There's more to postpartum wellness than Kegel exercises? Who knew? I certainly did not...at least not until 12 long weeks after delivering my baby, which is when I was finally referred to pelvic floor physical therapy and found relief from the constant pain and worry that was affecting every part of my day and night.
Pelvic floor physical therapy dramatically improved my quality of life, almost instantaneously. Physically, I experienced a miraculous and almost immediate reduction in what had been chronic, aching pain since the delivery of my baby (during which I sustained a 3rd degree laceration of the sphincter). After just two therapy sessions, I was overjoyed to find myself more comfortable with the bending, squatting, kneeling, and sitting required for me to finally be able to play with my baby on the floor. I was delighted to find that I could stand for longer intervals, even while holding the baby. I was able to walk at a more normal place and navigate stairs with greater ease. I was even rapidly gaining more control of my bowels, a problem that, as a fit, healthy young woman, I was completely unprepared to have been facing.
Psychologically, the impact was just as great. I was comforted in knowing that I now had a partner in healing. I was so thankful that my physical limitations were no longer negatively impacting my ability to parent. I was so relieved to know that what I was experiencing had a name, had a cause, and most importantly, had a treatment. I now knew that I wasn't alone. That I would, indeed, get better. That this wasn't going to be a lifelong struggle. That the pain I'd been facing wasn't necessary to experience after childbirth. It wasn't something I'd just have to wait out. There was a targeted, proven, simple treatment, and I was on my way to recovery.
But why did it take 12 isolating, painful weeks for me to find such support and healing? I delivered my baby at a world-class hospital. I had excellent prenatal care. I work in healthcare and am a relatively informed, knowledgeable, and proactive patient. However, when I expressed my situation to my midwife at my one- and six-week postpartum visits, I was never told about pelvic floor therapy as a treatment option. Just 'this is normal.' 'You'll start to feel better soon.' And 'do your Kegel exercises.' I'd sustained a serious tear during childbirth and could have been immediately referred. But I was not, and did not know to ask. I was only finally referred to therapy by a friend who coincidentally happens to work as a pelvic floor nurse practitioner (and is the only reason why I'd even ever before heard the term "pelvic floor").
Getting quality care shouldn't hinge upon coincidentally knowing the right people. I am lucky to have been one of the few who find their way to pelvic floor therapy, and even luckier that I was able to start treatment relatively soon after needing it. But, I shudder to think of where I'd be today if it weren't for a series of coincidences that landed me in the right hands. I hope that more practitioners will become knowledgeable in this important area of women's health so that other women won't have to rely on chance to feel well.
***This testimonial is particularly special to us—coming from one of our own Physical Therapists at Marathon Physical Therapy who wanted to share her combined perspective as a clinician and patient!
As a physical therapist I have always had an interest in women’s health, particularly pelvic floor health. The majority of patients I treat have varying degrees of pelvic floor dysfunction that can lead to problems including painful intercourse, urinary leakage, or pelvic organ prolapse. One of my favorite populations to work with is pregnant women, or those that are (relatively) early postpartum. Clinically it seems just small changes – lifting mechanics or core stabilization, to name a few – can drastically improve these women’s quality of life.
I had more training than the average expectant mother in regards to musculoskeletal changes my body would go through perinatally. And, unlike most pregnant women, I knew how to prevent these normal changes from causing pain. While pregnant, I did all the exercises I educate my patients on: to strengthen deep core muscles, work on muscle extensibility (stretch!), be mindful of posture and body mechanics, and use support when necessary (I used an abdominal binder regularly after 35 weeks). For how uncomplicated my pregnancy was, I was in for a surprise with my delivery. My little guy was born sunny-side up, and to avoid a c-section I required a (large) episiotomy with the use of suction. Can you say ouch???
Despite my education, I was extremely ill-prepared for how I would actually feel postpartum. For starters, it was a good week before I could sit without significant discomfort. Understanding the level of tissue disruption caused by the episiotomy did not decrease my shock at the pain levels that persisted well past discharge from the hospital. In those first 8-10 weeks postpartum, it seemed everything that physically could go wrong, did go wrong. Urge and stress incontinence? Yes! iastasis rectus, or separation of abdominal wall? Check! Dyspareunia, or painful intercourse? Yep! I am now four months into my recovery, and while still there all of these issues are continually resolving.
