How Pelvic Floor Therapy (Literally) Saved My A**


General / Thursday, March 8th, 2018

When you’re pregnant, you learn to expect a lot of gross and uncomfortable things during labor and delivery. You hear that you could vomit, that you could have back labor, that you may poop while pushing, that you’ll probably tear and could even need an episiotomy. More broadly, you expect that little thing called “the most excruciating pain of your life.”

One injury I did not expect from labor was in my tailbone. (Five bucks if you can properly pronounce the medical name, coccyx.) Everything between your legs, front to back, is a burning ball of agony after labor; but for me, the tailbone pain continued as other postpartum soreness and side effects subsided.

Sitting in certain positions – slouching, leaning back, laying down – sent a bolt of lightning up my spine. And when you’re a new mom, you spend a lot of time in those positions with long, frequent feedings, pumping and trying to get in sleep wherever possible. Even sneezing or laughing could send shockwaves through my body (sure gives new meaning to the term, “laughing my ass off”).

Like any millennial mom, I turned to the Internet for help. I learned it was a fairly common injury, but instead of providing any helpful solutions, my web search just freaked me out more. Women talked about how they’d dealt with tailbone pain for months or even a year after labor, and how there was no fix other than to let the bone heal itself. I started to fear that I’d be living with this misery for a long time, if not forever.

Finally at my six-week appointment, I got to talk to my doctor about it. She immediately said, “I’m going to send you to postpartum physical therapy.”

“That’s a thing?” I asked, relieved and surprised.

Yup, it’s a thing. According to Lucie’s List, the “pelvic floor” refers to a group of muscles that attach from the pubic bone to the tailbone. It’s the bottom of our “core” and looks a bit like a hammock; like a hammock, it provides support, specifically to our key organs. This area can stretch to 2.5 times its length during delivery, and as a result, can become weak. In fact, pelvic floor dysfunction affects nearly 50% of women after childbirth.

Specialized pelvic floor therapy, according to The Bump, can encompass the treatment of pelvic pain, urinary symptoms and/or bowel symptoms and include a combination of manual and hands-on treatment, neuromuscular re-education and postural repositioning.

I thought my PT appointment would just address my tailbone issue, but it was so much more. Because let’s be real, pregnancy and labor do a number on your internal organs and functions – from bowel movements to walking to laughing to sex, nothing is the same afterwards. The PT did a full-body check-up, reviewing my hip and spine alignment, my posture, my abdomen, and a whole lot of stuff between my legs (aka, the pelvic floor). It felt good to be “cleared” of any other pregnancy- and labor-related issues, such as the common condition diastasis recti, a separation of the abdominal muscles.

Then we got to the tailbone. You know that episode of Friends where Joey has kidney stones, and the doctor asks him if he wants to send something “up” or pass the stones naturally? Well, those are kind of the options you have for the tailbone. You can either allow a therapist to go “up” your rectum to apply counter-pressure and massage the bone back into place, or… well, that’s really the best option. It was uncomfortable, but I was desperate for relief.

While examining the area, the doctor told me my tailbone was tilted inward, towards my body. The tiny bone is naturally curved in, like your rear; I had assumed that it was pushed backwards, out of place, from the pressure of having a baby pass through. But in fact, she posited that it was probably pulled inward during the process of pushing, when I’d had my legs curled up and holding my knees.

When the realignment process was done, it still hurt, but less intensely. The doctor also gave me some homework: kegels. “That’s going to help my tailbone?” I asked skeptically. She explained that kegels help muscles throughout the entire pelvic floor region, and that making that whole area stronger would help relieve some pressure as well as prevent further injury in the future.

The PT’s main tip for my tailbone, though, was to stay off it as much as possible. I told her how hard that was as a new mom, when I’m constantly nursing or trying to get in some rest. She suggested making some small adjustments to help manage the pain:

  • Even when seated, try to keep the tailbone elevated – sit on a backwards Boppy or neck pillow, a kneeler pad with a hole cut out, or two rolled up towels under each butt cheek. There’s even a product called the Tush Cush designed for just this purpose (but a DIY version works just as well).
  • Put a heating pad on the area while nursing or laying down.
  • Sit on firm chairs or couches, as you can sink lower into soft ones.
  • Sit straight or lean forward, but don’t slouch, which puts more pressure backwards.

I took her advice and implemented some changes; I kept two rolled-up towels with me wherever I sat, even in the car. That effort combined with two more sessions where the doctor went – ahem – “up” made the discomfort subside more and more. Eventually I retired the rolled-up towels and heating pad, but it wasn’t until about week 15 when I realized my tailbone wasn’t constantly in pain. Even now, 10 months after giving birth, there are still times when I feel a dull ache in my tailbone if I sit just right (or wrong) – a reminder that your body is never fully back to “normal” after having a baby.

I understand that if you’re pregnant, the last thing you want to hear about is another gnarly side effect or malady. But there’s no way to predict what will happen to your body during labor, or what kind of shape you’ll be in afterward. So if you’re dealing with this or any one of a myriad of similar issues after having a baby, maybe these tips – or reaching out to your own pelvic floor PT specialist – can help. You deserve better than to live in pain, mamas.

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