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  • Writer's pictureNew Seasons Physical Therapy and Wellness

Things I wish someone would have told me - The Pelvic Floor Edition

Updated: Jul 9, 2021

Last week I had a great discussion with my client centered around what she wishes she would have known about her pelvic floor the early days and weeks following childbirth. I took what she was saying as a call to share what I know. In the past I have shied away from addressing this topic for fear of scaring people or providing false hope. Birth is a charged subject for many. I am writing to you because I want you to have an amazing birth and nourishing 4th trimester. The words that follow are a combination of my experiences, experiences of my clients and what I have learned in formal coursework, from mentors and from reading books in the birthworld. As a Physical therapist specialized in caring for women with pelvic floor conditions I will stay in my musculoskeletal lane. My intention is not to write a book (this decade) but rather to highlight themes I see repeating themselves in the women I work with.

Your pelvis and pelvic floor muscles are meant to stretch to accommodate your baby’s head and shoulders passing through. This has been happening for thousands of years and more often than not, all goes well. SWEET! Your pelvic floor muscles did not tear, that’s wonderful, no stitches. You are home free - WRONG. A baby still passed through your vagina, causing major stretch to your muscles, nerves and connective tissue. Maybe you brought your baby into the world through a cesarean birth and think that you are home free in the pelvic floor department. Sorry mama, WRONG again. Your uterus grew to the size of a watermelon and your pelvic floor muscles were working overtime to support that jumbo organ. There is a good chance that you pushed for hours too. Yup- you are going to need to give your pelvic floor some love.

So what happens to tissue when it stretches to many times its original length?

Nerves - Nerves are responsible for carrying messages around our bodies. The most common nerve stretch injury in birth is to the pudendal nerve. An overstretch to this nerve can result in a reduced ability to generate force through your pelvic floor muscles resulting in a heaviness feeling or leaks of pee or poop. You could also be feeling change in sensation around your vulva and perineum. Stretch injuries to nerves begin to heal within minutes but can take weeks to months to be fully healed.

Read on to learn how to set up the best environment for healing your postpartum body.

Muscles - Like nerves,muscles are built to stretch but in the case of birth, they can be overstretched. Pelvic floor muscles that have been stretched to accommodate a human head, or abdominal muscles that have been stretching to make room for a growing baby are not going to go right back to their original length once the baby is birthed. An overstretched muscle can not generate as much force as a muscle that is functioning at its optimal length and thus can not offer as much support.

What can you do about all of this. Let’s start with a short list of things you can do during pregnancy to minimize risk.

Fill your nutrition bank. Your baby is going to be sure to get what it needs and take if from your body. It is up to you to make sure there are enough nutrients for both of you. While growing a baby does not require a major increase in calories it is important to reduce consumption of common inflammatory foods and eat plenty of healthy fats, protein and fiber. Begin to plan for how you are going to have nourishing food to eat in the first few weeks with your new baby.

Get to know your pelvic floor. Lear how to relax it, contract it, bulge it, breath into it, touch it, stretch it, look at it.

Move your body. Walk, squat, dance, lift, stretch and do whatever makes you feel awesome!

Prepare your mind and trust in your body. I entered my first birth quite scared about all of the things that could go wrong with my pelvic floor. That did not serve me well, all of that fear made it very difficult to relax these muscles. I needed to trust in my body and find my primal birth space.

What can you do in birth. To do this justice I would need to write a book or an entire course. Luckily there are already great books and resources out there.

My baby is earthside, now what?

Eat healthy food. This is the foundation of how you are going to heal your body - like seriously, on a cellular level. If you are feeding your body what it needs you will recover faster and more completely. Eating healthy food is going to increase the chances of nice soft and gentle postpartum poops. This is something you will really appreciate. For more on optimizing your postpartum poops check out

Rest as much as you can. In my first birth I heard this advice but didn't really listen to it. The second time around I intellectually understood why it was important but thought it didn't totally apply to me since I had an “easy” birth. It wasn't until my new baby was about 4 weeks old that I had enough self awareness (after 2 rounds of mastitis, feeling emotionally frazzled, and a cervix that was hanging lower than I preferred) to put the brakes on and stay in bed for long stretches in the middle of the day.

Now this is where I am so conflicted. I understand that many new mothers are not in a situation where they are able to follow these recommendations. Maybe you need to return to work two weeks after your baby or maybe you already have children at home and limited resources to bring someone in to help you out. In the past that has kept me from speaking out but today I am just going to lay it out there. Here is a little perspective. In more traditional cultures (like cultures with thousands of years of wisdom) this is what an early post partum month might look like. For 4-6 weeks you spend most of your time in resting, bonding with your baby, and eating healing foods that other people cook for you. You do minimal housework and you stay in your home recovering from the wild experience of birth and preparing for the years of motherhood that lie ahead. In these cultures it is the role of the family and community to support new mothers.

Don’t have family that is willing or able to care for you in this way? Hire a postpartum doula. Learn more about postpartum doula services here.

Connect with your pelvic floor. For most new mothers I encourage pelvic floor contractions within hours of giving birth. These early and gentle contractions help with swelling reduction and early healing. At a loss as to what this means or feeling symptoms you are concerned about, please seek the help of an expert. I would love to help you sort this out in the early days.

Ease back into activity and formal exercise. Your 6 week postpartum check is not the all clear to jump back into intense exercise. You are going to want to spend some time on rehabilitating your stretched muscles. If your gut tells you you are working out too hard, listen to it. There will be plenty of time for marathon training once you have the pelvic floor and abdominal strength to support your efforts.

Recognize the signs of pelvic floor dysfunction. If you have any of these symptoms beyond 6 weeks postpartum then seek help. This is nothing to be alarmed about but your symptoms will be less likely to resolve over time at this point.

*Unintended passing of urine stool or gas

*Feeling pelvic pressure or heaviness

*A painful scar

*Pain with vaginal penetration

*Pain with sitting

I hope you have found this information helpful but remember that is it is not comprehensive. If you have concerns about your recovery from birth then speak up. Do not let yourself or a loved one suffer in silence when there is so much that can be done. Have questions for me? A good way to get your questions answered is by scheduling a 15 minute complimentary call with me. I look forward to hearing from you.

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