By Dr. Katy Girlinghouse, PT, DPT
Pelvic Health Physical Therapist
There’s a lot of information out there about healing your pelvic floor postpartum. Here’s the top five things that every mom needs to know.
First, do you Kegel or not? Kegels are just another name for pelvic floor muscle contractions which are strengthening exercises that are good for the pelvic floor. But not everybody needs to strengthen all the time at every stoplight. Just like our hamstrings need to stretch and be flexible, our pelvic floor needs to stretch to open the vagina for birth and have sex, to empty the bladder and bowels. I often teach moms active breathing which incorporates a pelvic floor contraction and a pelvic floor lengthening. You can do this at home by inhaling and letting your pelvic floor relax, then exhaling and contracting your pelvic floor.
2/3 of women do pelvic floor contractions wrong. I know you’re thinking “not me! I can do them right”! but you would not believe how often I teach people to engage the pelvic floor more efficiently. To correctly, engage the pelvic floor you need to squeeze around the vagina and anus, and then lift up towards your head. If you feel that you’re squeezing all in the front or all in the back or a bearing down or you feel like you might leak you’re doing it wrong. To retrain the pelvic floor for an efficient contraction. I often use a mirror so that you can see your pelvic floor, squeezing and lifting up toward your head. If you don’t want to look down there, another option is to sit on a rolled up, washcloth, and then squeeze and lift the pelvic floor. When you do this pelvic floor contraction, you should feel less pressure on the towel. If you feel more pressure when you squeeze, you’re probably bearing down. Click here for a video of me, explaining diaphragmatic breathing and demonstrating some of these techniques.
The pelvic floor helps with urinary, bowel, and sexual function. Many people are aware of the urinary problems such as leaking when you cough, sneeze and jump on the trampoline. Or maybe you’ve heard that a frequent need to pee or having to rush to the bathroom is from a dysfunctional pelvic floor. But did you know constipation could be caused by pelvic floor tension. This is known as outlet dysfunction. The pelvic floor is tense and doesn’t open and let the stool escape which causes constipation. This can cause problems during pregnancy or postpartum. Especially if you have tearing during birth. Tearing in birth can cause pelvic floor tension because the muscles are guarding and protecting that tear so that it will heal. This is great and a normal process as long as the pelvic floor, then relaxes once that tear heals in the first few weeks when it doesn’t you end up with pelvic for tension and constipation or fecal smearing and pain.
Pain caused by the pelvic floor can look like a lot of different things. It could be pain with sitting, pain with standing or pain with activities. Although pain looks quite different for many people we assess many of the same things to figure out a treatment plan. We always want to make sure that the pelvic floor is relaxing fully as tension in the pelvic floor can cause pain in the bladder, bowels, belly, tailbone, hips and thighs. Once we know that the pelvic floor can relax fully, then we can look at strengthening the pelvic floor to provide stability to the pelvis and work as part of the core to provide you stability to be able to pick up your kids, do dishes, and go for a run.
The last thing that I wish every mom knew about their pelvic floor is that sex should not be painful. Not the first time, not the 51st time, not after having kids, not during pregnancy. Never. So often we get told that pain after having kids is normal and it will just take some time to get used to it. I refuse to accept that pain is normal and you should too.
Maybe you learned something by reading this today. Maybe you knew all of this already but I hope that you share this with someone who doesn’t know all of the amazing things that their pelvic floor can do.
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