The Postpartum Project
What is the Postpartum Project?

The Postpartum Project is WholeBody’s community outreach program.

As women and mothers ourselves, we are passionate about bringing information to the women who can benefit most from it. Through our pelvic floor/postpartum rehab program we have noticed a startling trend- women are suffering needlessly with the lingering effects of pregnancy and birth, mostly because they don’t know that there is help available to them. Knowledge is power and this knowledge gives women the ability to advocate for themselves and get the care they deserve. 

In European countries pelvic floor physical therapy is the standard of care. In fact, in France every woman is offered 10-20 visits with a pelvic floor physical therapist following every birth – and it’s paid for by the French government! Unfortunately, here in the US, most doctors aren’t properly informed about the benefits of pelvic floor PT. This often means that when women report ongoing issues, their doctors incorrectly tell them that there is nothing that can be done, or even worse, that the only solution is surgery!

The system is broken and The Postpartum Project is our effort to change things! Our mission is to educate, empower, and help heal women in all postpartum stages- even YEARS after giving birth. That’s right! It’s NEVER too late to give the body what it needs to heal. 

We aim to not only educate women on a variety of issues that they may be dealing with, but also to provide actionable steps they can take to help heal their bodies. In addition, we have included information on available resources, should you need more hands-on help.  

Who are we? 

We are physical therapists at WholeBody Physical Therapy, Running, & Wellness in Troy, IL. Stephanie Hemker is a pelvic floor physical therapist and Rebecca Willmann is a certified postpartum corrective exercise specialist. Together we head up the pelvic floor/postpartum rehab program – but more than that, we are women and mothers who can relate to life in a postpartum body! 

How can we help? 

Scroll down to read up on any issues that may hit home for you. Try out the exercises we have included. If you feel that you need a more customized program or hands-on help, call or text us at 618-967-5539 or email us at Rebecca@WholeBodyFix.com.

We would be happy to discuss any issues you may be dealing with.

Common Postpartum Complications

Urinary Incontinence: 

There are 3 main types of urinary incontinence:

1. Stress Urinary Incontinence: This is when you leak urine when you cough, laugh, sneeze, jump, run, lift, walk, etc. This is due to a pelvic floor that cannot respond to the increase in pressure in the abdomen with these activities.

2. Urge Urinary Incontinence: This is when you have a sudden urge to go to the bathroom so much that you sometimes cannot make it. This is due to a pelvic floor that is no longer able to manage your bladder. In a normal urinary system, your bladder will fill. Your bladder is a muscle and once it is full enough, it will contract. This sends the message to your brain that you must go.

Now, let’s say you are in a meeting, at the grocery store, or playing with your children and you cannot go to the bathroom right at that minute. Your pelvic floor should contract gently which in turn causes your bladder to relax. Essentially, your pelvic floor should be telling your bladder “Not yet”, allowing you to make it to the bathroom on your terms.

When your pelvic floor cannot give this feedback to your bladder, the bladder continues to contract earlier and stronger. Eventually, your bladder takes complete control, and you are constantly running to the bathroom and possibly leaking on the way. You should be able to hold your bladder for 2-3 hours without issues. You should be peeing no more than 8 times per day and once at night.

3. Mixed Incontinence: This is a mixture of both stress and urge incontinence.

**An interesting fact about these issues is that this can be caused by your pelvic floor being overactive or underactive and the only way to know for sure is to be examined by a pelvic floor physical therapist. **

Tips:

  • One way to improve urinary urge is by making sure the urine in your bladder is not irritating to the bladder.
    • Make sure you drink enough water. Many people will limit their water intake due to the leakage. This will only make your problem worse because the urine that is in your bladder is especially irritating. A minimum of 64 oz is recommended.
    • Certain foods and drinks can be especially irritating to your bladder
    • Bladder irritant list
    • Do not go to the bathroom “just because”, this trains your body to void too soon feeding into the bladder being in control.

