Postpartum Physical Therapy: When You Need It & How It Helps

Whether it’s your first baby or your third, giving birth is an incredible experience. However, it can leave you with musculoskeletal issues that add to the challenges of caring for a newborn. 

Let’s face it … mom’s needs are often placed on the back burner while adjusting to the new normal. But if issues like pelvic pain, discomfort, and incontinence are not addressed right away, they can continue for years after childbirth.

So, what is postpartum physical therapy and how can it help?

Postpartum physical therapy, sometimes called postnatal physiotherapy, is a vital tool for recovery after childbirth. It uses targeted exercises and treatments to address the musculoskeletal issues that childbirth can cause. It will help you function better while caring for your new baby and prevent issues like incontinence from becoming long-term.

This guide will help you decide if you need postpartum physical therapy, how it can help, how to find a qualified therapist, and what to expect during treatment. 

What is postpartum physical therapy?

Your nine-month marathon is over, but the hardest part is just beginning. Many women come out of childbirth struggling with various forms of pelvic floor dysfunction.

A postpartum physical therapist will help you restore strength, function, and mobility, particularly in the pelvic floor and core musculature. Common treatments in postpartum PT include:

• Pelvic floor exercises. These will help strengthen muscles that support your pelvic organs. Restoring your pelvic floor strength will prevent or reduce incontinence and pelvic organ prolapse. 
• Manual therapy. This will help with pain relief, improve blood flow in the pelvic floor, reduce scar tissue, help with muscle relaxation, help with pelvic muscle coordination retraining, and help decrease symptoms of urinary incontinence. 
• Breathing exercises. This is helpful in stress reduction and overall recovery.
• Core strengthening exercises. These help restore strength in the core muscles weakened during pregnancy.
• Stretches. For pain relief, stress reduction, and reducing muscle tension.

How to know if you need postpartum physical therapy

After having a baby, you may notice discomfort and other symptoms that you’ve never experienced before. The pelvic floor is a group of muscles and nerves that support the pelvic organs and can be particularly affected by pain and dysfunction after childbirth. 

During labor, the pelvic floor muscles undergo a significant amount of stress. In fact, they can stretch more than three times their normal length as the baby passes through the birth canal! As you can imagine, this can be damaging to muscles, connective tissues, and nerves. 

If you are experiencing any of the following symptoms—whether you gave birth weeks ago or years ago—they were likely caused by childbirth and should be treated by a professional. 

1) Urinary or fecal leakage

The official term for the involuntary loss of urine or stool is incontinence. This is common postpartum due to stress on the pelvic floor during childbirth. 

If you experience incontinence regularly after childbirth, especially with coughing, sneezing, or exercising, you should seek pelvic floor physical therapy for specific muscle-strengthening strategies.

2) Frequent or urgent urination

Do you find yourself needing to urinate more often and/or more urgently than usual? This can happen postpartum due to changes in bladder function and pelvic floor support.

If you need to pee more than every two hours and/or you have a hard time delaying your search for a restroom, you may have pelvic floor dysfunction. 

Muscle weakness, muscle tightness, or other factors could be contributing to these symptoms. A pelvic floor physical therapist can help determine what’s going on and treat it appropriately. 

3) Constipation lasting longer than 1-2 weeks

If you’re pooping less than three times a week, with stools that are hard, dry, and difficult to pass, you’re constipated. Unfortunately, this can be common postpartum due to changes in hormones, diet, and pelvic floor function.

If constipation lasts more than a couple of weeks, it’s likely related to pelvic floor dysfunction. A good pelvic floor physical therapist can teach you exercises and techniques that will help you improve bowel function and relieve constipation.

4) Feeling of heaviness or soreness in the pelvic region lasting longer than 1-2 weeks

Heaviness, pain, or soreness in the pelvic region could be a sign of pelvic organ prolapse. This happens when your pelvic organs aren’t supported properly and can drop into the vaginal canal. This can occur postpartum due to the strain of pregnancy and delivery.

Make sure to seek out the help of a pelvic floor physical therapist if you’re persistently feeling heaviness or discomfort in the pelvic area so that you waste no time in strengthening and supporting the pelvic floor muscles.

