Amanda Wilde (Host): The pelvic floor is an important part of the body. It supports organs, circulation, continence, and many other functions, but it's one of those things you may not notice until you're pregnant. So today we'll talk about the effects of pregnancy on pelvic health with Darinda Dugas and Rachel Lucas, Pelvic Health Physical Therapists with Duly Health and Care. Welcome to Duly Noted, a health and care podcast.

I'm Amanda Wilde. Darinda, Rachel, great to have you both here.

Darinda Dugas, PT: Great. Thank you. I'm glad to be here.

Rachel Lucas, PT: Thank you. Thanks for the invitation.

Host: Darinda, you and Rachel, are both physical therapists. And many of us are unaware of pelvic physical therapy. So what specifically is pelvic health PT?

Darinda Dugas, PT: So pelvic health physical therapy tends to encompass a kind of a wide umbrella of different conditions. Pelvic floor therapists will often treat women who are pregnant, also in the postpartum period. There are also other conditions outside of pregnancy that affect both male and female pelvic floor function that can contribute to pain with everyday activities. It can contribute to either urinary or bowel loss or leakage and just sort of general stability for the pelvis which can contribute to things like low back pain.

Host: So pelvic health PT corrects those conditions?

Darinda Dugas, PT: Yes, pelvic floor PT is looking at the pelvic floor muscles which respond to physical therapy just the way any other muscles in the body would respond. They're just a little bit harder to get to and tend to control functions that most people don't talk about as frequently with other people.

Host: So Rachel, what postpartum health issues are addressed by pelvic health PTs?

Rachel Lucas, PT: So one of the main things that happens when a female becomes pregnant is we have extra hormones circulating throughout our body, which relaxes the ligaments that help stabilize the pelvis normally. With less of that ligament to support, the pelvic floor has to work even harder to take up the slack to keep a person upright as that fetus and uterus grows.

At the same time, the pelvic floor muscles lengthen and weaken as pregnancy progresses. And so due to all these changes that happen to the woman's pelvic floor, even before childbirth, the pelvic floor can then also be affected during childbirth, whether you have a vaginal delivery or a C-section, and can cause pelvic floor dysfunction.

Host: So Darinda, what are some of the most common pelvic floor issues that you see that women may experience after childbirth? And what are their potential long term effects?

Darinda Dugas, PT: So the one that is by far the most common and that gets joked about by many new mothers is the urinary leakage with coughing, sneezing, laughing, jumping, and those types of activities. That is probably one of the most common issues afterwards, and is one of the things that can be most easily treated with physical therapy.

 Long term, if you don't get treatment for it when it's just little leaks that are occasionally happening, it can progress to bigger leaks or more frequent leaks, leaking where the activity isn't as vigorous and can contribute to a lot more sort of social isolation and issues that way. Also for women who've had a vaginal delivery, if there was any tearing or an episiotomy, they can have some pelvic pain from that. That may interfere with return to intercourse with their partners. That can be something that lingers if it's not treated and doesn't necessarily get better on its own.

And though diastasis of rectus abdominis, which are the abdominal muscles, and the gap there that gets created by pregnancy, can also be treated as part of the pelvic floor rehabilitation. If you don't treat that early on, sometimes that can contribute to back pain and just a general feeling of weakness with a return to exercise or even child care activities as the baby grows and gets heavier when you're still lifting and carrying them around.

Host: So, like most things, it's better to treat this sooner rather than later. Rachel, we've been talking about what goes on during pregnancy and how physical therapy might be able to help with pelvic floor stuff, but we haven't talked about the how. So how can physical therapy help women address and manage pelvic floor dysfunction post pregnancy?

So a therapist trained in pelvic floor physical therapy will do a comprehensive assessment of not just those internal pelvic floor muscles, but also hip strength and core strength. But it is important to be able to assess those pelvic floor muscles internally so we can assess for their strength, their coordination, their endurance, so we can really tell what has changed during pregnancy.

And like we touched on, the sooner you get into a pelvic floor physical therapist, the better it is because again, if these issues are left unaddressed, they can become greater imbalances later on in life.

 Darinda, are there any specific at home exercises or techniques that can help strengthen or rehabilitate pelvic floor muscles either before or after childbirth?

Darinda Dugas, PT: You can do Kegels prior to pregnancy, during pregnancy, and immediately postpartum. Those are sort of the fancy name for pelvic floor exercises. It can be confusing for some women to know if they're using those muscles correctly. Cause when you do a pelvic floor contraction appropriately, you're not really able to see it because those muscles are underneath your pelvis.

