Postpartum pelvic health: 11 common questions answered

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. Hello, everybody. Welcome to the Restoring Human Movement podcast. This is your guest host, Dawne Costantino, and today we are getting into the topic of pelvic health. I'll dive a little deeper into this, but really what I want to say is, if you're new to the podcast, welcome. We're super glad you're here. If you're not new to the podcast, welcome back. We are today continuing to add just more to the many, many, many episodes we have already recorded.

This one's going to be short and sweet because I'm by myself. There's no banter going back and forth between me and Sebastian and his silly analogies that he likes to use. If you've been listening, you know what I'm talking about. Today, what I did was I got a little help from AI. I've been really hesitant to use AI, but it's actually been really helpful to just give me some ideas on what to cover. Usually, my ideas for podcasts, for videos, really come from patients that have seen that week. Today, I actually decided to just type specifically what kind of questions do postpartum moms have about pelvic health in the postpartum time.

That's what we're going to hop into. I think it gave me about 11 questions to cover. We may not get into all of those, but let's just hop right into it. So, the first one here is why is pelvic health so important after birth? Really simply put, your pelvic floor just went through trauma. Let's say at least if you gave, you know, vaginal birth. Even if you didn't give vaginal birth, C-section scars play a really big role on function overall, core strength specifically, the way you may move afterwards, things of that sort. So, we really want to keep in mind the importance of the pelvic floor. The pelvic floor is basically, I like to call it like a hammock at the bottom of your torso.

This is where you pee from. This is where you poop from. This is where you give birth from. This is where you have intercourse from. And the muscles down there, the ligaments down there, the joints, all are responsible for mainly keeping your organs inside of your body. So, the strength of those muscles are super important to make sure that the function of those organs can continue. The pelvic floor also plays a massive role in just overall stability in the body, specifically core stability, really simply put again, like it eccentrically loads when we go through diaphragmatic breathing. This increase in pressure during that type of breath that puts load onto the pelvic floor, helps transfer movement, helps transfer load, helps you safely perform exercise, helps you safely perform activities of daily living on a day-to-day basis.

So, the pelvic floor plays a really big role in a lot of things. And when it comes to musculoskeletal conditions like back pain, hip pain, tailbone pain, groin pain, pain and discomfort that comes after childbirth, pain and discomfort that, you know, even people who haven't had babies yet are dealing with. We're a lot of times focusing on the pelvic floor, the health of it, not specifically it by itself, but the way it functions in the system. So, I cannot push hard enough how important the health and the function of your pelvic floor really is. Looking at these questions, like what we're talking about here, it says, discuss the role of the pelvic floor in supporting organs and how neglecting pelvic health can lead to long-term issues.

Those long-term issues are ones I just mentioned. We may be dealing with prolapse. We may be dealing with incontinence. We may be dealing with back pain. We might be dealing with hip pain. Both of those in a chronic state. It's a lot of things that can all come back to the pelvic floor. And those are only just a few that I'm mentioning. So, on to the next question. What are some common pelvic health problems new moms see? So, issues like urinary incontinence is mentioned here. Urinary incontinence can actually come from a few different things. So, if this is something that you're dealing with, please make sure that you are seeking medical help to be absolutely certain that it's not something big, bad, scary that is preventing you from being able to control your going number one, going number two, basically.

There are some spinal conditions that can contribute to this. If we're talking about in the postpartum time, you gave birth, you've given birth to multiple children, and you're just dealing with some urinary incontinence, that can be improved with strength of the pelvic floor. So, Dr. Lindsay Mumma always talks about, if I ask you this question, how would you answer it? If you had a full bladder and you went to a trampoline park, would you pee your pants or not? If the answer is no, you're probably okay. If the answer is yes, there's something to work on here. So, even if you've had children, I think this is a very common misconception that I've given birth to three children, so this is just normal for me now.

