A woman’s body undergoes tremendous changes during pregnancy as well as postnatally. These often result into pain, discomfort and sometimes medical conditions. Postnatal physiotherapy can help resolves these post pregnancy issues, namely pelvic floor pain, diastasis recti (bulging belly), lower back pain, Urinary incontinence, Sciatica among others. Physiotherapists at ReLiva attend to several of these postnatal concerns of new mothers across clinics in Mumbai, Pune, Thane and Navi Mumbai.
Your body during pregnancy and after child birth
Pregnancy and childbirth can bring immense joy, but a pregnant woman’s body goes through tremendous changes that can notably affect her day-to-day life. In a relatively short span of time, the centre of mass changes, the pressure on the organs rise and there is increased weight to be carried. While some uneasiness is expected, the discomfort can get overwhelming.
Doing simple exercises during pregnancy and forming healthy habits can help you in multiple ways including the following:
- cope with many of the bodily changes that happens because of pregnancy.
- reduce injuries and problems in the future.
A physiotherapist is the best person to go to concerning these points. Physical Therapy will not only help prevent and/or ease distress in context with aches, pains and incontinence, but will also help you all the way for:
- preparing you for labor’s physical stress and
- getting you back in shape after your baby is born.
What is postnatal physiotherapy?
Post-natal physiotherapy encourages you to start a little bit of exercises as soon as possible after delivery. It gives you more information on how to look after yourself and about what things you need to be careful of.
The exercises conducted during a PNC physiotherapy session are safe, they will help you recover and make you feel good about yourself. The physiotherapist in charge of you will carry the exercises forward with gradual progressions. PNC physiotherapy will mainly target:
- your abdominal muscles
- pelvic floor muscles,
- the back,
- your bowel and bladder functions and
- give you ergonomic and postural advices
- corrections for child care and other functional activities.
It will help treat problems that have occurred because of pregnancy and help prevent future physical problems. Post-natal physiotherapy will help you look after yourself even while looking after your baby. [ Happy & Fit Pregnancy: Back to Shape ]
How can Reliva postnatal programs (PNC) help?
ReLiva has a dedicated Prenatal and Postnatal Care service namely FabMoms: this means that ReLiva has the expertise to assess, identify and treat pregnancy related concerns apart from offering prenatal care.
Physiotherapists at ReLiva will properly assess, treat and educate you in effective and safe exercises that have been proven to reduce back pain, pelvic pain, and urinary incontinence during your post-partum phase of life. She will first screen you to ensure safe participation in an exercise program.
Then you will be assessed for posture, strength, flexibility, balance as well as any musculoskeletal issues that could have a bearing on physical health.
Post that, you will be instructed on how to perform exercises safely and effectively. Rest assured that an individualized approach would be used to ensure recovery.
Educational sessions and discussions will be held regarding post-natal issues from time to time.
 
What are some of the common concerns that can be handled with Post natal Physiotherapy?
1. Physiotherapy Advice for Pelvic floor after pregnancy
What is Pelvic Floor?
Pelvic floor muscles are three layers of muscles that support the pelvic organs and span the bottom of the pelvis in a funnel shaped orientation.
They have the following essential roles:
- Provide support for the pelvic organs and their contents
- Withstand increases in intra-abdominal pressure
- Contribute to stabilization of the spine/pelvis
- Maintain continence at the urethral and anal sphincters
- Reproductive function
What happens to pelvic floor during pregnancy?
During pregnancy, the pelvic floor muscles withstand the total change in weight of the body, in their antigravity position. The pelvic floor drops as much as 2.5 cm or 1 inch at that time. Extreme stretching of the pelvic floor tissues is inherent in the process of labour and vaginal delivery. The pelvic floor musculature may also be torn or incised during the birth process.
This causes reduced tone and strength in the muscles leading to problems with its essential roles of continence, support and stabilization.
How Physiotherapy helps in Pelvic floor dysfunction?
Post-natal physiotherapy helps one target this problem area using strengthening exercises and electrical stimulations.
2. Physiotherapy Advice for Abdominal muscles after pregnancy:
What are Abs?
The abdominal muscles are located between the ribs and the pelvis on the front of the body, commonly known as ‘The Abs’. They consist of the rectus abdominis, transversus abdominis and the internal and external oblique muscles.
They have the following essential roles:
- The abdominal muscles support the trunk.
- Allow Movement.
- Hold organs in place by regulating internal abdominal pressure.
- Helps to keep your body stable and balanced as part of the core of the body.
- Protects the spine from grave injury.
How does Pregnancy affect abdominal muscles?
Pregnancy could affect abs in two ways:
1. Upper Abs
The abdominal muscles, particularly both sides of the rectus, as well as the linea alba, are all subjected to significant biomechanical changes and become stretched to the point of their elastic limit by the end of pregnancy. This greatly decreases the muscles’ ability to generate a strong contraction and thus decreases their efficiency of contraction. The shift in the centre of gravity also decreases the mechanical advantage of the abdominal muscles.
2. Abdominal Separation (Diastasis Recti)
Another commonly occurring condition because of pregnancy is Diastasis recti. It is the separation of the rectus abdominis muscle in the midline at the linea Alba. The continuity and integrity of the abdominal musculature is disrupted. The condition of diastasis recti, even though there is no pain at the abdominal area, may produce musculoskeletal complaints, such as low back pain, possibly because of decreased ability of the abdominal musculature and thoracolumbar fascia to stabilize the pelvis and lumbar spine.
