reverse any damage to pelvic floor muscles and connective tissue (2). PFPT is a non-invasive first-line treatment for disorders related to pelvic floor dysfunction (2) like urinary incontinence, pelvic organ prolapse and pelvic pain. 

PFPT includes therapies such as biofeedback, neuromuscular electrical stimulation, and manual therapy (3). Through biofeedback and electrical stimulation treatments, patients can gain awareness of the pelvic floor and in turn, coordinate muscle contractions and improve endurance (3).  

When to refer to a Pelvic Floor Physical Therapist

There is a considerable body of evidence that indicates pelvic floor physical therapy is an effective and low-risk treatment for a variety of disorders related to pelvic floor dysfunction such as incontinence, pelvic organ prolapse, and sexual dysfunction. Providers caring for patients with pelvic floor dysfunction should have knowledge of the pelvic floor anatomy and ability to teach basic pelvic floor exercises. When basic exercises aren’t enough (and evidence suggests they usually aren’t (4)) to improve your patient’s pelvic floor function, it’s time to seek out a pelvic floor physical therapist. These specialized physical therapists work with patients to develop tailored plans based on their symptoms and pelvic floor function. 

Pelvic floor physical therapy can be prescribed proactively

Pelvic floor physical therapy also has demonstrated benefits when used to prevent problems during pregnancy and birth. Pregnancy is a risk factor for developing both urinary incontinence and pelvic organ prolapse (2). Multiple studies suggest that when pelvic floor physical therapy is done during pregnancy or in the first few months after delivery, there is a decrease in urinary incontinence during the postpartum period for up to one year after birth (5, 2). 

How pelvic floor therapy can improve quality of life

Patients are often hesitant to discuss incontinence of any kind with their providers. Both urinary and fecal incontinence might feel shameful or embarrassing. Remember that patients may not volunteer this information to you in a standard visit. Consider asking patients who are pregnant or postpartum if they have symptoms even if they don’t mention them. 

Sexual dysfunction, too, can also be embarrassing. Asking your patients about their sexual wellness and satisfaction at each visit may lead to better outcomes for your patients and an improved provider/patient relationship. 

Explaining pelvic floor physical therapy to clients

Even though PFPT is effective, minimally invasive and low-risk, there is a general lack of understanding and knowledge about it (2). It is likely your patients will not be familiar with the idea of pelvic floor physical therapy or may not know anyone who has received it. If you plan to refer a patient to pelvic floor physical therapy, you should help them anticipate what to expect. Start by explaining the known benefits of PFPT and that their physical therapist will perform an assessment to create a treatment participation. Explaining this in advance to patients will help them have a better overall experience. 

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References:

  1. Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, Spino C, Whitehead WE, Wu J, Brody DJ, Pelvic Floor Disorders Network. Prevalence of symptomatic pelvic floor disorders in US women. Jama. 2008 Sep 17;300(11):1311-6.
  2. Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics and Gynecology. 2019 Dec 1;31(6):485-93.
  3. Lawson S, Sacks A. Pelvic floor physical therapy and women’s health promotion. Journal of Midwifery & Women’s Health. 2018 Jul;63(4):410-7.
  4. Lamin E, Parrillo LM, Newman DK, Smith AL. Pelvic floor muscle training: underutilization in the USA. Current urology reports. 2016 Feb 1;17(2):10.
  5. Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay-Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Incontinence Group, editor. Cochrane Database of Systematic Reviews [Internet]. 2017 Dec 22 [cited 2021 Sep 29]; Available from: https://doi.wiley.com/10.1002/14651858.CD007471.pub3
  6. Friedman HS. Encyclopedia of mental health. Academic Press; 2015 Aug 26.
  7. Hadizadeh-Talasaz Z, Sadeghi R, Khadivzadeh T. Effect of pelvic floor muscle training on postpartum sexual function and quality of life: A systematic review and meta-analysis of clinical trials. Taiwanese Journal of Obstetrics and Gynecology. 2019 Nov 1;58(6):737-47.
  8. Schvartzman R, Schvartzman L, Ferreira CF, Vettorazzi J, Bertotto A, Wender MC. Physical therapy intervention for women with dyspareunia: a randomized clinical trial. Journal of sex & marital therapy. 2019 Jul 4;45(5):378-94.
  9. Sobhgol SS, Smith CA, Dahlen HG. The effect of antenatal pelvic floor muscle exercises on labour and birth outcomes: a systematic review and meta-analysis. International Urogynecology Journal. 2020 Jun 6:1-5.