Mommies, this is seriously going to be one of the most important pregnancy/postpartum posts I will EVER write. Are you worried about tearing during childbirth? Or postpartum incontinence (peeing when you laugh/cough/run)? Are you doing Kegel exercises all day long because your birth books told you too? Worried about postpartum sex? Have you heard about abdominal separation during pregnancy? Well, I’m so happy you are checking this out because this post can truly change your postpartum body and health and answer all of your questions. You are about to meet my pelvic health physical therapist, friend and soon-to-be mommy Merci Treaster, PT, DPT. I was actually just back in her office a few weeks ago and I was reminded how grateful I am to have been referred to her.
About 5 months into my pregnancy, I was visiting my prenatal chiropractor in Atlanta & was complaining about the pain I was feeling around my hips & pelvis. My chiro told me it was called ‘round ligament pain’ caused by your ligaments stretching and thickening to make space for your growing baby. My chiropractor referred me to Merci. When my chiro told me Merci was a pelvic floor PT I won’t lie, I was a little weirded out. I’m not shy at all when it comes to bodywork, but I was definitely thinking “what on earth is she going to do to me?”. Maybe you’re wondering the same thing, so please let me share my experience & my chat with Merci to help you understand how important your pelvic health is.
As soon as I stepped into Merci’s office I was put completely at ease. She was super easy going, friendly and close in age to me. We stepped into a private room and talked about what type of discomfort I was having. Because I was pregnant, no internal work could be done, so instead, she worked on releasing some of the muscles around my pelvis and glutes and tended to my round ligament pain. While she was working on me, she was asking me what I was doing to physically to prepare for childbirth. Besides working out and eating as best I could with my food aversions, I was proud to tell her I was doing my Kegel exercises. She was not as proud of me as I expected! She explained to me that most women are doing Kegel/ pelvic floor exercises wrong and it was doing more harm than good. We ended our session by her giving me some strengthening and stretching exercises to do and instructions on how to correctly strengthen my pelvic floor. She also checked how my abdominal separation (diastasis recti) and taught me ways to prevent it from getting worse.
This stuff really worked you guys! As you have probably read, I had a fast, easy and natural childbirth. I did tear but it was minimal and easily healed in a few weeks. I was able to keep my diastasis recti to a minimum and it is almost completely back to normal now. She also really helped ease some of the ligament discomfort I was having. I never had any leaking and I know my pelvic floor strengthening had everything to do with that.
Postpartum sessions were a lot different and, in my opinion, even more beneficial. I went back to see Merci a little less than 3 months after having Lily. I wasn’t able to have sex for 8 weeks postpartum because of my retained placenta and resulting surgery, but when Andy and I did have sex it hurt..a lot. I knew it would be uncomfortable but I had no idea I could have real pain. Merci explained to me that a lot of your internal muscles become tight and need to be released in order for your body to completely heal. It was also important to take care of the scar tissue I had from tearing during childbirth. Merci’s internal exam was totally easy. She lightly released the muscles that had been causing me pain during sex & had me perform a couple exercises to see how my pelvic floor strength was coming along. Then she checked my diastasis recti and reminded me of what I could be doing to help it heal completely back together.
Mommies, after my third postpartum visit with Merci, my pain with sex was completely GONE. I could tell my body was finally healing properly and my scar tissue was starting to soften. I knew Merci knew her stuff but after seeing all of the changes, I was a total believer. I will absolutely be seeing Merci or a therapist where I live in California that can help me after every pregnancy. I know now that I don’t have to deal with incontinence, I know my abs can heal back together & that I (and Andy!) can enjoy postpartum sex just as much as we did before. What a gift, truly. I am so grateful to Merci for healing me and allowing me to be more confident in my postpartum body.
I know you probably still have more questions, so check out my interview with Merci below where you can learn more about what pelvic health therapists do & some suggestions about how you can improve your own pelvic health!
Chatting with Merci Treaster, PT, DPT
How did you get into this type of therapy?
