Physical Therapy and the Pelvic Floor

Pregnancy Birth Post natal pre natal wiggle room.

By: Lauren Rae Mallari PT, DPT

Physical therapists are specialists in soft tissue, joint and biomechanics assessment and treatment. This just means that we are very good at assessing how well your skin, fascia, muscles, nerves and joints move, or don’t move, as you move through life, and if you do those motions efficiently.

As a Pelvic Floor Physical Therapist, I assess all of this in relation to how well your body is prepared for delivery of baby or how well it has “come back together” after the delivery of baby.

For moms to be, I can help to eliminate physical factors that may prevent the normal descent of baby through the birth canal. The pelvis and pelvic floor muscles must be able to lengthen and open efficiently, so we work on the pelvic floor muscles all around, from the pubic bone to the sit bones to loosen and help them lengthen. We will also work on mobilizing the pelvic bones to ensure they are able to gap open so baby has enough room to exit the birth canal. We will also look into mobilizing ribs, hips, knees and ankle joints so you are able to get into the positions you need to, to get that baby out! Neuromuscular control of the pelvic floor muscles will also be address in order to improve your awareness and control of them so you are better able to release the pelvic floor and allow baby to descend more smoothly. During all of this, we will be strengthening and retraining your core, glutes and other muscles to help you hold up against the Relaxin that is in your body and maintain good support for the growing baby inside of you.

For many moms after delivery, their core and pelvic floor strength (think kegel) is not as strong as it used to be, potentially leading to issues such as, urinary incontinence and difficulty getting back to your normal level of activity.) Which is why its so great to get a head start and get into Physical Therapy BEFORE you have the baby!) Regardless, after delivery, it is super important to get your strength back as soon as medically allowed because now, you’re carrying baby (and then probably doing something else with the other arm), carrying a car seat, bending over really weirdly to buckle car seat in, getting up and down from the floor to play with baby/toddler/kid and then thinking about or trying to get back in “pre-baby shape”.  All of which, you REALLY need great core and pelvic floor strength for!

After your tummy has been stretched out by baby, many women have what’s called a diastasis recti. This is when the abdominal muscles have been separated down the midline, making it very difficult to achieve an efficient core contraction. One of the most important muscles to get back in order is the transverse abdominis, which acts as your own, natural corset, helping to close that diastasis recti and provide your lumbar spine and pelvis with the stability it needs. I can assess for the diastasis recti and then help to facilitate your transverse abdominis to contract again, after having been stretched out for 9 months! The other very important group of muscles to get back in working order is the pelvic floor. The pelvic floor just went through A LOT. I will assess the tone and strength of the pelvic floor muscles and then work with you to get them contracting again. Pelvic floor and core strength are one in the same and are crucial for maintaining urinary continence, avoiding low back pain and returning to “pre-baby shape”.

Of course, there is even more to discuss about Women’s Health and Pelvic Floor Therapy, but I hope this shines some light on how Physical Therapy is so specifically important for women’s issues.