Physiotherapy following childbirth is designed to assist with recovery of the pelvic floor and core, along with the rest of the body and health in general. The initial 3 months following childbirth is referred to as the ‘4^th trimester’, and during this time it is essential to allow the body to recover from pregnancy and childbirth. During pregnancy posture must change to accommodate for the beautiful wee baby growing inside. The ribs widen as the heart increases by 50% of its normal size and the ligaments soften to allow the body to stretch. The muscle activity around the pelvis changes as the pelvic position changes. This is a normal process and a clever way the body adapts to have a child. The pelvic floor is a group of muscles that sit like a trampoline in the base of the pelvis. With the increased weight of the baby resting on the pelvic floor it also undergoes some stretch throughout pregnancy.

Changes to the pelvic floor during birth.

During a vaginal delivery, or attempted vaginal delivery, the muscles and nerves stretch significantly to allow the passage of the baby from the inside to the outside. The pelvic floor is designed to stretch to 250% of its resting length, much more stretch than any other muscle of the body. However, depending on the circumstances of the delivery, that stretch to the tissues may be temporary but sometimes if there is a greater degree of stretch, a longer duration of stretch or the need to use instruments such as forceps, the tissues may be injured and not be able to return to their predelivery state. Due to the constantly changing circumstances of each mother’s labour and delivery it is possible to injure other structures around the pelvis during vaginal deliveries such as the pelvic bones, the tailbone, the nerves and the tissues that hold the pelvic organs inside the body. For those who have a caesarean section delivery the pelvic floor has undergone the stress of the pregnancy. There may have been stress to the vaginal and pelvic floor tissues and muscles if a vaginal delivery was initially attempted, and then in order to access the baby for delivery the abdominal wall tissues and muscles are injured as they are cut to access the baby therefore also need time to heal and recover. We know the scar takes at least 3 months to heal to a reasonable strength when it can then start tolerating more stress and loading. Due to these significant effects on the structures around the pelvic floor and pelvis it is very important to allow time for these injured tissues to recover follow childbirth, and to rehabilitate them in a safe manner. Pelvic health physios can help to guide women in this recovery, as well as check if there has been injury to the pelvic floor muscles or other structures during childbirth. Allowing the appropriate time to recover and rehabilitate from the normal adaptions from pregnancy, childbirth and the potential injuries that may have occurred is beneficial to optimize recovery and to address any symptoms or difficulties women may be having in the 4^th trimester, but also to reduce the risk of pelvic health problems later in life. Pelvic floor physical therapy has been proven to reduce the risk of pelvic organ prolapse, urinary, bowel, and sexual dysfunction and pelvic pain.

When to begin Pelvic Health Physiotherapy;

It is highly recommended to start pelvic floor physiotherapy around 6 weeks following delivery. This is to screen for any potential injuries, and to help to guide recovery including exercise and return to sports and fitness whether your goal is circus performing, running 5km or 50km. Having said that, it is never too late to see a pelvic floor physio. Many pelvic health symptoms that occur after having children and are often thought to be a ‘normal’ consequence are in fact common but not normal. They are a sign of pelvic floor dysfunction and often respond very well to pelvic health physiotherapy. A good example of this is leaking when you cough, sneeze or jump on a trampoline- this is common but not normal!

Postpartum physio can also help with:

• Difficulty peeing or emptying the bladder, leakage of urine, and bladder urgency or frequency

• Constipation, difficulty with bowel movements, and leakage of bowels

• Painful sex, diminished or absent orgasm

• Separation of the abdominal muscles

• Restoring core function and strength of the abdominals and pelvic floor

• Pelvic floor and pelvic girdle, low back, and hip pain

• Caesarean section and episiotomy scar tissue and pain

• Pelvic organ prolapse prevention and/or treatment

• Eliminate pain from trauma to the pelvic floor and muscles

• Reduce pain from nerve damage in the pelvic and pelvic floor

Postnatal physiotherapy helps with this and really should be a standard part of our healthcare as it is in France! As a profession we are excited that the upcoming ACC Maternal Birth Injury coverage will improve access for many new mothers to undergo postnatal rehabilitation- more on that in our next post. Our Pelvic Health Physiotherapy team at Active Health are here to help you recover and live your best life! Call us at 03-383-6290 to see one of our team.