POSTPARTUM

PHYSICAL
THERAPY

It is beneficial for all new moms to have their pelvic floor

evaluated by a physical therapist after theyve been cleared to
resume sex and exercise.
This kind of early intervention can help address any concerns,
and ultimately enable new moms to return to functional and
active lives while possibly preventing future pelvic floor
dysfunction.

Pelvic floor dysfunction describes a wide variety of clinical

conditions involving impairment, separately or in
combination, of the nervous, muscular, and fascial elements of
the pelvic floor and perineum.
These include disorders of micturition, defecation, and sexual function
as well as organ prolapse and pelvic discomfort.

Pelvic Organ Prolapse - defined as protrusion of one or more pelvic

organs into the vaginal canal.
Uterine prolapse- occurs when the uterine cervix descends into the
vagina.
Rectocele, cystocele, and urethrocele - refer to bulging of the
rectum, bladder, or urethra into the posterior or anterior wall of the
vagina.

The exact cause of pelvic organ prolapse and the number of

women who develop it are unknown.
Weakening or loss of the noncontractile elements (visceral
ligaments, fascia) of the pelvic floor and perineum and
concomitant loss of pelvic organ support is the traditional
explanation , however, injury to the pudendal nerve and
denervation of muscles of the pelvic diaphragm and perineum
have also been implicated in the etiology of prolapse.
50% of parous women have pelvic organ prolapse to some
degree.
Conservative Treatment : Exercise & other techniques to
strengthen muscles of the pelvic diaphragm and perineum,
and surgery may be indicated in some individuals.

 Urinary Incontinence define as the involuntary

loss of urine so severe as to have social and/or hygienic
consequences.
true incidence is unknown
is more common in women than men, in older than
younger women, and in multiparous than nulliparous
women
Prevalence of urinary incontinence is estimated to be
1030% in females and 1.55% in males, aged 15 to 64
years.
Factors contributing to the development of urinary
incontinence:
prostatectomy in males, changes in hormone status and
vaginal delivery in females, and supraspinal neurological
lesions, advanced age, functional impairment, and drugs in
both sexes.

Vaginal delivery can damage the nerves to the pelvic

floor as well as the muscles, particularly the EUS.

Neurological lesions of the spinal cord or below the pons can

result in detrusor-sphincter dyssynergia -characterized by
lack of coordination between detrusor contraction and EUS
relaxation
Lesions above the pons may cause detrusor hyperreflexiacharacterized by loss of inhibition to the detrusor

Anorectal Incontinence - involuntary loss of

flatus (gas) to liquid or solid fecal material
More than any other type of pelvic floor
dysfunction, anorectal incontinence causes social
withdrawal and mental anguish, and it may be
(along with urinary incontinence) the single most
important factor in the decision to place an
individual in an institution
Urinary and anorectal incontinence have some
factors common to their developmentvaginal
delivery, supraspinal neurological lesions,
advanced age, functional impairment, and drugs.
Iatrogenic or parturient damage to the levator
ani, particularly the puborectalis, the EAS, and

Common postpartum
complaints
Urinary difficulties. Women with urinary incontinence leak urine when they
sneeze, cough, or run. Some women feel a frequent or sudden, urge to urinate,
even when their bladder isnt full. Others are unable to start the flow of urine at
will or empty their bladder completely when urinating.
Anal incontinence. Many postpartum women have difficulty controlling gas or
bowel movements.
Perineal pain. This symptom is common in postpartum women, especially those
who tore during childbirth or are recovering from an episiotomy. (The perineum is
the area of skin between the vagina and the anus.)
Pelvic pain. Some women have pain during sex for many months or even years
after childbirth. And some have chronic vulvar pain, burning or itching.
caused by tight pelvic floor muscles, which can lead to inflamed tissue and nerves.

Pelvic organ prolapse. When pregnancy and childbirth weaken the pelvic floor
muscles the uterus, bladder, and/or bowel can slip out of place. Rehabilitating
these muscles can help prevent or improve this condition.

Evaluation
Musculoskeletal Examination: This includes an assessment of structure, muscles,
tissue, and a manual evaluation of the pelvic floor muscles.
Diastasis Recti Examination: Patients with a diastasis recti are given specific
exercises to correct the problem.
Scar mobilization for Cesarean section, episiotomy, and other vaginal scars: Scar
tissue can cause persistent pain and lead to discomfort and pain with intercourse.
Manual PT for concerns of pain with vaginal intercourse or penetration:
normalize pelvic floor muscle tone, eliminate myofascial trigger points and decrease tissue
hypersensitivity with manual techniques that can successfully resolve pain with vaginal
intercourse or penetration

Pelvic Floor Muscle motor control exercises and training to treat urinary
incontinence:
Kegel exercises