By Megan Hernandez & Yong Zheng, MD
Ever heard of pelvic physical therapy? Probably not. And if you have, a single word likely comes to mind: Kegels. But pelvic therapy involves much more than repeatedly contracting and relaxing your pelvic floor muscles (the muscles that control the flow of urine).
In fact, many pelvic floor physical therapists are baffled that pelvic floor care for new moms is often summed up in one incomplete, oversimplified and often ineffective piece of advice: “Do your Kegels.”
“Most women have never been assessed to see if they are doing Kegels properly,” says Megan Hernandez, pelvic physical therapist at Anne Arundel Medical Group (AAMG) Physical Therapy. Pelvic physical therapists are experts of the musculoskeletal system. “We completely examine our patients’ abdominal and pelvic muscles and we help with bowel, bladder, and sexual functioning. We also use biofeedback and electric stimulation to teach the muscles to work properly.”
Moving beyond Kegels
Pelvic physical therapy helps treat problems like incontinence, prolapse, pelvic pain, low libido, painful sex, and constipation safely, and without medication or surgery. It can even help with that post-baby belly pooch called diastasis recti. So why isn’t it a standard treatment option for these postpartum issues? Well in some places, it is.
In countries like France, Australia, and the Netherlands, doctors actually prescribe pelvic physical therapy to new moms. Most women receive therapy sessions before they’re cleared to resume physically demanding activities (read: sex and exercise).
“In Europe, new moms are taught, mainly by physical therapists and midwives, how to do Kegel exercises before they leave the hospital,” says Yong Zheng, MD, urogynecologist with Anne Arundel Medical Center’s Women’s Center for Pelvic Health. “After delivery, if a woman has a third or fourth degree tear, she’ll undergo physical therapy as a standard part of postpartum care.”
But in the U.S., pelvic therapy still isn’t part of routine care for new moms. “In the United States many women, and even some doctors, are not familiar with pelvic physical therapy,” says Hernandez.
Here’s why: At the six-week checkup after giving birth, doctors assess the uterus and cervix, but often ignore the pelvic floor muscles. And since most pelvic floor issues aren’t life-threatening, many women suffer in silence and wait for symptoms to go away.
But symptoms don’t always go away and they can have lasting effects. “If these issues are not addressed, women can experience continued weakening of pelvic muscles, which leads to worsening of incontinence,” says Megan.
What can I expect at a pelvic physical therapy session?
Biofeedback: displays your pelvic muscle activity on a computer screen to better understand when you are squeezing or relaxing your pelvic muscles. This truly helps you know how to properly strengthen or relax your pelvic floor.
Electric stimulation: also called e-stim. A physical therapist uses a device to deliver a weak electrical current to re-educate your muscles how to contract properly and improve sensation and awareness of the pelvic area.
A commonsense solution
Pelvic physical therapy after giving birth just makes sense. Think of it like this: Pushing a 5- to 9-pound child through a small canal in the body is arguably the most strenuous athletic event of a woman’s entire life. Just like triathletes and marathon runners ice, stretch, and rest their legs after a big race, new moms should also heal their strained muscles.
“While vaginal delivery is a natural process, it is truly very traumatic to the pelvic floor,” says Dr. Zheng. “It’s imperative to let the pelvic floor heal properly after delivery because those muscles can be your best friend but can also be your worst enemy.”
Start the conversation
Until the U.S. catches up with Europe’s pelvic care standards, it’s up to women to talk to their doctor. “Talk to your health care provider about any symptoms that occur or are exacerbated after delivery,” says Dr. Zheng. “When in doubt, ask.”
Asking your doctor for a referral for pelvic therapy could mean the difference between a full recovery and worsening pelvic floor issues. “Incontinence is common after birth, but not normal to extend past the six-week mark,” says Megan. “Although it is hard to manage a newborn, and a mother’s own needs are often put second, it is important to seek care as soon as possible.”
Megan Hernandez is a pelvic physical therapist with Anne Arundel Medical Center. Yong Zheng, MD, is a urogynecologist with AAMC.
