Strategies to Optimize Pelvic Floor Recovery After Pregnancy

Dr. Kailey Edgar PT, DPT with Optimal Sports Physical Therapy in Helena, MT specializes in Pelvic Floor Physical Therapy.

Many women struggle with pain, incontinence, or pelvic floor dysfunction after having a baby. One of the most common questions we get after pregnancy is “what can I do to improve my pelvic floor function?”

Urinary incontinence and pelvic pain after childbirth are common. However, many women continue to struggle with healing, especially after a perineal tear or episiotomy.

Some women experience a delay in return to normal function, and worse yet, some never fully recover. I bet if you think about it, you can recall a friend, an aunt, or a sister that has said, “I have leaked a little ever since I had my baby.”

Are you struggling with pain or incontinence after pregnancy? Struggle no more!

While many women will heal naturally over time, there are some things that have been shown to help women heal better during the postpartum time period. Taking time early in recovery to address the pelvic floor will likely help shorten the duration of symptoms and lead to better pelvic floor function in the long run.

Following some of these tips may help you work toward a complete pelvic floor recovery after pregnancy.

Keep reading to see Dr. Kailey Edgar’s tips for pelvic floor recovery after pregnancy. Be sure to follow all medical advice from your birthing provider. If you have questions, ask your birthing provider and ask them to refer you to Pelvic Floor Physical Therapy(PFPT).

Pain Relief

Childbirth is commonly a painful experience. After giving birth, many women continue to experience pain: low back pain, pelvic floor pain, and other pain. Ask your birthing provider to help you determine the best pain relief for you during labor as well as after giving birth. There are many different pain relief options, and being aware of your options allows you to ask for the option(s) that you prefer.

Ice

After giving birth, either vaginally or via C-section, you may feel swollen or inflamed throughout the pelvis, abdomen, and vagina. Using ice may help reduce pain and swelling, thus helping to provide you some level of comfort during the initial phase of healing. The general recommendation is to apply ice for the first 48-72 hours (or 2-3 days). Some women have found that freezing maternity pads provides a convenient and sterile way to ice.

Compression

Compression may also help with pain and swelling. For the first few days, using a frozen maternity pad in your underwear may provide enough support, however as soon as you feel like you can, using compression leggings, shorts, or underwear may provide more support to your abdomen, pelvis, and vagina. The level of compression should feel supportive,not restrictive, and should not cause any increase in discomfort. If discomfort occurs, immediately stop using compression and contact your care provider. Some women find that wearing compression leggings for the first 30-60 days helps with overall recovery.

Personal Hygiene

Follow your OB/GYN provider’s instructions regarding personal hygiene. Be sure to keep the area clean using only water. It is generally recommended to avoid using soap, as some soaps can irritate the healing tissues. Afterward, towel pat the area dry to avoid any rubbing or irritation from drying. Do not put any creams, gels, or Neosporin on the area unless specifically directed to by your healthcare provider.

Rest

Rest is one of the most important factors in healing and pelvic floor recovery after pregnancy. It also happens to be the most difficult thing for a new mom to do. However, by prioritizing rest, you may potentially help maximize your recovery.

Rest helps reduce pressure on your pelvic floor. Lying supine (flat on your back as opposed to reclined position) can help reduce pressure on your pelvic floor.

Ask family and friends for help in the early stages to help your recovery. Chances are they want to help so take them up on it so you can rest. Friends and family can help with meals, household chores, grocery shopping, and other errands until you feel up to doing your normal chores.

Rest is one of the most vital parts of recovery. Interestingly, women who get the least sleep during the postpartum period, often develop the worst postpartum depression symptoms. Try to rest when the baby rests.

Posture

Maintaining an optimal posture throughout the day can help decrease any low back or pelvis pain. It is especially important to watch your posture during the first few weeks while you are recovering from the birthing process.

Whether you had a C-section or vaginal delivery, the pelvis muscles are weak, the ligaments are stretched out, and your low back has minimal support during this phase. Watch your posture and positioning while breastfeeding, changing diapers, carrying your new baby, and loading them in and out of the car.

Pressure Management

When there is an increase in internal pressure, as there is when performing a Valsalva maneuver, pressure on the pelvic floor increases. This additional pressure can further add to pelvic floor weakening and difficulty with continence.

Focusing on maintaining normal breathing can help to manage pressure when lifting or while having a bowel movement. Avoiding constipation will help decrease pressure on your weakened pelvic floor, which may also limit episodes of bowel incontinence while your pelvic floor is healing. Focus on your breathing to better manage internal pressure.

Nutrition

Nutrition is another method to aid in postpartum recovery. Studies suggest that Vitamin D levels may be decreased in the postpartum time period, as well as other vitamin levels. While nutrition alone will not cure postpartum depression, eating well will aid in overall recovery.

Eating a balanced diet with an appropriate amount of caloric intake will aid in muscle recovery, feeling better, and will aid in breastfeeding as well. Eating a wide variety of protein, fruits, and vegetables will give your body the building blocks for recovery. Think whole foods. Maintaining proper hydration and increasing fiber intake can also decrease the risk of constipation while healing.

It is estimated that a woman who is breastfeeding needs an additional 450-500 kCal/day more than her normal caloric intake. That means that a woman who is breastfeeding should consider increasing her caloric intake to 2300-2500 kCal/day vs. 1800-2000 kCal/day for a moderately active woman.

Eating enough calories is important to ensure quality milk production as well as proper healing during recovery. Keep in mind that nutritional needs vary widely from woman to woman and infant to infant.

If you have further questions and need help fine-tuning your nutrition during the postpartum phase, please ask your birthing provider for a consultation with a nutritionist or a lactation specialist.

Exercise

Another important key to recovery is to begin gentle activities as your body allows based on pain levels. Beginning gentle pelvic floor contractions as soon as the day after giving birth has been shown to be both safe and effective. Starting with small, gentle, pain-free contractions can help with swelling, pain, and start reactivating the neuromuscular pathways to start the process of regaining strength and control.

The key to these pelvic exercises is to perform them correctly. Hopefully, you have already seen a pelvic floor PT, however, if not, ask your birthing provider to refer you to a pelvic floor specialist.

Exercise has also been shown to be a key factor against the development of Postpartum Depression (PPD). Walking has been shown to help significantly decrease symptoms of PPD. No time for a long walk? That’s ok. Even just 10 minutes of light walking helps to decrease PPD symptoms. Shorter walks more frequently throughout the day also help fight any symptoms of depression.

After giving birth, most care providers recommend a very gradual return to normal activity level. In the first 6 weeks, focus on light walking, pelvic floor contractions, gentle core activation exercises, and posture exercises; then gently progress in weeks 6-12 to pilates, yoga, and other stability-based activities while maintaining light aerobic exercises.

By 3-6 months, most women are able to progress their intensity levels gradually to higher-level strength training and maybe some light jogging. At the six-month mark, most women can return to their prenatal activity levels, including running and jumping.

The importance of a gradual return to exercise can not be emphasized enough. It is important to be able to perform each level of exercise pain-free for 4-6 weeks prior to advancing to the next phase. Given that the pelvic floor muscles are weakened and stretched, we want to decrease any risk of causing future complications, including a prolapse.

Proper level of exercise can aid in pelvic floor recovery after pregnancy, however too much or too little may increase your risk of delayed recovery.

For personalized guidance on exercise progression, be sure to ask your care team, or seek a referral to a pelvic floor PT who can help guide you.