It is with great pleasure that I introduce Birthside’s first guest blogger! Meet Carolyn Pridham, registered physiotherapist at Body Quest in St. John’s, NL – here to give us the low down on physiotherapy for the postpartum pelvic floor.
A healthy pelvic floor is made up of muscles, connective tissue, and nerves, and is important for supporting pelvic organs, maintaining continence, and facilitating birth. During pregnancy, the pelvic floor tissues are under constant tension. If the pelvic floor is overstretched or damaged during delivery, this can cause pelvic floor dysfunction. Symptoms may include urinary incontinence, pelvic organ prolapse, or even pelvic pain, which can include dyspareunia (pain with intercourse) or perineal pain after an episiotomy.
So where does Physiotherapy come in?
Pelvic Health Physiotherapy is important to identify underlying issues in the pelvic floor to help prevent future pelvic floor dysfunction. Physiotherapists have many techniques to help overcome any of the symptoms indicated above. The most commonly talked about pelvic floor exercise is the infamous “Kegel,” but is this treatment method indicated for everyone post partum?
To Kegel or not to Kegel? That is the question!
A common misconception is that every woman who experiences incontinence after childbirth should do her Kegels. Unfortunately, it’s not that simple. Incontinence can be caused by increased or decreased tone of the pelvic floor. When the pelvic floor muscles have too much tension, urgency and increased frequency of the bladder can be the result. Hypertonic muscles can also cause pelvic pain and can cause dyspareunia. Conversely, when the muscles have low tone, they can cause stress incontinence and pelvic organ prolapse. It is also possible to have a combination of both hyper and hypotonic muscles. This is why in some cases Kegels can actually do more harm than good. If Kegels are indicated in a patient’s exercise program, they are often not performed correctly. A trained Pelvic Health Physiotherapist can determine if Kegels are appropriate and if they are being done properly through internal examination. Physiotherapists trained in rehabilitation of the pelvic floor have been determined to be the most suitable first line of defense, before surgical consultation, for stress, urge, and mixed incontinence in women.
So what should I expect?
Anyone can come for an assessment after childbirth, as women feeling fine on the outside are unable to see what is happening inside. Just like any examination in physiotherapy, every clinician has their own way of doing things. Typically, an initial assessment will include a detailed patient history (as lifestyle can greatly impact the status of the pelvic floor) and an examination of the low back, pelvis, lower extremities, and abdomen. After an external examination, an internal pelvic exam is necessary to test tissue integrity, muscle tone, strength, endurance, and coordination, as we cannot reach the pelvic floor musculature externally. Subsequent follow up treatments may include education, modalities, manual therapy, soft tissue release, and exercise prescription. Even someone who had the “perfect” pregnancy and delivery can benefit from seeing a Pelvic Health Physiotherapist for guidance on return to exercise and sport, ensuring safe practice and good pelvic floor health in the future.
92 Elizabeth Ave
St. John’s NL A1A 1W7