Growing up both of my parents were in the health field with one being an OBGYN and the other a chiropractor. I was basically born with an anatomy book in my hands J I was in the delivery room with my mom constantly. Hearing words like vulva, vagina, uterus, placenta, cervix, etc. were common nature. Even my friends would come on “rounds” with my mom on the weekends and we would help with circumcisions. My mother always said that prenatal and postpartum care in the US was lacking in terms of the musculoskeletal system. Women constantly complained of back pain, hip pain, weakness while they were pregnant and then postpartum would ask am I ready for exercise? What kind? How much? Why does sex hurt? And so on…. And the worst part was my mom, being a healthcare professional, did not know what to tell them. She was taught that they were “medically” safe.
I decided that being OBGYN was not going to be my calling so I went into another field related only to the musculoskeletal system…physical therapy. I went to PT school with pelvic health as my passion even though there were not many PT’s doing pelvic health at the time. My goal was to one day work with my mother.
Tell me a little bit about what a pelvic floor physical therapist does
Pelvic health is a sub-specialty of physical therapy. Pelvic health therapists are trained beyond the scope of PT to do internal pelvic floor examinations to asses for anything pelvic health related. Reasons for seeing out a pelvic PT could include anything from pelvic pain, leakage, lack of pelvic floor control, prenatal, postpartum, diastasis recti, post-surgical.
Why is it important for women to actively maintain their pelvic floor health?
Similar to how it is important for women/men to keep other muscles strong and working properly, it is important for the pelvic floor to be working correctly. The pelvic floor should be strong, coordinated, and have proper so that urinary/fecal leakage does not occur. Beyond this, it is important for someone to teach women how to properly engage (or relax) their pelvic floor. In school, at the gym, or when seeing physical therapists people are taught how to do a proper squat, row, pull up, etc. Who teaches women and men how to do a proper pelvic floor contraction?
What percentage of your patients are prenatal or postpartum?
I would say 60-75%. The other percentage of my clients have pelvic pain, post-surgical issues, core weakness, low back pain, decreased stability with sports/exercise.
What are the complaints you see most with pregnant women?
During pregnancy the complaints I see most are low back pain, hip pain, round ligament pain, “coning” or separation of abdominal musculature, pelvic pain, and a large percentage of them are just coming to make sure they are doing exercises properly so they do not injure themselves while pregnant.
What are the biggest misconceptions you see about preparing your pelvic floor for childbirth?
- Number 1- Most people are doing WAY TOO MANY KEGELS….and doing them wrong. Would we ever do 200 squats a day? NO! Then why are we reading on google to do 10 sets of 20 Kegels throughout the day. Just like there is a wrong way to do a squat, there is a wrong way to do a Kegel. I have very few clients who have actually done a pelvic floor contraction (Kegel) correctly with proper strength, control, and no accessory motion.
- Number 2- Crunches! People are told to do crunches to prevent diastasis recti. This is a misconception and they can be done incorrectly and cause an increase in DR.
- Number 3- Vaginal weights. I had a patient once tell me that she has been using vaginal weights to prepare her pelvic floor. This could ultimately cause the pelvic floor to develop too much tone and have a hard time relaxing fully. Yes, it is important to have a strong pelvic floor but with proper full contract and full relax.
Most women are terrified of tearing during childbirth, do you have any suggestions on how to prevent it or keeping the tearing to a minimum?
Work on learning how your pelvic floor is “acting” on a regular basis. You would be surprised to know how many women clench their pelvic floor muscles throughout the day. Learning what relaxed is will help during the childbirth process.
Seeing a pelvic health therapist can help prepare the women by teaching her about her pelvic anatomy, what positions are best during childbirth and teach proper stretches that can help relax the pelvic and hip musculature.
When can you start seeing a patient postpartum?
I tell people that when you have been cleared by your provider to see a pelvic health PT you can make an appointment. This is usually around the 6-week postpartum mark for vaginal deliveries and 8-12 weeks for surgical deliveries.
My mom, the OBGYN, reports she was never trained to actually assess the pelvic floor musculature for restrictions, tone, nerve dysfunction, etc. Most OBGYNS/providers also do not check for diastasis recti and pelvic floor dysfunction which is another reason it is important to at least get evaluated by a pelvic health specialist.
