July Knowledge Drop
Each month for our newsletter, the Lady Blurb, we'll share answers to some questions you've submitted. The questions below were taken directly from you! To submit a question for next month, comment below or email us at contact@ladybirdpt.com.
**The answers to these questions are not meant to be used as medical advice. These answers are not meant to take the place of a skilled physical therapist or discussion with your medical provider. If you are experiencing concerning symptoms, please contact your physician.**
This month, we’re answering:
1. Help! I’m 37 weeks pregnant and just learned about pelvic floor PT. What can I do between now and birth?
2. I have a sharp pain in my low back when I get in and out of bed, it’s worst in the middle of the night. What can I do?
3. I always leaked a little with exercise but it has been getting worse. Why is that happening??
1. Help! I’m 37 weeks pregnant and just learned about pelvic floor PT. What can I do between now and birth?
You are NOT alone! We get so many calls from people in their last few weeks of pregnancy who just learned about pelvic floor PT and the urgency feels so real. First and foremost, remember that you’re OK, and it’s never too early or too late to start taking care of your pelvic health. In a perfect world, we would see every pregnant person for at least one prenatal physical therapy visit around 30 weeks of pregnancy. But if you’re just finding out about pelvic floor PT and preparing your pelvic floor for birth with just a few weeks left in your pregnancy, don’t fret!
First and foremost, I’d recommend our online course, Birth Preparation and Postpartum Planning. This 2.5 hr course focuses on training your pelvic floor for birth, reducing the risk of common complications and teaches you exercises you can practice on your own at home. We talk through pelvic floor relaxation, push preparation and practice, perineal tear risk reduction, pushing positions and prepare you for postpartum recovery as well. With this course you also get access to our 6 week postpartum core recovery program, Baby Steps Fitness. This course was created to teach you all the things we wish our patients knew heading into birth. The entire goal is to arm you with information to support your birth.
In addition to our course recommendation, here are some other things you can do to prepare your body for birth:
Work on hip and back mobility. Birth is an endurance sport and mobility of your spine and hips plays an integral role in your ability to find comfortable positions during labor. Everyone is different, but some of my favorite movements include:
Cat-cow
A figure-4 stretch
Practice pelvic floor relaxation. Your pelvic floor’s job during birth is to get out of the way. The easier it is for you to relax your pelvic floor, the better! Check out our pelvic floor relaxation flow to learn more.
3. Deep core strength. While your pelvic floor needs to relax and move out of the way during vaginal birth, a strong core helps to push your baby out. Strengthening your core during pregnancy also helps to reduce the severity of diastasis recti postpartum. Some basic movements include:
Transverse abdomninis isometrics
Bird dog
4. Schedule your postpartum pelvic floor PT appointments
Pelvic floor PTs all over the country are overbooked, running multi month long waitlists. Don’t wait until your baby is born to schedule your postpartum care. Call now!
2. I have a sharp pain in my low back when I get in and out of bed. What can I do?
Full disclosure - without talking to and evaluating you, I cannot confidently say what’s causing your pain. With that said, a common form of low back pain that arises specifically with bed mobility, typically on one side of the low back around the dimple, is sacroiliac joint pain. It typically presents as short lasting, strong, sharp pain during a specific movement. If this sounds like you, here are 8 ways to manage SI joint pain.
But for those hurting while rolling around in bed, I recommend:
Engaging your deep core muscles before you move
Log rolling to move instead of sitting up when getting in and out of bed (watch this video to learn how!)
Reading this blog post on ways to reduce pain with bed mobility
3. I always leaked a little with exercise but it has been getting worse. Why is that happening??
Ya’ll, our bodies are finicky and oftentimes when we ignore a problem, it slowly starts talking to us more and more. Leakage is no different! Urinary incontinence is typically a result of muscle weakness or tightness, coordination deficits or pressure management problems. Let’s explain each of those before we go on.
Muscle weakness or tightness
Your pelvic floor muscles wrap around your urethra. When they contract, they cut off urinary flow. When they relax, they allow you to pee! If your muscles are weak, they may lack the strength to keep pee in when we want it to stay in. If your muscles are tight, they may be too fatigued to do their job when the time comes. Both of these issues can lead to urinary incontinence.
Coordination deficits
If you have all the strength in the world but you don’t know how to turn your muscle on, you can’t access that strength. Similarly if your muscles are weak but you can’t figure out how to coordinate a muscular contraction, you can’t strengthen them. Coordination is a prerequisite to strength training.
Pressure management problems
Strength is only one part of bladder control, the other is pressure management. Your pelvic floor muscles need to be strong enough to counteract your intraabdominal pressure. If you’re not sure what kind of pressure I’m talking about, think about what it feels like when you’re pushing to poop. You hold your breath and bear down, using the pressure in your belly to push poop out. That pressure is intraabdominal pressure. If you hold your breath throughout the day, bear down instead of lifting your pelvic floor (hello coordination, again) or wear a tight belly band, you may be increasing your abdominal pressure. When pressure goes up, so does the stress on your pelvic floor. It’s possible your pelvic floor is strong but the intraabdominal pressure is stronger.
If any one of these deficits are present and you don’t directly address them, they can slowly get worse overtime. If you’re not addressing the weakness or tightness, your muscles may slowly get weaker or tighter. If you don’t address the coordination deficits, they’ll never improve. And if you have pressure management problems, you’re progressively stressing your pelvic floor.
Any one of these reasons may explain why your leakage is increasing overtime! But the good news? Pelvic floor PT can help all of it.
Working with a pelvic floor physical therapist can help address sexual dysfunction, bowel and bladder concerns and help you prepare for pregnancy, birth and postpartum recovery. Contact us here to learn more about setting up an appointment with us, today!
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.