What is pelvic floor rehabilitation therapy?
Pelvic floor rehab is a type of physical therapy that can help mums after they’ve had a baby.
Specialist physiotherapists, who have extra training in women’s health, offer pelvic rehab therapy. They can examine your pelvic floor to find out where the problems lie, and work out a programme of recovery tailored to your needs.
Your pelvic floor stretches between your pubic bone and tailbone and cradles your pelvic organs, which are your womb (uterus), bladder and bowel.
Your pelvic floor muscles help you to control the flow of wee out of your bladder via your urethra, and poo and wind via your anus (NHS 2015a). The muscles also help you squeeze and relax your vagina when you’re having sex (Aschkenazi and Goldberg 2009).
During pregnancy and childbirth your pelvic floor muscles can tear, weaken or simply over-stretch. As a result, you may lose some control over the opening of your urethra, and leak wee accidentally, especially when you cough or sneeze (stress incontinence) (Steen and Wray 2014).
Many mums leak wee and wind, and have soreness in the pelvic area after giving birth (Thom and Rortveit 2010). This should get better in the first couple of months, if you do your pelvic floor exercises daily.
For some mums, though, the damage doesn’t recover with normal pelvic floor exercises, and pain and incontinence is long-lasting. In severe cases, damage to the pelvic floor can cause women to leak poo (faecal incontinence), making day-to-day life difficult and distressing (Steen and Wray 2014).
Damage to your pelvic floor can also affect your sex life. You may find sex uncomfortable, or just less satisfying. The sensations in your clitoris and labia are affected by how well your pelvic floor muscles are working (Aschkenazi and Goldberg 2009), and retraining your pelvic floor can help to put this right.
It’s understandable if you’re reluctant to seek help, or feel embarrassed about discussing incontinence or sexual problems. But many of these symptoms are not normal for a mum after childbirth, and you shouldn’t feel you just have to put up with it. Your physio will want to help you, and will be sensitive to your needs.
Your physiotherapist may ask your permission to check your pelvic floor with an internal examination. This will involve her using her finger to gently feel inside your vagina, and possibly your rectum, to assess the damage to your muscles.
Depending on her diagnosis, a pelvic floor rehab programme may include:
- Pelvic floor exercises.
- Training in how to relax your pelvic floor.
- Bladder/bowel emptying techniques, such as raising your legs to help with constipation, and leaning forward when you wee (NHS nd).
- Massage of tight muscles.
- Lifestyle advice. Depending on your diagnosis, this could include be to avoid heavy lifting, or to reduce prolonged standing.
How can pelvic floor rehabilitation help me?
If any of the following problems are affecting you, then pelvic rehabilitation can help you (NHS 2015a):
Incontinence – both urinary and faecal
As well as the more common stress incontinence, you may also feel an urge to wee when your bladder isn’t full, or have trouble emptying your bladder completely when weeing (NHS 2016).
If you have faecal incontinence, you many pass wind and/or small amounts of runny poo accidentally (Makol 2008, NHS 2015b).
Both types of incontinence are treatable, so there’s no need to suffer in silence. Doing your pelvic floor exercises in a way suggested by your physio, alongside bladder and bowel emptying techniques, can help you to regain control (NHS 2016).
If your incontinence is happening as a result of a serious tear during birth, or an episiotomy that needs correcting, you may need to see a doctor for treatment. Find out more about complications after an episiotomy or tear.
Pelvic and perineal pain
These types of pain are common for new mums, especially if you had a tear during the birth or are recovering from an episiotomy. Your perineum is the area of skin between the vagina and the anus. This area can be vulnerable during vaginal birth, especially if you have an assisted birth.
Your pain may be caused by tight muscles, torn or stitched tissue, or just weak muscles that mean it’s hard for you to support your pelvic organs.
An overactive pelvic floor can happen after a tear during childbirth. The tear may cause certain muscles to work too hard, or become tight because they’re tensing around tender spots. Some women develop an overactive pelvic floor because they try to keep their pelvic floor muscles tensed for long periods.
If you have tight muscles, you may continue to feel pain, even after your wound has healed. If you have an overactive pelvic floor, or very tight muscles, your physio can provide trigger point massage, or trigger point release as it’s sometimes called.
Trigger point release is similar to any other massage, with the main difference that the pelvic floor can be massaged internally. Trigger point release identifies sensitive points, helps your muscles to relax and, after time, move naturally. Your physio will use her fingers to massage your thighs, buttocks, and the tissue inside your vagina.
The goal is to gently stretch this area and release trigger points that are causing pain. This can be uncomfortable, particularly if you have long-standing (chronic) pain or aren’t keen on the idea of internal massage.
Your physio will be gentle and explain every aspect of the treatment before asking your permission to carry on.
Any discomfort when your physio presses on tight muscles should not last long. You should have a sense of release or relief afterwards, when the tightness eases. Each time you have the massage treatment, it should become more comfortable.
Pain on penetration/during sex
Some women have pain during sex for months or even years after childbirth. And some have chronic pain, itching, or burning in their vulva – the tissue surrounding the opening of the vagina.
This can happen for a variety of reasons. Tight or overactive pelvic floor muscles are common causes. Your physio may recommend trigger point massage, alongside tailored pelvic floor exercises, to ease your symptoms.
When pregnancy and childbirth weaken or stretch the pelvic floor muscles and the surrounding tissue, one or more of the organs they support – the womb, bladder, and bowel – can bulge into the vagina. This is called prolapse.
Prolapse is more common in older women, but it can affect younger women who’ve experienced a long and complicated labour, had a large baby, or lots of babies (NHS 2015c).
With pelvic floor rehabilitation, you can often get your pelvic floor working again to minimise the symptoms of the prolapse.
Some mums worry that they have prolapse when in fact they have a weak pelvic floor and slackness in the surrounding muscles. When you are unable to support your muscles, you often get a “dragging” feeling in your vagina. This will go away or reduce as your pelvic floor regains strength.
When should I get help with my pelvic floor problems?
The sooner you get help, the better. See your GP to discuss being referred to a women’s health physiotherapist.
Women who have ongoing incontinence problems are more likely to suffer from postnatal depression (PND) (Steen and Wray 2014), so it’s important for your mental health as well as your physical health.
Pelvic floor training works, and can help you get back to feeling “normal down there”. As long as you continue with the exercise programme your physiotherapist has advised for you, you should recover well (Bø et al, 1999).
Pelvic rehab may also help to decrease your chances of having a complicated birth in future (Salvesen and Mørkved 2004).
Why aren’t my usual pelvic floor exercises enough?
Pelvic floor exercises are great for strengthening your pelvic floor muscles. But some women need to be shown how to do them properly by a women’s health physio to fix the particular problems they’re having.
For example, if your problem is caused by tightness or over-activation of the pelvic floor muscles, practising contracting, but not releasing them, can make the muscles tighter and your symptoms worse.
That’s why seeing a specialist physio, who can give you a tailored rehab programme, is best if you have ongoing problems.
This blog was originally published on the BabyCentre Website as part of my work for them as a Women’s Health expert. To read the original article, click here.
Here is a link to my profile:
For some further information, please see my other pages: