8 Reasons Everyone Needs Postpartum PT

Everyone who goes through pregnancy and gives birth can benefit from postpartum pelvic floor physical therapy, also known as postpartum physiotherapy. Almost half of postpartum people experience pelvic floor dysfunction following pregnancy and childbirth. Pelvic floor therapy after birth can help treat these common postpartum conditions with a combination of hands-on manual therapy, exercise and education. 

It’s also important to note that pelvic floor physical therapy postpartum can be beneficial for those who aren’t experiencing debilitating symptoms. In this piece, we’ll cover the most common postpartum conditions, what causes these conditions, common reasons people seek postpartum PT, how to get started working with a postpartum physical therapist and 8 reasons everyone should see a pelvic floor physical therapist after birth.

What are common postpartum conditions?

There are a number of common postpartum conditions that impact your bladder, bowel and sexual function as well as pain in and around your pelvis. The most common postpartum conditions we treat as pelvic floor physical therapists include:

• Urinary incontinence: Urinary incontinence, or urinary leakage, is defined as leakage of urine that occurs at any time it’s unwanted. This can happen with a cough or a sneeze which is known as stress incontinence. It can also happen if you get a strong urge to urinate and can’t make it to the bathroom in time, which is known as urge incontinence.

• Pubic symphysis pain or groin pain: Pubic symphysis pain is pain at the front of the pelvis, right below the bladder, where the pubic symphysis is. This can also create or be confused for groin pain or round ligament pain.

• Sacroiliac Joint (SIJ) pain: This is pain that occurs at the back of the pelvis, typically on one side, where the sacrum joins the ilium to form the sacroiliac joint. 

• Diastasis recti abdominis: This is when the two rectus abdominis muscles, or six pack muscles, separate down the center along a line of fascia called the linea alba. This occurs in all pregnancies and continues in up to 68% of people postpartum. 

• Pelvic organ prolapse: Pelvic organ prolapse occurs when ligaments supporting the bladder, uterus or rectum are overly stretched allowing the organ to sit lower in the pelvis than it originally sat. This can lead to feelings of heaviness in the pelvis, or like there’s a ball in your vagina.

• Painful sex: Painful sex occurs for a number of reasons after birth, including scar tissue from an episiotomy or tear in the vulva, hormonal changes or muscular guarding. This can also occur as a result of infection like a urinary tract infection or bacterial vaginosis.

• Low back pain: Back pain is common after pregnancy and birth because of postural changes, the demands of childcare and underlying weakness in the core, hips and pelvic floor.

• Sciatic pain: Sciatic pain starts in the back and can travel down the leg into the buttocks, back of the thigh and even to the calf and foot. This usually occurs for the same reasons low back pain happens.

• Coccydynia or tailbone pain: Tailbone pain, or coccydynia, can happen for a few reasons following birth. These can include birth injury leading to fracture or dislocation, muscular guarding and tension around the tailbone and constipation or other bowel issues like hemorrhoids or fissures.

• C-section scar pain: About 1 in 4 have chronic c-section pain following a cesarean birth as a result of scar tissue and surrounding soft tissue restriction. Another additional contributor can include movement patterns that arise during surgical recovery. 

• Hip pain: Hip pain is a common postpartum condition and can occur as a result of a labral tear arising from birth, postural or movement impairments, muscle weakness or tension and/or joint stiffness, just to name a few possible culprits.

• Fecal leakage: Fecal leakage is most common following a grade III or IV perineal tear which impacts the external anal sphincter.

What causes these common pelvic floor conditions postpartum?

There are three primary causes of common postpartum conditions and postpartum pelvic floor physical therapy can treat all of them to get you symptom free. These conditions occur largely due to three main reasons: muscular weakness, muscular tension and impaired coordination. 

Let’s dive into each of these and explain how they contribute to the common conditions discussed above and how postpartum pelvic floor physical therapy can help. 

Muscular weakness: When muscles are weak, they have to work harder to do the same job. This can lead to muscle fatigue, impaired movement patterns and pain. Imagine carrying around a heavy backpack all day. Imagine that this backpack weighs twice as much as the typical bag you carry. By the end of the day, you’d likely be slouching and trying to use other muscles to make up for the fatigue in your shoulders and back. Day after day, this would lead to pain in all sorts of places. This pain would occur because your body isn’t used to carrying the extra load, so your muscles aren’t strong enough for this to be comfortable. Pregnancy isn’t all that different! Except during pregnancy, you wear the backpack on the front and it gets heavier every day until the baby is born.