5) Low back and/or tailbone pain

These pains are common postpartum due to the stresses of labor, changes in posture, and lifting and carrying a newborn.

If this pain persists and limits your ability to care for your baby and live a high quality of life, physical therapy can help. A pelvic PT can address muscle imbalances and postural issues, prescribe appropriate strengthening exercises, and provide pain-relief techniques.

6) Abdominal separation

The technical term for this is diastasis recti. When you contract your abdomen (postpartum), you’ll see a bulge or gap at your abdominal wall. Diastasis recti is common during and after pregnancy due to stretching of the abdominal muscles. 

A pelvic floor physical therapist will be happy to provide you with exercises to help close this gap and strengthen the core musculature to improve your function.

7) Pain with intercourse, tampons, and/or pelvic exams

This pain can be a sign of either pelvic floor muscle tension or pelvic injury/trauma. 

If you have pain with any of these activities, it is important to seek help from a pelvic floor physical therapist. Your therapist will help with relaxation techniques, strengthening exercises, and techniques to improve pain and function.

Other circumstances that increase the risk of pelvic floor dysfunction

Some necessary interventions used in childbirth can increase the likelihood of pelvic floor dysfunction. These include:

• Episiotomy. A surgical incision made at the opening of the vagina to assist with a safe labor/delivery. A pelvic floor physical therapist can help with pain relief, scar tissue management, and muscle strengthening.
• Use of forceps or vacuum. Tools used to help deliver the baby can sometimes lead to muscle and/or nerve damage. Physical therapy can help restore this function.
• Prolonged pushing. Pushing for greater than 60 minutes is hard on the pelvic floor musculature and can cause incontinence, pain, and heaviness. A pelvic floor physical therapist can help you strengthen and support the pelvic floor.
• Tearing requiring stitches. Some vaginal or perineal tears require sutures for effective healing. See a PT for pain relief, scar tissue management, and muscle strengthening.
• Cesarean section. C-sections can result in pain, incontinence, and muscle weakness. You should turn to pelvic floor physical therapy to learn strategies to help you with your recovery, including scar management and appropriate muscle-strengthening techniques.

How postpartum physical therapy can help

Physical therapy is important in helping new moms recover after childbirth. Even years later, it’s important to have strong muscles supporting the pelvic floor, to ensure effective bowel and bladder control and overall pelvic health. 

Physical therapy not only helps with physical recovery but also supports emotional well-being, allowing new moms to embrace their new roles without the heavy burden of pain or dysfunction.

Physical therapy is the preferred first-line treatment for most postpartum issues. If needed, medication can provide temporary pain relief, and surgery may be necessary in severe cases. However, even in these cases, physical therapy should be used in conjunction with other medical interventions.

How can postpartum physical therapy help with specific symptoms?

1) Urinary or fecal leakage and frequent or urgent urination

In physical therapy, you’ll learn pelvic floor exercises to strengthen the muscles that support bowel and bladder control. You’ll also practice muscle coordination exercises with the use of biofeedback to help with bladder function.

2) Constipation lasting longer than 1-2 weeks

In physical therapy, you’ll learn relaxation techniques for the pelvic floor muscles. You’ll also be given dietary and lifestyle recommendations to support regular bowel habits. 

3) Feeling of heaviness or soreness in the pelvic region

You’ll learn strengthening exercises that will help your muscles lift and support the pelvic organs. Your therapist will also use manual therapy techniques to help with pain and tissue mobility.

4) Low back and/or tailbone pain

You’ll learn exercises to strengthen the core and pelvic floor muscles to reduce strain and improve posture. Your therapist will use manual therapy to help with pain, as well as provide ergonomic advice to apply at home.

5) Abdominal separation

You’ll work on strengthening the core muscles to gradually bring the abdominal muscles back together. This will also help with core stability and pain reduction.

6) Pain with intercourse, tampons, and/or pelvic exams

Your physical therapist will perform manual therapy techniques to help relax and desensitize the pelvic floor muscles. You’ll also learn strategies to help manage and reduce pain.