Exercises:

Try modifying your diet and using these techniques. If you do not notice a change in 3-4 weeks, you should see a pelvic floor PT.

Painful Sex: 

Pain with sex or dyspareunia is a very common problem affecting up to 60% of women at some point in their life. This pain can be with initial penetration, deep penetration, only with some positions, or even after intercourse or during or after orgasm. Due to how common pain with sex can be, it is sometimes thought to be “normal”.

We have many women who tell us that they thought sex was supposed to hurt because they had a baby, were post-menopausal, or were small statured. We’ve even had some women who were told sex is supposed to hurt for women. We are always surprised at the number of women who have just accepted painful, non-pleasurable sex as a way of life.

Some women are even told by their doctors that there is nothing they can do or to just use more lubrication. This can be devastating to women as painful sex can not only be frustrating for the woman, but it can impact her personal relationships. Some common causes of pain with intercourse are spasmed muscles of the pelvic floor, scar tissue, decreased lubrication due to hormonal changes, or weakness or atrophy of the pelvic floor muscles.

Physical therapy can help by using manual techniques to decrease spasming or scar tissue in the pelvic floor as well as giving you exercises to do at home that can also help the muscles to relax. We also can align the pelvis and ensure that the other muscles within your pelvis and abdomen are doing their job, so the pelvic floor does not have to work so hard. Ultimately, our goal is to teach your pelvic floor how to maintain the proper tone and strength to allow for pain free and pleasurable sex.

Tips: 

  • Communicate with your partner about what positions are painful, which are not, and what you are feeling. Use a water based or natural lubricant as dryness can worsen the problem.

Exercises:

Pelvic Organ Prolapse: 

Pelvic Organ Prolapse or POP for short is when one or more organs of the pelvis slip out of place. This is due to an imbalance of pressures within the abdomen resulting in symptoms such as heaviness in the vagina, a feeling of something falling out of the vagina, a change in sensation during sex, constipation, and incontinence to name a few.

Usually, the muscles and soft tissues of the pelvic canister work together to maintain the pressures in the abdomen. These muscles include: The pelvic floor, inner abdominal muscles, the diaphragm, and small muscles in your back called the multifidi.

If there is weakness or tightness in any of the structures, it will change the way the pressures are controlled and can contribute to prolapse symptoms.

Physical therapy can help as we will look at how the whole system is working and ensure that the necessary structures are strong enough, but also able to relax to allow for proper control of these pressures.

A recent study found that not only could prolapse symptoms be improved with a manual therapy approach, but the prolapse could be corrected as well. Which is amazing!

Pelvic Canister & Pelvic Floor Illustration

Pelvic Canister & Pelvic Floor Illustration

 Tips: 

Exercises:

Diastasis Recti: 

Diastasis Recti is the partial separation of a woman’s stomach muscles or “six pack” muscles during pregnancy. It occurs in many women during the last weeks of pregnancy, and for most women it will resolve by eight to twelve weeks postpartum.

A diastasis rectus that lingers after the first several weeks postpartum may be caused by increased tension in the pelvic floor or diaphragm, weakness in the inner core and pelvic floor, tissue laxity in the abdomen, and overuse of the rectus abdominis (six pack ab) muscles.

Due to these imbalances, increased force is distributed through the front part of the body (similar to POP) and can result in pain, difficulty working out, and difficulty doing daily activities.

Physical therapy can help with this by ensuring the muscles and structures of the abdomen and pelvis are all working as they should – contracting, relaxing, and coordinating together to prevent increased pressures moving through the abdomen and increasing the diastasis recti.

Illustration of Diastasis Recti

Diastasis recti illustrationTips: 

Exercises:

Back Pain: 

One of the main jobs of the pelvic floor is to stabilize the pelvis and sacrum. Your spine sits on your sacrum and if there is instability throughout the pelvis or the sacrum, this can contribute to problems up the spine as well. Also, the pelvic floor does not function alone. It works very closely with your inner core muscles, multifidi muscles, and diaphragm to support and stabilize your mid-section. Any dysfunction here can result in increased stress through the spine and result in back pain, hip pain, and leg pain.

