Pelvic Floor Therapy & Postpartum Recovery
Plus an interview with Physical Therapist Samantha Nidenberg Coxhead
Among the many surprises after giving birth, the one that stood out to me the most was just how much everything hurt and how arduous recovery was. Like many Instagram-influenced moms, I believed that my body would be back together by that magical 6 week check-up in which my doctor would give me the greenlight to start exercising again and go about my normal life. After a marathon 48 hours of labor though, followed by pushing out a 9+ lb baby, I wasn’t sure I’d physically recover in 6 months, let alone in 6 weeks.
Fortunately, my doctor prescribed a course of pelvic floor therapy. I went in not knowing what to expect, but I came out of it with a deeper understanding of how my muscles interact with each other and a renewed confidence in myself. Those feelings of renewal are very much due to my wonderful physical therapist, Samantha Nidenberg Coxhead, who made our biweekly sessions not only physically rewarding, but also mentally soothing. Samantha treats her patients with zero judgment, which made it easy to share intimate details of my physical challenges and allowed her to determine the best treatment plan for my recovery.
Below, I interviewed women’s health specialist Samantha Nidenberg Coxhead, PT, DPT, to share the basics of pelvic floor therapy, and what to consider if you would like to seek treatment. If you think pelvic floor therapy is right for you, talk to your doctor about local options and the best next steps.
What is pelvic floor therapy? What parts of the body will you target?
Physical therapists are doctors that specialize in muscles, bones, joints, and connective tissues. There are dozens of specialties that physical therapists can get into, one of them is pelvic floor. Pelvic floor physical therapists work on the pelvis, spine, legs, and any muscles, connective tissues, and joints that are part of, or connected to the pelvis.
All humans have a pelvic floor. It is a group of muscles that act as a sling underneath your bladder, rectum, and (for women) your uterus. This group of muscles are deep core muscles and has 4 main jobs:
They help with controlling your core, torso, and hips.
They manage the pressure system in your abdomen. When we breathe, our lungs fill with air and our diaphragm (the muscle right under our lungs) pushes down into our abdomen, pushing our organs with it. Our pelvic floor responds and relaxes, elongating to prevent our organs from being squished.
They need to be strong enough to prevent the leaking of urine and feces.
They also need to be able to relax enough to make it so we can empty our bladder and bowels fully, have sex without pain, and climax internally or externally.
All physical therapists use a variety of methods to improve your symptoms and get you the best possible outcome. They use exercises to strengthen, stretches to lengthen, modalities like heat, ice, ultrasound, and electrical stimulation to help manage muscle function, relaxation, and pain, and manual therapy to work directly with impacted tissues.
Why should postpartum people consider getting pelvic floor therapy?
Carrying a baby is a lot of hard work. Your body goes through a lot of hormonal and physical changes. On top of that your body goes through a whole different process in giving birth. Whether you have a vaginal birth or a C-section, your body and its tissues are going through a new kind of trauma. If you injured or had surgery on your wrist, knee, foot, or hip, doctors would prescribe physical therapy. Today, more and more doctors are recognizing that they can do the same thing after birth. Pelvic floor physical therapy can be beneficial to make sure your body is recovering in the most effective and quickest way possible.
How do you know if you need pelvic floor therapy?
After giving birth, via C-section or vaginally, some symptoms can occur. They range from upper, mid and low back pain, pain with sex or orgasm, abdominal pain, pain with bowel movements, urine leakage, constipation, difficulty emptying bladder, clogged milk ducts, vaginal heaviness, and other symptoms. All of these symptoms, and more, can be improved by seeing a pelvic floor physical therapist. If you are experiencing a symptom that you did not have before getting pregnant or having the baby, you can try and find a therapist to help.
What does a typical session involve?
Each session is created to match a patient’s needs. Generally, all sessions include some kind of stretches, strengthening exercises, and assessment of painful body parts or muscles that you are working to improve. Some assessments are internal vaginal or rectal, depending on what is being assessed. Some are external, like when looking at abdominal separation or hip alignment. You are then given homework to work on to continue to improve your symptoms at home.
Should women who have a C-Section also consider pelvic floor therapy?
Regardless of whether you have a vaginal birth or a C-section, your body has gone through a lot of changes during and after pregnancy. Pelvic floor physical therapy is common for all postpartum mothers, but the type of treatment may vary depending on the type of birth you had.
How soon after giving birth can I start therapy?
Generally, a prescription to see a pelvic floor PT is written at your 6-week postpartum check-up. However, if you are in horrible pain, you can be seen sooner. Depending on your insurance, you can actually come to a pelvic floor PT without a prescription, and the therapist can send your evaluation to your doctor to get it approved.
