Women's Health

By: Dr. Anuja Mathew, DPT, MsPT, OCS – Orthopedic and Pelvic Floor Physical Therapist

First, I would love to introduce myself if you don’t already know me. My name is Dr. Anuja Mathew and I am a licensed Physical Therapist in the states of New York and New Jersey. I am board-certified in Orthopaedics, with an Orthopedic Clinical Specialist certification (one that is earned by 5% of Physical Therapists across the country – not to toot my own horn), as well as trained in Women’s Health/Pelvic Floor. I’ve been in practice for over 10 years now, and am a strong promoter of manual therapy, therapeutic exercises, and biofeedback. I have been treating patients with orthopedic conditions such as sports injuries, tendonitis, arthritis, lumbar/cervical pain, and post-surgical rehabilitation. I also have experience in Women’s Health conditions such as Urinary Incontinence, pelvic pain, pubic symphysis dysfunction, diastasis recti, and prenatal and postnatal rehabilitation.

Congrats on being pregnant! Many people struggle to get to where you are, so be proud! Motherhood is a fun and rewarding journey, but it can also be a tough one. Many soon-to-be and new mothers might experience pain in places they haven’t experienced before, and working through those pains can be a challenging journey. This rewarding chapter in your life may also come with some unwanted side effects like lower back pain, soreness, or pelvic pain. These often occur during prenatal carrying and postpartum delivery. Physical therapy can help with any pains that might’ve popped up during this time, but it can also help you have a smoother pregnancy and birth in general.

A woman’s body is constantly changing during pregnancy. This increase in weight may cause an increased strain on the spine, along with the increased ligament laxity could cause pain and instability in the lumbar and thoracic spine and pelvis. The pelvic floor is a complexity of joints, ligaments, connective tissue, and muscles. All of which can be affected due to numerous reasons which cause tightness, weakness, and pain in your body.

Some common questions we get are during one’s pre or postnatal journey include:

1) Is it normal to have back low back pain during pregnancy? How can I prevent sciatica?

Some discomfort in your lower back is normal during pregnancy. In fact, the American Pregnancy Association reports that 50-70% of women experience back pain while pregnant. As your ligaments stretch and your pelvis widens, you will feel some discomfort in the first trimester. As your belly grows, the center of gravity shifts and this causes increased strain on your lower back. Anything more than just discomfort should be addressed right away. Sciatica is one of the more common diagnoses during pregnancy. A lot of times it could be pelvic girdle pain that is misinterpreted as sciatica. It would help to do some strengthening of your hip muscles to improve stabilization in your pelvis and reduce the pelvic girdle pain.

2) What exercises can be done during pregnancy to reduce low back pain? Do’s and Don’ts.

Exercises done during pregnancy should focus on hip strengthening, and gentle stretches for the lumbar spine, hamstrings, adductors, and glutes. Prenatal yoga is usually safe to perform.

Do not perform any abdominal exercises like crunches or sit-ups, as it might make your diastasis worse, and to be honest — there is a very little chance that you will get 6-pack abs while your belly is growing. If you have been a runner prior to pregnancy, you can continue running, but be careful in your 1st and 3rd trimester. A belly belt/support should be worn or Kinesio-taping should be done to prevent diastasis during your prenatal and postpartum journey.

Other good measures to take are strengthening your upper body during breastfeeding, as you most likely will have poor posture that might lead to upper back and shoulder pain. Maintaining good posture during pregnancy with postural awareness, strengthening, and stretching is a MUST. Though the Kegel is a good exercise to start during pregnancy, it is not always advisable for all pregnant patients. People suffering from vulvodynia, dyspareunia, or pelvic pain should focus on reverse Kegels and relaxation more than performing regular Kegel exercises.

3) Am I at risk for gestational diabetes?

Doing regular, gentle exercises, and walking can prevent gestational diabetes. So just remember to stay active during your pregnancy, and you should be good to go!

4) How do I stop urine from leaking when I don’t want it to. And when should I go to the doctor/physical therapist?

Performing pelvic floor strengthening is not just in the form of Kegels but other strengthening methods integrated with core strengthening can prevent leakage.

If you notice any pressure in your vagina, any bulging from your vagina while passing urine or otherwise, you will need to consult your physical therapist or OBGYN to rule out pelvic organ prolapse. If the leakage of urine has prolonged for more than 6 weeks postpartum and is getting worse, then you need to see your physical therapist.