Related Reading: Pregnancy related Common Aches & Pains
How physiotherapy helps abdominal tone and bulging belly?
PNC physiotherapy can help an individual with these abdominal problems including abs and abdominal separation, with the right kind of stabilization and core exercises and even prevent this condition in the first place by maintaining good abdominal tone.
3. Physiotherapy Advice for Back care after pregnancy:
Back pain is reported by 50% to 80% of pregnant women at some point during pregnancy. In addition, symptoms may continue in the postpartum period, with prevalence in as many as 68% of women, for as long as 12 months after delivery.
What may be causing the pregnancy back pain?
Pregnancy related back pain commonly occurs because of the following:
- postural changes of pregnancy,
- increased ligamentous laxity,
- hormonal influences, and
- decreased abdominal muscle function.
How does Pregnancy affect my back?
The thoracolumbar fascia is lengthened via its connection to the abdominal wall, which diminishes its ability to support and stabilize the trunk effectively. Joint hypermobility occurs because of ligamentous laxity and may predispose the patient to injury, especially in the weight-bearing joints of the back and the pelvis.
How Physiotherapy helps treat pregnancy related back pain?
Physiotherapy can help treat low back pain symptoms effectively with many traditional low back exercises, proper body mechanics, posture instructions for pregnancy, improvement in work techniques, along with superficial modality application.
 
Healthy back habits after pregnancy:
- Follow ergonomic advices given by the physiotherapist for childcare.
- Strengthen your core muscles.
- Do not lift too heavy too quickly.
Related Reading: SI Pain & Pregnancy: Tips
4. Physiotherapy Advice for Neck and Shoulder after pregnancy:
How are neck and shoulder affected due to pregnancy?
Cervical lordosis increases as compensation for the shift in the centre of gravity. The shoulder girdle and upper back become rounded because of breast enlargement. This postural tendency persists in the postpartum period due to infant care demands. Tightness of the pectoralis muscles and weakness of the scapular stabilizers may be pre-existing or induced by the pregnancy postural changes.
Changes in posture do not automatically correct after childbirth, and the pregnant posture may become habitual. In addition, many childcare activities contribute to persistent postural faults and asymmetry.
How Physiotherapy helps treat neck and shoulder pain postnatally?
Physiotherapy can help reduce pain caused by these postural imbalances by modifying each activity that the mother has to perform and strengthening the right muscles while reducing joint stresses.
5. Physiotherapy Advice for Bladder problems after pregnancy:
How can Pregnancy cause bladder problems?
Post pregnancy, 1 in 10 women suffer from one of the two bladder issues. These could be of two broad types.
1. Urinary Incontinence:
Urinary incontinence is usually characterised by sudden loss of urine with day to day activities like laughing, coughing, sneezing, walking, exercising or lifting something heavy.
2. Urinary Retention:
Due to urinary retention one may have difficulty passing urine. This problem usually can last up to 3 days post-delivery. One in 500 women may have symptoms that last more than 3 days.
How Physiotherapy helps treat Bladder issues after pregnancy?
A post-natal physiotherapist will help you out with pelvic floor strengthening exercises and advice you on catheterizations if need be.
Related Reading: Treating Urinary incontinence with Physiotherapy
Healthy bladder habits after Pregnancy:
- Drink plenty of fluids.
- Only urinate when your bladder feels full and not as a habit.
- Try not using the washroom for urination more than once a night.
- Keep your pelvic floor strong with training for the pelvic floor muscles.
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6. Physiotherapy Advice for issues related to C-section birth:
Will C-section delivery cause problem for a pregnant woman?
Postpartum intervention for the woman who has had a caesarean delivery is similar to that of the woman who has had a vaginal delivery. However, a C-section is a major abdominal surgery with all the risks and complications of such surgeries, and therefore the woman may require general postsurgical rehabilitation.
How can a physiotherapist treat concerns related to C-section?
After a caesarean section delivery, there are certain concerns that need to be handled by physical therapists, namely:
- Risk of pulmonary, gastrointestinal, or vascular complications
- Postsurgical pain and discomfort
- Development of adhesions at incision site
- Faulty posture
- Pelvic floor dysfunction
- Urinary or faecal incontinence
- Organ prolapse
- Hyper tonus
- Poor proprioceptive awareness and disuse atrophy
- Abdominal weakness, diastasis recti
- General functional restrictions post delivery
It is important to be a bit more careful with your daily movements given that your body is tender, recovering and adjusting to the new responsibilities. Our team of physiotherapists have collated a few tips for new mothers to imbibe in their daily life to ensure overall good health
Healthy habits after pregnancy:
- Do not lift anything heavier than your baby is for the first 2 months.
- Before lifting anything, be sure to tighten your pelvic floor muscles and brace your lower abdominal muscles.
- Stand tall.
- Change your baby’s clothing at your waist height level.
- Sit in a comfortable chair with good back support while nursing your baby.
Healthy bowel habits after pregnancy:
- Drink plenty of fluids, especially water.
- Avoid constipation.
- Avoid straining in the washroom.
- Eat plenty of high fibre foods.
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This post is based on the contributions from Dr Carol Johnson (PT), Dr Swapnaja Joshi (PT) and Dr Madhura Bhagat (PT). They are Masters in Physiotherapy and regularly attend to pregnant and new mothers at respective ReLiva clinics for a variety of postnatal and prenatal discomforts.