I strongly believe a large part of my recovery at this point is due to my background and training. Without it, I would have never guessed to strengthen deep core or use abdominal support while pregnant. Or work on core stabilization, a specific crunch to correct my abdominal separation or complete pelvic floor “drops” (lengthening contractions) instead of kegels (shortening contractions) postpartum. I find it extremely unfair that the average woman (aka non-physical therapist!) does not have access to this information. And, as a clinician I would much rather treat these issues as they occur – as opposed to treating the progression of this dysfunction 10, 20 or even 40 years later. I am so excited to be a part of Share MayFlowers in an effort to increase awareness of these issues to optimize EVERYONE’S outcome.
I have two boys, who were 4 and 2 at the time that I first found my way to physical therapy. During my older son’s birth, a forceps delivery was required and I had trauma to my pelvic floor. The forceps clipped my external labia, which swelled to the size of an orange. Sadly, my Ob-gyn never talked about it. I found myself starting to urinate a lot more and uncomfortable with intercourse. My symptoms gradually faded, but with my second son the same situation occurred. Both boys have medical issues, though, so I put my own issues on the back burner so I could focus on them. When my oldest son was 4, however, I started to have extreme pain that I thought was a urinary infection. I saw my Ob-gyn, who referred me to a Urologist who then thought that I may have interstitial cystitis (IC). After some independent online research I was convinced that I did not have IC, but when I approached my Urologist, she told me I was in denial, and this (denial of the IC diagnosis) was a part of the grieving process. I felt like neither doctor was listening to me when I told them that I felt like my organs were coming out, that I had problems with constipation, that intercourse was uncomfortable, and that I was urinating all the time at night.
Ultimately, I found out about pelvic floor PT on my own and went to my first appointment (in the middle of a snowstorm!) in February 2009. I didn’t know a lot about pelvic floor PT but I explained what was going on to Jessica, my therapist, and she told me she could help. She identified a 4-5 finger width diastasis, leaving my core really weak as other muscles tried to compensate. I was pulling up into my rib cage and tightening my pelvic floor trying to stabilize my core when I was carrying my kids around leaving my pelvic floor super-tight and not functioning well. What really helped was the education and finally being told what was going on. For example, they told me to try not to go to the bathroom every 5 minutes because I needed to train my bladder! They told me to sit on the toilet seat when I urinated so my pelvic floor could relax. I also liked that in my experience at Marathon PT, we talked about all the components that may be contributing to my symptoms. Stress, for example, can worsen the problem, so I did a lot of work to incorporate breathing and relaxation techniques. They gave me the tools I needed to be successful in addressing any problems I might come across in the future.
I was so excited at the promise of help with these issues! I worked a little bit with Jessica and then worked with another physical therapist, Heidi, for several months. By the Fall of 2009, I was discharged from physical therapy and my symptoms had almost completely resolved. Occasionally, I had a pulling sensation or frequent urination, but these were rare. I was set up to do pilates and personal training at Marathon to help build my core and make it strong without reverting to the bad habits that had contributed to my symptoms in the first place.
I now talk a lot about my experience and my pelvic floor PT because I really think that a lot of moms have these same problems but are not talking about it. I want them to know to ask for a screening prenatally to learn how to care for your body while pregnant to help be proactive in your well-being. I would also recommend that they tell their OB/GYN they want to have a pelvic floor PT consult after giving birth. I truly believe ALL women can benefit from this and if everything is fine, great! But if not, then women immediately start to prevent years of physical symptoms and pain. For women not immediately postpartum, I still tell them that the benefits are true whether their “baby” is 6 weeks old or 16 years or 26 years old!
Lastly I want other moms to feel comfortable to seek out treatment and assistance. That is why I mention what I do to other moms—I now talk a lot about my experience before and after pelvic floor PT because I really think that a lot of moms have these same problems but are not talking about it. You’d be amazed—all I have to say is, “I once had pelvic floor physical therapy” and I can see women thinking about that. They start to ask about what that is, and what it treats and are shocked to hear that the issues they have experienced aren’t unique to them; that someone else has the same symptoms they do. And, most importantly, that by seeking care, I was able to treat it and live symptom free. I want other moms—and all women!—to know that they don’t need to be embarrassed about their symptoms, or tolerate their pain. This is something that can be treated