Life as a new mom has so many challenges—diaper changes, late-night feedings, spit-ups, and worse. The last thing a new mom needs is to be in pain on top of everything else.
However, according to the National Institute of Health, 24% of women experience some level of pelvic floor pain and dysfunction after childbirth.
There are many causes of postpartum pelvic floor pain after childbirth, including muscle strain, trauma, hormonal changes, and nerve damage. The good news is that there are treatment options available to help moms recover.
This guide goes over what pelvic floor pain is, its causes, and how long it might last. Most importantly, we’ll talk about how to find relief using pelvic floor physical therapy.
What postpartum pelvic floor pain is & where it often occurs
Pelvic floor pain is a general term that refers to pain over the abdomen and below the belly button. However, during pregnancy and after childbirth, pain can happen in several different areas of the pelvic girdle and lower back.
The pelvic girdle is made up of three bones—the pelvis, the sacrum, and the coccyx. Pain can occur at any of the joints where these three bones meet.
The pubic symphysis—the joint where the two pelvic bones meet in the front—can cause pain over the very lower part of the abdomen. The sacroiliac (SI) joint—the joint where the pelvis meets the sacrum—can cause pain over the small of your back. And the coccyx—also known as the tailbone—can cause pain in the buttock area.
Within the pelvic girdle, there are many soft tissue structures—muscles, tendons, and ligaments—that may be possible sources of pain. Some women experience pain in the groin or in the vagina because of injury to internal structures such as the vagina or the uterus.
Causes of pelvic floor pain after birth
There are many causes of pelvic pain, and it can be frustrating and difficult to pinpoint the cause of yours. If any of the descriptions below sound familiar, discuss it with your healthcare provider so you can move toward diagnosis and treatment.
1) Trauma during delivery
Vaginal Tearing
Due to the degree that the tissues need to stretch to deliver your baby, tears can occur. Tears are common and considered part of the birthing process.
Tears can range in severity and can happen in the vaginal wall, perineal muscles, anal sphincter, and/or rectum. Tearing will result in pain over the affected tissues. If you have a tear, your healthcare provider can give you information about expectations for recovery and how to care for the injury or repair.
Episiotomy
An episiotomy is a cut made in the perineum—the tissue between the vagina and the anus—made to increase the size of the vagina to help make delivering your baby easier. An episiotomy will usually result in pelvic or perineal pain. If you have an episiotomy, your healthcare provider will give you information about expectations for recovery and how to care for the repair.
Instrumental delivery
In certain circumstances, instruments may be used to help with the delivery. A forceps or a vacuum may be used to help deliver the baby in situations where the mom or baby’s health is at risk. These instruments can cause injuries such as tearing and trauma in areas where they are used.
2) Muscle strain and damage
The physical pushing that occurs during labor and delivery puts a high degree of strain on the muscles of the trunk, back, and pelvic girdle. Your abdominal muscles have already been stretched due to your growing baby bump, and then you are asked to generate enough force to push out a baby. This takes a tremendous toll.
Some women develop diastasis recti, which is a separation down the middle of the rectus abdominis (the six-pack ab muscle). This separation can cause abdominal pain and create an apparent bulge over the abdomen, like an abdominal hernia. The resultant loss of muscle support can sometimes cause low back pain both during pregnancy and after delivery.
Internally, the muscles of the pelvic girdle and uterus also contract to help push baby out. The strain placed on these muscles can take a toll. After delivery, your body may have difficulty coordinating the muscles of the pelvic floor that participate in peeing, pooping, and sex. This is known as pelvic floor dysfunction. Pelvic floor dysfunction can lead to symptoms of constipation, incontinence, and painful intercourse.
3) Nerve damage
Nerve damage after childbirth is most often caused by pressure placed on the lower back and nerves during the labor and delivery process. The risk for nerve damage increases with long labor and prolonged pushing. Nerve damage can result in numbness over the skin and muscle weakness.
Pudendal nerve
The pudendal nerve is a nerve that runs from the back side of the pelvis to the genitalia. The strain of pushing during labor can injure this nerve, causing numbness, burning, or shooting pain in the perineum. Sitting usually becomes uncomfortable. Because the pudendal nerve controls the muscles that help you pee or poop, injuries to the nerve can make going to the bathroom difficult.
4) Hormonal changes
After childbirth, estrogen levels rapidly decrease, causing mood swings, vaginal dryness, and decreased sex drive. Vaginal dryness can be a source of pain for new mothers. It can feel like burning, itching, or soreness in the genitalia. It is usually most apparent during sex, which can be uncomfortable.
5) Pelvic organ prolapse (POP)
Pelvic organ prolapse (POP) is when the pelvic organs—the bladder, uterus, small intestine, and/or rectum—actually sink into or out of the vagina due to damage to the pelvic floor muscles. Symptoms of POP are a physical bulge of tissue at the opening of the vagina, low back pain, pressure or aching in the pelvis, and/or changes in urination and bowel movements. POP can be treated with pelvic floor physical therapy but, in severe cases, may require surgical correction.
Finding relief through pelvic floor therapy
Many women will joke and bond over accidental peeing incidents while laughing, coughing, sneezing, running, or jumping. Public Service Announcement: Stress urinary incontinence after childbirth is not normal!
Unfortunately, referring new moms to a pelvic floor physical therapist after childbirth is not a standard procedure, though it should be.
Pelvic floor physical therapy is a treatment option for all kinds of pelvic floor dysfunction, including incontinence, painful intercourse, and pelvic organ prolapse.
When to see a pelvic floor physical therapist
If you have any of the following symptoms, you may benefit from seeing a pelvic floor physical therapist:
Postpartum care
Painful urination
Painful bowel movements
Pain when using a tampon
Pain during or after sex
Stress urinary incontinence (urine leakage during coughing, sneezing, laughing, etc.)
