HOW PHYSIOTHERAPY HELPS IN POSTPARTUM WOMEN

Dealing with pelvic health issues after having a baby is common and left  untreated can lead to decreased physical and mental health, isolation and  depression. Many women do not return to the activities they once enjoyed  due to fear of embarrassment.

What is the pelvic floor?

The pelvic floor muscles are a group of muscles that attach to the front, back  and sides of the pelvic bone and sacrum, which act like a hammock or sling.  They also wrap around your urethra (where urine comes out), rectum, and  vagina. The pelvic floor muscles must be able to contract to maintain  continence and relax to allow for urination, bowel movements, and in women,  sexual penetration.

Potential pelvic floor issues postpartum:

1. Pelvic floor dysfunction: Pelvic floor dysfunction can be as a result of  carrying a child for 9 months and delivering either vaginally or through  a C-section.Dysfunction may present as tension, weakness, or  sensitized tissue, all of which can be treated by physiotherapy.  Dysfunction may result in urinary or fecal incontinence, pelvic organ  prolapse, or pain.

2. Bladder and Bowel Dysfunction: A woman may experience urinary  or fecal urgency immediately postpartum. Many women experience  stress urinary incontinence, which is leakage of urine with activities  such as coughing, laughing, sneezing, or running. Pelvic organs  including the bladder, uterus, and rectum may prolapse or hang lower  than usual. Constipation or inability to fully evacuate your bowels may  ensue.Treatment in physiotherapy may include learning to use the  breath to relax and lengthen the pelvic floor muscles, or how to  properly contract the pelvic floor muscles so that you can develop  strong, healthy muscles that support your pelvic organs and assist your  sphincters in keeping you continent.

3. Painful Scars: Pelvic health physiotherapists can provide education  and guidance on scar management, whether it is from vaginal tearing/ episiotomy during childbirth or a C-section scar. With the help of a  desensitization technique, the therapist will teach first how to start  gentle touch around the scar in non painful manner.When gentle touch  becomes tolerable, your physiotherapist might have you do skin rolling  around or on the scar. On a C-section scar, your therapist may teach  you to pick up the scar or gently stretch it in all directions in order to get  flexibility in scar and also to ensure that scar should not adhere to the  surrounding tissues.

4. Dyspareunia: Dyspareunia refers to the experience of painful  intercourse. This can occur in the postpartum phase for a few reasons.  First, tissue injury from natural tearing or an episiotomy can leave that  area feeling more sensitive than usual.Second, the postpartum period  can be a time of vaginal dryness, particularly if you are breastfeeding.  Repeated application of lubrication during intercourse is a must. Pelvic  health physiotherapists use many different approaches to treat  dyspareunia including education, desensitization strategies for both the  tissue and nervous system, scar tissue mobilization, and

accommodators (cylindrical objects of progressively larger sizes used  to help the vagina and brain become accustomed to stretch once  again). This is all with the goal of helping a patient enjoy sex once  again!

5. Diastasis: is the separation of the right and left rectus abdominis  muscles or the six-pack muscles due to stretching and thinning of the  linea alba, which is connective tissue that runs vertically from the  bottom of your ribs to the top of your pubic bone, joining the right and  left sides of your abdominal muscles. During pregnancy, it is normal for  the linea alba to stretch to accommodate the growing fetus. For some  women, the gap between the abdominals shrinks back to its pre pregnancy state quickly and without effort. For other women, the gap  remains.Therapist will help you to learn engaging of core and core  strengthening exercises.

Your therapist will teach you how each of these muscles works together  in a synergistic manner and will show you how to engage each of these  muscles correctly, all the while breathing comfortably. When you have  learned to activate your inner core, your therapist will progress your  exercises to include larger muscles groups, eventually working into  functional movements such as squatting and lifting, all the while  engaging your core in an effective manner.

6. Exercise: it has so many benefits on whole-body health including  mental and emotional well-being that it is imperative to include in the  postpartum period and beyond. It is recommended that women start  pelvic floor exercises in the immediate postpartum period to reduce  urinary incontinence. In general, it is suggested that a woman avoid  high impact activity such as running or aerobics or rigorous strength  training until at least six weeks postpartum. However, for many women  six weeks is too soon to return to prepartum activity levels. The return  to exercise needs to be considered on an individual basis with your therapist, but must always be done in a  graduated manner.Returning to exercise in  the postpartum period should not be a  race, but instead, a time to be gentle with  your body. Don’t forget it just performed  the miracle of bringing a tiny human into  this world.

Resource:www.pelvic health solutions.ca

Contributed by Sumeet Kaur, Registered PT, Pelvic Floor Physiotherapist,  InFocus Rehabilitation Centre Inc, 1-905 702 7891