Muscular tension: When muscles are tight, they lack flexibility and the range of motion a healthy, flexible muscle has. This can lead to pain in the muscle and surrounding joints as well as odd movement patterns. Imagine that you want to take a drink of water. You see your water bottle, but when you go to reach for it, your bicep is so tight that you can’t fully extend your arm. Because your bicep is tight, you have to rotate your entire body to get to the water bottle and take a drink. Now imagine you had to do this every day for months and months. Eventually, your wrist, elbow, shoulder and probably even neck and back wouldn’t feel so good. Muscular tension makes us move in funky ways to make up for the lack of flexibility, wherever it exists.

Impaired coordination: Pregnancy causes major changes in coordination in the abdominal, hip and pelvic floor muscles. When coordination changes, the way your muscles function and move your body change, too. Difficulty recruiting these muscles as a result of impairment coordination can lead to all of the common symptoms listed above. Going back to our water bottle analogy, let’s now assume that your bicep is flexible enough to reach your water bottle, but now your brain can’t figure out how to bring the mouth of the water bottle to your mouth. So you try, and you get close, but each time you try to drink you end up spilling on yourself instead of seamlessly coordinating a sip from your bottle. Your pelvic floor can struggle in this same way.

You can work with a pelvic floor physical therapist after birth to address muscle weakness, tension and coordination in order to address all of the common postpartum symptoms listed above.

If you’re experiencing muscular weakness, a postpartum pelvic floor therapist can help you regain strength by testing your muscle strength and creating a personalized program addressing your weaknesse. If you’re experiencing tension postpartum, your pelvic floor PT can use manual therapy and other tools to help your muscles regain flexibility. If coordination is the root of your symptoms, working with postpartum pelvic floor therapy can help train your brain to better control your muscles to get you feeling better.

How can working with a postpartum PT help you?

The postpartum period is full of uncertainty and the endless instagram and Google scroll can make it challenging to determine how you can best use your limited time to address your symptoms. Working with a pelvic floor physical therapist postpartum can help you identify which approach will most effectively treat your symptoms. A postpartum pelvic floor PT can create a daily routine that takes 5-10 minutes and gets your results instead of putting in hours and feeling like you’re not making progress.

An experienced pelvic floor physical therapist can help you get to the root cause of why you’re having symptoms and treat the cause instead of the symptom so your symptoms improve and don’t return in the future.

When should you start working with a pelvic floor physical therapist after birth?

When you begin working with a pelvic floor physical therapist entirely depends on your goals. Working with a pelvic floor PT during pregnancy is ideal for those who want to prioritize birth preparation and pre-habilitation for postpartum recovery. At Lady Bird PT, we typically begin working with patients at the end of the first trimester, around 14 weeks.

If you’ve already given birth, it’s important to remember it’s never too early or too late to begin working with a pelvic floor PT. We will typically see our patients for their first postpartum visit at 3 weeks postpartum. Some opt to wait until their 6 week follow up with their OBGYN or midwife, in which case we schedule a 6 week postpartum evaluation. It’s important to note this timeline doesn’t change whether you have a vaginal or cesarean birth.

In all 50 states, you can schedule an evaluation with a pelvic floor PT without a referral from your provider. In Texas, you can work with a pelvic floor physical therapist for up to 15 days without a referral from a medical doctor (MD), certified nurse midwife (CNM) or chiropractor (DC). If you’re having trouble getting a referral to PT, your pelvic floor PT can help you after your first appointment. They can help by sending notes to and following up with your medical provider.

8 Reasons Everyone Needs Postpartum PT

1. No one else assesses pelvic floor and abdominal muscle function: It’s a common misconception that OBGYNs and midwives assess pelvic floor and abdominal muscular function during the 3 or 6 week follow up appointment, but this is not the case. The purpose of the 3 and 6 week visit with your OBGYN is to ensure that you’re healing without any sign of infection, that your uterus is returning to pre-pregnancy size, that there’s no sign of hypertension or additional medical risk factor placing you in medical danger. Ideally, every postpartum appointment would also screen for postpartum anxiety, depression and psychosis. With that said, this appointment typically does not screen for pelvic floor muscle and abdominal muscle function both because OBGYNs and midwives have limited time with patients during these appointments and because this is not their area of expertise. Remember, a typical postpartum check up with your OBGYN is 10-15 minutes. An evaluation with a pelvic floor PT should take around an hour. Everyone should see a pelvic floor PT for at least an evaluation of muscle function status after both vaginal and cesarean birth.