Other circumstances that increase the risk of pelvic floor dysfunction

Physical therapy can help manage and rehabilitate the pelvic floor following necessary interventions used in childbirth. Your therapist will provide manual therapy and personalized exercises that will address your specific needs for optimal recovery.

How to find the right postpartum physical therapist for you

Despite the proven benefits of postpartum physical therapy, many healthcare providers are still not aware of its importance. This can leave new moms without the critical support they need to fully recover after childbirth.

Pelvic floor therapy is essential postpartum and should be a standard part of care. No matter if you gave birth weeks ago or years ago, it’s never too late to seek help. 

Finding a qualified therapist who you trust is paramount through this process. Here is what you should look for:

• Licensed Physical Therapist who specializes in pelvic floor therapy. They should have an extensive list of continuing education classes within the pelvic floor genre, particularly through the Herman and Wallace Pelvic Rehabilitation Institute and the American Physical Therapy Association. 
• Credentials and years of experience. Look for a therapist who has at least 3 years of clinical experience. If you must see a newer graduate, make sure they’ve got an experienced mentor they work with regularly.
• Approach and technique. Ensure that the therapist performs both internal and external therapy. Make sure appointment times offered are at least 45-60 minutes to ensure adequate time for proper internal and external treatment.
• Cost and insurance coverage. Research your insurance benefits to find out potential out-of-pocket costs and whether you need a doctor’s referral before treatment. Check our other resources to learn more about the cost of pelvic floor therapy and when insurance covers pelvic floor therapy.
• Location and accessibility. Look for a clinic that is nearby. However, know that to find someone highly qualified, you may need to travel a little bit further.
• Referrals from your OBGYN, friends, and family. Ask people you trust for recommendations.
• Personal preferences to consider. There are both female and male pelvic floor physical therapists out there. All who are qualified are wonderful, but think about whether the gender of the provider matters to you.

It may take a few consultations to find a therapist that feels right. Don’t be afraid to find someone else if you’re ever uncomfortable or feel unsupported.

What to expect during and after postpartum PT sessions

Postpartum PT can make a huge difference in your recovery from childbirth. Knowing what to expect can help you feel more prepared and comfortable as you begin your journey to recovery.

You’ll typically work with a specialized pelvic floor physical therapist over a series of sessions, each session being tailored to your specific needs. You’ll learn exercises and techniques that promote healing, strengthen your body, decrease pain, and improve your overall well-being. 

Preparing for your first postnatal PT session

Before your first visit, take some time to think about your goals. What are you struggling with specifically, and what specific activities are you hoping to see improvement in? Write down a list of all the symptoms you are experiencing.

Wear loose, comfortable clothing. Know that you will likely be asked to change into a hospital gown for your evaluation and for any manual techniques. Of course, these sessions will be held in a private room.

Initial session

In your first session, your therapist will ask you questions about your medical history, including your pregnancy, childbirth experience, and any current symptoms. You’ll go over your goals and what you hope to achieve through PT. 

At this point, you’ll likely be asked to change into a hospital gown, and your pelvic floor assessment will begin. This may involve an internal examination (with your consent) to assess the strength and function of your pelvic floor musculature. 

Based on your evaluation, your therapist will explain their recommended treatment plan, including the number of sessions you’ll need (typically around six sessions, but it can vary). They’ll also walk you through a group of exercises that you can work on at home.

Know that this initial visit will last about an hour. Also, it is typically ok for you to bring your baby along with you.

Follow-up sessions

In most cases, you’ll see your therapist about once per week. In these follow-up visits, you’ll talk about your progress, will be re-evaluated manually as needed, and your treatment plan will be adjusted as necessary.

Sessions will focus on progressing specific exercises and techniques to address your recovery needs. Manual therapy may be performed once again in a private room as needed.

Once you have achieved your goals, as well as the objective goals of your therapist, you will be ready to discontinue formal therapy sessions. However, it is important to continue any exercises prescribed to you at home to maintain your progress and prevent any future issues.

Postpartum physical therapy can help you recover from the challenges of childbirth and live life fully, even years into motherhood. Early treatment is encouraged, but it’s never too late to seek care!