Mary Brier, age 35, learned about postpartum pelvic floor issues in physical therapy (PT) school, but it wasn't until she had her baby that she realized the significant impact pregnancy would have on her body.
“I thought my experience with a cesarean would be different from my sister Katie’s. She had problems after a vaginal delivery,” recalls Mary, a Doylestown Health physical therapist.
“I expected my body would come back gradually and naturally. However, after a few months, my incision felt tight. It hurt when I moved a certain way and was sensitive when clothing rubbed against it. My core felt unstable because I could not engage my abdominal muscles and my lower back ached,” explains Mary, who also had anal and vaginal discomfort.
Healing After a Vaginal Delivery
Mary’s sister Katie Brier, 34, experienced a vaginal tear at age 25 — a common occurrence, especially with a first baby. The tear did not heal correctly, so her doctor reopened the wound to have it re-heal.
Unfortunately, as time passed, Katie began to experience sharp, shooting vaginal pain. “I also had rectal pain with bowel movements, from working out, or even from sitting on a hard surface.
“When I mustered the courage to talk to a healthcare provider about my vaginal pain, the doctor was dismissive, telling me it was normal and not to worry. So, I just lived with the symptoms for eight years. It was hard on my self-esteem,” she says.
Pregnancy Changes
“Pelvic floor dysfunction is a quality-of-life issue that affects more than half of the women in the United States,” says Dr. Alex Soriano, a board-certified OB/GYN and urogynecologist specializing in pelvic floor disorders."
“Many women experience scar tightness, restriction with movement, or weakness in the abdomen after a cesarean,” says Jenna Boyes, Doylestown Health physical therapist and outpatient clinical lead pelvic floor specialist. “And, if you have a tear during a vaginal delivery, it is crucial that you see a urogynecologist as quickly as possible for scar management and healing.”
You Don’t Have to Live with Postpartum Symptoms
Jenna says you don't have to live with vaginal pain, urine leaks, fecal incontinence, or painful intercourse just because you had a baby. “Your vagina should not hurt when you insert a tampon, and your back shouldn’t hurt when you bend over to pick up your child.”
Almost every woman can benefit from pelvic floor PT after giving birth. The sooner you seek treatment from a prenatal pelvic floor specialist and/or a urogynecologist, the better the outcome.
Dr. Soriano recommends having a conversation with your prenatal care provider before you deliver because some easy interventions early on can significantly reduce your chance of having leakage, pain, and dysfunction later.
Understanding Your Pelvic Floor
The vagina and rectum have a complex muscle system called the pelvic floor that helps support:
- Bladder and bowel control
- Sexual function
- Stability
- Movement
- Back and hip function
The nerves of the pelvis can cause itching and stabbing pain.
Pain That’s Hard to Talk About
Women tend to stay silent about discomfort after delivery for a variety of reasons, including:
- Lack of awareness
- Putting aside your own health and well-being as you focus on caring for your baby
- Thinking postpartum discomfort is normal, even years after having a baby
- Feeling embarrassed to talk about symptoms
- Being dismissed when you open up about your pain
Getting Mary Back on the Move
Weeks after her cesarean, Mary had surgery to remove a twisted ovary. Therefore, she was recuperating from the impact of a pregnancy and cesarean on her body, along with another abdominal surgery.
As she recovered, she realized she was unable to engage her abdominal muscles. Since the baby doesn't pass through the birth canal, many women think they can't experience symptoms after a cesarean, but as upright beings, our abdominal muscles are connected to our pelvic floor," Jenna explains.
“With weakened abdominals, I relied on other muscles for support,” says Mary. “In therapy, Jenna helped me re-balance and engage my core. She massaged and stretched my incision, relieving tightness and keeping nerves from becoming stuck in my scar and used cupping for static stretches for a deep release of scar tissue.”
Pain-free after PT, Mary is back to running, riding her Peloton® bike, and lifting kettle bells. She has a stable core, which is important as she works with patients and keeps up with her 17-month-old baby boy Uisdean.
An Answer for Katie
“When I announced I was pregnant with my second baby, Mary was so excited. She said, ‘You’re going to do pelvic floor after you have this baby and it’s going to be great!’” Katie recalls. Mary had suggested pelvic floor therapy to me long before she tried it, because I had confided in her about my symptoms over the years.
“I wasn’t sure anything could be done about ongoing issues from eight years ago when my daughter Sylvia was born, but the Postpartum Recovery Program was life-changing,” says Katie, who started working with Jenna around six weeks after she had her second baby, a girl named Hazel.
“After being dismissed by others after my first baby, Jenna validated that my symptoms were due to old pelvic floor injuries and scar tissue on my vaginal wall. Some of my muscles were tight, others were overcompensating for weaker ones, and some weren’t working at all.”
Jenna worked with Katie to stretch her scar tissue. She also designed a personalized program of stretches and exercises, which Katie does at home, and with Jenna at our Clark Outpatient Rehabilitation Center.
“My pain is completely gone,” says Katie.
Physical Therapy for Postpartum Wellbeing
“Pelvic floor physical therapy is the cornerstone of treatment for pain, and most patients improve symptoms with physical therapy alone,” says Dr. Soriano. “By expanding access to a pelvic floor specialist early in the process, we hope to prevent future problems and reduce the need for surgery.”
A physical therapist will design your exercise program based on your symptoms and then supervise one-on-one sessions in the gym and the exam room to help you meet your goals.
Expanding Treatment Options with Urogynecology
Having a urogynecologist at Doylestown Health means that women in our community have access to a broad range of pelvic floor therapies including the following:
- Medications, suppositories, and creams
- Botox injections for overactive bladder or pelvic floor dysfunction
- Neuromodulation (an implantable device that stimulates the nerves in the bladder and rectum)
- A pessary (supportive device for a prolapsed organ)
- Acupuncture therapy
- Dietary regimens
- Trigger point therapy (for incisional pain and neuropathy)
- Surgery
Call 215.345.2894 or visit Pelvic Floor Therapy - Women | Doylestown Health
About Clark Outpatient Rehabilitation Center
The Clark Outpatient Rehabilitation Center offers physical, occupational, and speech therapies as well as hand therapy, lymphedema therapy, and pelvic floor rehabilitation, and programming for neurological impairments with ample space. Its location within steps of Doylestown Hospital—and convenient parking—on the health system’s flagship campus is in careful consideration of facilitating patient access to these popular and critical services.
