Postpartum rehabilitation: 5 questions to a physiotherapist

You have just had a child, carried it and felt it growing inside you.

Your body, this fabulous "machine" capable of creating and giving life, has worked hard over the last few months.

Today, it needs to rest, of course, but you still have a little extra effort to make so that it regains its former tone.

Yes, your body is now that of a mother and may be modified (those stretch marks that mark the traces of your former belly or breastfeeding, your pelvis, perhaps a little wider, which has difficulty finding its place in your old jeans...), but your posture and the capacity of your muscles must be recovered so that all the functions of your body are optimised.

WHAT IS REHABILITATION FOR ?

Rehabilitation is used to restore postural and tissue imbalances secondary to pregnancy and childbirth (whether vaginal or caesarean).

Indeed, the postural changes linked to pregnancy will have several effects on your body and its functions:

- a change in the distribution of pressure on the lumbar area (the lower back), the pelvis and the perineum,

- a lack of stability and support in this area.

The consequences can be back, pelvic or hip pain, digestive problems, urinary or anal incontinence, organ descent (or pelvic organ prolapse), etc.

In addition, we can also improve the appearance of a caesarean scar or episiotomy/tear and help if there is pain during sexual intercourse.

On paper, a distinction is made between "perineal rehabilitation" and "abdominal rehabilitation" but in practice this is an aberration. In fact, the whole abdominal area (from the diaphragm to the perineum, via the lumbar vertebrae, the ribs and the abdominal muscles) is a highly coordinated unit that needs to learn to work in synergy.

Abdominal rehabilitation, contrary to what one might think, is not intended to make you (re)find your chocolate bars from your twenties. Its main purpose is to ensure that your deep abdominal muscles protect your perineum during exercise and even just when standing.

REHABILITATION: FOR WHOM ?

For all women who have had a pregnancy!

Photo ©Pinterest

Even if you don't feel any symptoms or discomfort, your body has undergone changes that require a little "reset". Sometimes your gynaecologist will ask you during the post-natal examination to tighten your perineum and will assure you that "it's OK, everything is fine, you don't need re-education". Unfortunately, muscle strength is only one of many points to be taken into account, which will inevitably have been damaged a little.

REHABILITATION: WHEN ?

You can also undergo rehabilitation during your pregnancy to treat any pain and prepare your pelvis and perineum for the birth.

Photo ©MelissaJean

HOW DOES REHABILITATION WORK ?

The technique will depend on your needs and expectations. There is no single method, especially if the one proposed does not suit you. A good therapist should be able to offer you different tools and be able to change the technique if the one offered is not sufficient. In all cases, a manual examination (a vaginal touch) is necessary.

A first assessment will allow us to observe your posture, to note the presence of tensions, to evaluate the tonicity of your muscles, their voluntary and reflex control, to appreciate the elasticity of a scar and if it is still painful and finally, to check the mobility of your joints.

Manual techniques can then be combined with exercises, and the use of devices, such as a vaginal probe, can be suggested if necessary.

"Self-education" tools (connected probes, Geisha balls, etc.) can also be used but cannot replace re-education by a health professional. Indeed, each woman is different and will not need the same exercises. Hence the importance of the initial assessment!

REHABILITATION: BY WHOM ?

A physiotherapist specialised in pelvi perineology or a midwife.

NB: abdominal re-education and scar work can only be carried out by physiotherapists and must be started at the beginning of the re-education.

It may also be useful to consult an osteopath, a naturopath, a relaxation therapist or any other professional who can bring you well-being during this period of great change. It's well known that physical well-being comes first and foremost from psychological well-being. So I invite you to consult in case of a drop in morale (even temporary), lack of confidence, period of doubt, which are certainly normal for this period but which you are not obliged (and you do not have to!) to go through alone.

To find a physiotherapist specialising in pelvic-perineal rehabilitation near you, you can consult the following specialist directories:

- https://www.arrep.org/annuaire-des-adherents/adirectory/blog/10-membres-de-l-afrepp.html
- https://www.eirpp.com/annuaire/
- https://annuaire.degasquet.com
- https://www.lesclesdevenus.org/annuaire-pro/