Any woman who has experienced childbirth will tell you her body is never quite the same afterward. Even after the six-week recovery period, many women find things aren’t quite back to normal. You may never look exactly like you did before becoming pregnant, but if you take care of yourself as well as your baby, you can be happy with the new you.

Physical therapy can help restore muscle function after the nine-month “athletic event” of pregnancy and childbirth.

Over time, women’s bodies usually naturally recover from the effects of pregnancy.

“In some post-pregnancy women, muscles have become so weakened, over-worked, or damaged they may need to be re-trained to function properly,” says Jessica Woodman, DPT, a physical therapist specially trained in women’s services who practices at Intermountain Riverton Hospital.

Physical therapists are trained to restore muscle function, and some receive additional training to help with women’s issues including those related to pregnancy and childbirth, such as overly separated abdominals or pelvic floor muscle disorders.

“If you’re having bladder problems or pelvic pain after childbirth, you may benefit from pelvic floor physical therapy,” Dr. Woodman adds.

Bladder problems and pelvic pain are common, but not normal symptoms after childbirth and may indicate you’re among the one-third of U.S. women with a pelvic floor disorder.

Other factors besides pregnancy that contribute to pelvic floor disorders include aging, obesity, chronic coughing, constipation, and pelvic surgery. 

Pelvic floor disorders are especially common if you’ve given birth more than once or to twins or multiples. Utah’s high birthrate means many Utah women are in this category.

Common symptoms of pelvic floor muscles not functioning properly:

• Leaking urine when you cough, sneeze or do exercise that involves running or sudden movement — which is called stress incontinence.
• Increased urinary frequency, or difficulty emptying bladder
• Pain in the pelvis, abdomen, low back or tailbone
• Pain during intercourse or sexual dysfunction
• Bowel issues
• Pelvic organ prolapse — when your bladder or uterus drops and presses against your vagina.

If you’re having bladder problems or pelvic pain, or have abdominal muscles that remain separated, consult with your doctor or a physical therapist who specializes in women’s issues.

Where are the pelvic floor muscles?

“The pelvic floor muscles are like a ‘sling’ from the front of the pelvis back to the tailbone. These muscles support the pelvis and its internal organs and openings,” says Dr. Woodman. “They’re the muscles you use to stop urination midstream.”

Pelvic floor physical therapy may include strengthening exercises, such as kegels, as well as surrounding core and hip musculature. Kegel exercises are the repeated tightening and releasing of the pelvic floor muscles for a few seconds. They can be done while standing, sitting or lying down. They were developed in the 1940s by Arnold Kegel, MD. These exercises can be difficult to perform correctly. A physical therapist can teach you proper technique and recommend treatment for your particular case.

Other related exercises include:

• Relaxation exercises
• Re-educating the muscles
• Biofeedback therapy, which uses electrodes to externally measure muscle activity
• Manual techniques
• Patient education about the diagnosis

Is pelvic floor physical therapy effective?

According to medical studies, pelvic floor muscle training combined with bladder training effectively resolves urinary incontinence for most women.

Studies also show pelvic floor therapy can also help reduce pelvic pain.

In some cases, a pelvic floor disorder and its symptoms may be severe enough that surgery to repair the weakened muscles may be recommended, for example in the case of pelvic organ prolapse (when your bladder or uterus drops and presses against your vagina).

What does a pelvic floor physical therapist do?

• They’re specially trained to assess pelvic floor muscle tone, pain referral points, muscle strength, and coordination.
• They develop a specific treatment plan to help strengthen and restore function of pelvic floor muscles, which you can follow in the therapy setting and at home.

Larger than normal abdominal separation: another common post-pregnancy problem.

During pregnancy and childbirth the fibrous tissue, which attaches the right and left abdominal muscles, begins to thin and separate to allow for the growing baby and for delivery.

After childbirth and when hormone levels return to their pre-pregnancy levels, the gap between your left and right abdominals should begin to return to normal. Sometimes it becomes so stretched out, it loses its elasticity and you’re left with a larger-than-normal gap, or diastasis recti. That may be a reason your lower tummy protrudes. 39 percent of women still have abdominal separation at six months post-partum according to a 2015 study.

Women with one or more of these factors have a higher risk of diastasis recti:

• They’ve had more than one baby
• They’ve carried twins or multiples
• They’ve performed unsafe abdominal exercises while pregnant or postpartum
• They have a petite body size
• They gave birth later in life
• They have poor muscle tone
• They haven’t exercised consistently
• They have a history of an umbilical or ventral hernia or pelvic instability

Signs your abdominals may be overly separated after pregnancy

• You have larger than normal separation between left and right abdominals
• Your tummy protrudes below the naval

Your physician or a physical therapist can determine if you have an abdominal separation that measures larger than normal and discuss whether physical therapy could help.

To get a general idea if you may have diastasis recti, lie down with your knees up and place your fingers vertically just below your naval. Then lift just your head, not your shoulders, and see if your abs separate more than two finger-widths. 

Are abdominal exercises effective in treating diastasis recti?

“It’s important that women do the right kind of abdominal exercises using the proper technique to treat diastasis recti,” says Dr. Woodman. “Doing crunches or other exercises improperly may actually make it worse. It’s best to start with basic strengthening exercises for the deep core muscle, the transversus abdominis, which will allow good core strengthening without further damage.”