For people who don't feel confident in their ability to do them correctly, getting an evaluation by a PT at any point can be helpful. There are some general cues about how to do them. But the pelvic floor exercises are typically the best way of preparing your pelvic floor for pregnancy and to rehabilitate it postpartum. In general, physical therapists will tell you that having a regular exercise program that includes some cardio, some strength based training, and some flexibility training is just a general good way of keeping your entire body in shape, and you can consider the Kegels or pelvic floor exercises to be a part of that whole body exercise program.

So the more fit in general you are, the better support the rest of your body is giving to your pelvic floor.

Host: So that really is an important part of keeping the pelvic floor functioning properly or at least helping it along. Along with those exercises, Rachel, that Darinda just described, are there any other lifestyle modifications we can make or habits that we can begin or end that would support optimal pelvic health during and after pregnancy?

Rachel Lucas, PT: Yes, definitely. Exercise like during the touchdown is a very important part of it. But a lot of items that we go over with our patients is really maintaining a healthy diet. Or if you can during pregnancy, start a healthy diet, but a lot of times it's hard to start it then. But, by minimizing the amount of weight that you gain outside that healthy range, this helps to minimize the stress on the pelvic floor.

Also t ouching on diet, eating a diet that's high in fiber is important because this helps to keep our body and our bowel schedule more regular and avoid constipation, which constipation can also increase stress on the pelvic floor. Drinking plenty of water to help with overall health, but also to again, maintain good bladder and bowel health.

Host: Darinda, is there a connection between the abdominal separation that some people experience and pelvic floor dysfunction? And how can physical therapy address that issue?

Darinda Dugas, PT: Yes. So most women during the third trimester of pregnancy will have a gap between the two big abdominal muscles that run down the center of the abdomen. That is called a diastasis recti. It can contribute to postural issues, low back pain, and just a feeling of weakness postpartum. The pelvic floor muscles along with these same abdominal muscles, your back muscles, your hip muscles; they all play a role in providing stability to the pelvis and the torso when you're sitting, standing, any of those positions involved for daily activities and child care. Most pelvic floor therapists who are treating postpartum patients will find that they have additional training to assess and rehabilitate that diastasis.

Doing the appropriate progression of abdominal exercises can help close that diastasis sooner postpartum. And even sometimes even years postpartum people have come in and we've been able to make the diastasis smaller. It also helps patients feel comfortable and confident in returning to exercise and that they're not going to do anything that might injure their abdominal muscles or cause them to have back pain because they're compensating for the diastasis.

 And so physical therapy really gives patients, both the right set of exercises to match what level of function and strength that they have, and then being able to progress them through additional exercises to build up that strength and function so that they can return to whatever type of exercise they prefer, whether it's videos or classes, or doing things on their own, they can feel comfortable that that's protected.

We'll also, typically cover other things that may contribute to having a diastasis get worse. Like Rachel mentioned things like constipation, poor lifting technique, different childcare activities that can stress out that area if done incorrectly can actually make a diastasis worse over time. And part of the treatment is education on how to avoid those types of activities.

Host: It sounds like any pregnant woman or post pregnant woman can benefit from pelvic therapy PT, but Rachel, what are some signs that indicate a woman will benefit from seeking physical therapy for postpartum pelvic health concerns?

Rachel Lucas, PT: There definitely is a plethora of symptoms and signs that can happen due to the trauma of carrying a baby for nine months and childbirth, whether through C-section or vaginally. But, some of those signs and symptoms can include pelvic heaviness, tailbone pain, pelvic pain, pain with intercourse, urinary urgency and frequency. The famous leaking urine when you're coughing, sneezing, jumping, laughing, feeling like they have some bulging or doming in their stomach when they're moving. They could have bowel issues, including constipation, fecal incontinence, just at the incision, such as at the C-section incision, or if they had vaginal childbirth at the perineal scar, or just difficulty standing or sitting.

So, you know, if a woman just doesn't feel right after they gave birth, they just feel they're weak and they don't feel right, like we've kind of touched on throughout our talk, is just seeking that help sooner, being their own advocate, even if their doctor doesn't really recognize that they may need physical therapy at this point, just to get that optimal outcome and improve quality of life.

Host: That's a great point. Thank you, Rachel. And Darinda, thank you. This is crucial information on how physical therapy can help and correct pelvic floor issues after the strain of pregnancy. And I'm sure a lot of us will benefit from it. Thanks again.

Darinda Dugas, PT: You're welcome. Thank you.

Rachel Lucas, PT: Thank you.

Host: That was Darinda Dugas and Rachel Lucas, Pelvic Health Physical Therapists with Duly Health and Care. For more information, visit DulyHealthandCare.Com. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for other topics of interest to you. Thanks for listening to Duly Noted, a health and care podcast.