Once Postpartum, Always Postpartum!

If you have been following my postpartum journey as a pelvic health physical therapist, then this blog is for you. If you have not been following my postpartum journey but you are currently pregnant, plan to get pregnant, are a new mom, or have multiple kids already then, this blog is also for you. I am not embarrassed to discuss the symptoms I had postpartum because I want women to know that they can discuss these symptoms with me, their healthcare providers, and friends. 

Currently in the United States, there is no standard of care for postpartum women. Yes, the 4thtrimester” is now a term, but it is not implemented consistently, yet. At your 4-6 week checkup after childbirth your head is a mess, you are sleep deprived, still bleeding, possibly still in pain, weak, and not thinking about the future of your pelvic floor, right? However, right now in this model of healthcare it is up to you to ask questions regarding the status of your pelvic health! You most likely will not have your abdomen assessed, pelvic floor assessed, body biomechanics assessed, and posture assessed. You may have urinary issues already like diastasis recti, painful sex, urinary leakage, pelvic pressure and not know that those are not normal. (Yes, these are all very common pelvic floor issues). You may mention them and hear “oh, it will get better, you just had a baby!” I do not want to talk about all 4-6 week checkups like this, because in my area there are many providers that now have the discussion with all patients! However, it is not standard of care for all practices. 

Rewind to my birth, (refer to my “Birth Story” blog), just 12 short months ago; I had a 3rddegree tear, a million stitches, a minor rectal prolapse and I was told to return to all normal activity prior to giving birth because my stitches had healed. Guess what normal activity is for me? Orange Theory Fitness, running, jumping, biking, and other high intensity exercises. If I would have returned to normal activity I would not be where I am today. Fast forward 2 weeks, I saw my amazing pelvic health physical therapist, she addressed my level of scar tissue, pelvic pain, posture, core weakness, and addressed why I was having fecal incontinence. After a few weeks of doing my own homework (daily) I was “cleared” by my physical therapist to begin returning to my normal activity level. Hint the work “begin.” How long did it take me to return to my normal activity, pain free intercourse, coughing without leaking, running without leaking feces on myself (yep, that happened), and sprinting 10.0 on a treadmill during orange theory? It was not until around 6 months postpartum that intercourse was comfortable again, I could run without leaking, cough without leaking, and 10 months postpartum that I was exercising at the same level that I was prior to giving birth. It was a long road. I did exercises related to my pelvic health daily. 

What did my postpartum physical therapy look like? 

-internal (vaginal and rectal) release treatment for my scar tissue, tight musculature

-re-educating my pelvic floor and core musculature

-addressed hip immobility

-posture support

-self care

-core stability

-hip stability

-home exercise program (just a few minutes a day)

Fast forward to current day, June 20, 2019. Right now, I am exactly 12 months postpartum. It took 12 months of diaphragmatic breathing, scar tissue release, neuromuscular control work, pelvic strengthening, core strengthening, endurance work, postural support, mental support, and time to get to where I am today. I am proud to say that I am here. I am not upset it took me this long. Do you know how long it takes other injuries to heal? Think about all the athletes with ACL tears, achilles ruptures, shoulder injuries? 

I can tell people my birth story and my recovery story but also tell them that I do not have any of the symptoms my clients report to me on a daily basis. Why am I going on and on about this? Because I see way too many women come in 1 year postpartum, 2 years postpartum, etc. with all of these signs/symptoms that have never been addressed and they are frustrated, upset, and worried they will never resolve. My goal: that every woman knows what to look for postpartum to address their pelvic health. I want every woman to know the terms pelvic organ prolapse, incontinence, scar tissue, high tone pelvic floor, dyspareunia, vaginismus, pessary, (I can go on and on). 

So why the title, “Once Postpartum, Always Postpartum,” ? Well, I believe this is a fitting title because even one year out I am still constantly working on things related to my body being pregnant, having Oliver, and recovering from my birth. You are not “done” just because your pelvic health physical therapist discharged you from care. Just like an athlete is not “done” because they returned to their sport. My weekly exercise routine includes stability work for the musculature related to pregnancy and beyond. In the car, I continue to work on diaphragmatic breathing and releasing my pelvic floor. I am constantly monitoring my body when I do new core exercises. I make sure to stretch and work on posture due to Oliver growing by the second! This is never ending right, because every day there is a new challenge. Just because my posture is good with a 3 month old doesn’t mean it will be good with a one year old! 