2. Confidently return to exercise: Physical therapy after pregnancy will help you confidently return to exercise postpartum, without constantly asking yourself if you’re doing what’s right for your body or why the exercise you’re performing isn’t getting you the results you want. A postpartum pelvic floor PT can help you if you’re wondering whether you have a diastasis recti and need to modify your core exercise. They can help you determine how to modify your exercises to avoid aggravating your prolapse. And if you’re feeling great, they can walk you through postpartum exercise guidelines so you can keep feeling great as you progress exercise intensity.

3. Address underlying pelvic floor symptoms: Did you know up to 50% of people experience pelvic floor symptoms following birth? Common postpartum symptoms include urinary incontinence, pain with sex, prolapse or heaviness in the pelvis, abdominal weakness, back pain and groin pain. Pelvic floor therapy after birth can identify and treat the underlying causes of your pelvic floor symptoms so you can get back to feeling like yourself in your body. While these symptoms are common, they’re also treatable. You don’t have to accept your symptoms as your new normal.

4. Reduce the risk of symptoms arising or worsening during a future pregnancy: Working with a pelvic floor PT after birth helps reduce the likelihood of symptoms arising during future pregnancies, even if you’re feeling great following your first birth. Subsequent pregnancies stress the same tissues that were stressed during the first, so underlying weakness or minor symptoms can be exacerbated by future pregnancies. Rehabbing your body after your last pregnancy can reduce the risk of your groin pain, leakage or prolapse symptoms from returning or worsening with your next pregnancy and birth.

5. Better sex: Birth has a big impact on your pelvic floor (shocker, I know) which has a huge impact on sexual function. Additionally, milk production further impacts your pelvic floor after childbirth by reducing the amount of estrogen available to your vulvar tissue. Roughly half of postpartum people will experience postpartum dyspareunia, or pain with sex. The most common contributors to pain during sex after birth include muscular tension, scar tissue or hormonal atrophy. Working with a pelvic floor PT after birth can help you determine the cause of your pain, an appropriate course of treatment, and get you back to enjoying sex as quickly as possible!

6. Set yourself up for a healthy future: While it’s becoming better known that pelvic floor symptoms are common after birth, people with vulvas experience a jump in pelvic floor dysfunction risk factors later in life, during menopause. Treating underlying pelvic floor impairments following childbirth can improve your pelvic health and resilience both in the short and long term.

7. Gaining a better understanding of your body: The United States educational system does a pretty poor job of educating people with vulvas about their bodies. It’s incredibly common for people to be entirely unfamiliar with their genitals, making it even more confusing when symptoms arise. Working with a pelvic floor PT can help give you the sex education you should have but did not have in grade school so you can proceed through the rest of your life with a clearer understanding of your own body and its needs. It’s not your fault if you feel unfamiliar with your vulva, but you don’t have to continue feeling disconnected from this part of yourself.

8. Save yourself time: Google, Youtube, Instagram and ChatGPT are incredible sources of all sorts of information. When it comes to pelvic health, this is both a gift and a challenge. If you’re like many of the folks we see both in-person and virtually, you’ve spent hours reading blog posts, watching Youtube videos or scrolling endlessly through the gram and are left even more confused about what’s going on with your body. Do you have a diastasis recti or prolapse? Should you be doing kegels or do you have a tight pelvic floor? Working with a pelvic floor PT after birth will give you clear answers on what’s going on with your body and what your body needs so you can confidently get back to feeling how you want.

Have questions about working with a postpartum pelvic floor physical therapist?

If you’re wondering if pelvic floor PT postpartum is right for you, reach out to our team with your questions. We’re passionate about helping you find your way back to feeling strong, healthy and confident after birth. Call us at 512-766-2649, email us at contact@ladybirdpt.com or send us a message here to get started.