Postpartum Pelvic Floor Assessment Timeline: When Should You Start PT?

Currently, there is no standard of care for pelvic health rehabilitation in place for postpartum women in the United States. Women are often left with more questions than answers surrounding recovery and in particular return to activity. Musculoskeletal impairments including Pelvic Floor Dysfunction and Diastatis Recti are two common examples of post pregnancy related musculoskeletal disorders. For many women, the stock 6 week medical clearance visit has come to feel incomplete, too far out from birth, and lacking a comprehensive systems check despite clearing women to return to all aspects of their lives! I have yet to ever hear a patient say " My 6 week check was so thorough."

Pelvic Health Physical Therapists are in a perfect position to step into supporting women in their early phase of postpartum recovery, the 4th Trimester, which is marked by birth and extends through 3 months, through direct access care. Women can benefit physically, emotionally, and socially from early intervention postpartum care as a way to help her feel supported during the immense transition into motherhood. Postpartum evaluations offer musculoskeletal assessment and neuromuscular training specific to the patient and any medical circumstances related to the pregnancy and birth. Women want to be engaged in recovery and are deeply invested in their health and deserve a higher standard of care postpartum. Some benefits of Pelvic Health Physical Therapy include but are not limited to:

• Core Canister Neuromuscular Coordination Retraining

• Musculoskeletal pain screening and management

• Professional scaled approach to return to movement

• Bladder and Bowel screening, education and behavior strategies

• Professional Support network recommendations and referral expertise

• Normal vs Abnormal symptom screening

  
  

Examples of an early intervention visit at 2 weeks postpartum may include: A woman who underwent a c-section learning how to start with indirect incisional desenstization, deep transverse abdominal recruitment, global core canister isolation, postural support and strengthening, and likely self positional strategies that can help offset stiffness and pain. An example of a 2 week postpartum evaluation for a woman who delivered via a vaginal birth with a second degree tear may include; external perineal screening for tissue healing and visual cuing for deep core connection/coordination, trunk and neck postural support and strengthening to help reduce tissue tension and low back pain, and patient specific deep core coordination reentry and cuing for accuracy.

I often recommend women schedule a postpartum evaluation as soon as 2 weeks postpartum. I commonly have active patients schedule this visit when they're pregnant and wrapping up prenatal care with me. Understandably, this may not be doable for some ( I totally get it, I was hanging on by a thread at 2 weeks postpartum after my babies!), but support early on does help to facilitate improved functional outcomes limiting risk associated with pelvic floor and musculoskeletal disorders. The hope is that instead of getting "cleared" at 6 weeks to get back to ALL the things ALL AT ONCE, women can be supported by multiple medical providers including Pelvic Health Physical Therapists, who can offer skilled screening and assessment helping improve functional outcomes for women.