Will I need to exercise at home too?
Strength is built over time and with continuous practice. Habits are formed and retraining is accomplished with repetition and consistency. On average, it takes an adult 400 attempts at a skill/task to make it a habit. When going through physical therapy, we focus on a few key things with patients: we want to build lasting strength, good habits, and retrain your body to return to your pre-pregnancy self. You will be given homework, and asked to continue a program on your own. In general, the more you work on things at home, the faster you continue to improve.Your exercise programs will be designed based on your needs and current level of function, and we will work with you to make the program as convenient as possible.
For some people it may not be possible to go to a specialist for therapy. Are there any techniques they can practice at home?
The 3 major things I would recommend all postpartum mothers, and people in general should do.
Get a stool for your bathroom. Elevating your knees above your hips, puts your pelvic floor in the most optimal position to relax and allows you to have a bowel movement and empty your bladder most effectively.
Diaphragm breathing, or belly breathing is one of the most effective ways to relax the muscles in your pelvic floor. This kind of breathing requires your abdomen to expand and get bigger when you breathe in, and contract and get smaller when you breathe out. Your chest should move very little. It can seem counterintuitive, but performing this kind of breathing for 3 minutes a day will help make it part of your normal breathing pattern. This breathing can be used to help manage tension and pain, as well as help with relaxation. You can even use this kind of breathing while trying to use the bathroom to help with bowel and bladder evacuation.
Your TA is your deepest core muscle. It is towards the side of your abdomen and goes from your hip bone all the way up to your ribs. It is the muscle that works with your pelvic floor to prevent urine leakage. It is naturally activated when you forcefully exhale. While laying on your back with your knees bent and feet flat on the table, take a deep diaphragm breath. As you exhale, purse your lips and push the air out with force, and at the same time try and bring your belly button towards your spine. This not only helps with vaginal pressure and urine leakage, but it can also help strengthen the rest of your abdominal muscles and repair any abdominal separation that occurred while you were pregnant.
How long will it take to see results?
Results vary depending on what someone wants to accomplish, when they start therapy, condition they are in when therapy starts, ability to come to sessions and continue to engage in their home exercise program. Some patients come for 20-24 weeks, and when they leave, are able to return to running 5-10 miles a day without symptoms. Some patients come for 4 weeks and feel good enough to continue on their own. The average length of treatment for postpartum patients is between 12-16 weeks.
Is pelvic floor therapy typically covered by insurance?
While this question always depends on insurance, pelvic floor physical therapy is generally covered by insurance if you have a co-pay or a deductible. The biggest issue tends to be the number of visits that insurance will cover and who provides the prescription for therapy. HMO plans require a primary care provider, while PPOs allow specialists like OBGYNs to send referrals. You can talk with any clinic you want to schedule with, and ask them if your insurance covers you.
Personal Recs from Chrissy
Here are a few things that have improved my life at home thanks to PT.
Lumbar support: My posture became terrible from leaning over to breastfeed and pump, but adding a back support pillow like this one or the Boppy really helped.
Back release: My favorite part of PT was stretching on the foam roller to ease my aching shoulders. I bought one for home and now lay on this long foam roller most nights to release my back and shoulder tension before I go to bed. Dick’s Sporting Goods also has a good one.
Bathroom stool: I became a step-stool convert after my PT recommended it. Life changing.
A weekly roundup of personal tips and helpful finds
Cozy Cardio is In: Fortunately for our postpartum bodies, it’s now cool to take it easy exercising. Leisurely cycling and hot mama walks are all part of this cozy cardio trend. (Glamour)
Gamify Babysitting: This mom offered the babysitter extra money if she chose to complete a list of chores. The more chores she completed, the more she got paid. Not the worst way to tackle your to-do list. (Today)
Kid’s Book Rec: I Love You Like No Otter. A sweet Baby & Me book just in time for Valentine’s Day.
Cook: This sheet pan baked feta from the New York Times is a favorite of mine. It’s a pretty straightforward recipe: You add some slices of feta cheese to a sheet pan with a can of chickpeas and a mix of veggies like tomatoes, shallots, and broccolini and you roast it for ~20 minutes at 400 degrees. Easy and healthy. (NYT Cooking)
Don’t forget to sprinkle it with olive oil before roasting! Photo: NYTCooking
This week’s mom win comes from Sirena J.
After 7 days of sleep training (and lots of crying), my son successfully slept through the night (11 hours!) after weaning him from the swaddle AND a middle of the night bottle. He also decided to roll over for the first time ever that same night and scared mom and dad, but we'll take the wins where we can get them!
Each week we’ll feature a mom win from one of our readers. If you have a win you’d like to share, please leave a comment below and we will feature you in an upcoming issue.
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