July Knowledge Drop
Each month for our newsletter, 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.
**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:
How soon after giving birth should I go to pelvic floor physical therapy?
I’m working on healing my pelvic pain, but I’m having a bad flare up. What can I do to help myself out of a flare?
Help! I feel like I have to pee all of the time and get really strong and frequent urges to urinate. What is going on?
1) How soon after giving birth should I go to pelvic floor physical therapy?
As a pelvic floor physical therapist, maternal health and wellness advocate, and as someone who believes that postpartum moms deserve better care, I always recommend sooner rather than later. I will often encourage my patients to schedule either a virtual or in-person physical therapy visit about 4-6 weeks after giving birth. Of course if there are medical complications or other complicating factors, we can schedule later than this time frame.
Early initiation of postpartum physical therapy care allows us to help you with the following:
Reconnecting with your core and pelvic floor to develop optimal muscle strength and coordination
Learning good posture habits early (so your neck, shoulders, and back feel good with feeding, carrying, and holding baby!)
Body mechanics when lifting and holding your baby, carrying the car seat, pushing the stroller, etc
Developing a simple, safe, and effective home exercise routine
Coach you through any early struggles and connect with you other providers
Develop a postpartum plan to help prevent common issues down the road
What if I’m further out than 4-6 weeks postpartum?
Come on in for a visit! We recommend seeing a pelvic floor physical therapist no matter where you are in your postpartum journey. We teach you pelvic health and wellness skills that apply to the rest of your life and treat and prevent any common issues/complaints. At Awake Pelvic Health & Wellness, be believe in providing you with the best quality, evidence-based postpartum care to help you prevent issues, treat symptoms, build strength, and get back to doing the things you love.
2) I’m working on healing my pelvic pain, but I’m having a bad flare up. What can I do to help myself out of a flare?
“It’s. Just. A. Flare” - these are four simple, but powerful words to help you remember that everything, including a pelvic pain flare, is temporary.
We know that pain flares can come up due to a known triggering incident, due to the brain’s/nervous system’s hypersensitivity, or they truly can come up out of the blue (which can be super frustrating!) But what we do know is that flares soften, they go away, and we can move forward. Sometimes the journey of healing pelvic pain can feel like one step forward, and two steps back, but I encourage to stay the course.
Here are some strategies to you can try while you are in a pain flare:
Thoughts and mindset: to the best of your ability repeat to yourself “I am safe, I am calm, I am healing” or another phrase that feels soothing to you in the moment. Kind self-talk can be helpful in switching from fight/flight/freeze to a rest and digest state, which can be helpful for pain.
Stretches: yoga stretches such as child’s pose, happy baby, pigeon, etc with deep breathing can be helpful. Additionally, if your physical therapist taught you how to use a pelvic floor wand for internal muscle release, this could be another great tool to utilize during this time.
Breath-work: Sit or lay down in a comfortable position. Inhale for a count of 4, hold for a count of 4, exhale for a count of 4, hold for a count for 4 and repeat. Simply doing intentional breathing exercises can help calm your entire system.
Set boundaries: it’s OK to say no and to create the time and space that you need for yourself to take care of you.
Medications: if your doctor has prescribed something to help with pain, aim to use that. This can be very helpful during states of higher pain.
Movement: for some people, going in nature for a gentle walk, an easy yoga practice, or stretching can be a great way to move through and out of a flare.
Everyone will respond different to different tools, so find the things that seem to work best for you. Keep those ideas on a physical or mental list so that you can come back to it anytime.
3) Help! I feel like I have to pee all of the time and get really strong and frequent urges to urinate. What is going on?
Whenever someone is having significant urinary urgency and frequency, we always want to first rule out any medical causes of this including a UTI, other infections, nerve related issues, or prostate problems (for men). Once these have been ruled-out, then pelvic floor physical therapy can be a great solution for you. Before we dive into what could be causing urinary urgency and frequency, let’s talk about what IS normal for the bladder function and bladder habits:
The adult bladder can hold up to 16 oz of fluid. It is normal to get an urge to urinate at about 1/2 full, with the expectation that you can delay your urge
Normal frequency of urination can range from every 2-4 hours (depending on fluid consumption)
Upon initiation of urination, flow should feel easy, not forced or weak and you should feel like you’ve completely emptied
When the above is not happening and someone is finding themselves rushing to the bathroom every 10-30 minutes with a significant urge, then we want to determine what might be going on. In some cases the muscles of the pelvic floor may actually be too tight, putting pressure on the bladder and nerves to the bladder. Another common cause is having sub-optimal bladder habits, such as getting into the habit of peeing “just in case”, chronically limiting fluid intake, and a history of waiting too long to urinate - all of these can cause the messaging between the brain and bladder to get “confused” and leading to poor bladder signals.
To help reduce urgency and frequency. Start by aiming to incorporate the following Health Bladder Habits:
Stay hydrated. Aim to drink 1/2 your bodyweight in ounces of water
Limit bladder irritants such as caffeine, coffee, carbonation, and alcohol
Go when you need to, not when you don’t need to (try to not “pee just in case”)
Put your bladder on a schedule, don’t let yourself go more than 4 hours without peeing
Once, you’ve been putting these habits into place, and you do find yourself getting strong urges, we want to train the brain and bladder out of these urges over time. When you do get a strong and sudden urge, first stop, sit down or stand, and take 5 deep, slow breaths. Next, try 10 pelvic floor muscles contractions (kegels). Wait for the urge to pass or mostly pass. Then proceed going to the bathroom without the significant urge.
If you try these and need more support, reach out to us or your local pelvic floor physical therapist!
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!
