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Does Your Pelvic Floor Need a Therapist? Physical Therapy Might Be the Answer To Your Postpartum Recovery

For many postpartum women, the journey through healing means reconnecting with a body that feels unfamiliar — stretch marks, weak muscles and those pesky hemorrhoids. When you look into your baby’s sweet eyes and feel the weight of her in your arms, it’s easy to overlook the physical healing required. For some women, the postpartum experience means chronic pain or weakness that lasts for months or even years. If your body still doesn’t feel right after Baby, it might be time for your pelvic floor to get therapy. No, our pelvic floors can’t talk, but they still need support. A physical therapist can provide the help you need to feel strong and empowered in your body again (spoiler alert, it’s not just kegels).

“My biggest goal is to help women feel empowered, strong and confident in their postpartum body. I want to help them decrease pain and get back to any activities that bring them joy.”

-Hannah Enochs PT, DPT, OCS

Hannah Enochs PT, DPT, OCS, is an Indianapolis-based physical therapist who specializes in women’s health. Enochs has seen the gamut of women dealing with postpartum issues, whether they had their baby six weeks ago or thirty years ago. Every woman’s journey through postpartum healing is unique and emotional. Most women expect weakness in their core and pelvic floor, but are surprised when issues like incontinence, chronic constipation, abdominal muscle separation and pain with sex become a problem weeks or months after having a baby.

“A common theme I hear is that women weren’t expecting to have these problems, and that comes with a lot of frustration. Sometimes women just feel like this is the new normal and things won’t get better,” says Enochs. “There can be lots of feelings tied up in this including feelings of loss — it’s scary to feel like your body has totally changed and not knowing what you can recover from.”

Pain with sex or incontinence is more common than most women realize. A 2015 study of 1200 postpartum women showed that 24% were still having symptoms of chronic pain during sex 18 months after birth. A 2018 study of over 800 women found that 37% experienced pain with sex six months after birth, and a 2000 study showed that of the women interviewed (aged 15–97), 35% reported having urinary incontinence.

While physical therapy has been a part of postpartum care for years, it is not widely discussed at postpartum follow-ups. “…patient access to care was often limited to mothers who have a referring provider having prior experience with physical therapy, or it was simply left to the patient to find her own answers for her postpartum issues,” Carrie Pagliano, PT, DPT, president of the APTA Section on Women’s Health, said of postpartum care. Incorporating physical therapy into fourth trimester recovery is a part of a growing shift towards more comprehensive postpartum care.

Whether it’s weak muscles or back pain, postpartum issues are not simply ‘‘part of having a baby.’’ It requires intervention by a women’s health professional, and physical therapists are available to help.

Enochs uses a combination of education, exercise progression and manual therapy to help women recover from the issues they may be having. “My biggest goal is to help women feel empowered, strong and confident in their postpartum body. I want to help them decrease pain and get back to any activities that bring them joy.” Short term, Enochs says that physical therapists seek to address the immediate issues you are dealing with. Long-term, PTs can help you achieve confidence in your postpartum body (and who doesn’t want a little more of that?).

In addition to a tailored recovery program, PTs can help build exercises into your existing lifestyle. If you have found an online program that you already enjoy, they can help you select specific exercises to prioritize. Avid yogi? They can fit a program into your flow. Don’t have time for ‘formal’ exercising? PTs help incorporate helpful movement into things you are already doing, such as lifting up your baby or changing diapers.

Most importantly, Enochs wants women to know that if they are feeling unlike themselves, this isn’t something you have to deal with forever. “I want women to know they can do what they want to do even though their bodies have changed. Women’s bodies are amazing and resilient, sometimes we just need a little help to fully recover or reach our goals.”

Enochs understands the benefit of postpartum-focused physical therapy first-hand. Despite second degree tearing with the birth of her first child, she describes her postpartum experience as standard; purposeful rehab at home with no major issues.

“I was the perfect example of why not everyone can ‘just go do some kegels’. While you want your pelvic floor to be strong, you don’t want to be hanging on for dear life in either your core or pelvic floor muscles.”

-Hannah Enochs PT, DPT, OCS

The birth of her second child was different. Even though she had no tearing this time around, she noticed pain during sex that was getting worse.

“I was the perfect example of why not everyone can ‘just go do some kegels’. While you want your pelvic floor to be strong, you don’t want to be hanging on for dear life in either your core or pelvic floor muscles.” Enochs chose to see a PT who could evaluate her case objectively and suggest a tailored program.

After only a few weeks with some manual work with her PT and the use of a pelvic wand, she noticed substantial improvement. Less than a year after the birth of her second child, she now has pain-free sex and has resumed her typical exercise routine.

When it comes to any physical issues you are experiencing, the sooner you can address them the better. It is never too late to see a physical therapist for your women’s health or postpartum concerns. Enochs has worked with women who had a baby six weeks ago to women well into menopause. “I’d love to see any woman who thinks, ‘Ever since I had my baby/was pregnant, things just haven’t felt right.’” PTs can help you regain your confidence and advise you on what to do if problems arise down the road of recovery.

Not all physical therapists can provide the same quality of care for women’s postpartum concerns. When looking for a physical therapist, it is important to find one who specializes in postpartum and women’s health issues. Sites like Pelvic Rehab.com or PT Locator can help you find a provider in your area.

Postpartum recovery can be an intimate and emotional experience. So finding a doctor you trust is crucial. I have some simple steps to finding a doctor you can count on in my previous article.

There are so many changes a woman will experience over the course of her postpartum journey. When you feel overwhelmed and sad, you reach out for support. When you cross your legs every time you sneeze, or find yourself avoiding sexual pleasure because it hurts, it might be time for your pelvic floor to receive a little TLC, too. Consider seeking a physical therapist to help your body feel as powerful and strong as you know you are.

I own a content marketing and copywriting business, helping people share their stories. Married to someone who tolerates me, parent to two toddlers who don’t.