The Mama Body: Physical Therapy During And After Pregnancy

Physical Therapy During And After Pregnancy

A Guest Blog by Lizanne Pastore PT, MA, COMT

Eighty percent of the bodily changes occurring during pregnancy happen in the first trimester!  Isn’t that astounding?  A woman’s body must adjust quickly to a 40% increase in fluid volume, increased heart and respiratory rates and myriad other changes that may affect us in different ways.  The fluid volume increase, for example, can make our connective tissues weaker—our tendons can get a little mushy and our nerves and blood vessels a bit softer.  This extra fluid and tissue weakening makes us more prone to things like leg swelling, varicosities, tendonitis, carpal tunnel syndrome, or sciatica.  

The hormonal changes in pregnancy play a big role in our metabolism, mood, memory and, of course, ligamentous laxity.  Some pregnant women experience instability not only in the pelvis and hips, but also in the joints of the spine, elbows, and wrists.  Our musculoskeletal system is taxed by these changes even before the baby gets very big.  Then, as baby grows, we might begin seeing rectus abdominis separation (“diastasis recti,”) spinal problems from posture and center of gravity changes, even rib dysfunction as the ribs are forced out and up to make room for belly.  Foot pain from falling arches from the sudden weight gain can occur, and on and on. 

In the pelvic girdle, there is a list of other maladies that can be downright scary to a pregnant or postpartum mama.  And most women are not warned about these potential problems.   Pelvic girdle pain manifesting as coccyx, pubic or sacroiliac joint pain; groin or hip pain; pelvic muscle or nerve pain; plus urinary or fecal incontinence or pelvic organ prolapse are some of the more common things occurring during or after pregnancy. 

After birth, as Mom is busy caring for her newborn and any other children at home—schlepping heavy car seats, strollers, laundry baskets, breastfeeding through the day and night, lifting ever-heavier babies into and out of cribs—she wonders why everything hurts, or why she feels a clicking in her pelvic bones when she lifts her leg!  Well, she is busy performing exceedingly challenging tasks with a sub-optimal musculo-skeletal-neural system (not to mention sleep deprivation!) 

It is well documented that both pregnancy and vaginal birth increases a woman’s risk of developing pelvic organ prolapse or becoming incontinent later in life.  And many women think that leaking during or after birth is “normal” because their friends, moms, aunts, and sisters leaked, plus there are 20 different brands of incontinence pads to choose from in the drugstore, so it “must” be normal.   

But this is wrong; leaking and pelvic organ prolapse is common, but not normal or OK.   The same holds true for back or pelvic pain.  Sure pregnancy puts demands on our bodies, but there is no reason to “put up” with pain, leaking, prolapse, numb hands or legs!  There is a health professional who knows all about this—a physical therapist specially trained in women’s health issues and the pelvic floor.  These PT’s are special – they understand the pregnant and postpartum body and are experts in negotiating a path to health and strength for women with special concerns.

After an initial assessment, which often includes a thorough pelvic muscle exam and possibly even a biofeedback analysis, the woman is prescribed a home program.  This program may include a combination of postural or corrective exercises, motor training or strengthening exercises, bladder and bowel re-training, special instruction to change movement strategies to limit stressors on the body, and even self-care techniques for pain or prolapse, such as self massage for constipation, or gentle inversions for prolapse. 

Wouldn’t it be amazing if every pregnant woman and new mama could have a visit with a PT like this?  Guess what – they can!  If you are reading this article and are pregnant talk about this option with your doctor.  And if you have friends, sisters, aunts and co-workers who might be pregnant or new moms, talk to them about it.  Tell them to ask their doctors for a referral to woman’s health physical therapist!  

Need help finding a qualified PT? Visit the NAFC Specialist Locator to find one in your area.

About the author:  A physical therapist for 29 years, Lizanne has specialized in treating women and men with complex pelvic floor and pelvic girdle issues since 2005.  She has worked primarily in San Francisco and the Bay Area, running a successful private practice for the past 18 years. She writes, lectures, and teaches about pelvic health at the professional and community levels and is currently a board member of the NAFC.  