Daily I hear from my patients that, “I had no idea this is what we would do in physical therapy after I had my baby,” and “why didn’t anyone tell me about this?” So, my goal is to change this, to improve the awareness of pelvic health physical therapy. Pelvic health should be the standard of care for all women. 

Oliver is almost one month old! That is crazy to even think about. 

I am happy to report that I am feeling great physically! My stitches have all healed (and there were many of them) and I do not have any of the signs or symptoms that would warrant me to be extra careful. This doesn’t mean I can start back at Orange Theory Fitness, but it does mean I can get an exam from a pelvic health physical therapist and start increasing my exercises. I have started walking quicker (19 min mile pace instead of 30 min mile pace) and I have added core exercises in. These are very low impact core stability exercises that focus only on the “true core” which included transverse abdominis (TrA), pelvic floor, diaphragm, and multifidus (low back muscle). I will post a video of the exercises below. In the video I am doing 3 exercises, the first exercise is focusing on the TrA. I am engaging this muscle as I lift my foot off the couch about an inch. My goal is to see if I can limit the amount of him drop on the side I am lifting my leg. (DO NOT HOLD YOUR BREATH). The second exercise I am letting my leg gently fall to the side and using my TrA to bring my leg back to neutral. The third exercise, I am engaging my TrA as I let my leg go out straight. These 3 exercises look very simple, but I am still sore from doing them! As you can see I am always breathing and not "sucking in". 

So, when can you get evaluated by a pelvic health physical therapist? What the heck is pelvic health physical therapy? And what do they look for? 

What is pelvic health physical therapy? 

Pelvic health is a sub-specialty of physical therapy. Pelvic health therapists are trained beyond the scope of PT to do internal pelvic floor examinations to asses for anything pelvic health related. Reasons for seeing out a pelvic PT could include anything from pelvic pain, leakage, lack of pelvic floor control, prenatal, postpartum, diastasis recti, post surgical. 

When can an evaluation be done? 

Honestly, the rule of thumb is 6 weeks for vaginal delivery and 8-12 weeks for C-sections. But, like many things in our healthcare system..we do them to “save our butts”. We could be evaluating sooner so that individuals have “tools in their toolbox” to help them immediately. If you had any stitches, tearing, repairs done then it is best to hold off on an internal evaluation until after they have healed. However, a pelvic health PT can help educate you on ways to help your body recover immediately. 

Signs/symptoms to look out for post-partum:

-core weakness
-instability in the pelvic region
-pelvic pain
-urinary issues (leakage, pain, frequency)
-bowel issues (leakage, pain, constipation)
-pelvic pressure
-low back pain
-hip pain
-pubic bone pain
-separation of the abdominals
-postural difficulty

What is a pelvic health exam? 

I get this question a lot! In simple terms, it is just like a musculoskeletal exam of any other body part. It just seems scary because it includes an examination of your vaginal and/or rectal musculature. This is not scary. Ask anyone who has had a pelvic health exam and they will tell you that their provider made it very comfortable and not painful/scary. During the exam your PT will examine everything from posture, breathing, strength, soft tissue, walking, and basic functional movements. They will then discuss the findings with you and go over proper body mechanics, give you a home program to begin working on, and will answer ALL questions related to pelvic health, exercise, and daily tasks. We have heard it all, so ask anything! 

Please, comment below with questions regarding pelvic health physical therapy. And, if you have had pelvic health PT in the past, I encourage you to pass along your experience and open up about how it helped you. Many people are fearful of saying they had pain with sex postpartum, that they leaked urine every time they walked up the stairs, or that they felt a water balloon exiting their vagina….these are all things that so many women suffer with and although they are all common symptoms, they ARE NOT NORMAL. There is help out there. You can look on the APTA (American physical therapy association) website and go to the women’s health section and search their area. You can also go to google and type in pelvic health/women’s health physical therapy to find therapists in their area.