Dr. JULIE BREWER, PT, DPT, WCS, BCB-PMD Pelvic Health Physical Therapist, Houston Methodist West Hospital
Continuing our discussion on postpartum health, we wanted to touch on something many forget or leave out, and that’s the pelvic floor. There’s so much we don’t know about postpartum recovery and so few people willing to discuss it candidly. However, we found Dr. Julie Brewer at Houston Methodist. Dr. Brewer is a pelvic health physical therapist who is board certified by the Biofeedback Certification International Alliance (BCIA) and the American Board of Physical Therapy Specialties (ABPTS) and specializes in complex pelvic floor disorders.
We got some insight from Dr. Brewer on her specialties and why PT can be so important for new moms!
The pelvic floor muscles are part of the deep “core” group, attaching to the pelvic girdle from the pubic bone to the tailbone. The pelvic floor muscles support the trunk, control bowel, bladder and sexual function and assist in normal circulation. Pelvic floor dysfunction is incredibly common after pregnancy and childbirth.
Often times in the postpartum period, women may experience urinary or fecal incontinence, pelvic/vaginal/rectal pain, painful intercourse, lack of sensation during sexual activity or a feeling that things are “falling out” during exercise. These symptoms are very common, but not NORMAL, and they may or may not resolve on their own. Research has shown that up to 40% of women experience tearing of the pelvic floor muscles during vaginal delivery, but often times do not cause any symptoms for many years.
Many people are told that Kegel exercises will help with these conditions. While Kegel exercises can be helpful, many people have overactive, tight or uncoordinated pelvic floor muscles. Learning to relax the pelvic floor is often addressed first in pelvic floor physical therapy.
New mamas have a LOT of their plates! Gentle kegel exercises and diaphragmatic breathing can begin immediately postpartum! Some women have difficulty “finding” their muscles again after childbirth due to weakness, trauma or lack of coordination. PT can help with the overall recovery process and getting back into exercise.
Dr. Brewer said her practice generally recommends a new mother come in for PT after 6 weeks postpartum, once they have been cleared by their medical provider. They work on rehabilitating the abdominal/pelvic floor muscles, mobilizing a C-section scar or a perineal scar though manual therapy, practicing good body mechanics for infant care and specific exercise. Occasionally they recommend vibrator or dilator work to the pelvic floor muscles as part of a home program. This can be very helpful in relaxing tense muscles, easing perineal scar pain and improving body awareness.
As a pelvic floor physical therapist, Dr. Brewer treats women (and men!) with bowel, bladder, sexual dysfunction and pelvic pain conditions. She’s a Doctor of Physical Therapy with board certification in Women’s Health. The pelvic floor is a group of skeletal muscles that are located between the pubic bone and the tailbone. Just like any other skeletal muscle in the body, they can be weak, tense, tight and/or uncoordinated. Conditions like urinary incontinence, overactive bladder, painful intercourse, constipation, fecal incontinence and pelvic pain can be caused by pelvic floor dysfunction. Many of these conditions affect women during pregnancy and postpartum due to the changes that occur in the pelvic floor. Vaginal birth can cause injury to the pelvic floor muscles and C-section scars often heal with increased sensitivity, pain and tightness. Some women have a separation in the abdominal muscles, called a diastasis recti, which can contribute to pelvic floor dysfunction, low back or pelvic girdle pain. Additionally, many postpartum women are eager to get back into exercise, but feel like “things are falling out” or like their body “isn’t the same.
What does a pelvic floor PT do? A pelvic floor PT will listen to your complete birth and medical history and ask questions about your bladder, bowel, sexual function and daily activities. Next, a physical exam of your posture, flexibility, strength, breathing and movement patterns, abdominal muscles will be done. A pelvic PT will then examine your pelvic floor by assessing externally and internally through the vagina or rectum to feel the resting tone, strength, relaxation and flexibility.
Pelvic PT often involves manual therapy to the pelvic floor. Your PT may suggest a dilator or vibrator to help gently stretch and relax the pelvic floor muscles, particularly if you are having pain. Treatment may also involve biofeedback to help improve your awareness and coordination of the pelvic floor. Pelvic floor PT is highly individualized, and your therapist will work with you to create a home exercise program specific to your goals.
In Europe, women are automatically referred to pelvic floor rehabilitation at 6 weeks postpartum. Why don’t we get that here in the US? There are so many factors which play into this, but fortunately through social media, many pelvic floor PTs are creating awareness and educating the public and medical community on the benefits of postpartum physical therapy.
In Texas, however, a prescription is required by a physician to begin physical therapy.
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