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What is pelvic rehab therapy?
Pelvic rehabilitation is a type of physical therapy that can be very helpful for postpartum moms. Pregnancy and childbirth can damage the muscles and connective tissue of the pelvic floor, causing all kinds of inconvenient and uncomfortable symptoms for women after they give birth.
The pelvic floor stretches between the pubic bone and the tailbone and cradles your bladder, bowel, and uterus. The pelvic floor muscles enable you to keep urine and feces in – and release them – when you need to. They also help you contract and relax your vagina during sex.
When the pelvic floor muscles are tight or weak, they can cause annoying symptoms or even pain. A urogynecologist or a pelvic floor physical therapist (PT) can evaluate these muscles and determine whether they're contributing to your symptoms.
If they are, the PT can work to release trigger points – areas where the tissues are stuck together rather than sliding easily against each other. PTs also teach you to do exercises at home to help relax muscles that are tight and strengthen muscles that are weak.
What is pelvic rehab therapy like?
Physical therapy for pelvic rehabilitation involves several different kinds of techniques that focus on the muscles and connective tissue of your pelvic floor and abdomen.
Your therapist will teach you to identify various muscles, so you can strengthen or release them. All of the muscles in this area work together to help you maintain your core strength and prevent incontinence.
Women lose a lot of tone in their abdominal muscles during pregnancy. About two-thirds end up with what's known as diastasis recti, a separation of the rectus abdominis muscle along the center of the belly. This condition can contribute to lower back pain, constipation, and urine leaks, as well as that stubborn postpartum stomach pooch that may last for months or even years.
Diastasis recti cannot be fixed with crunches or sit ups. In fact, these exercises can make the problem worse. Instead, the condition requires special strengthening exercises that focus on the deeper transverse abdominal muscles. Your therapist can teach you how to do these abdominal rehabilitation exercises at home.
Your therapist will also use her fingers to massage your thighs, buttocks, and the tissue inside your vagina. The goal is to gently stretch this area and release trigger points that are causing pain. This can be uncomfortable, particularly if you have chronic pain or are reluctant to allow probing inside your vagina.
First, you should know that the physical therapists who do this work have learned it by having it done to them and have a good idea of what you are feeling when they touch you in intimate places. They are trained to be very gentle and will adjust their touch to make sure it's not too intense for you.
Patients say it feels much like a regular massage. They feel discomfort when the therapist presses on tight muscles, but then a sense of release or relief afterward, when the tightness eases. Over time, the therapy becomes less uncomfortable and your symptoms should improve.
Which postpartum problems can be helped by pelvic rehab?
Various conditions can be related to problems with the pelvic floor. These problems are particularly common in postpartum moms, but they can last beyond the first six months or strike later in some women.
- Urinary difficulties. Women with urinary incontinence leak urine when they sneeze, cough, or run. Some women feel a frequent or sudden, compelling urge to pee, even when their bladder isn't full. Others are unable to start the flow of urine at will or empty their bladder completely when urinating.
- Anal incontinence. Many postpartum women have trouble controlling gas or bowel movements.
- Perineal pain. This is common in postpartum women, especially those who tore during childbirth or are recovering from an episiotomy. (The perineum is the area of skin between the vagina and the anus.) A tight pelvic floor causes some new moms to experience persistent perineal pain, even after their wound heals.
- Pelvic pain. Some women have pain during sex for many months or even years after childbirth. And some have chronic pain, itching, or burning in their vulva – the tissue surrounding the opening of the vagina. This can make it hard to tolerate wearing tight clothing and even underwear. Others have pain during bowel movements. These symptoms are often caused by tight pelvic floor muscles, which can lead to inflamed tissue and nerve endings.
- Pelvic organ prolapse. When pregnancy and childbirth weaken the pelvic floor muscles, one or more of the organs they support – the uterus, bladder, and bowel – can slip out of place. Rehabilitating these muscles can help prevent or improve this condition.
Don't Kegels help?
It depends on what's causing your symptoms. Kegels are exercises you can do to support your pelvic floor muscles. Your doctor may have recommended doing Kegels to relieve urinary symptoms. Kegels help some women, particularly those with weak pelvic floor muscles, who may be leaking urine.
But many women are not taught to do Kegels correctly. And if your problem is caused by chronic tightness in the pelvic floor muscles, practicing contracting but not releasing them can actually make the muscles tighter and the symptoms worse.
Instead, these muscles need to be retrained so you can tighten and then relax them when you need to.
How do I find a pelvic rehab physical therapist?
You can start by asking your doctor or midwife for a referral to a urogynecologist or a PT or doing an online search for pelvic rehabilitation in your area.
- Visit the American Physical Therapy Association website. Click on Find a PT and search for a women's health physical therapist near you.
- Visit the International Pelvic Pain Society website and click on Find a Provider.
- Visit the Herman and Wallace Pelvic Rehabilitation Institute website and search the practitioner directory.
Make sure the program you choose offers manual therapy (such as trigger point release) and not just pelvic floor strengthening techniques.
Note: This article was also reviewed by Stephanie Prendergast and Melinda Fontaine, physical therapists at the Pelvic Health and Rehabilitation Center in San Francisco.