Just because it's common doesn't mean that it's normal. So, keep that in mind. If you're looking to improve your urinary incontinence in your postpartum time, again, seek medical help first. Just make sure that big, bad, scary things are ruled out and not contributing to this. And if it all comes back to, we just need to work on the strength and the function of the pelvic floor and the core, then there are tons of people out there that are really, really good at that. Chiropractors, PTs, pelvic floor PTs, chiros that are good in the pregnancy and postpartum world as well. So, keep all of that in mind.

Next thing here is pelvic pain. Pelvic pain is a pretty general way to describe pain anywhere in the pelvis. We could be talking about the pubic bone. We could be talking about the tailbone. We could be talking about the glutes. We could be talking about the groin. We could be really talking about the pelvic floor itself, maybe heaviness there, painful sex, things of that sort can present when it comes to pelvic pain. So, how bad it is, how constant it is, if you have control or don't have control, how much it's affecting your life, your happiness, all of those things are questions to ask yourself.

If that's what's going on, even if it's in its minor stages, just make sure to go get assessed. Make sure that there's not something that we could be doing to help improve upon some of this stuff. But again, this pelvic pain in general is kind of an umbrella term for a lot of stuff. So, I think you'll hear me say that a lot in this podcast today. Go get some help. Have somebody assess you. Someone that typically does like an overall body function assessment would be something that I would highly suggest. Of course, primary care, OBGYN, keep them in the loop. Have them do the necessary tests that they need to be sure that you are on the right path, that you are seeing the right person.

I might be a little bit biased when I'm saying this because I am in the community of conservative health. But most of the time, your chiropractors and your PTs are going to spend at least 30 minutes with you, assessing you, taking you through neurologicals, orthopedics, testing strength, seeing how not just the pelvic floor is functioning, but how the low back moves, how strong the glutes are, how mobile the hips are, all of that stuff plays a massive role. So, pelvic pain, if that's what you're dealing with, go get assessed. As we mentioned, prolapse is also something that you may notice with pelvic health problems.

All of these things, again, can affect your daily life. So, if it's really, really starting to affect you, the sooner you get this treated, the better it's going to be, the better you can show up for the people around you. Next question. What symptoms should I be worried about and when should I seek professional help? So, I think I kind of mentioned that in the last one. I'm actually just going to read what the answer AI spit out here and then we can, you know, kind of change that accordingly if we need to. So, red flags that moms should look out for. Consistent pain, incontinence, heaviness in the pelvic area.

Those are times to go consult somebody to make sure that there is not something that is progressively getting worse moving forward. Prolapse is not something to take lightly. We definitely want to get on top of that for overall health and function. Again, I mentioned incontinence. A lot of times this really comes back to just what we went through in our pelvic floor. Giving childbirth is not an easy thing on that system, but there are other things neurologically that can contribute to incontinence. So, you know, I feel like I'm beating a dead horse here, but just go get it checked. Be absolutely certain.

I don't want to scare you. I'm just trying to educate you. How can chiropractic care help with pelvic health after childbirth? So, chiropractic care just, I'm hesitating here because there's so much that you can do under the umbrella term of chiropractic care. And so, most of the time when you think of chiropractic care, you think of adjustments, mobilizations. You go in, you get pop, pop, crack, crack, and you go. If that is the chiropractor that you are seeing and it's making you feel better, wonderful. Making sure that the joints are moving the way that they should be moving so that the nerves are functioning the way that they should be functioning so that the muscles that are supplied by those nerves are strong and functioning well, which then kind of zooms out and talks about this overall health and function and movement.

All of that is important. So, if you are only getting adjusted and as long as the person you are seeing has done a thorough and proper exam on you and has given you a game plan and you feel like you are progressing, then you are on the right path. And so, chiropractic care can really, really help with proper movement of the joints. Adjustments can be really, really helpful with pain as well. So, all of that stuff is just one piece of a puzzle. We, in our office, we really like to add a little bit more to that. So, we don't just adjust. We adjust if necessary. We always don't. We don't force it upon people.

