Heal Postpartum Pain and Incontinence

A women’s health physical therapist, I see many women devastated by painful sex, urinary incontinence, and joint pain after childbirth. Please know that there is hope, there is help—in most cases, there is even a cure. And it doesn’t involve drugs or surgery.

You’re about to learn three “secrets” that few pregnancy books talk about—and few doctors know about. In fact, they may be the best-kept secrets with regard to treating vaginal pain, incontinence (urine leakage), and joint pain after giving birth.

1. After childbirth, you don’t have to live with pain and incontinence.

2. Drugs and surgery are not the only available treatments.

3. Pelvic floor physical therapy—a specialized type of physical therapy—can significantly relieve or eliminate problems following delivery. Growing numbers of studies are proving its effectiveness, and growing numbers of new moms are testaments to its success. The American Physical Therapy Association even created the Section on Women’s Health, which is devoted to this new specialty.


Vaginal pain

It’s normal to feel vaginal discomfort the first few times you have intercourse after delivery. (Tip: Don’t push past your comfort level, or the discomfort may turn into pain.) The culprit may be unhealed vaginal tears, episiotomy scars, a forceps or vacuum delivery, the baby’s pressure on the pelvic nerves during childbirth, sexual abstinence, or low estrogen levels during breastfeeding.

If your pain persists, talk to your doctor. If your doctor tells you prolonged vaginal pain is “normal” and “wait for it to go away,” suggest pelvic floor physical therapy. If your doctor hasn’t heard of it, refer her or him to the resources at the end of this article.


How pelvic floor physical therapy can help

Your physical therapist will use hands-on techniques to release, stretch, balance, and reduce pain sensitivity in your pelvis, abdomen, back, legs, and (when you’re ready) vagina. She may use ultrasound or cold laser to heal any vaginal tears or thick, sore scars.

Exercises are vital. Your therapist will give you exercises to stabilize your core; improve your posture; and stretch and strengthen your abdomen, back, hips, and legs. She’ll also teach you exercises for your pelvic floor: first, to relax your muscles, promote blood flow, and increase vaginal elasticity; then, to tone your muscles. Pelvic floor exercises can be tricky, and many women do them incorrectly. To teach you proper technique and to track your progress, your physical therapist may enlist safe, painless biofeedback.

When you’re ready, your therapist may introduce dilators to stretch, and decrease pain sensitivity in, your vagina.


Incontinence

Some new moms develop stress incontinence: urine leakage when they cough, sneeze, cry, laugh, lift, or exercise—in other words, whenever they put pressure on their bladder, abdominal muscles, or pelvic muscles. Their reduced bladder control stems from weakened or injured pelvic floor muscles (a result of pregnancy or childbirth); injured pelvic nerves; or diastasis recti, a common condition in which the growing fetus stretches the mother’s abdominal wall until bands of muscle separate. Fortunately, diastasis recti usually heals on its own. When it doesn’t, incontinence may result.


How pelvic floor physical therapy can help

Your physical therapist will use gentle hands-on techniques to stabilize your pelvic, abdominal, and back muscles. She’ll teach you exercises to stabilize your core; improve your posture; and strengthen your abdomen, back, hips, and legs. If you have diastasis recti, she’ll give you specialized abdominal exercises—traditional sit-ups won’t help and may even hurt. She may add safe, painless biofeedback training to guide pelvic relaxation or toning exercises and to reeducate the muscles that control urination. If you can’t recruit the correct muscles, she may “jump-start” them with therapeutic electrical stimulation (e-stim).


Joint pain

New moms may have back, hip, pubic bone, or neck pain—even wrist pain from carpal tunnel syndrome or De Quervain’s tenosynovitis. There are several possible causes: the physical strain of having carried a growing fetus; the pregnancy hormone relaxin, which relaxes ligaments; diastasis recti; the rigors of labor; and the strain of holding and carrying a baby.

How pelvic floor physical therapy can help

To rehabilitate your postpartum body, your physical therapist may use core stabilization, stretching, and strengthening exercises; hands-on techniques; posture and movement retraining; ultrasound; cold laser; relaxation techniques; and hot and cold packs. She’ll tailor the exercises to a body recovering from childbirth, and she’ll teach you how to nurse, burp, and hold your baby in ergonomic, body-friendly ways. She’ll also show you how to avoid a common trap: doing core exercises incorrectly and straining your pelvic floor.

Raquel Perlis