Navigating the 4th Trimester: How Pelvic Floor Therapy SupportsPostpartum Healing

Navigating the 4th Trimester: How Pelvic Floor Therapy SupportsPostpartum Healing

July 3, 2024

Navigating the 4th Trimester: How Pelvic Floor Therapy Supports Postpartum Healing

Today we will be highlighting postpartum care and recovery during the “4th Trimester.” Postpartum care is more commonly utilized now to help new moms recover from pregnancy and delivery, whether that is vaginal delivery or cesarean.

Many moms may be wondering; is pain normal after giving birth? There is a wide variation in pregnancy and birth experiences, and some may experience this variation within each of their pregnancies as well! As a result, it can sometimes be difficult to tease out what is
“normal.” We are here to let you know that, while some things are common experiences, they are not necessarily normal.

Common symptoms reported after birth include:
● Vaginal or perineal pain
● Tender/sore breasts
● Headaches
● Muscle soreness
● Back pain
● “After pains” (contractions)

Generally, within the first 6 weeks of postpartum, these symptoms should start to reduce. At your 6 week follow up appointment, your OB or midwife will likely clear you to return to your daily activities such as exercise, penetrative intercourse, and more. If you are not feeling better or ready for these activities by 6 weeks postpartum, or experiencing different symptoms than the one listed above, it is important to bring up these concerns to your provider. However, we recognize that it may have been difficult to talk about your symptoms, or that you may not have gotten the full answer you were seeking, which may have left you feeling underwhelmed and still confused about your symptoms. This is the last thing you need when caring for a newborn! Let’s cover some of the reasons postpartum pain may be occurring, which symptoms may present, and how pelvic floor physical therapy can help!

Hormonal Changes

After giving birth, the levels of the hormone estrogen drop significantly and can remain this way for many months if you are also breastfeeding. Estrogen has many important roles to play in your body and health. One important role is regulating tissue health, particularly of the vagina. When estrogen levels are lower, you may experience symptoms of dryness and increased sensitivity. If your OB cleared you for penetrative intercourse at your 6-week postpartum appointment and you found it to be painful, this could be part of the reason why! Oftentimes, when tissues are sensitive and irritated, pain may increase. Then the muscles around those tissues may also become tight or irritated.


It is important to note that a c-section is a major abdominal surgery, and there are many layers of muscle and tissue that have to heal afterwards! Scar tissue is a natural part of the body’s healing process. However, it is not as elastic as the tissues around it, and as a result, the c-section scar on your abdomen may feel “stuck” or tight. This can limit normal movement of the surrounding tissue, and your body might create movement from somewhere else to compensate, resulting in pain.

Episiotomy or Perineal Tearing

Scar tissue can also occur as a result of an episiotomy or perineal tearing, similar to the formation of scar tissue after a c-section. The tissue surrounding the site of the cut or tear may also become tight and sensitive. Just as symptoms can vary, so too can the recovery period. It is not normal to experience sensitivity around the healing tissue up to 6-8 weeks after delivery. You may notice this sensitivity or pain with activities such as intercourse, sitting, or exercising.

Diastasis Recti

During pregnancy, your rectus abdominis muscle (the 6-pack muscle!) separates along the linea alba, which is the connective tissue in the middle that holds the two sides of the muscle together. This separation is necessary to allow the belly to expand while the baby is growing! After delivery, the separation naturally begins to close. There are many factors that affect the closure, and a separation of less than 2 centimeters is considered normal. However, if you are experiencing a wider separation this can make it harder for your core muscles to work together effectively. As with scar restrictions, you body may compensate with other movement patterns as a result.

Pelvic Instability

Not only do hormonal changes affect the vaginal tissues, but they also influence your pelvic girdle to allow for adjustments as your baby grows and help prepare your body for labor. The hormone relaxin is primarily responsible for these changes, as it helps to increase laxity of the ligaments that support our joints. While the loosening of the ligaments around your hips is helpful in allowing your pelvis to expand during pregnancy, it can reduce the stability of your pelvis. In response to this increase in laxity, your body often tries to create stability by tightening the surrounding muscles and changing your posture. This can also contribute to pain.

Pelvic Floor Dysfunction

Your pelvic floor muscles help control bladder, bowel, and sexual functions, as well as provide support to the pelvic organs. Pregnancy and childbirth puts extra demand on these muscles due to many of the reasons we discussed above. When your body has been working overtime due to the factors such as the weight of the baby, postural changes, increased ligament laxity, and labor, you may experience pelvic floor dysfunction. This includes symptoms such as vaginal, perineal, tailbone, anal, pelvic, low back, or hip pain, painful intercourse, painful urination or bowel movements, pain with sitting or exercising, urinary urgency or frequency, urinary incontinence, pelvic organ prolapse, and constipation.

Nerve Irritation

Compression or stretch on nerves may occur with changes to the body during pregnancy or delivery. The most commonly involved nerves are the sciatic nerve or pudendal nerve. These symptoms may include burning, shooting, stabbing, tingling, numbness, itching, or increased tissue sensitivity. You may experience these symptoms in the low back, buttocks, back of the thighs, lower abdomen, front of the hips, groin, perineum, or vulva.


In pelvic floor physical therapy, your PT will create a personalized treatment plan to address your symptoms and the root cause, whether that be muscle tension, weakness, nerve irritation, scar tissue, fascial restrictions or other pelvic floor dysfunction. Interventions used may include exercise, manual therapy treatments, and other skilled techniques.

Every individual’s body responds differently to pregnancy, labor, and delivery. As a result, every mom can benefit from a pelvic floor physical therapy evaluation. Here at Treasure Valley Pelvic Health, our skilled PTs are here to help. Each PT is trained to evaluate, assess, and treat the many sources of pain, and other symptoms, we discussed today. Reach out to us today to get started on navigating your postpartum journey; we are here to support you!

In Health,

The Team at Treasure Valley Pelvic Health

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