If you're there for that, we're happy to do it. If it's necessary, we're happy to do it. If it's not safe for you, there's other ways that we can go about accomplishing what we need. So, we like to spend a lot of time. We usually spend about 45 minutes to an hour with each person. Let me start from the beginning here. You come in for the first time. We're going to do basically, well, we're going to talk about what's going on. What have you been feeling? What do you, what is this preventing you from doing? What are your goals? What are we trying to get back to? Okay. And we dive into just really creating a narrative around what's happening, making sure that, you know, you're in the right office and you shouldn't be seeing somebody else.

And if you are in the right office, we're going to give you options. Based on those options, we're going to have a plan of attack. So, then we're going to hop into some range of motion. How are we moving? How is it feeling? Is it normal? Is it not normal? Is it painful? Is it not painful? Is it just limited and we can make it better? Then we're going to get into orthopedic and neurological testing. Orthopedic testing really stresses certain tissues in the body. And if it reproduces your pain, it gives us a better idea of that tissue being your pain generator. So, for example, tailbone. Okay. Tailbone pain can be tailbone pain or tailbone pain can be a ligament referral or tailbone pain can be a spine nerve referral.

So, it's really, really important for us to assess to see is this, you know, what tissue is causing this pain and that's what an orthopedic exam is for. A neurological exam is to be sure that everything is functioning properly. Neurological exam makes sure that your strength is there, your reflexes are there, your sensation is there, and you don't have anything pathological going on. So, we're going to do an all thorough encompassing assessment like that. From there, we're going to dive into, again, if there are any adjustments that need to be had, let's do it so that we have access to those joints, to that range of motion, proprioceptive feedback from that joint.

Then we're going to get into mobilizing what needs to be mobilized, giving you a first aid movement or position or exercise that helps bring discomfort down so you feel like you have some control, giving you some exercises that will start to build some strength, start to build some stability. I'm being super general right now because it really just depends on what we're talking about and who is in front of us. But overall, this is answering the question of what can chiropractic care do? At least chiropractic care in our office, all of that is a part of it. And it's really about creating a nice little recipe for the person in front of you.

I think that's enough on that question. Let me know if you have questions on that one. Hey, everyone. It's Sebastian. I'm going to hijack the show just for a second here to tell you about an opportunity that we have called the Discovery Session. A lot of people over the years have reached out to us from our YouTube channel because we have 150,000 YouTube subscribers at this point in time, probably more by the time you're listening to this. And we have a lot of people listen to this show and read our articles online. They're frustrated. People are frustrated about not being able to get back to full activity.

They're frustrated they can't really trust their body. They're frustrated that they have not found any long-term answers or things to make them happy. And so we're here to help. We may not be the ones to actually help you, and we're okay with that. But we're hoping that if you are able to speak with us, that we can maybe give you some insight of things that you potentially haven't tried yet. And if we know people, we'll suggest those people too. So if you want to take advantage of the Discovery Session, all you need to do is go to p2sportscare.com and find the Book Now button. It's all in there.

We have virtual or in-person options. You can go to the show notes for this show and find a link that will directly connect you to us, or you can call us, 714-502-4243. We'd love to help you the best that we can, and we're always here to serve. Now back to the show. Are there specific exercises that I can do to strengthen my pelvic floor after childbirth? Yes. And I think the first one that everybody's going to think of is Kegels. I'm not against Kegels. I think they're great. Definitely use them, but we should be doing more with it. So, I mean, AI's answer here is offer guidance on safe exercises like Kegels or pelvic tilts to begin the healing process and improve pelvic health.

I love that answer. Nothing wrong with that answer. I think it's great. Pelvic tilts are a really good one, and they can be used for a lot of different reasons. For activation of the muscles that move your pelvis into different directions. So that's what pelvic tilts are. Pelvic tilts in a certain direction can put you in a proper, more optimal position for exercise. So we want to make sure that you are stabilizing properly through the core before we go through something like getting up and out of a chair or picking up baby's toys off of or, yeah, baby's toys off the floor, things of that sort.

