A woman’s body goes through all kinds of physical changes during pregnancy and childbirth. Some of those changes are to the pelvic floor muscles, which support the increasing size and weight of the baby during pregnancy. After pregnancy and childbirth, it can take some time for those muscles to recover and get back in shape.

Jade Elliott spoke with Jessica Woodman, a physical therapist with Intermountain Healthcare who specializes in pelvic floor physical therapy, about what those pelvic floor muscles do and some common post-pregnancy symptoms and problems that involve the pelvic floor muscles, and how physical therapy can help.

Where the pelvic floor muscles are and what they do

The pelvic floor muscles are like a “hammock” on the inside of the pelvis. They run from the pubic bone in front back to the tailbone. There are three layers of the pelvic floor, which provides support for internal organs, controls function for your openings, and helps with sexual function.

“Before pregnancy, those without pelvic floor symptoms may not specifically pay much attention to this region. After pregnancy, it can be very common for several different pelvic floor symptoms to begin. This can be due to a possible weakness, or tightness, of the pelvic floor muscles, interfering with proper function,” said Jessica Woodman, a physical therapist with Intermountain Healthcare who specializes in pelvic floor physical therapy.

Pelvic floor conditions are common

National studies show between one fourth to one-third of U.S. women have a pelvic floor condition.

According to Woodman, pelvic floor symptoms can be especially common for women who have given birth more than once or to twins or multiples. Utah’s high birthrate means many Utah women are in this category.

Common symptoms of pelvic floor muscles not functioning properly

•  Urinary stress incontinence: leaking urine, when you cough, sneeze or do exercise that involves running or sudden movement.
  
•  Urinary urge incontinence: leaking urine when trying to get to the bathroom
  
•  Increased urinary frequency, or difficulty emptying bladder
  
•  Pain in the pelvis, abdomen, low back or tailbone
  
•  Pain with intercourse or sexual dysfunction
  
•  Constipation or fecal leakage
  
•  Pelvic organ prolapse: when one or more internal organs is not supported well
  

“Stress incontinence, or leaking urine when you cough, sneeze or exercise can occur after childbirth. It’s common, but it’s very important for women to know this can be treated. There are many women out there dealing with urinary leakage, not knowing they can get help and see improvement. I want women who have these symptoms to know they don’t have to accept the status quo or just live with these symptoms forever.”

“It’s also not uncommon for women to experience pelvic pain, which can include pain with intercourse. This can stem from tightness of the pelvic floor, which can be treated in a specific way. Pelvic floor physical therapy can be a truly life-changing intervention for many women,” added Woodman.

In addition to pregnancy and childbirth, other factors that contribute to pelvic floor conditions include aging, obesity, tailbone injuries, chronic coughing, chronic constipation, hip weaknesses, and pelvic/abdominal surgery. So even if a woman hasn’t had a baby, she could still have some pelvic floor issues.

Woodman said women with these symptoms can talk to their doctor or see a physical therapist specializing in post-pregnancy issues for an assessment. Pelvic floor symptoms can often be improved with physical therapy, especially if treated early on, but sometimes surgery may be recommended. It’s a good idea to start with the least invasive option of physical therapy first.

Kegels exercises may help some conditions if done properly

Many women have heard of doing Kegel exercises to help strengthen pelvic floor muscles. Kegel exercises are the repeated tightening and releasing of the pelvic floor muscles for a few seconds. Pelvic floor muscles are the same muscles used to stop urination midstream. Kegels can be done while standing, sitting or lying down. They were developed in the 1940’s by Dr. Arnold Kegel.

“Pelvic floor symptoms may be due to weakness or tightness of those muscles. Kegels can help with weakness, but may exacerbate the problem in patients with tightness. Kegels sound kind of simple, but there’s a right way to do them and a specialized therapist can help you know how to do them properly,” said Woodman.

“It’s not just squeezing those muscles, but also involves breathing and movement. Complete pelvic floor therapy involves not just Kegels, but working to stabilize the whole pelvis and help restore normalized function,” she added.

Therapists use different visualization techniques to help patients do pelvic floor exercises correctly. Each patient is unique, so different techniques work for different patients. Therapists can give patients a treatment plan for the type and frequency of exercises to do at home.

When to see a pelvic floor P.T.

You can see a therapist during pregnancy or postpartum. There are delivery positions that protect the pelvic floor. And you want to make sure you’re breathing when exerting. There are some foundation deep core exercises you can start while pregnant.

Postpartum visits are best after a woman’s six-week appointment with her doctor or midwife to ensure healing has gone well and there are no other concerns.

What to expect at your first appointment

Your first appointment will begin with a thorough history of a patient’s symptoms and personal goals. If the patient is comfortable, a pelvic floor muscle assessment can be performed with a pelvic exam in a closed private room. This is the best way to assess muscle weakness or muscle tightness, coordination or pain, so that treatment can be customized. Pelvic floor physical therapy can still be very beneficial without an exam. Physical therapists can also help with whole-body considerations to help patients learn the best practices and exercises to improve their physical conditions.

Pelvic floor treatments

Therapy and treatments may include strengthening and coordination, relaxation exercises and manual techniques varying from: scar mobilization, to joint mobilization, to muscle release.

Pelvic floor physical therapy is effective

According to medical studies, pelvic floor muscle training combined with bladder training effectively resolved urinary incontinence in women.

Studies also show pelvic floor therapy can also help reduce pelvic pain.

Finding a pelvic floor physical therapist

Intermountain has 12 pelvic floor physical therapy locations across Utah. For more information visit intermountainhealthcare.org to find a physical therapy location close to you and ask for a pelvic floor physical therapist.

The Orthopedic Specialty Hospital in Murray, Utah also offers online Pilates classes with a focus on pelvic floor muscles, which teaches control, strength and relaxation.

Classes are held twice weekly with daytime or evening options. Cost is $40 for one month of eight classes. Call TOSH at 801-314-2210 to register.

There are national websites where you can search for a registered pelvic floor physical therapist by zip code such as Pelvic rehab.com.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.