Getting in Shape Down There After Childbirth
by Caryn McAllister, PT, DPT / President & CEO of High Quality Home Therapy
After giving birth, your new bundle will naturally be your top priority. But as they say on airplanes, you need to put your oxygen mask on first. It’s vital to consider your own postpartum care, even though your newborn will consume most of your energy.
Pelvic floor physical therapists can help you get your body back safely and quickly!
So many changes occur during pregnancy while a beautiful little human grows inside you: internal parts shift, bones spread, skin, muscles and fascia (the fibrous muscle coverings) stretch and ligaments become lax. During delivery, the vagina spreads farther apart than ever dreamed about (or rather “nightmared” about!) to allow the baby to exit. But sometimes it just can’t physically open enough, and studies show that during delivery, 44-75% of women will tear.
Some lucky mamas give birth and their vaginas heals quickly.
Others, however, aren’t so lucky, and they can develop weakness, pain and/or incontinence. Sex may feel irritating or painful, or they may find they have lost sensation down below. Most women end up with a vagina that is larger and weaker than it was prior to giving birth vaginally. These issues affect new moms both physically and emotionally. Bladder, bowel and sexual function are important components of female health.
So what to do?
- Always seek out medical attention to ensure that it’s just an issue of weak and loose musculature and to rule out any other problems.
- Seek the help of a pelvic floor physical or occupational therapist.
- Educate yourself in your anatomy and practice some simple exercises.
Understanding Your Pelvic Floor
The pelvic floor serves as the base of the core muscles and works with the deep abdominal muscles, back and hip muscles, and diaphragm to support the spine and control abdominal pressure. The pelvic floor consists of 11 muscles in 3 different layers and connective tissue that surrounds them. In order to have optimal pain free functioning, all the core muscles must be toned and able to contract in a coordinated manner. Problems can develop if any of the core muscles or fascia within the core are too tight, too loose or just aren’t in sync.
According to Dr. Erin Fiakos, a neurologically-trained member of the Women’s Health and Pelvic Floor Department at High Quality Home Therapy, “Your pelvic floor not only acts as a sling to support your bladder, uterus and bowel, but also assists with continence, sexual performance (orgasm), and joint stabilization.” Exercise, education, myofascial release and modalities such as ice and biofeedback can help. Since it may be hard to isolate and palpate pelvic floor muscles, some women benefit from internal myofascial techniques.
Many people aren’t fully aware of what movement specialists can do for you “down there.”
Pelvic floor specialists are physical or occupational therapists who have advanced training in both orthopedic and neurological rehabilitation. Anatomy, physiology, wound healing and pain management are all large components of the this highly specialized training, and compassion and professionalism are requirements, as would be expected! “Just like all other skeletal muscles, pelvic floor muscles can be conditioned, and usually these muscles develop pretty quickly so the results with pelvic rehab are seen fast,” says Dr. Kristen Tracey, pelvic floor specialist at High Quality Home Therapy.
Caryn McAllister, DPT, owner of High Quality Home Therapy, suggests learning to isolate the various muscles that surround the three openings of the pelvic floor. “First experiment with tightening the small muscles that stop your urine stream, followed by those that prevent the passing of gas or a bowel movement. Following this, pull the muscles of your vagina up and in – it feels like an elevator ascending all the way up to your lower stomach – then release down slowly, feeling each part of the vaginal wall. While women have three distinct openings, we typically don’t think about the muscles “down there,” and simply lump them all together. “It’s even useful to recognize how the lower abdominals interact with the pelvic floor muscles – and these are all very learnable,” according to Dr. McAllister.
Alicia Teitlebaum, MS, PT of High Quality Home Therapy suggests post-partum mothers should start to exercise slowly. It’s important to remember that your body has gone through so many changes with pregnancy and birthing. Be gentle with yourself and set realistic fitness goals, allowing yourself time for healing. Many women rush back into exercising without strengthening from the inside out. Ms. Teitlebaum found help with a pelvic floor specialist following the birth of her third child. birth. “My experience influenced me to learn more and help others because I personally understand how much women’s health rehabilitation can help new moms. I now specialize in women’s health and pelvic floor rehab at High Quality Home Therapy and love applying all that I learned personally and professionally to enhance the lives of other new moms.”
Stephanie Chartier, MS, OT, is an occupational therapist who works with patients with pelvic floor dysfunction. “Most people don’t even know what an occupational therapist does, so I typically explain it as very similar to a physical therapist but with a focus on activities of daily living (ADLs). Bladder, bowel and sexual function, three ADLs, are exactly what women’s health occupational therapists focus on when working with pelvic floor patients” So many women wonder if they will ever enjoy intimacy again after delivery.
Having a baby should never mean kissing away orgasms and great sex!
Getting your pelvic floor conditioned properly after delivery can help you get those muscles firing so you can orgasm like you did before, and maybe even better!
The body wants to heal, it just needs the right conditions to heal.
For those who aren’t healing as quickly after delivery as they would like, don’t fret. You just have to understand the principles associated with the body healing and take it one step at a time. With respect to healing, specifically to vaginas, there’s a lot of variations of normal. And change doesn’t occur over-night – it takes some time. So be patient with yourself, learn as much as you can about healing post-delivery, and seek the guidance of a skilled pelvic floor therapist – you won’t regret it!
How to do a Kegel Exercise:
Do not start any exercise program until you are cleared by your medical doctor.
You must first recoup from delivery before starting any exercise at all.
According to Dr. David Wise and Dr. Rodney Anderson, Kegel exercises were, “developed to help women restore their continence after childbirth”. Dr. Arnold Kegel himself developed the exercises “to help his patients increase their sexual function and gratification as well as to address problems of prolapse and incontinence. Here’s how to do the Kegels, according to pelvic therapist Amy Stein, MPT:
First identify the muscles by stopping your flow of urine.
Once you found the muscles, squeeze, then relax. Repeat.
Dr. Gunter elaborates on Kegel exercises and explains the difference between sustained contractions and quick flicks.
Sustained Contractions involve holding the squeeze for 5 seconds, then relaxing for 10 seconds. Do 10 reps, 3 times daily. Build up to hold for 10 seconds, doing 10 reps holding 10 seconds, 3 times a day.
Quick Flicks are simple contractions with release that take only 1-2 seconds. 5 quick flicks is 1 cycle. Do 5 cycles then rest for 10 seconds for one full set (total of 25 quick flicks) 3 times a day.
- Wise, D PhD and Anderson, R, MD. A Headache in the Pelvis Harmony Books, 2018.
- Gunter, Jen MD. The Vagina Bible: The vulva and the vagina – separating the myth from the medicine. Citadel Press, 2019.
- Stein, Amy MPT. Heal Pelvic Pain: A proven stretching, strengthening, and nutrition program for relieving pain, incontinence, IBS and other symptoms Without Surgery. McGraw Hill, 2009.
- American Physical Therapy Association Section on Women’s Health (SoWH). https://www.womenshealthapta.org/ Last accessed 11/26/2019
- Freeman, Robert, Chapple, Christopher and Moffat, Marilyn. Evidence-based Physical Therapy for the Pelvic Floor: Bridging science and clinical practice 2nd edition Churchill, Livingstone Elsevier, 2015.