Getting Your Pre-Baby Body Back

It’s not just about shedding weight; a return to wellness also involves your pelvic health

Having a child guarantees your life will change. But some of those changes don’t have to be permanent. 

As a woman progresses through pregnancy, her body shifts to accommodate a growing baby. Once she delivers, either vaginally or via Cesarean section, the body doesn’t always automatically re-shift and she may experience physical symptoms that could indicate potential health issues.

Standard postpartum care in the United States allows a new mom to see her gynecologist six weeks after the birth. About 40% of women miss this appointment, according to Justina Perry, PT, DPT, PRCP, a Certified Pelvic Rehabilitation Physical Therapist with Pelvic Health Rehabilitation Services at Southcoast Health in Dartmouth.

The Fourth Trimester

This important time in a woman’s recovery from childbirth is sometimes referred to as the fourth trimester and is endorsed by both the American College of Obstetricians and Gynecologists (ACOG) and the American Physical Therapy Association (APTA) as vital to postpartum care.

Without seeing a physician for follow-up care after delivery, many potential health conditions can go unresolved. They include pelvic health issues such as incontinence, diastasis recti (a separation of the abdominal muscles), painful intercourse, painful scarring from an episiotomy or C-section, or pelvic organ prolapse (a descent of the bladder, uterus or rectum), which can feel like a heaviness or pressure for some women.

“Prolapse can feel like something is falling out of you; some people say it feels like sitting on a tennis ball,” Perry says. Other postpartum issues include back pain, pubic bone pain and/or hip pain. “While these issues are common, they are not normal and should be addressed,” she adds. “As physical therapists trained in pelvic rehabilitation, we are the experts to address these problems.”

Many women don’t realize such health issues can be treated with physical therapy in their early stages. “A lot of women who come in for pelvic physical therapy in their menopausal years will say the problems first started after childbirth, but that they notice the problem more now,” Perry says.

Perry praises the concept of the fourth trimester, which encourages women to see their medical providers for comprehensive care at least twice — at three weeks and again before 12 weeks after giving birth. Ongoing medical care during the 12 weeks after birth gives new moms the opportunity to discuss any pelvic health issues (as well as other conditions such as postpartum depression). “If a woman is experiencing troublesome symptoms, her physician can refer her to a physical therapist who can treat the pelvic problems as the musculoskeletal injuries they are,” Perry says.

What Is Pelvic Rehabilitation?

The pelvic floor muscles sit at the base of the pelvis and support the bladder, bowel and uterus, controlling sexual function, orgasm, urine and bowel function. At a standard six-week postpartum visit, where a woman is typically cleared to resume sexual intercourse, it may be too early to know whether she will experience painful sex. Some women may not speak up at all about any pelvic pain at the six-week checkup, focusing instead on the new baby.

Pelvic rehabilitation is physical therapy for the pelvic muscles, says Janet Gillis, PT, WCS, a board-certified specialist in women’s health physical therapy at Southcoast Health’s Pelvic Health Rehabilitation Services. Treatments focus on a mix of exercise, manual therapy and teaching. “At an initial evaluation, a physical therapist will look for impairments of the pelvic floor muscles through a vaginal exam,” Gillis says. Such impairments can include pain, weakness or tight muscles. The exam also seeks to determine what is causing the issue.

“Above all, we are always teaching the patient to self-manage the condition, which is the essence of physical therapy — teaching patients to be independent and manage their conditions,” Gillis says. In Europe, such care is covered automatically by insurance; in the United States, patients need to ask their physicians for a referral to a pelvic physical therapist and be more proactive about getting care for the problem early on.

Above all, new moms should not accept pelvic pain or incontinence as a natural result of having a baby. “It is not normal,” Gillis says. “Addressing these conditions early on will help later in life as well,” in terms of avoiding future surgeries for advanced problems and improving quality of life.

“After the birth of a baby, you want to be active in your lifestyle and have a women’s health physical therapist help you address your goals and get your body back so you can keep being healthy,” Perry says. “This is important, and we want to help women achieve those goals.”

Find more information about pelvic health rehabilitation, including instructional videos, testimonials and other resources.