If you're looking to get back into exercise, let's make sure that you're in that right optimal position to go through some of these things. So a little segue, specific exercises, really like if you're only, obviously you're only listening to this on audio, I can explain them. I can throw them out there. Things like planks and side planks and squats and things of that sort, diaphragmatic breathing. I love all those things. If you have no idea what those are, or if I start shooting exercise names out there that maybe is called something else by somebody else, it makes it really, really difficult for people.

So I just created a free PDF that should be linked in the show notes. If you click on that PDF and you download it, it is really plain Jane. I just threw it together because as I've been making these podcasts, I realized that I'm like, go to our YouTube and, you know, go to our website and good luck in finding it with all of the stuff that we've put out there. So instead of just compiled into a really short PDF, core exercises, pelvic floor and diaphragmatic breathing, ways to use that skill into different exercises and different ranges, strength exercises, things of that sort. So it's not an all encompassing like week by week, day by day, how you can progress yourself through a program like this.

But if you want some really easy references on what exercises that you can do, I've picked pretty low risk, pretty high reward ones there that you can use. So please click on that. But pelvic floor exercises specifically, I am always going to come to the breath. Why are we teaching you to do the one thing you've known how to do since you were born, which is breathe? Where to direct that breath can go such a long way. And as we age, as you know, our lifestyle choices changes, our movement patterns changes, the way our body is forming, our breathing patterns change too. So pelvic floor and diaphragmatic breathing is actually a way to start slowly, eccentrically or lengthen the pelvic floor in a safe way.

We use pressure through the abdomen to load the abdominal wall, to load the obliques, to load the transverse abdominus, to load the back muscles. What this can do is set you up for a safe place in the core to start moving through. So if you can learn this skill and you can learn to brace through this skill, meaning kind of stiffen the abdomen, make sure we don't get soft, make sure we don't find ourselves in weird positions before we go through an exercise. That skill goes a really long way when we're building it into something like a side plank, a glute bridge, overhead lifts, leg exercises like lunges and squats.

This is the foundation. We got to do it. So do your Kegels, but also start to introduce in this diaphragmatic pelvic floor breathing and make sure that you're doing it properly. Have somebody take you through it. Have someone else who knows if you're doing it properly assess you and put their hands on you and make sure you're doing it right and teach you to know that you're doing it right. So as always, go see somebody. So yeah, I mentioned a few exercises there that you can start to build in for pelvic floor health strength after childbirth. Next question. How can I tell if I'm engaging my pelvic floor muscles correctly during exercises?

So this one can be difficult. I believe I've already mentioned Dr. Lindsay Mumma. Her book is literally here right next to me. Your pelvic floor sucks, but it doesn't have to. Buy her book. It's really great. And it's a very, for the lay people, it's not very medical. It teaches you, honestly, the answer to this question here, how to know if your pelvic floor muscles are engaging. But her way of teaching this is my favorite way to teach it to others. So I did want to credit her for that. But one of the best ways to know, truly, it is just by feel. Like, most of the time, if you're sitting down right now and you, you know, try to push a fart out, you're going to feel muscles down under activate.

And that's what you're trying to look for. It's really this just like feeling down there. But sometimes our sensation can be skewed after childbirth. Maybe our connection to that area has been a little bit dissociated. So we want to build that connection again. We want to build that feeling back again. Maybe pain is overriding our ability to feel that, too. So the way that Dr. Lindsay Mumma teaches it is by sitting on your hands. Depending on the length of your arms, this might be difficult. So just imagine sitting on the edge of a chair, your butt bones, you're sitting on your butt bones there and on each side to the side of you, like your hands, arms are to the side of you there.