What type of complaints do you see in postpartum women?
Common complaints: core weakness, diastasis recti (separation of abdominal), vaginal heaviness, urinary leakage, pelvic floor weakness, pain with intercourse, pelvic pain with sitting, low back pain, hip pain, overall body weakness
How many sessions does it usually take to see results?\
Great question! We would love for people to see results starting immediately! However, since women are coming in for all different types of issues the results vary. Examples: stress urinary incontinence (leaking with cough/laugh/sneeze/exercise) can actually be a very easy fix. Sometimes it is just a matter of training the pelvic floor muscles how to work again and when to work! However, pelvic pain, caused by the tightening of pelvic floor muscles can take a few more sessions because the therapist will have to work on releasing the pelvic floor manually and myofascial restrictions surrounding the area.
So, the answer to this question is, it depends!
If a woman doesn’t see a pelvic floor therapist, will their body eventually heal the pelvic floor itself?
A woman will have healing postpartum whether or not they see a therapist. However, it could be healing that could eventually cause more problems. For example, after an athlete has an ACL repair in their knee, they have to see a therapist in order to get full knee range of motion back, strength to return, and re-education to the muscles to return to that sport. If they did not see a PT their knee would heal, it would just heal with range of motion limitations, improper strength, and probably pain for a long time. It is very much the same postpartum. Not everyone will have long lasting issues if they do not see a pelvic health therapist but they might go a long time without a diagnosis of diastasis recti, prolapse, incontinence, core weakness, pelvic pain…. Then those will be the people who say “I leak when I jump or run” and their friends will say “me too, that’s normal after you have a baby” The fact is, these issues are COMMON but they are not NORMAL. Your body postpartum does not have to leak, have pain, be weak, etc.
What other types of conditions can pelvic floor therapy help?
Prenatal, postpartum, pelvic pain (women and men), incontinence (women and men), constipation, fecal leakage, pain with bowel/bladder emptying, urinary frequency, overactive bladder, painful bladder syndrome, pelvic organ prolapses, post-surgical (hysterectomy, vasectomy, prostatectomy), sexual dysfunction, diastasis recti (separation of abdominals)
What would you tell women who are afraid of the invasive nature of this therapy?
Pelvic health physical therapy is indeed looking at the pelvis. What this means is anything from the diaphragm (breathing muscle) to basically below the pelvic bone. Posture, strength, muscle length, muscle tone, myofascial restrictions, etc. are all evaluated. An internal pelvic floor exam is performed of the vaginal and/or rectal musculature. This allows the pelvic floor therapist to correctly examine for pelvic floor dysfunction. There is nothing to be concerned about during this evaluation. The therapist assesses the pelvic floor in a dimly lit private room. No “tools” are used, only one small finger is used to best examine the pelvic floor. This type of therapy is done in many other countries, the U.S is just behind in making this a protocol pre and postpartum.
What is the most extreme case you have had? Were you able to help?
Some women develop fistulas (or holes/pathways) between bladder and vagina, vagina and anal canal that can cause many problems with fecal leakage, urinary leakage, pain, prolapse, infections. I have had many women with this problem that end up needing to have surgery. Sometimes the body will try to heal itself if it goes untreated but can cause a lot of restrictions leading to greater issues and pain. I was able to help minimize pain and leakage but ultimately the patient needed to have surgery. Our goal always is to try to avoid surgery but sometimes it is necessary for the client to have the greatest quality of life.
How can women find a therapist in their area?
Women can look at the APTA (American physical therapy association) website and go to the women’s health section and search their area. They can also go to google and type in pelvic health/women’s health physical therapy.
Great Articles on Pelvic Health:
Hope you enjoyed this super informative post! I can’t recommend pelvic health physical therapy enough. If any of you have found great therapists in your area, leave your recommendations below for other mamas!
You can find Merci at Functionize Health & Physical Therapy in Decatur, GA
For more from Merci click HERE