Why pelvic floor physical therapy?
In the United states, standard postpartum care includes a single 6 week visit to check on the woman’s uterus, coo at the baby, and ask a few questions to check on the woman’s mental health. Sometimes the provider my check for rectus diastasis, but usually not. Sometimes the provider may ask the woman to bear down or cough to check for prolapse, but often not. Sometimes the provider may as the woman to contract her pelvic floor muscles, but this is not a pelvic floor muscle evaluation.
In France, standard postpartum care includes a full pelvic floor exam and 10-20 physical therapy sessions including pelvic floor treatment to address muscular and functional deficits. This includes every woman with every pregnancy.
Often, I am asked why women should have pelvic floor physical therapy postpartum. Some reasons are more obvious than others. If a woman is having pain with vaginal penetration (sexual acts, tampons, medical examinations), scar pain, or incontinence, these are all symptoms that demonstrate the pelvic floor is not functioning normally. Did you know that low back pain, pelvic girdle pain, or general feelings of weakness are also signs that the pelvic floor is not functioning normally?
In pregnancy, the pelvic floor muscles can become overstretched and over worked. The uterus has a growing baby inside and on top of the pelvic floor muscles. Increased mobility of the pelvis means the pelvic floor muscles work hard to create stability as the woman moves through her day.
In delivery, the pelvic floor muscles are stretched to their absolute maximum, and often tear. An episiotomy or grade 2, 3, or 4 tear is a tear to the pelvic floor muscles. If you still doubt that every woman should have pelvic floor physical therapy, then consider it in comparison to other muscles of the body. Name any muscle that can be torn apart, sewn back together, and then function effectively without specialized care.
Could you imagine someone not receiving physical therapy after tearing and undergoing surgical repair of their quadriceps muscle? What about tear and repair of the biceps? hamstring? achilles tendon?
When muscles are torn, specialized care is needed to ensure recovery and good function in the future.