5) You guys can improve scar tissue? What benefits does that have besides aesthetic reasons?

Physical therapy can help with scar tissue mobility for C-section scar, episiotomy scar, or scarring from a 1st-3rd degree tear. Scar tissue causes fascial restriction, which means it can adhere to the surrounding soft tissue and organs. This will often cause pain, poor extensibility, and decreased strength in the area.

You should wait until 6 weeks postpartum to start massaging or mobilizing your scar tissue.

6) How can I get rid of this split down my ab muscles?

That split or gap is known as Diastasis Recti, which is the separation of the abdominal muscle. During pregnancy, the uterus moves up into the abdomen and stretches between the rectus abdominis muscles to make room for the growing baby. Diastasis Recti can cause low back or pelvic pain but don’t worry, a physical therapist can help in reducing this separation through soft tissue mobilization in the abdomen, strengthening techniques, and even breathing techniques!

Some things to remember during pregnancy to avoid diastasis are: do not perform abdominal crunches and use Kinesio tape or a belly support belt during your 2nd and 3rd trimesters.

Here’s how to perform a self-test at home to see if you have Diastasis: Lay on your back, lift head off the ground, leaving your shoulders resting. Take your fingers and feel down the central abdomen, beginning at the sternum and travel all the way down while assessing that central line until you hit your pubic bone. While feeling down the midline, here’s what to look for:

1. How wide is your separation?
2. How deep is it?
3. Can you feel the walls on either side of the separation?
4. Is there any bulging in your central abdomen as you lift your head? (if you do see bulging, it is a sign that there is significant weakness in the deep layers of the abdomen)

7) Sex hurts. Will it always be like this? When does the pain go away?

This is known as Dyspareunia, which is a recurrent pain that is often located in the genital area and may occur before, during, or after sexual activity. This pain might come on as a result of the way your body changes during pregnancy, infections/STIs, vaginal dryness, or just stress. But luckily there are things you can do at home, or we can do to help Dyspareunia. Simple stretches like child’s pose, happy baby, along with diaphragmatic breathing and pelvic floor relaxation can go a long way. Pelvic floor massages and the trigger point release method using your finger, pelvic wand, or a miracle ball can help your symptoms as well. Pelvic wands and miracle balls are available online for purchase, however, we would not advise using these during pregnancy.

8) What is Pubic Symphysis Dysfunction and how do I know if I have it or am at risk for it? What can help these symptoms?

Pubic Symphysis Dysfunction is when your ligaments that normally keep your pelvic bone aligned during one’s pregnancy become too relaxed and stretchy after childbirth. This causes the pelvic joint – or symphysis pubis – to be unstable and which in turn, causes pelvic pain. Some symptoms include difficulty while walking and pain in your pelvis, typically focused in the pubic area but can also radiate towards the upper thighs and perineum. This doesn’t only happen while walking, but can happen while one is lifting heavy items, climbing stairs, getting dressed, getting into your car, or even while in bed.

You can do many things to ease your discomfort. We would recommend Hip stabilization exercises during pregnancy and also using an SI loc belt. Avoiding triggers is also important, this includes keeping your knees together during transfers like getting out of a car or getting out of bed, sitting down while getting dressed, and avoiding heavy lifting.

9) Why do I need a Pelvic PT for my pre-natal/post-natal care when I already have an OB/GYN that I go to?

An OBGYN is usually the first doctor people think of when it comes to prenatal care, delivery, and the postpartum journey. However, they usually aren’t trained to address the musculoskeletal implications like a Physical Therapist is. A Pelvic Floor Physical Therapist is even more apt to treat your pains and discomforts if you are pregnant, just gave birth, or just have any pelvic pains that might be also causing your abdomen, back or hip pain. However, not all OBGYNs will know when to refer their patient to a Pelvic Floor Physical Therapist, which is why often we encourage people to ask for a referral from their physician themselves. Some OBGYNs still may not give a referral, but you can always come straight to us and we can give you a free consultation!

No one deserves to live in pain, and the best way to help it is to prevent any further complications from happening. We believe in Preventative health as much as Reactive health, which is why seeing a Pelvic Floor Physical Therapist is important, especially while pregnant, to prevent any pain or conditions from happening in the first place. Here’s to healthy pelvic floors, and tearing down the stigmas that often surround Women’s Health issues!