As a licensed physical therapist specializing in pelvic floor and core dysfunction, I treat women who experience pelvic pain, sexual pain, leaking, constipation, urinary urgency, have restricted C-section/episiotomy scars and weak pelvic and core muscles, months or years after delivering their children (Vaginal or C-Section).
If all moms consulted a physical therapist soon after giving birth, this is what I would teach:
1) To prevent leaking urine or feces, or future prolapses of the bladder or rectum, do pelvic floor strengthening exercises (if there is no pelvic pain). Many women do not know how to recruit these small muscles surrounding the vaginal and anal region. Some either hold their breath, or tighten their inner thighs, gluteal and abdominal muscles when doing the pelvic floor muscle contraction. A licensed PT can guide on how to recruit these muscles without substitution via our manual and biofeedback therapies.
Pelvic Floor Strength Exercise: Contract the pelvic floor muscles (squeeze the anal and vaginal regions) for up to 10 full seconds (one - one thousand, two -one-thousand, etc). Then, more importantly, relax, completely let go of the contraction, softening for up to 20 seconds. If 10 second contraction and 20 second relaxation is too much, start with 5 seconds contraction and 10 second relaxation. Do this exercise 10 times, once in the morning and once at the end of the day. They can be performed in lying, sitting even standing (once you are good at the exercise).
2) To reduce pelvic pain, breathe and relax your pelvic floor muscles. Slow deep breathing, produces a calming effect on your muscles, heart, and brain activity. It also gently massages the abdominal contents. If you have pelvic/lower back/hip/groin or abdominal pain, consult with your doctor first and then see a pelvic physical therapist for our targeted therapies and exercises to reduce pain and regain function.
Diaphragmatic Breath Exercise: Inhale for 5 seconds, hold the inhale for 5 seconds, exhale for 5 seconds. Repeat 2 times, twice a day or as needed. During your inhalation, allow your stomach to expand or balloon to allow the diaphragm to descend which fills the lungs with oxygen. As the stomach expands, think letting the pelvic floor muscles widen, soften (no pushing outward!). As you exhale, allow the stomach to contract and see if you can keep your pelvic floor muscles relaxed.
3) To reduce your belly post baby, reduce the DR or "diastasis rectus", which is the separation of the two long rectus abdominal muscles as the baby grew in utero, you can wear a compression garment and strengthen your lower abdominal muscles. The abdominal binders and/or compression shorts that support the pelvic floor can be worn daily during and after delivery to prevent further widening of the DR.
Core Exercise: Breathe in. Breathe out and think of zipping up a tight pair of jeans. There should be no major movement of your spine, just the lower abdominal region moving "up and in" as it tightens. Hold this for 5 seconds. Breath in as you release. Breathe out as you tighten and hold. Repeat 10 times. Do this 5 times throughout the day. A physical therapist can help with your DR by modifying the exercise. This can be done during pregnancy to minimize the DR and keep a strong core.
4) To prevent binding of fascia, abdominal restrictions and pain, mobilize your C-section scar.
Scar Tissue Massage: Gently press your fingers against the scar and pull the scar in a upward direction and hold the end range for a minute. Then move downwards, to the R, and L sides, holding the end range of each direction for a minute, until you feel less burning, less tension. Eventually you can try to pick up the scar up in-between your thumb and fingers to lift the scar away from your body, affording more stretch. For perineal scars, your physical therapist can perform manual therapies and guide you in self perineal stretches and use of a dilator to help increase the flexibility of the scar.
5) To return to pain free intercourse, if painful due to episiotomy scar, your physical therapist can perform intravaginal manual therapy, scar mobilization and teach you how to gradually and painlessly stretch your vaginal area with dilators.
Along with postural exercises, instruction on how to lift, carry and feed baby, your physical therapist can help you regain your body, prepare for another child and most importantly, prevent the pain and other issues that so many of our mothers took for granted as a "normal part of having babies".