Pelvic Floor Physio: What to Expect

Disclaimer: All content and media on this blog is created and published online, and contain personal anecdotes. It is not intended to be a substitute for professional medical advice, and should not be relied on as health or personal advice.

There’s a big movement (maybe it’s a little movement but it’s big to me because new mom factor) around helping mothers postpartum to recover efficiently.

This post feels timely considering International Women’s Day was yesterday!

My own mother, at the time of my daughter’s birth, kept saying, “we didn’t have this back then”, and it’s true. In the late 80s, you gave birth, and if you didn’t bounce back or your body behaved a certain way, it was just because you gave birth. Thankfully, we have a better grasp on women’s health, and understand that (queue cheesy line), “Women’s health is everyone’s health”. Unpack that whatever way you will, but my own health largely determines how I contribute to a workplace, my household, childrearing, society, etc. Healthy ladies (healthy people!) = a healthy society. I’m oversimplifying it, but you get it.

Today, we’ve got boatloads of resources for expecting families and new parents: midwives, public health nurses that come to you, prenatal classes, doulas, postpartum doulas, and pelvic floor physio – okay, what?

Here’s a quick rundown of what would inspire a lady to get to a pelvic floor physiotherapist:

  • Painful sex. Yes. This is so unbelievably prevalent for myriad reasons. But sex shouldn’t hurt! I’ve had a few friends that have sought out pelvic floor physio for this and it seems to help!
  • Childbirth. Enough said, ha ha
  • Surgery. Bladder, hysterectomy, bowels, anything where the organs in this area might be affected.
  • Heavy lifting. Uhhhhh, too much CrossFit too fast = bad news bears for some people. That was half a joke, but yeah: weak muscles and lots of bodywork too quickly can make the body angry and fight back.
  • Being overweight. I can’t speak to this, but I can only imagine the pressure on one’s pelvis would make life difficult

What does pelvic floor physio do? 

It helps women rehabilitate their pelvic floor muscles! The muscles in your pelvic floor support the uterus, bladder, and bowel. If your pelvic muscles are weak, say hello to snissing and incontinence (peeing while sneezing…also happens around the 3rd trimester of pregnancy in my experience), prolapse (not fun) and trouble with bowel control. Yikes.

For other women (and myself), pelvic floor muscles may be overactive – in the case of after childbirth and painful sex, this can happen. Pelvic muscles will switch on involuntarily when they should be relaxing so pelvic floor physio would help you release your muscles. Overactivity can cause difficulty with having sex, emptying the bladder or bowels, or using tampons or menstrual cups.

This is a huge simplification of what pelvic floor physio encompasses, but I can speak to my own experience following childbirth and what I learned from the physiotherapists I worked with. Keep reading if you’re not easily grossed out and are okay with a little bit of TMI. My sis-in-law and I are typically grossed out by people’s detailed accounts of postpartum, so I’ll keep this as general as possible.

A bit about my experience with pelvic floor physio:

I had 8 sessions at pelvic floor physio. I started going to pelvic floor physio when the baby was about 12 weeks old. The first session was an assessment and took about 45 minutes for them to discuss my childbirth experience (tearing, whether or not I’m breastfeeding, epidural, what the delivery was like, concerns, etc), and do an internal assessment (seeing where the scar tissue was sitting, where I’m tight, prolapse, all the fun things).

To give you a broad overview of my concerns, I was stitched up really well. So well that I was a little on the tight side. My tears were pretty standard (second degree), but I tore towards my urethra instead of towards my anus. During my healing from childbirth, this meant that there was a bit of scar tissue that needed to be broken up so that my urethra didn’t feel external pressure / so that I didn’t feel like I had to empty my bladder all the time. So yes, to break up the scar tissue, the physiotherapist went in and manually worked on breaking it up. There was also some bladder prolapse; 1 on a scale of 1-4, which I was told would resolve on its own over time, and it did. I was told bladder prolapse is common while breastfeeding since your body still has the hormones hanging around that are responsible for making everything loose and relaxed. I believe the hormone is called relaxin (how apropos!)

Sex was also awful and excruciating. I asked the physiotherapist why the “6 weeks and back at it” rule was so prevalent, and she said it’s because 6 weeks is the amount of time it takes for tissue to repair itself. So okay, you can have sex at 6 weeks postpartum, but it might suck and you might not even be physically or emotionally ready, plus you’ll have relaxin floating around making your bladder funky in a bad way. She likened the 6-week rule to breaking an arm: you don’t run back to the gym and lift what you used to after you’ve had a broken arm or a rotator cuff injury – you wait it out until your body is fully healed, and start with smaller weights and work back up. Your body is still doing a boatload of healing!

Lastly, there was a bit of diastasis recti, or abdominal muscle separation going on as well, or a finger space (I was told this was pretty standard). In my case, if I tried to do a situp I couldn’t feel it, so I had to learn how to get my abdominal muscles to talk to each other again. Sounds weird, but basically it was all about learning how to activate different core muscles.

My midwife also strongly recommended waiting 6 months before going back to the gym and starting with moderate exercise (walking, swimming, etc). She said your pelvic floor needs to repair itself first, then you can get back into using it to lift, do sit-ups, etc. Also, handy that babies typically start solid foods around the 6-month mark, so having someone else caring for your kid is easier and you don’t need to have pumped milk ready to go.

If you’re feeling like watching a funny and informative video (my cousin sent me this), check out the link below!

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