Postpartum leaky urine, and all of the other post baby pains may be inevitable… But they don’t have to be permanent.

When mamas tell you that your body will be very different after having a baby, they are not exaggerating! I experienced back pain, hip tingling and numbness, constipation, leaking urine, painful sex and a noticeable difference in the way my abdominal muscles worked. All of these things were clearly related to my pregnancy and delivery and were still issues at 4 months postpartum. Nothing in the above list was particularly debilitating on its own, but everything added up and affected my quality of life in a big way. I had always been active and maintained a regular yoga practice, so I wasn’t used to my body feeling so out of whack. I felt like I was living in an older, creaky, tired version of myself.

Most people believe that this is all just part of having children. They think there is a great sacrifice of feeling good in your own skin if you want to be a mother. This simply isn’t true. There are solutions to all of these problems through various treatment options. For me, I found the greatest success with my Physiotherapist, who specializes in women’s pelvic floor health.

I began working with Lauren MacArthur and within just a few sessions, I no longer had back or hip problems. My bladder and bowels were back to normal. My core felt a lot stronger and I was finally able to return to my fulfilling and active intimate relationship with my husband. I began to feel like myself again. It wasn’t easy. I had daily homework and I discovered quickly that it was up to me to do the work, but now, 9 months into motherhood, I feel better than ever!

There are parts of the world where Physiotherapy for the pelvic floor is part of the prenatal and postpartum care within the medical system. In France, every woman has an assessment with a Physiotherapist before she even leaves the hospital. This is the ultimate combination of preventive and curative medicine because these little problems, if left untreated, add up to be much bigger problems later in life. Any mamas out there have a 6 year old that they can’t run after because they will leak urine? It’s all preventable and treatable – especially in the early stages.

I caught up with Lauren, my Physiotherapist, and invited her to answer a few questions about Pelvic Health Physiotherapy.

What does a Pelvic Health Physiotherapist do? Just like with any other problem that you would see a Physiotherapist for, we address tissues (muscles, tendons and ligaments and nerves) looking for dysfunction, specifically within the pelvic floor.

When you say pelvic floor, what does that mean? The pelvic floor is the group of muscles that are contained within the pelvis that run between the pubic bone and the coccyx. Some people think of it as a sling that holds up the organs – bladder, uterus, rectum.

Who are your ideal patients? Anybody who thinks they have an issue in that area and are willing to explore it. Most commonly – women come in their third trimester and then follow through to postnatal care. I am also happy to see people who have chronic low back and hip pain. There can often be an underlying issue with the pelvic floor.

What are the most common reasons women seek your care? My practice specifically specializes in pre and postnatal care but a Pelvic Health Physio can address any problems in those tissues – most common would be urinary leakage. Sometimes people come in for dyspareunia – painful intercourse. Another common condition is the diastasis recti – a separation of the abdominal wall musculature, also known as “Mummy tummy”.

What would would a typical first visit look like? An intake form and a discussion about health history and the main concern. There is also an educational piece about the pelvic floor. I like to teach people about how things work. With consent, there is an internal exam or we can defer that. In that case, it would be more like a standard physio exam. Then there is homework – I always send people home with self care.

Is it necessary to have the internal exam? It’s not necessary on the first visit but it is an important component – if you are coming to see me for work on that area, it is important to assess the tissues. If you went to see a surgeon to have surgery on your knee, you wouldn’t have them do the exam through your jeans. It is the same thing with pelvic health. This is the reason why the specialty exists – the area needs to be properly examined.

((As a side note to the interview, I would like to mention that the internal exam is nothing like having a gynecological exam with your medical doctor. It was very respectful, discreet and not at all unpleasant. There were no stirrups or lights. Lauren talked with me the whole time and the exam felt secondary to everything else that was being discussed. I actually learned a lot and got to know my body on a whole new level))

Did your subspecialty require extra courses on top of the training to become a Registered Physiotherapist? Yes. You can only become subspecialized once you are a Physio and have done the exams to become licensed – then you complete extra coursework and are on the roster with the College of PT of Ontario.

How long does it take to see results? This is a tough question – it depends what the main concern is. Its most ideal to come in at 32 weeks, then 36, then 40, then follow up at 6 weeks postpartum. After that it has a lot to do with the nature and history of the problem. If I had to throw out a number, 6 weeks is a typical timeline to see improvement.

What kind of long term effects can women see without treatment? If the pelvic floor isn’t strong, over the years and with gravity, the tissue and organs can descend, which leads to pelvic organ prolapse. The bladder, rectum, uterus can start to come out of the body. This can occur years after birth, I often see women whose kids are 5 and they have a sudden onset of symptoms that have been years in the making, and the just have never had it addressed. Diastasis recti or “Mummy tummy” can lead to a hernia, issues with going to the bathroom properly, having to wear a pad due to leakage, not being able to play sports with your kids, reduced intimacy – if you have pain in the area and the muscles are high tone and short, then intercourse can become an issue.

What do you find the most rewarding about your work? – I love that I get to work with people to make a difference in their quality of life. Impacting a woman’s life in a way that she can go out and feel confident and wear whatever she wants or get her intimate life back. The solutions are holistic and the women are able to discuss the challenges they are having around their postpartum period. I’m happy to hear about every kind of birth story. I want to hear what’s on going with their body. People always ask “how’s the baby” but I give women an opportunity to talk about how it’s going in their bodies and maybe say “actually, it’s not so great”. Then we can find solutions.

Are there any important tidbits of info that you would like to share? Yes! Kegels are not appropriate for everyone. When it comes to pelvic floor dysfunction, that’s the one thing that’s popular. A blanket prescriptions of doing kegels is not appropriate in about 50% of cases and can actually lead to further dysfunction. It’s the same as finding a great pair of jeans for your body – get the right information, get the right fit. Do the work, but make sure the work that you’re doing is right for your body. Get an exam the determine what’s going on – not all women are the same.




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