Pain and Incontinence During Pregnancy and After Childbirth

Times have changed since your mother had you. These days, women don’t have to “just live with” vaginal pain, urinary incontinence (leakage), or joint pain during pregnancy and after delivery. That’s because physical therapy has changed too. It’s no longer just for joint problems—it’s also a safe, proven treatment for problems that can afflict pregnant women and new moms. This new type of physical therapy is called women’s health physical therapy or pelvic floor physical therapy. After treatment, most women feel significantly or completely better.

After childbirth

Vaginal Pain

It’s normal to feel vaginal discomfort the first few times you have intercourse after childbirth. The culprit can be unhealed vaginal tears, episiotomy scars, a forceps or vacuum delivery, the baby’s pressure on the pelvic nerves during delivery, sexual abstinence, or low estrogen levels during breastfeeding. If your discomfort or pain persists, it may be time for pelvic floor physical therapy.

Raquel and her staff use hands-on techniques to release, stretch, balance, and reduce pain sensitivity in your back, pelvis, vagina, abdomen, and legs. We may use ultrasound or cold laser to heal any vaginal tears or any thick, sore scars. We also give you exercises to stabilize your core; improve your posture; and stretch and strengthen your abdomen, back, hips, and legs. We teach you pelvic floor exercises to relax your pelvic muscles, promote blood flow, and increase vaginal elasticity. In many cases, we add pelvic toning exercises. Pelvic exercises can be tricky, and many women do them incorrectly. To teach you proper technique and to track your progress, we often enlist safe, painless biofeedback.

When you’re ready, we 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. Their reduced bladder control stems from weakened, overstretched, or injured pelvic floor muscles (a result of pregnancy or delivery); 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.

Our physical therapists use gentle hands-on techniques to stabilize your pelvic, back, and abdominal muscles. We teach you exercises to stabilize your core; improve your posture; and strengthen your abdomen, back, hips, and legs. If you have diastasis recti, we give you specialized abdominal exercises—traditional sit-ups won’t help and may hurt. We usually add biofeedback to guide pelvic relaxation or toning exercises and to reeducate the muscles that control urination. If you can’t recruit the correct muscles, we 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. The culprit may be the pregnancy hormone that relaxes ligaments; diastasis recti; the rigors of labor; or the physical strain of carrying the baby, both before and after birth.

To rehabilitate your postpartum body, our physical therapists employ core stabilization, stretching, and strengthening exercises; hands-on techniques; posture training; ultrasound; cold laser; relaxation techniques; or hot and cold packs. We tailor the exercises to a body recovering from childbirth, and we show you comfortable, body-friendly positions for nursing, burping, and holding your baby.

During pregnancy

During the second or third trimester of pregnancy, some moms-to-be develop vaginal pain; incontinence; or pain in the back, hip, or pubic bone. The culprit can be hormonal changes, the baby’s weight and pressure, diastasis recti, shifted organs, postural changes, or tissue swelling. Raquel and her staff use the same effective techniques we use for postpartum women—but we avoid ultrasound, cold laser, biofeedback, and e-stim. These treatments are not recommended for pregnant women.