October 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:
How can I make my tailbone stop hurting?
I’m having a hard time feeling my abs after childbirth, any tips?
Why has sex been different since I entered perimenopause?
1. How can I make my tailbone stop hurting?
Tailbone pain is common and quite literally a pain in the a$$. Fortunately, it’s typically relatively easily treatable, but the treatment for tailbone pain depends on the reason for the pain. Common causes of tailbone pain include:
Muscular and skeletal restrictions around the tailbone: The most common type of tailbone pain is the kind of pain that arises with no clear cause or injury. Folks often report noticing tenderness after sitting on a hard surface, having pain when transitioning from sitting to standing, or experiencing pain after sitting for extended periods of times. If there’s no clear injury that led to your pain, your musculoskeletal system may be to blame. More specifically, tightness or weakness in your glutes and pelvic floor or stiffness in your hips and lower back can irritate the tailbone and lead to pain.
Tailbone fracture: Tailbone fractures can occur after a fall on your bottom and are an uncommon but possible childbirth injury. If you started experiencing severe tailbone pain following a specific event like a fall or birth, start by contacting your provider.
Tailbone dislocation: Tailbone dislocation can also occur following a fall or childbirth.
If you’ve experienced a traumatic injury or if you’re experiencing constant pain that’s unrelated to movement, start by contacting your provider. If your tailbone arose with no clear injury and gets worse when you sit, transition from sitting to standing or when you cough or sneeze, pelvic floor PT can help. Our pelvic floor physical therapists can assess your body and determine what’s going on in your body that’s leading to your pain, as well as what you can do about it.
In the meantime, here are a few things you can try:
Pay attention to whether you’re clenching your butt cheeks throughout the day: Are you clenching your anus, right now? So many of us carry our stress in our pelvis. If you find yourself clenching your glutes throughout the day, you’re also clenching your pelvic floor and the muscles around your tailbone. Keep reminding yourself to unclench.
Foam roll your glutes and IT bands: Muscle tension in the glutes and IT bands can contribute to tailbone pain and the tendency to clench your pelvic floor. Foam roll your glutes, IT bands and any muscle in your lower body for 1-2 minutes a couple times a day.
Practice deep belly breathing: Practice taking slow, deep, belly breaths and feeling the air fill your lunges, belly and pelvis as you inhale. As you inhale you should feel your pelvic floor drop and relax. As you exhale, your pelvic floor should return to it’s original position. Don’t do kegels at any point during diaphragmatic breathing. Focus on feeling the relaxation between your sit bones on your inhale.
Do 20 reps of cat-cow a couple times a day: Tailbone pain can arise as a result of stiffness in your hips and back. Cat cow helps bring some gentle mobility into these joints and can help relieve pain.
Give us a call: Manual therapy can make a huge difference for tailbone pain. Contact us here to learn more about how tailbone mobilization, myofascial work and dry needling can help your tailbone pain.
2. I’m having a hard time feeling my abs after childbirth, any tips?
So many people struggle to reconnect with their abs after pregnancy and childbirth. Adding resistance is one of my favorite tricks. If you have a physioball, here’s one of the easiest ways to start feeling your core again after childbirth:
Start on all fours with a small physioball behind you, against a wall. Straddle it with your feet on either side of the ball.
Exhale and pull your navel to your spine. If you can’t feel that, imagine hugging your hip bones and rib cage towards each other, or imagine a zipper from pubic bone to sternum zipping you up as you exhale. Exhaling while engaging your abdominals helps manage pressure and assists in activating your abdominal muscle muscle fibers.
Once you feel your core engaged, push your bottom back into the ball behind you. Your arms can help, but make your core do the heavy lifting. Hold for 10-20 seconds. Relax and repeat 5 times.
If that’s easy, follow steps 1-3 and then layer on arm movements. See the movements in the videos below.
3. Why has sex been different since I entered perimenopause?
Perimenopause occurs at different times for each person but may begin as early as mid to late 30s for some. Perimenopause is marked by changes to the menstrual cycle. This can include changes to flow, length of period and frequency or periods. During this time, your body starts to experience a drop in estrogen. This drop in estrogen significantly impacts vulvar tissue and thus sexual function.
With reduced estrogen comes vaginal dryness, thinning of vulvar tissue and sensitivity at the vaginal opening. Tissue can also become friable, or easily torn. All of these changes can make lubricants and foreplay more important and in some cases can make sex painful. Once sex becomes uncomfortable or painful, libido can become impacted and pleasure can become even more elusive. And once your brain and body learn that sex isn’t fun, the muscles in your pelvic floor can respond by guarding and tightening with any attempted penetration.
If you’re experiencing changes with sexual activity during perimenopause or menopause, it’s important to address each of these factors.
In order to address hormonal changes: Talk to your provider about a topical estrogen cream to be used at the vaginal opening. This can help supply your tissue with the estrogen it needs as your body changes. Topical estrogen can help reduce the risk of UTIs as you age, as well.
In order to address libido changes: Don’t push through the pain. Once your brain learns that sex hurts, it makes it harder to desire sex. We adapt to avoid things that cause us pain. Instead of pushing through pain with sex, while you treat the underlying causes of the pain, try engaging in intimate activities that feels good. This can mean external stimulation, kissing or cuddling. If you have a partner, reconnecting with them physically in low-pressure ways can help stimulate your libido. Other ways to improve libido include stress management, daily exercise and healthy diet.
In order to address muscle guarding: Work with a pelvic floor PT who can address underlying musculoskeletal changes to help reduce your pain. They can guide you through how to use tools like dilators and pelvic wands if they’re appropriate for you, talk you through choosing the best lube for your body and create a personalized rehab and exercise program for you to feel your best.
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.