Put your hands underneath your butt bones far enough that your fingertips are just inside the butt bones. Excuse me. Everybody knows what their butt bones are. I don't think that'll be too hard for you to know what that is. So we don't want you touching bone. We want your fingertips kind of moving inward towards the midline, towards the anus, towards the vagina. If your arms aren't long enough for that, what you can do is take one hand and reach directly in front of you underneath the pelvic floor and sit on that. Then what you're going to start to do, to know if you're doing it properly, again, bear down like you're trying to initiate a fart or to let out a nice little toot.

And you'll feel the pelvic floor muscles drop into your hands there. If you can't feel it, take time. Okay. Don't push too hard. We don't want to create any injuries. If you toot, that means you know you're doing it right. Or if you giggle and you feel that, that's how you know you're doing it right. Then we want to start to breathe there. So it really takes time and practice. If you're not getting it right away, that's okay. But this is the best way to know is by using your hands and your fingertips to feel movement down there. Okay. So that's the best way to know if you're doing it. Again, if you need somebody to teach you this, just go see somebody.

It might be a little bit weird and, you know, intimidating. Find somebody that you know and trust and that makes you feel comfortable. They can, if you don't want anybody else putting their hands on you, that's okay. Find somebody who can teach you how to do it. That is out there. Search for it. So let me make sure I answered this question. Are there specific? Oh, that's it. How can I tell if I'm engaging my pelvic floor muscles correctly during exercise? You're going to feel it. You truly are going to feel it in your hands. And if you're not, you're probably not doing it right. Is it safe to exercise my pelvic floor or do core work if I've had a C-section?

Absolutely. You should be doing this. So C-section scars, when they're out of time in healing, as always, we're respecting healing timeline. Get cleared for this stuff by your doctor before going and seeing somebody. But, you know, tissue work and mobilization of the scar is super, super important here. But the C-section can actually affect your awareness of the area down there as well. Sensation changes. Core activation changes. So it is absolutely safe and absolutely necessary for you to be doing this stuff after you've had a C-section. When is the question? Always go see your doctor and ask that question.

It's different for everybody. Okay? AI's answer here was address the concerns of moms who had a C-section delivery explaining the importance of gentle, progressive movements in the recovery process. Gentle is the highlight question here. A little bit goes a long way. Just learn the skill again. Re-introduce the nervous system to this area again. Make sure sensation is there. Make sure function is there. We don't have to go ham right away. It's not about how much we do or how hard we do it. Slow, easy, gentle, progressive exercises can go a really long way. Can posture or daily habits affect my pelvic health postpartum?

Yeah, absolutely. I'm not a huge stickler about posture, but there is a time and a place for us to be having a posture conversation. Proper posture through certain exercises is probably the biggest time that I talk about posture because if we're in a nice neutral spine, neutral pelvis, then we can breathe properly and we can disperse load and energy properly for exercise. So that's what I'm going to talk about posture. Stagnant posture, any posture for too long, even if it's the perfect one, is going to hurt. So movement is medicine here, but daily habits I'd like to highlight. So let me see what AI's answer is here.

Discuss how posture and everyday activities like lifting, sitting, or breastfeeding can impact pelvic health and how to improve these habits. So how it impacts pelvic health here. Okay, so lifting in general specifically. So lifting, when we go to lift something, the way that we do it can either put absolutely no load on the pelvic floor and extra load somewhere that doesn't need to be taken on that load, like your low back or your knees. Or too much load can even create a lot of strain there. I have a couple patients right now that are in my mind where it's just, if we don't do it properly, there is a flare-up in the pelvic floor that occurs.

So how you disperse the pressure, where you activate from, building better team players when we're doing things like lifting is really, really important. So sitting, breastfeeding. Again, I always have a, like, here's ideal as your doctor who, you know, knows the body. Ideally, you'd be doing it this way. But, you know, it's, you got a child and you got to take care of this child and you got to feed this child and you got to do it in any way that you possibly can. And sometimes at the sacrifice of your own body and your own pain that you were feeling. So what I encourage people to do is try something different each time.