If you have had long standing back, hip, or leg pain, have tried PT, chiropractic, massage, etc. with only temporary relief, there is a chance your pelvic floor is contributing to your pain.

Pelvic Canister & Pelvic Floor Illustration

Pelvic Canister & Pelvic Floor Illustration

Tips/Exercises: 

Other Related Conditions

Endometriosis

Endometriosis is a very painful condition in which tissue like the lining of the uterus grows outside of the uterus. This can cause scar tissue and adhesions in your abdomen and result in debilitating pain throughout a woman’s menstrual cycle. This pain can also contribute to spasming in the pelvic floor which in turn causes more pain.

Physical therapy can help by working on the adhesions and scar tissue in the belly as well as improving the spasming in the pelvic floor. Your physical therapist will use specific manual therapy techniques to improve the tone and mobility of your soft tissues and muscles.

Sexual Assault and Pelvic Floor Dysfunction  

Sexual abuse and assault aren’t easy topics. There is a high correlation between a history of sexual abuse or trauma and pelvic floor dysfunction. Sometimes, the muscles of the pelvic floor will tense in response to sexual stimuli following abuse. These muscles can carry unnecessary tone even when not stimulated which can result in pain, incontinence, etc.

We always recommend that anyone with a history of abuse consult with a mental health expert, but therapy can help to retrain  the body to respond more appropriately to a sexual stimulus as well as perform more appropriately with daily activities.

Pregnancy related pain

Pregnancy is a truly beautiful time in one’s life. The female body goes through many changes during pregnancy. While this is an amazing feat, it sometimes leaves the mom feeling less than ideal. Increasing hormones, changing postures, and a growing baby can lead to back pain, pelvic pain, and pubic bone pain.

Physical therapy can help by using manual therapy techniques to ensure the alignment of your pelvis is correct and that muscles in your back and pelvic region are not weak or overworked (common causes of pain).

Infertility

Did you know that one in 8 families will struggle with infertility? Did you also know that physical therapy can help? A pelvic floor physical therapist can work on the muscles and fascia within the pelvis to improve mobility of these structures and aid in removing any mechanical blockages such as adhesions or scar tissue that may impede the ability for sperm to meet egg.

Also, by performing myofascial work to the pelvis, abdomen, and pelvic floor, blood flow can improve aiding in the function of the reproductive organs. Lastly, if you are experiencing pain with intercourse PT can help, which may make it possible to have sex more regularly to aid in conception.

Constipation

Did you know that 16% of all people and 33% of people 60 and over suffer from chronic constipation? Drinking enough water, eating a good amount of fiber, and regular exercise are all great ways to help treat and prevent constipation. Sometimes this is not enough though.

Many people do not know that physical therapy can help you poop. Sometimes soft tissue restrictions in your abdomen can limit passage of a bowel movement through the colon. Also, many people suffer from something called dyssynergia. This is when your pelvic floor muscles (the muscles that you use when you poop) contract instead of relaxing. Physical therapy can help with retraining these muscles to work correctly and work on releasing any soft tissue restrictions that may be slowing the transit of your bowel movement.

Tips: 

  • Using a toileting stool can help make having bowel movement less difficult. By using a stool to get your knees above your hips, you change the angle of the rectum making it easier to get the bowel movement out. If you often strain to have a bowel movement, this might be a great thing to try!

Amazon.com: Step and Go LLC Toilet Stool 7” New – Proper Toilet Posture for Better and Healthier Results : Health & Household

Exercises:

Tailbone pain

Tailbone pain is pain in the region of the tailbone (coccyx). Many patients will complain of pain following prolonged sitting, pain with going from sit to stand, or pain at the end of a bowel movement. This can occur following childbirth. It also can occur following a fall on your bottom and is common in cyclists.  Tailbone pain is more common in women than men.