Misconceptions About Being A Mom And Bladder Health

Moms and Bladder Health

Becoming a mother is one of the most joyful things that can happen to a woman.  But it can also be challenging.  Not only are you dealing with the demanding task of raising a little one, your own body is undergoing constant change as well.  There are a lot of misconceptions out there about how our bodies should perform after we have kids - many of them false.  Take a read below and learn some of the most common misconceptions around bladder health and becoming a mother.  

Misconceptions around bladder health and becoming a mother

Fact or Myth?  After having kids, it’s normal to pee a little when I laugh, sneeze, run, etc.

Myth. While this can happen for a few months after childbirth, it is not something that is “normal.” It should be dealt with.  Talk to your doctor or a trained physical therapist about some exercises that may help get you back to normal, and product suggestions that can help you manage incontinence in the meantime.

Fact or Myth?  If you’ve had kids, you can expect to have urinary incontinence or OAB when you become older.

Myth.  It’s true that sometimes incontinence does not rear it’s ugly head until well after you’ve had your children – often in your 40’s or 50’s.  But that doesn’t mean that it’s a sure thing you will suffer from incontinence – especially if you are proactive in getting your pelvic floor strong now.  It’s never too late to start incorporating your pelvic floor into your workout routine.

Fact or Myth?  I might as well get used to being incontinent – now that I’ve had a baby there is nothing I can really do about it anyway.

Myth.  As we mentioned above, incontinence is certainly not normal, and there are a host of things that you can do to manage, and even fix it for good.  For starters, adult absorbent products can help you manage immediate leaks that you may be suffering from post childbirth until you are able to build up your strength again.   When you schedule your 6-week postpartum check up with your doctor, schedule a visit with your physical therapist as well – it’s a great time for an initial evaluation and you can learn some good postpartum exercises to start right away.  And if you are still feeling like things are not quite right after a couple of months, talk with your doctor about what you can do.

Fact or Myth:  I don’t have to worry about working on my pelvic floor until after I’ve had the baby.

Myth.  One of the best things you can do to prepare yourself for childbirth is to start working out your pelvic floor today.  Not only will it make your delivery easier, but you will be that much stronger and your recovery in the postpartum days ahead will be much faster.

Did Your Mom Or Grandma Talk About Bladder Health With You?

Talking About Bladder Health

It’s a rare day when we people tell us their family has a known history of bladder and bowel concerns. So often, a struggle with overactive bladder is considered a rite of passage with childbirth, or an enlarged prostate is chocked up to older age. While age and the stress of childbirth are two predominant factors in both of those symptoms, it can still be very helpful for families to learn when and why their loved ones experienced struggles with continence so they can take proactive measures to avoid the same circumstances.

Two examples of how this could play out are outlined below: 

·      A woman experiences leakage and stress incontinence after having a baby, only to hear from their mothers that they experienced the same thing.

·      A man tells his parents about his latest test result only to hear his father say, “Oh yea. I struggled with an enlarged prostate before I finally went to the doctor last year.”

In the examples above, both individuals with new bladder health concerns could have taken preventative measures to lessen the chances of them getting to the point they are now.

The woman could’ve talked to her yoga or Pilates instructor and asked for tips to build her pelvic floor before labor and delivery. Or, when she built her birthing plan with her Doctor, she could’ve stressed consideration her Mother’s past experiences.

If the man had known his father’s situation, he could’ve talked to his doctor about his family history during his yearly check up months earlier. Maybe his father’s experience would’ve spurred him to take note of his prostate health much sooner.

We encourage an open dialogue about bladder and bowel concerns for two reasons: being transparent can help future generations learn how to best care for their bodies and being honest about a health concern can foster a community of family and friends who keep you accountable to a treatment plan.

When’s the last time you spoke to your family about bladder health? Share your experience below.