Scott Webb (Host): It's not uncommon for women to experience pelvic health issues during pregnancy and postpartum, and my guest today is here to explain how physical therapists can help. I'm joined today by Kate Myers, she's a physical therapist with Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Kate, it's so nice to have you here today. I know you're a physical therapist and my daughter wants to be a physical therapist, but that's maybe a separate podcast today. Let's talk about pelvic health physical therapy during pregnancy and postpartum. And maybe you could just start there. Give us a brief explanation of the pelvic floor and its role in the body.

Kate Myers: Thanks for having me. I'm super pumped to be here. This is a topic that I'm pretty passionate about and I love treating. So specifically, the pelvic floor is a space down in the pelvic girdle. So, these are muscles that support the organs inside, so the bladder, the bowel, the uterus, specifically for women. And then, they also do things for bowel function, bladder function, as well as sexual appreciation.

And so, if we think about the pelvic floor muscles, we've got a couple of different layers. So if you would think about the muscles from the outside, the muscles go around the openings like a figure eight. So, they're going to go around the anus and around the vaginal opening. Their job in this layer is to squeeze or to close those muscles or those openings to keep things in. So, this would include urine, feces, gas. But they also have to relax or to open to allow those things to come out. If we just kept them squeezed all the time, we would never pee or poop and that wouldn't be a good thing. If we think about the muscles from the deeper layer, so the ones Inside, they're going to run front to back from the pubic bone to the coccyx or the tailbone. So, they lift everything inside like a hammock. So inside, again, we've got the bladder, the uterus, and the rectum. And so, they lift and support, but they also have to relax and lengthen to have a bowel movement, to have intercourse, and to have a baby, which is what we're talking about today.

And so, as a pelvic health physical therapist, so we work on those muscles, but we on a lot of things around it. So, we'll work on the abdominal cavity, the core muscles, the back, the butt, the thigh, all of those areas play a role into these pelvic floor muscles since they're so close together. And so, all of it's connected and it is certainly something we work on all the time.

Host: Yeah. As you say, right, it keeps things in when we want them in and lets them out when appropriate, right? And especially in the case of pregnancy. So, let's talk about that. Let's talk about the physical changes that can occur during pregnancy.

Kate Myers: Yeah. So, there are many, many changes that are going to occur when somebody is pregnant. I would say argue all systems in the body are going to be affected. So, a lot of things that we see in physical therapy, so the abdomen is going to grow because there's a growing baby inside there. And so, this is going to change somebody's center of gravity. So what that means, it's going to bring everything forward. So as a result, posture will change. This can increase the curve in somebody's lower spine. In addition to the abdomen, the breasts are going to grow. And so, this is going to create a more forward head posture, which can increase neck pain, tightening in the chest muscles. It can make your spine feel stiff, difficult to move, which those things can cause pain.

Additionally, you know, during pregnancy, there are lots of hormones. They make us anxious, they make us depressed, but they also affect how our muscles and our ligaments function. And so, that increased muscle laxity is due to a hormone called relaxin. And so, we notice that, you know, a lot of pregnant women will feel kind of loosey goosey, not as supported as they once were a few months ago. And so, yes, we need this hormone because it's going to help relax everything during labor, but this can also contribute to some of the imbalances and pains people feel, because they're lacking that support that they so desperately need as their body is growing a baby.

In addition to that ligament laxity that we have, the pelvic bones are also going to shift because they are trying to accommodate the growing baby inside of there. And so, the ligaments are laxed to create that shifting that's going to occur. But then as a result, those pubic bones, those pelvic bones, they can become kind of painful, causing difficulty with moving and walking and things like that. And so, that is just a little bit of some of the changes that occur that we see in PT. But there are even more, just from a cardiovascular standpoint, a respiratory standpoint, all due to the fact that we're growing a human, which is pretty cool.

Host: Yeah. Growing a human for sure. So, let's do a little bit kind of a before and after. Let's talk about pelvic PT when someone is pregnant. And then when you're done, we'll talk about postpartum.

Kate Myers: Because of all those changes that occur for pregnancy, there are lots of things that we can work on in physical therapy. So, we can address those aches and pains. So, some of the most common pains that we see are SIJ pain or sacroiliac joint pain, which is your lower back region. We also see a lot of pubic bone pain or the medical terms will be like pubic symphysis dysfunction. And then, we can also see pelvic pain. So, pain that feels deep inside the pelvis. So, we address those.

We also can then address in pregnant women things that are affecting specifically the pelvic floor. So, the bladder, the bowels, the sexual standpoint. So from a bladder standpoint, you know, a lot of pregnant women will experience extreme urinary frequency or urgency and even some leakage, which makes sense, again, as there's a baby pressing on the bladder. And so, we can address those so that way they're not popping up again postpartum.