This issue can be due to a problem with the mobility of the coccyx or the structures that attach to it. Many of the muscles of the pelvic floor attach to the coccyx, so, if you are experiencing tailbone pain, you may benefit from seeing a pelvic floor PT.

Pelvic Canister & Pelvic Floor Illustration

Pelvic Canister & Pelvic Floor Illustration

Exercises: 

Return to Physical Activity

While most women are eager to return to pre-baby workouts ASAP, it’s important not to push your healing body too much. To make things easy, we have included our postpartum exercise recommendations below. 

What to Avoid first 6 weeks to 4 months postpartum

  • Hard Plyo exercises- Jumping jacks, Burpees, Running up Stairs 
  • Running
  • Hard Biking/Hard swimming
  • Front Ab exercises: Planks, Sit ups, V-sits, roll downs, Leg lifts, or anything that makes the abs “bulge”. 

Safe Cardio 6 weeks to 4 months postpartum

  • Keep your intensity to 25%-50% of what would feel really intense or hard
  • Walking, Elliptical, Bike (with good posture) and Swimming (with good posture)
  • 10 to 30 mins per session
  • Start with 5 to 10 mins then reassess. 
  • Focus on your breathing and stay tall. Do NOT pull in your belly button or clench your pelvic floor.

Postpartum Belly Band use: 

We often get asked about using Belly Bands to support your belly after birth. Belly Bands should be used with caution because they can increase the risk for pelvic organ prolapse. If you feel like your belly needs support it’s best to get an evaluation by a pelvic floor physical therapist to make sure that you won’t be doing more harm than good.

Resources

Physical Therapy Evaluation

WholeBody has a comprehensive pelvic floor program and we are here to support you in any way. Once we do an evaluation, we can develop a customized exercise program to work toward your specific goals, ease you safely back into workouts, and provide you with any hands-on therapeutic techniques that may be needed.

If you would like an appointment with a physical therapist, feel free to email Rebecca at Rebecca@WholeBodyFix.com to talk more about what you are experiencing and how we can help. 

The Running Program

We LOVE helping women resume running SAFELY! To this end, we work hand and hand to make that happen. First Stephanie (our pelvic floor PT) works to heal your pelvic and abdominal muscles. Just before you are ready to transition to Rebecca (our certified running coach and postpartum corrective exercise specialist) Stephanie will assess 3 key areas to determine if your pelvic floor is ready for the loads that come with running.

At that point, Rebecca will assess overall strength and biomechanics. She will develop a customized exercise program to get your body running-ready as well as prescribe a 100% customized training program that is tailored to your changing needs week to week. 

Pelvic Floor Yoga Workshop

Yoga is a great option for getting back to activity postpartum. (Really, yoga is great for everyone, postpartum or not, male, female, any age…We LOVE yoga!) This workshop will provide education on how your body may be different from pre-pregnancy, what to avoid, and what are the best poses and exercises to help get your pelvic floor, and inner core working at their best to provide support and stability so you can rock your postpartum period! 

Email Rebecca@WholeBodyFix.com to find out when our next Postpartum Yoga workshop will be. 

Birth prep session

Childbirth is such an exciting event and is often likened to running a marathon. What is so interesting though, is that so many women go into childbirth without much preparation. Especially in our ever more sedentary society, it is so important for women to learn how to move, position, and prep their body during pregnancy to help aid in a positive birth experience.

In our birth prep sessions, Stephanie will provide strengthening exercise, stretching, relaxation techniques, and manual techniques to ensure your pelvis is in an optimal position. These sessions also include labor position education so you can go into your birth knowing your body is prepared.  

Bottom line, if you suffer from any of the above conditions, there is help available to you! You do not have to “just live with it”!!

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