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Expert Q&A: Can Pelvic Floor Physical Therapy Help Prevent Postpartum Depression?

Pelvic floor physical therapy has so many benefits, especially during the first 2 years postpartum, when the strain of pregnancy and childbirth can take a massive toll on the pelvic floor and abdominals. But one benefit that isn't on most people's radar is the potential for this care to positively impact maternal mental health. So when we came across a study that found that participating in a physical therapist-led program that combined education with specialized exercises reduced the risk for postpartum depression by an astounding 50%, we were beyond excited.

To get more insight into why postpartum physical therapy can have such a profound effect on mental well-being, we turned to Origin Advisor Dr. Sarah Oreck, MD, MS, one of the few doctors in the U.S. with specialized training in reproductive psychiatry.

Based on your knowledge and experience, do these study results surprise you?

They don’t surprise me at all. We know that movement and exercise on its own can be very helpful for depression and anxiety. Having a physical therapist to guide you as you heal and adjust postpartum, ask you questions, and ultimately help you treat symptoms — of course that's going to be better for your overall well-being.

There’s also the sexual health component that pelvic floor PTs can help with. So many people struggle with getting back into their sex lives because they are having pelvic pain or other symptoms. Sex can be an important component of well-being and having a stable relationship.

Can you speak to the disconnection that postpartum individuals can feel when it comes to their body — and how pelvic floor physical therapy might help?

There is so much disconnection with the body. There are weight changes and hormonal changes. Your body is sometimes unrecognizable compared to what it was — and how it felt — before. You might have pelvic pain or discomfort. A pelvic floor PT can ask you about these very intimate issues and provide education, which our medical system does not.

I really think everyone should be getting pelvic PT after having a baby, whether they had a c-section or a vaginal birth. The same is true for people who have lost pregnancies because their pelvic floor has also changed. You might think, ‘Well I was pregnant for a while and then everything kind of just ended.' But you may still be feeling a lot from that pregnancy. And if you've given birth before, there may already have been a lot of stress on your pelvic floor.

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We often hear patients say that they aren’t comfortable talking to their doctor or OBGYN about symptoms like bladder leaks or pain with penetration. Why do you think that’s the case?

There’s so much stigma around talking to medical providers about this kind of stuff. Even if you live in a pocket where people are very sex-positive, there's still this wall. I think it’s likely due to poor training and lack of time. My experience with OB-GYNs is that what they need to learn is too large in scope. And so they aren’t well-equipped in terms of assessing mental health or pelvic floor health. This is no fault on their part. I have been a strong believer that obstetrics needs to be one field and gynecology and surgery another.

I don’t do pelvic exams in my profession, but in medical school, I did an OB-GYN rotation and, with pelvic exams, you're not taught to be aware of the patient's discomfort. You’re trained to say, ‘I'm putting my hand here,’ but it's not so much about, ‘Oh, does this hurt?’ The approach is ‘I have a job to do and I'm going to try to find your ovaries and make sure everything's okay. It's sort of a checklist.

Pelvic floor PT is very different because there's a feedback loop that is central to a pelvic assessment. PTs are asking ‘Is this uncomfortable or painful? What could be happening?’

The pelvic floor is just so different — so much more tied to emotion — than any other body part.

There is so much held in the pelvic floor, emotionally. There's such a high incidence of sexual assault that impacts the pelvis. And then you're giving new life also through this pelvis. When physical therapists are working on this area or talking about this area, the floodgates can open.

In a way, pelvic floor physical therapists are filling this void or lack of knowledge that happens due to flaws in our medical education system. Most providers are not well equipped to help with chronic pelvic pain; they don't have answers. I have seen a lot of patients bounce around between different providers as they try to get help. There are only very few specialized providers who can diagnose vaginismus, vulvodynia, and other pelvic floor disorders. So pelvic floor physical therapists are taking on a lot.

What benefits do you see in having postpartum patients work with both a mental health provider and a pelvic floor PT?

I think the two can complement each other so well. If you have a talk therapist and you're diligently working through your postpartum issues and you still have residual pelvic floor pain, incontinence, or pain with sex, those are things that therapy alone isn't going to resolve. It's only when you have the two together that I've seen the best outcomes.

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