I did it this way last time. I was sitting on the couch last time in a really crappy posture and my neck started to hurt. So this time around, I'm actually going to set myself up in a chair somewhere with some back support behind me and a pillow under my arm so that I feel a little bit more supported and I'm not in as much pain. Maybe I do it standing and walking around so that I'm getting some movement and some steps in. Maybe while baby is breastfeeding, as long as I've been cleared to do so, I'll get a couple squats in. Whatever it may be, whatever works for you and your child, but really what it comes down to is daily habits.

I really like to highlight if you do too much of one thing, that's when pain and injury starts to set in. Pain is a warning sign that something needs to change. So listen to it. Don't be afraid of it and change something. Do what feels comfortable. And if you need help, please reach out, have somebody suggest some things for you. But yes, daily habits go a long way. Change your position often. Change your posture often. Get some movement in when you can. Take care of yourself so you can take care of that baby. All right, let's see here. What are the signs and symptoms that my pelvic health is improving?

This will be the last one that we answer here. So it says, give moms a benchmark for measuring progress in their recovery, such as improved strength, less discomfort, or increased ease with daily activities. I mean, that hits the nail on the head there, ultimately. It really is. What we like to use is outcome measures in the office. There are subjective outcome measures and there are functional outcome measures. Subjective is what are you reporting to me? Pain intensity is a 5 out of 10. Now it's a 4, now it's a 3, now it's a 2, okay? That is a sign of improvement. Frequency. It was 80% of my day.

Now it's 50. Now it's 30. Or it's the same, but I feel like I have better control. When it does present, I actually feel like I know what to do to have better control over it, over the intensity, over the frequency of it. So these are all things that are kind of subjective improvements that you may be reporting to someone. I feel stronger. I feel like I have more energy. I feel like I can control needing to go to the restroom when I'm going from the kitchen to the bathroom. I can actually control it now. So these are all things you're going to report to me. It's really just, are we meeting goals here?

Functional improvements are typically what the doctor has or the person that you're seeing has control over. It's not something that you report to them, but it's something that they've assessed on you that they can have some accurate measurements of. Hip mobility is an example, okay? Improvement in hip mobility. I know that when I took you through this last time, we only got 20 degrees of hip internal rotation. Now we're at about 25, 30, okay? Palpation. The sacrum was absolutely stuck. It had no movement. It was creating pain when we were palpating it last time. Now it feels like it's got better freedom, better movement during palpation.

This area in your groin, the lower abdomen, the hip flexor was super tender to palpation as well as it was just, it had all these trigger points in it that you could feel. It felt like it was activated and on. It now feels nice and relaxed. You report that it is improving. So these are all, like, there's so many that I could go down, but, like, these are all things that show signs of improvement. So it's what you report, but it's also your initial assessment and things that are improving throughout that assessment in function, mobility, stability, and strength. So I hope these questions are helpful.

I think I mentioned already, but, you know, it's when it comes to core stability, strength, rehabilitation, pelvic health, hip mobility, all of that stuff, we've had so much expertise on that. And so I'm trying to take these skills and this knowledge and put it into the world of postpartum health. So if you are a mom who's looking for help right now, maybe you don't have the resources around you or been told by your doctor to go get help for this stuff, please do. Please reach out to me. If you're not near me, we do discovery sessions virtually, so we can always talk about whether or not virtual options would be right for you.

And sometimes in postpartum times, virtual is the best bet for you. So you don't have to figure out where you're going to go or what you're going to do or child care. We can do it right from home. We'll leave enough time that if something happens with baby, you can take the time with baby. We're very, what am I looking for? Kind of, oh, I'm missing the word. Anyways, whatever. Brain fart on the word, but we will be cognizant of all of that stuff. So virtual options are there. Come see us in person if you want to be assessed in person. Reach out to us anyways if you just have questions. We have a pretty big referral network around the country as well.

So if you want to know if we know somebody near you that can help you, we're happy to guide you down that path as well. Take care of the free or take advantage of the free PDF. Download it. Get started on it. Let me know how it goes. Talk to you guys soon.