Pelvic floor incontinence after childbirth can cause a number of problems for women. That includes pelvic pain, voiding and defecation problems, pelvic organ prolapse, and sexual dysfunction. These are not just an annoyance but can lead to health risks over time. There are various goals aimed at helping women to see improvement, and physical therapy is at the heart of the process.

Understanding Pelvic Floor Incontinence After Childbirth

The pelvic floor is a group of muscles, tendons, ligaments, and nerves that create a base for the pelvic area. While both men and women have this, in women, these muscles and connective tissues can become stretched out, uncomfortable, and lacking in proper function after childbirth.

For women, the pelvic floor holds the bladder at the front, supports the uterus, and keeps the vagina and rectum in place at the back. The muscles attach to the pubic bone at the front and the tailbone. The pelvic floor plays an important role in holding bladder and bowel control. In some cases, women suffer pain if these muscles are too tight, which can cause pain during intercourse. If too loose, they may contribute to incontinence.

Studies indicate that pregnancy itself, along with the process of childbirth, can cause pelvic floor incontinence to develop. This is especially true for the first child, which can create significant changes to the pelvic floor. This is due to the progressive increase in the volume of the uterus that happens naturally during pregnancy to accommodate the growing child. This leads to structures being overloaded and stretched significantly.

When delivery occurs, the child moves through this area, causing a stretching of the pelvic floor. For many women, this muscle damage simply improves over time. However, for others, the muscle damage doesn’t improve after childbirth, and connective tissues may remain in the outreached, prolapsed position.

The development of this incontinence is enough to have some studies looking at whether cesarean delivery is a better option for some women at risk for this condition. Those studies found that there is a lower risk of stress urinary incontinence with cesarean delivery, leading to lower risks of pelvic organ prolapse, overactive balder, or pelvic organ prolapse. However, there are significant other risk factors with cesarean birth that cannot be overlooked before considering this option.

Improving Pelvic Floor Incontinence

After giving birth, a woman’s body takes a significant amount of time to heal. However, it doesn’t always simply go back to how it was on its own. It needs support and proper exercise to ensure the best possible improvement.

Pelvic floor physical therapy may provide the solution that many women need. Consider, for example, an injury to the leg. If the muscles in the leg suffer damage from a sprain or strain, it may be necessary to consider physical therapy to get those muscles back into their proper position to ensure the leg can function as it should over time. The same concept applies to the muscles, tendons, and ligaments in the pelvic floor.

However, there’s more to pelvic floor physical therapy since it’s not a simple process, requiring a professional to aid in the process or the education in how to build up those muscles again.

It’s important to note that some types of pelvic floor conditions may require surgical procedures for repair. These are rarely the first step but may be necessary for those with extensive damage and numerous symptoms.

Can physical therapy actually work to improve pelvic floor incontinence?

It’s a big question, especially for women who are battling numerous symptoms. Studies indicate that it can provide a significant amount of improvement. Physical therapy for the pelvic floor may help with the functional retraining of those muscles. In doing so, it may help to:

• Improve pelvic floor muscle strength
• Improve muscle power
• Enhance muscle endurance to minimize difficulty with holding
• Improve relaxation of these muscles when overstrung

When these muscles improve, they are able to help support the bladder and other organs, providing less risk of incontinence to occur. As a result, many professionals recommend physical therapy as the first line of treatment for most types of pelvic floor disorders.

What Does Pelvic Floor Physical Therapy Involve?

An initial appointment is the first step in getting physical therapy in place. During this time, individuals work privately with their instructor or therapist to talk about their symptoms. It’s a good time to ask questions and better understand what to expect.

During treatment, exercises are used based on a person’s specific symptoms. Most of the time, this includes exercises for the pelvic floor muscles, movement coordination, and manual techniques. Some electronic therapies may be used. One such therapy is the use of biofeedback training, which can help patients visualize the pelvic floor activity, helping to improve functionality.

Advancing treatment is making a difference

The goal is always to provide specific treatment for that patient’s specific needs. For example, in some situations, the sacral nerves S2-4 that are in the pelvic floor region may need help to re-learn how to function properly. To do this, electrical stimulation (that does not hurt) is used to help teach these nerves and muscles how to function properly again.

In some cases, the use of internal weights can help to build up the strength of the muscles. Dilators may help reduce tension and pain during sexual intercourse and help with overactive bladder and bowel movements.

Also, new technologies, such as the use of ultrasound, are helping to provide improvement. Pelvic floor training with the use of ultrasound provides better insight to providers to create custom treatment plans to meet the needs of the individual.

Finding the Right Type of Treatment for You

If you are struggling with pelvic floor incontinence after childbirth, it’s important to take action to find relief. This type of problem does not improve on its own, but you may see significant improvement with physical therapy.