Getting in Shape “Down There” After Pregnancy

After giving birth, your new baby will be your top priority.  But you need to put your oxygen mask on first and be sure to consider your own postpartum care. 

Pelvic floor physical therapists can help you get your body back safely and quickly!

So many changes occur during pregnancy while a beautiful little human grows inside the body: internal parts shift, bones spread, skin, fascia and muscles stretch and ligaments become lax.  During delivery, the vagina spreads farther apart than ever dreamed about (or rather “nightmared” about!!) to allow the baby to exit. Sometimes it can’t physically open enough and studies show that during delivery, 44-75% of women will tear (2).

Some lucky mamas give birth and their VaJJ’s heals quickly. 

Others aren’t so lucky and can develop weakness, pain and/or incontinence, finding sex irritating or painful or they may find they have lost sensation down below.  Most people end up with a larger vagina that’s weaker than it was prior to giving birth vaginally. These issues affect new moms both physically and emotionally. Bladder, bowel and sexual function are important components of female health.

So what to do?

1. Always seek out medical attention to ensure that it’s just an issue of weak and loose musculature and to rule out any other problems.  
2. Seek the help of a pelvic floor physical or occupational therapist.
3. Educate yourself in your anatomy and practice some simple exercises.
The pelvic floor serves as the base of the core muscles and works with the deep abdominal muscles, back muscles, hip muscles and diaphragm to support the spine and control abdominal pressure. The pelvic floor consists of 11 muscles in 3 different layers and connective tissue that surrounds them, called fascia.  In order to have optimal pain free functioning, all of the core muscles must be toned and able to contract in a coordinated manner.   If any of the core muscles or fascia within the core are too tight, too loose or just aren’t in sync, problems can develop.  

According to Dr. Erin Fiakos, a neurologically trained member of the women’s health and pelvic floor department at High Quality Home Therapy (link to HQHTherapy.com and @hqhtherapy), “Your pelvic floor not only acts as a sling to support your bladder, uterus and bowel, but also assists with continence, sexual performance (orgasm), and joint stabilization.”  Exercise, education, myofascial release and modalities such as ice and biofeedback can help.  Since it can be hard to isolate and palpate some pelvic floor muscles some people benefit from internal myofascial techniques. 

Many people aren’t fully aware of what movement specialists can do for you “down there.”  Pelvic floor specialists are physical or occupational therapists who have advanced training in both orthopedic & neurological rehab.  Anatomy, physiology, wound healing and pain management are all large components of the training, and compassion and professionalism are requirements, as would be expected!  “Just like all other skeletal muscles, pelvic floor muscles can be conditioned and usually these muscles develop pretty quickly so the results with pelvic rehab are seen fast,” says Dr. Kristen Tracey, pelvic floor specialist at High Quality Home Therapy.

Other suggestions:  Caryn McAllister, DPT, owner of High Quality Home Therapy suggests learning to isolate the various muscles that surround the three openings of the pelvic floor.  “Play around with tightening the small muscles that stop your pee flow, then those that prevent you from passing gas and then pull the muscles of your vagina up and in so that it feels like an elevator ascending all the way up to your lower stomach and then release down slowly feeling each part of the vaginal wall.  We women have different openings but typically don’t even really think about the muscles “down there” and lump it all together. It’s even good to recognize how the lower abdominals interact with the pelvic floor muscles and these are all very learnable,” according to Dr. McAllister.

Alicia Teitlebaum, MS, PT of High Quality Home Therapy suggests starting to exercise slowly.  Your body has gone through so many changes with pregnancy and birthing.  Be gentle with yourself and set realistic fitness goals, allowing yourself time for healing.  Many people rush back into exercising without strengthening from the inside out.  Ms Teitlebaum found help with a pelvic floor specialist after she gave birth for the 3rd time.  “My experience influenced me to learn more and help others because I personally understand how much women’s health rehabilitation can help new moms.  I now specialize in women’s health and pelvic floor rehab at High Quality Home Therapy and love applying all that I learned personally and professionally to enhance the lives of other new moms.”

Stephanie Chartier, MS, OT is an occupational therapist who works with patients with pelvic floor dysfunction.  “Most people don’t even know what an occupational therapist does, so I typically explain it as very similar to a physical therapist but with a focus on activities of daily living (ADLs).  Bladder, bowel and sexual function, three ADLs, are exactly what women’s health occupational therapists focus on when working with pelvic floor patients ,” explains Stephanie Chartier, MS, OT.  So many women wonder if they will ever enjoy sex again after delivery.  Having a baby should never mean kissing away orgasms and great sex!  Getting your pelvic floor conditioned properly after delivery can help you get those muscles firing properly so you can go to the bathroom and orgasm like you did before, and maybe even better than you did before!

The body wants to heal, it just needs the right conditions to heal.  For those who aren’t healing as quickly as they’d like, don’t fret.  You just have to understand the principles associated with the body healing and take it one step at a time.  With respect to healing and specifically, VaJJ’s, there’s a lot of variations of normal (2). And change doesn’t occur instantly – it takes some time.  So be patient with yourself, learn as much as you can about healing post delivery and seek the guidance of a skilled pelvic floor therapist – you won’t regret it!

How to do a Kegel Exercise:

Do not start any exercise program until you are cleared by your medical doctor.  

You must first recoup from delivery before starting any exercise at all.  

According to Dr. David Wise and Dr. Rodney Anderson, kegel exercises were “developed to help women restore their continence after childbirth” (2). Dr. Arnold Kegel himself developed the exercises “to help his patients increase their sexual function and gratification as well as to address problems of prolapse and incontinence” (3).  Here’s how to do the Kegels, according to pelvic therapist Amy Stein, MPT:

First identify the muscles by stopping your flow of urine.

Once you found the muscles, squeeze, then relax.  Repeat.

Dr. Gunter elaborates on the Kegel exercises and explains the difference between sustained contractions and quick flicks.

Sustained Contractions involve holding the squeeze for 5 seconds, then relaxing for 10 seconds.  Do 10 reps, 3 times daily. Build up to hold for 10 seconds, doing 10 reps holding 10 seconds, 3 times a day.

Quick Flicks are simple contractions with release that take only 1-2 seconds.  5 quick flicks is 1 cycle. Do 5 cycles then rest for 10 seconds for one full set (total of 25 quick flicks) 3 times a day.

Resources:

1. Wise, D PhD and Anderson, R, MD. A Headache in the Pelvis Harmony Books, 2018.
2. Gunter, Jen MD.  The Vagina Bible:  The vulva and the vagina – separating the myth from the medicine. Citadel Press, 2019.
3. Stein, Amy MPT.  Heal Pelvic Pain:  A proven stretching, strengthening, and nutrition program for relieving pain, incontinence, IBS and other symptoms Without Surgery.  McGraw Hill, 2009.
4. American Physical Therapy Association Section on Women’s Health (SoWH).  https://www.womenshealthapta.org/  Last accessed 11/26/2019