Fecal incontinence
Pelvic organ prolapse
Lower abdominal or back pain
While these topics may be uncomfortable to discuss, it is important to seek treatment for these issues. After discussing your symptoms, your physician may provide a referral to see a pelvic floor physical therapist if they feel it’s appropriate.
Common pelvic floor therapy exercises & techniques
Pelvic floor physical therapy can include a number of techniques such as manual therapy and exercises for the pelvic floor structures to help you recover.
1) Manual Therapy
Your physical therapist may use any combination of pelvic floor massage, trigger point therapy, or scar tissue mobilization to promote relaxation, address abnormal muscle tension, and address any scar restrictions.
2) Biofeedback
Biofeedback uses a sensor probe to detect the activation of specific muscles, providing feedback on how to contract certain muscles. It helps increase your awareness of these muscles that we often don’t pay attention to.
3) Vaginal Cones
Would you have ever guessed that you could lift weights with your vagina? Well, that’s exactly what vaginal cones are for. They are a series of increasing weights that you insert and hold in your vagina. Once you can hold the lightest cone comfortably and easily, you move up to the next weight.
4) Electrical Stimulation
Electrical stimulation uses electrodes to stimulate contractions of the pelvic floor muscles. Again, this can be used to help you better understand how to activate certain muscles of the pelvic floor.
5) Dry Needling
Dry needling uses thin needles inserted into trigger points to help muscles relax and function better.
6) Pelvic Floor Muscle Training (PFMT)
Pelvic floor physical therapy will often include exercises to strengthen all the muscles of the core to support not only your pelvic girdle but also the lower back and all the organs within the trunk.
Here are some common exercises performed in pelvic floor physical therapy:
Kegel exercise. A Kegel exercise is a basic pelvic floor activation exercise. Activating your pelvic floor isn’t something you often have to think about, so for some patients, it’s difficult. Your physical therapist will work with you to ensure that you can control these muscles to help with incontinence issues.
Abdominal bracing – Transversus Abdominis (TA) activation. The transversus abdominis is a large core muscle that wraps all the way around your abdomen. Having good activation and strength in this muscle allows it to act as a corset and stabilizer of our back and trunk.
Pelvic tilt. The pelvic tilt is a basic core strengthening and activation exercise for the rectus abdominis muscle.
Diaphragmatic breathing. Working on your ability to use your diaphragm properly will help improve core stability, promote relaxation and improved breathing, and improve overall function.
Core stabilization exercises. Your physical therapist will take you through a series of exercises that gradually get harder and harder to improve your strength. Some common core stabilization exercises include abdominal brace marching, abdominal brace bent knee fallouts, dead bugs, and bird dogs, which are meant to progressively challenge and strengthen your core.
When to start pelvic floor physical therapy after childbirth
You will likely have a 6-week postpartum check-up with your healthcare provider to assess your recovery and address any remaining issues after childbirth. Be your own advocate! If you have any pelvic girdle pain, urinary or fecal incontinence, painful intercourse, or any other concerns, let your provider know.
Postpartum pelvic floor pain timeline: how long it lasts
Just as in most situations, the timeline for recovery is different for everyone. The length of your recovery can depend on the severity of the injuries sustained, your age, timeliness in treatment, the presence of other pre-existing conditions, and your overall health.
Here, we outline the different phases of recovery and what to expect in each of them.
First week or two after giving birth
Immediately after childbirth, your pain may be quite intense, especially if you had a c-section or an episiotomy or tearing. If you had a vaginal birth, it is common to have pain and swelling in the perineum, but you should notice the swelling starts to decrease within the first few days.
If there was any kind of tearing or if you had a c-section or episiotomy, you will have some initial discomfort from stitches, but it will start to subside within the first few days.
Postpartum cramping, also known as afterpains, can cause abdominal or pelvic pain but usually lasts only a few days after childbirth.
First 6 weeks after birth
During this phase, your pain levels will continue to decrease. Swelling and bruising will continue to improve. If you had any stitches, you may notice some itching, which is a good sign of healing.
Many women notice significant improvements in pain management, and their life starts to look more normal (as normal as it can with a newborn).
Most healthcare providers will have you come in for a postpartum 6-week check-up to assess your recovery. You will usually be given clearance to return to exercise and sex. This is a great time to voice any concerns about remaining pelvic girdle pain or pelvic floor dysfunction and inquire about pelvic floor physical therapy.
6 weeks to 3 months after birth
Continued healing and recovery will take place as your pain continues to decrease and your strength returns.
The strength of your pelvic floor muscles should continue to improve. If you find you are having any symptoms of pelvic pain, incontinence, or pain during sex, consider pelvic floor physical therapy. With pelvic floor physical therapy, you will see an improvement in pain, strength, and function.
3 to 6 months postpartum
Some women may still experience mild discomfort or pain with specific activities or movements, but most of your symptoms should be resolved. Please discuss any lingering issues with your healthcare provider.
6 months to 1 year after birth
By this phase, your pelvic floor strength should have returned to normal, and you should have no symptoms of pelvic pain or pelvic floor dysfunction. If any pain or dysfunction persists, it may warrant further attention.
1 year postpartum and on
In rare circumstances, some women may experience chronic pelvic floor pain that requires ongoing management. Long-term or more intensive pelvic floor therapy or other medical interventions may be necessary.
Emily Berberich, PT, DPT, SCS, ATC, CSCS is an orthopedic and sports medicine physical therapist. She earned her Bachelor of Science in Athletic Training and a Doctorate of Physical Therapy from Marquette University. Her treatment philosophy incorporates sports science, biomechanics, and strength and conditioning principles into rehabilitation to bridge the gap between recovery and performance.
