Maintaining Pelvic Health Postpartum

Most of us don’t think about our pelvic health much in our early lives. When everything functions as it should, there’s no reason to pay too much attention. Carrying and birthing a baby offers an ideal time to check in with our overall pelvic health, and to get ourselves set up to function well through the next phases of our lives. When you consider all the things our pelvis does for us, it’s worth the time and effort to get everything in order after major events like pregnancy and birth.

Though we often think of the pelvic girdle as one bone (or two halves), there are actually several bones involved, joined by 7 joints in total. This bony structure shifts around during pregnancy and birth to allow for babies to be born and can take up to 12 months to return to pre-birth positions. 

The pelvic floor is made up of all the structures inside the pelvic girdle. This includes the pelvic floor muscles, fascia, connective tissue, and the pelvic organs, including the bladder, rectum, and reproductive organs. The pelvic floor muscles form the bottom of the “inner core." The pelvic girdle and pelvic floor muscles are major players in postpartum recovery because they literally support our organs and allow us to move around and function without pain. 

Hormones also play a role in postpartum recovery, since estrogen produced from the ovaries supports the health of vaginal and vulvar tissues. Postpartum moms may not be producing as much of this type of estrogen from the ovaries until their cycle returns after baby. 

It’s impossible to talk about pelvic health without including the gastrointestinal and urinary systems. Though these structures are only partially housed inside the pelvis, their function is essential to optimizing pelvic health.

• Pelvic floor physical therapy is often the first line of treatment for many of these concerns. Pelvic floor physical therapists are always a good player to have on your team, as they can work with you to help improve your function and management strategies. 
• Pelvic floor muscle exercises, or Kegels, may or may not be a helpful strategy for your pelvic floor. Though they are often broadcasted as something “everyone needs to do," women with a tense or tight pelvic floor may find that Kegels can worsen their issues. On top of that, some studies show that up to 50% of women don’t perform Kegel exercises correctly! This statistic alone makes an excellent case for pelvic floor physical therapy after every birth, so that a professional can evaluate your pelvic floor and help you make a treatment plan specifically for your needs. 
• Coordinate the pelvic floor with movement. After all, Kegel’s are just one piece of the puzzle! Consider coordinating the pelvic floor into bigger movements, like bridges, sit to stand, and mini lunges.

• Strengthen the abdominal muscles. The deep abdominal wall has a reflexive relationship with the pelvic floor, meaning that they support and build on each other. After the long stretch of pregnancy, your abdominal muscles will likely need a bit of a boost to build up the strength that motherhood requires! Try exercises like the bent knee fall-out, low abdominal marches, quadruped lifts, and a modified side-plank to get you started. With each of these exercises, engage the pelvic floor and draw the navel up and in to engage the deepest layers of the abdominal wall. Try to avoid flaring your ribs or flattening your low back, and if you see your belly pushing out or you notice you’re holding your breath from effort, you’re probably working too hard! Slow and steady progress is the key to bringing these abdominal muscles back on board. 

• Nutrition and dietary changes can make a huge difference with bowel and bladder concerns. Some foods and drinks are bowel and/or bladder irritants, and can make leakage or abdominal pain feel worse. Focusing on whole foods with plenty of fiber, plenty of water, and limiting sugar, caffeine, and carbonation can help calm your systems and allow your body to get comfortable managing food and fluid without leaking or constipation. 
• Home-based biofeedback units have become more popular in the last couple of years. These devices are inserted into the vagina like a tampon and pick up on pelvic floor contractions. Those signals then transmit to your cell phone via Bluetooth and allow you to see your pelvic floor contract and relax Kegel exercises on the screen. These devices can be helpful for allowing you to see how you’re doing with more detail than you can pick up on yourself. You may want to go to a pelvic physical therapist before purchasing to be sure it’s the right tool for your needs. 

The term “pelvic health” might refer to anything related to gastrointestinal, urinary, sexual health, reproductive health, pain management, and even athletic performance. 

The most important thing to know about postpartum pelvic health is that most, if not all, of these concerns are treatable. Let’s look at the major categories of pelvic health concerns, common postpartum experiences, and what basic treatment options are available. 

Urinary Function

• Stress urinary incontinence, or “bladder leakage” with coughing, sneezing, laughing, jumping, or heavy lifting is one of the most common postpartum concerns, with approximately one-third of all postpartum women reporting some degree of incontinence. Other postpartum urinary complaints might include urinary urgency (feeling the need to suddenly rush to the bathroom), and frequency (voiding more than 8-10 times per day). 
• Previous generations have largely laughed these issues off as an inevitable consequence of having babies, but today’s mothers have more resources at their disposal. These concerns can be treated! 
• Pelvic floor muscle exercise programs are the first line of treatment for postpartum urinary incontinence. Consulting with a pelvic floor physical therapist is the best way to ensure correct application, timing, and coordination of pelvic floor muscle exercise to resolve stress urinary incontinence. 
• Certain foods and beverages are known to be “bladder irritants'' and can contribute to increased urgency or frequency. Try keeping a bladder diary for a few days, and writing down your food and drinks, as well as when you’re urinating or leaking. Things like caffeine, carbonation, artificial sweeteners, or acidic foods like tomato sauce could be part of the problem. 

Bowel Function

• Constipated? Sluggish bowels can result from many factors in the postpartum window: medications lingering from birth or postpartum pain management, dehydration that might be more significant due to breastfeeding, moving less while you’re recovering, and eating differently (hello, door-dropped casseroles!) might all be contributing factors. Unfortunately, constipation can lead to overall worsening pelvic function if it’s left unaddressed. Try drinking more water, checking in with your fiber intake, using a stool under your feet, and strengthening your abdomen to get things moving again. It’s also a good idea to check in with your healthcare provider or pelvic physical therapist about this since there are more strategies out there that might be just right for you!

Sexual Function

• Sexual health is a lifelong consideration involving factors that change naturally over time. After you’ve had a baby, sex may not feel appealing for a while. Hormones, healing, mental health, and overall fatigue may take a toll on your drive. You may want to discuss these feelings with your partner and prioritize non-sexual forms of intimacy for the first few months postpartum. Your drive should return as hormones level out, but don’t hesitate to discuss further options with your care provider, mental health therapist, or pelvic physical therapist, as sexual function is truly multifaceted. 

Pain

• Unfortunately, pelvic pain is one of the most under-treated concerns that women face. You might experience pelvic pain after birth that impacts intercourse, pelvic exams, baby-carrying, or even walking and running. No matter the reason, pain is never something to ignore. Pain is your body signaling that something is wrong, and should always be addressed. Speak to your provider about your pain, and don’t settle for dismissive responses. Pelvic physical therapy is an excellent resource for pain management. 

Mental Health 

• Some pelvic floor disorders can be linked to mental health, with emotions like anxiety, fear, or stress contributing to pelvic symptoms. These tense emotions can show up in the form of pelvic floor muscle tension (similar to how someone might tense their shoulders or their jaw), and over time this chronic tension can lead to issues like pain, urgency, and back pain. It’s worth considering how emotional health might be contributing to your pelvic floor concerns and sharing these potential links with your care provider. There may be more you can do to get your symptoms under control.

These broad pelvic health topics involve overall elements of women's health and wellness that we need to take care of in order to enjoy food, movement, and relationships. Pregnancy and postpartum are ideal times to address issues with urination, bowel health, sexual function, or pain management, especially because many of the same hormonal shifts occur again in perimenopause. It’s worth taking time to set yourself up for optimal function so that you’re ready for what the rest of your life will bring.