June Knowledge Drop
Each month for our newsletter, the Lady Blurb, we'll share answers to some pelvic health questions you've submitted. The questions below were taken directly from you! To submit a question for next month, comment below or email us at contact@ladybirdpt.com.
**The answers to these questions are not meant to be used as medical advice. These answers are not meant to take the place of a skilled physical therapist or discussion with your medical provider. If you are experiencing concerning symptoms, please contact your physician.**
This month, we’re answering:
What can I do, besides taking ibuprofen, to manage period pain?
What are 3 things you can do at 35+ weeks of pregnancy to prepare for birth?
What’s the pelvic floor’s primary role in pregnancy, birth and recovery?
1. What can I do, besides taking ibuprofen, to manage period pain?
Did you know painful periods are the leading cause of missed work and school? 60-90% of people who menstruate experience period pain or dysmenorrhea. Prostaglandins are a major cause of period pain. Prostaglandin levels rise to trigger uterine contractions during your period, leading to reduced blood flow to the uterus which causes pain. Traditional treatments for this pain are NSAIDS and heat packs, but we have other effective options, too.
There was a systematic review published earlier this year in the Journal of Women’s and Pelvic Health PT looking at the effectiveness of physical therapy treatments for period pain. You can read the entire systematic review, Effectiveness of Physical Therapy Interventions for Women With Dysmenorrhea: A Systematic Review, here.
This review looked at a number of period pain management interventions including:
Core strengthening
Diet modifications
Cardiovascular exercise
Manual therapy to the spine
Kinesiotaping
And what it found was that pretty much every technique (short of passive stretching) was effective at managing pain!
So what does this mean for you?
If you struggle with period pain, NSAIDs and heat are not your only option. Additionally, the way you fuel and move your body between periods may impact your period pain just as much as what you do while you’re menstruating. If you struggle with period pain, even if it’s a result of underlying causes like endometriosis, physical therapy may be able to help. Pelvic floor PTs can offer manual therapy to address the physical impairments contributing to your pain while discussing which lifestyle factors that you can consider modifying. If period pain gets in the way of you living your life, give us a call!
2. What are 3 things you can do at 35+ weeks of pregnancy to prepare for birth?
Are you 35+ weeks pregnant and just learning about pelvic floor PT? Don’t fret! While I recommend folks start working with a pelvic floor physical therapist as early as the start of their second trimester, it’s never too late to start supporting your pelvic health during pregnancy. So if you’re late to the pelvic health game, here are 3 things you can do in the last few weeks of your pregnancy to help prepare your body for birth and recovery:
Perineal massage: Download our free perineal massage guide, here.
The earliest it’s recommended to begin perineal massage is 34-36 weeks. The form of pelvic floor massage helps to relax pelvic floor muscle tension and gives you the opportunity to practice relaxing into the discomfort of feeling your perineum stretch. While performing perineal massage may not reduce your overall risk of tearing, evidence has shown a reduction in grade 3 and 4 tears for folks who perform perineal massage for 5-10 minutes, 1-3 times per week beginning week 35 of pregnancy.
Practice push preparation: Watch our 10 minute guide to push prep
Push preparation is a practice that gives you the opportunity to learn to coordinate your pelvic floor with your pushes, before labor! While your pelvic floor is supposed to relax as you bear down, it’s not uncommon for folks to paradoxically contract their pelvic floor. Practicing relaxing your pelvic floor muscles with different kinds of pushing can help ensure effective pushes during labor. Watch our 10 minute guide to push prep to learn more about open and closed glottis pushing and to learn a couple exercises to help improve your push efficacy!
Incorporate hip & lumbar mobility exercises
Your pelvic floor and abdominal muscles attach all along your pelvis and have fascial connections to your spine. Hypomobility, or stiffness, in your hips and lumbar spine can contribute to reduced movement in the pelvic floor itself. So even if you have just a few weeks left in your pregnancy, working on hip and lumbar mobility can help prepare your pelvic floor for birth! Consider exercises like cat-cow, a mermaid stretch and even using a foam roller or lacrosse ball to address tension in your glutes.
3. What’s the pelvic floor’s primary role in pregnancy, birth and recovery?
Preparing your pelvic floor for birth is a bit tricky because it’s primary role, and thus what you need to do to support it, changes from pregnancy to birth to postpartum recovery. So let’s breakdown what the pelvic floor needs during each of these periods and what we can do to support it.
During pregnancy, your pelvic floor is working overtime. One of the primary roles of the pelvic floor is to support your organs. As your baby grows and gets heavier in your uterus, your pelvic floor has to support more and more weight. This increased weight and work leads to fatigue in the pelvic floor muscles. This fatigue contributes to common pelvic floor symptoms during pregnancy like heaviness in the pelvis, urinary incontinence and even pain like pubic symphysis and SI joint pain. That’s why strengthening your pelvic floor and surrounding muscles during pregnancy can be so helpful! Strength training during pregnancy helps combat the stress and reduces the risk of symptoms developing through pregnancy.
While a strong pelvic floor is important to support your body through pregnancy, the primary role of the pelvic floor for birth is very different. The primary responsibility of your pelvic floor during a vaginal birth is to stretch and move out of the way. As your baby descends through the pelvis, they eventually reach your pelvic floor. Your pelvic floor functions as a wall between your baby and the outside world. If this wall is stiff and inflexible, it can make the journey more challenging. If these muscles are flexible and stretchy, your muscles will give way to allow your baby to pass. So while strengthening your pelvic floor throughout pregnancy is important, ensuring that your muscles maintain length as they gain strength is equally important. Maintaining strength and flexibility throughout pregnancy will help prepare your boy for pregnancy and birth.
As we enter postpartum recovery, the primary responsibility of the pelvic floor shifts once again. Now your pelvic floor’s primary focus is trifold. Your muscles have to focus on healing. They have to once again support your body and they also have to recover flexibility. Around 80% of people who have a vaginal birth will experience some degree of perineal tearing. Healing from this tissue trauma is your pelvic floor’s first responsibility following childbirth. At the same time that your body is healing, your pelvic floor resumes its role of providing support to your body. Your abdominal muscles, glutes and hip musculature work alongside your pelvic floor to keep hold up your organs and support your bladder, bowel and sexual function. Making sure it returns to its healthy, stretchy self is one way we can reduce the risk of symptoms like pain with sex during your postpartum recovery. To support your pelvic floor as it heals postpartum, we want to focus on continued strengthening of all the muscles we’ve already discussed, scar tissue mobilization as needed and making sure we’re giving your body enough time to rest and heal as you recover.
Working with a pelvic floor physical therapist can help address sexual dysfunction, bowel and bladder concerns and help you prepare for pregnancy, birth and postpartum recovery. Contact us here to learn more about setting up an appointment with us, today!
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.