Postpartum Case Study: Restoring a Strong Foundation

This case study is from a client session I had recently where there were a high number of issues that would have been challenging to address one by one or to even know which one to start with first. This is why listening to the body first is such an important assessment and treatment approach for every body. It can point us in the right direction and tune us into what is essential for healing — in this case, restoring a strong foundation.

Client History

A client came in to see me complaining of ongoing pelvic floor issues that she believed included bladder prolapse, hemorrhoids, and a hypertonic pelvic floor. She was unable to find relief or any change after treatments with two other pelvic floor PTs and after following the recommendations from those sessions. She had three vaginal births at home and one cesarean birth of twins. At the time of this case, her kids were ages 13, 12, 10, and 7-year-old twins. She started experiencing issues in 2015 after having her third baby. She informed me that her right hip is hypermobile, and she has hyper-rotation in her lower lumbar.

Complaints and Symptoms

This client disclosed that the right-side of her pelvic floor had been almost completely numb for over a year. She was experiencing bladder leakage with sneezes, jumping on the trampoline, running, pivoting, as well as a heaviness vaginally that only become noticeable when she was consistently working out. She shared that sex is uncomfortable and is unable to keep a tampon in. She tried a pessary ring but could not keep that in as well. She is also experiencing issues with hemorrhoids and often gets constipated as she is traveling a lot. Her adductors and illiacus on her right-side felt “super tight” to her. She complained of issues with scar tissue from a c-section and incision infection she had on her right-side after her last birth. She also disclosed that she has a chain reaction of tension in her right shoulder blade/trap/neck that gets activated with any unusual activity. She said that gentle workout (barre) helped her hip feel better, but it would sometimes make the shoulder/trap/neck worse and prolapse feel more noticeable. Lifting weights (even light weights) flared her shoulder/trap/neck pain.

A comment that really stood out to me when I was doing her intake was that she wanted to be able to walk when she is 65. She didn’t know if that would be possible in her current state. She has been diligently working on her body to try and feel better and shared that it had been really hard for her to stay in what she thought would be the ideal alignment of her body.

Assessment and Treatment

I love how in tune this client is with her body and what is going on. Though there were a lot of issues that she was presenting with, I always set these issues aside when I evaluate the body. I want to bring a neutral agenda when seeing what is being held in the body.

Standing Assessment

I always start my sessions in standing by placing my hands on her shoulders. I’m tuning in to her nervous system and getting a general sense of how her body reacts to gravity. With this initial assessment, I noticed that her shoulders on the right-side held more tension in them and didn’t have as much give to gentle downward pressure as the left-side.

External Assessment and Treatment

Her pelvis was in sacral flexion, her right PSIS was more prominent, and her right ischium was splayed out to the side. In correcting the sacral flexion and rebalancing the ischium and ilium, she felt immediate relief in her body. With her pelvis being so out of position on the right-side, her right shoulder had to take up weight bearing, and that is why she had less mobility in that shoulder in standing. When the pelvis can’t transfer weight effectively, the shoulders take over.

Internal Assessment and Treatment

Upon internal assessment, her pelvic floor muscles could contract but not well, and not all of them could contract. Her right-side muscles were numb to palpation and weaker than the left side. Bilaterally, her coccygeus muscles were both tight and had minimal contraction ability. I found the bladder was midline, but the junction of the bladder and urethra felt swollen and unhappy. Her cervix was midline but posteriorly with limited ability to move anteriorly, indicating a bilateral uterosacral ligament tightness.

After treating both the bladder and cervix, I brought my attention to the pelvic floor muscles. When I connected into her right-side tissues, I sensed a freeze response. When I asked her about this area she recalled her third birth at home. She was in a semi-reclined position, and she said it was the most painful position for her. Her midwife felt she was making good progress in this position, so she kept her here. This created the trauma response in her right-side pelvis and pelvic floor muscles. Knowing the tissues weren’t going to release without replaying this part of the birth, I encouraged her to reconnect back into that time frame and replay it differently. As she did, her right-side pelvic floor muscles just melted. It also brought back sensation to her tissues.

I then focused on her anal sphincter muscle and evaluated and treated this muscle as it had increased tone inferiorly from being stuck in sacral flexion for so long. Her ischiorectal fossa was tight on the left-side.

Prolapse Evaluation

Her pelvic floor muscles were better able to contract after all this work, but I wanted to see about the prolapse, so I had her blow up a balloon. In supine, there was no movement of her organs, so I rechecked in standing. With standing and blowing up the balloon, her urethra and bladder descended minimally, but with a knack (a pelvic floor muscle contraction prior to pressurization) there was no movement at all. We worked on helping to get her core to activate more automatically, and I gave this to her as the focus of her homework with her exercising.

Wrapping Up Her Session

When we finished the first session, she was amazed at how much better her pelvis, right hip, and low back felt. She had more freedom of mobility, and she noticed she didn’t need to work at alignment; her pelvis was just doing it naturally.

When she returned for her second visit a week later, she had worked out more strenuously and reported no issues on the right-side of her body. Her pelvis felt good and her pelvic floor muscles felt strong. She reported some upper cervical issues that we addressed, and internally, she only had a little bit of muscle tension remaining on the right-side. She no longer had any heaviness, and she reported that sex was pain-free.

Advice from Lynn

Our body is meant to function efficiently, and we shouldn’t have to focus on making it do something. When our tissues are in their happy place and tension and trauma are released, the body can move more easily and gracefully, as this client experienced. Focusing on the pelvis and the pelvic bones as our foundation is critical for postpartum recovery and pelvic floor muscle function.

About the Author: Lynn Schulte is a Pelvic Health Therapist and the founder of the Institute for Birth Healing, a pelvic health continuing education organization that specializes in prenatal and postpartum care. For more information, go to https://instituteforbirthhealing.com