Additionally, we see from a bowel standpoint lots of constipation. Again, there's not as much space in that abdominal cavity for the colon to move. So, constipation is pretty common. This can also lead to hemorrhoids, some discomfort in the abdomen. And then, again, when you're trying to labor and deliver this baby, that could affect the way the pelvic floor is moving. And so, we can work on all of that. Then, from a sexual standpoint, pain can be common during intercourse, but it's really not a normal thing that we like to say. We will work on how to relax those pelvic floor muscles, which can then help during labor.

And so, that kind of really segues into how we can get moms ready for the marathon that is, you know, labor and delivery. So when you're birthing a baby, we have to relax all of the muscles in the pelvic floor. And so, we do that via stretching, we do it with different positionings, we'll talk through different pain management strategies, we'll talk through how to breathe and how to push out your baby, because all of that is directly related to the pelvic floor. And so, our goal when people come to physical therapy as a pregnant patient, we want you to feel confident and comfortable going into that labor and delivery room, so that you can reduce your risk of tearing, reduce complications, and just have an easier time with it all.

Host: Yeah. Easier time in quotes, right? In air quotes, "easier time," right?

Kate Myers: Yeah. Not easy.

Host: All right. So, let's go the other end of the spectrum, if you will. And let's talk about postpartum PT.

Kate Myers: Absolutely. So, postpartum, similar to pregnancy, a lot of things have happened. So, we just pushed out a baby. Those muscles have been stretched to the maximum degree. And so, we need to work on getting that control back. And so, we're going to work on contracting those muscles. We're going to work on finding a balance. So that way, you can get back to exercise, movement, you know, picking up your baby without pain. We'll also talk about making sure your bowel, your bladder, your sexual health is all in working order. So, that way, you're not having urinary leakage when you cough, when you laugh, when you sneeze, you're not having any issues with hemorrhoids, things like that.

And so, when you come into PT postpartum, we'll also ask about how your delivery went. We want to make sure there weren't any significant tearing. There wasn't any complications that we need to focus on. A big piece of the postpartum PT world is making sure from a cardiovascular standpoint, that things are all in check. And so, not only when you deliver a baby does your body go through like the physical body go through a workout, but the heart also does. And so, we'll take your blood pressure. We'll monitor your heart rate while you're doing exercise. So that way, we know it's all in working order when you get back to running or XYZ, whatever you like to do. So, there are many things that we can do, and it's really all tailored to what each individual person, what their goals are.

Host: Yeah. The goal may be getting back to pickleball. You know, we know everybody plays pickleball now. Yeah, so this is perfect. This is good stuff today. I just want to finish up and have you tell folks about the new postpartum pelvic health program that was initiated this past spring.

Kate Myers: Absolutely. So, this has been kind of our project for a while now, but my colleagues and I, we've started a program now at the Indianapolis campus and in Mooresville, where every single person who delivers a baby at these hospitals receive an automatic PT order. So, that means that a physical therapist who is pelvic health-specialized will hopefully see them while they are up on the floor postpartum before they even have left.

And so, our goal in doing this is to try to prevent some risks. We're trying to prevent some readmissions, and we're also trying to spread the word about pelvic floor dysfunction. So that way, when people are 70, 80 years old, we're not peeing our pants or we're not having any pain that we could have worked on when we were 20, 30 years old.

And so, when we go up to the hospital floor in this unit, we're going to prioritize our C-sections and our third and fourth-degree tears. And then, depending on how many moms are laboring or delivering that day, we'll try to get to as many people as we can. At Indianapolis campus, there are lots of moms delivering, so we sometimes have to triage, but our hope is to see as many people as we can. And so, when we go in and we see you, we'll talk about how your labor and delivery process went. And then, we'll talk about how you're feeling now, especially if you had a C-section, we're going to monitor your vitals. We're going to take your blood pressure with activity. We're going to make sure you're wearing your abdominal binder correctly, which is going to help your pain. We're going to help you get in and out of the bed because, you know, post surgery, not only are you trying to take care of yourself, but you're also now taking care of a newborn. And so, that can be pretty tricky. And so, we'll help new moms navigate this time and then also for those C-sections and third and fourth-degree tears, they will get an automatic referral to outpatient physical therapy, pelvic floor specifically.

So, we'll see them in about six, eight weeks for them to come back into the clinic and make sure things are going as smooth as possible, just to again prevent things down the road. It's been a really great project that we've finally been able to initiate. And so far, the response has been great. It's been really wonderful, so we're excited to keep on doing it and helping as many people as we can.

Host: Yeah, that's awesome. My wife had two C-sections, so I'm familiar with that and what happens afterwards and what needs to be done. So, good to hear how you're helping folks. Appreciate your time today. Thanks so much.

Kate Myers: Thank you.

Host: And for more information about Pelvic Health Physical Therapy Services at Franciscan Health, go to franciscanhealth.org and search pelvic rehabilitation. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.