Maternal Mental Health and Its Impact on the Pelvic Floor

October is World Mental Health Month. Maternal mental health is a cornerstone of our pelvic health practice. The transition into motherhood brings about changes physically, mentally and emotionally. Every woman undergoing pregnancy, labor, and delivery experiences unique physical changes that require thoughtful recovery. This resonates deeply with us as healthcare providers specializing in pregnancy and postpartum care. When we address these physical changes during the prenatal and postpartum period, we can help to nurture and make a positive impact on a mother’s mental health.

How common are mental health issues in the perinatal period? 

Perinatal mood anxiety disorders include anxiety and depression that can affect the new mother anytime between conception and 1 year after delivery. According to Maternal Mental Health NOW, the LAMB survey conducted in 2016, 25% of mothers in LA county reported feeling depressed during this period. Rates of depression were rated highest for Medi-cal participants and Black mothers. 

What is even more concerning is that, as per the Listening Mothers Survey in 2018, 72% of mothers in California who felt depression or anxiety did not receive any therapies or counseling during that time. Postpartum depression and anxiety are common yet complex, and can feel isolating and scary. 

What to do if you feel depressed or anxious? 

Always speak to your healthcare provider about any mental health concerns you may have. If you are feeling down, having intrusive thoughts, feelings of anxiousness, suicidal tendencies, or anything that makes you or your family concerned, seek professional help. From the comfort of home you can also work on things such as exercises recommended by a pelvic health therapist, mindfulness, meditation, and virtual counseling, which can allow you ways of healing. Surround yourself with people who you can call your village, having a support system is significant, allowing you to prioritize self-care. By taking care of your mental health, you are caring for the health of your pelvic floor which we will further discuss below.

Mental Health and Your Pelvic Floor 

Our mental health has a direct impact on our pelvic floor health. When we are stressed or anxious, our bodies begin to hold tension. You might have noticed this when driving in traffic and you begin gripping the steering wheel tightly or your shoulders start to rise up towards your ears. A similar thing happens in our pelvic floor. When we are nervous or anxious, we start to clench our glutes, hold our knees together and contract our pelvic floor, often without realizing that we are doing it. We may do this throughout the day, especially when we are in a state of stress or “fight or flight” mode. These symptoms may manifest as urinary frequency, urgency, pelvic pain or constipation.

It is important to feel safe in your body. Many women experience drastic physical changes such as birth trauma, weakness or pain which impacts their function, further affecting their mental health. They may feel lost, not having the proper guidance to heal well. Pelvic floor therapy can help address the issues by treating the physical issues and providing the education to help women feel empowered and informed about their bodies. 

Here are a few types of pelvic floor issues we see in the clinic which often affects mental health, and how pelvic floor therapy can help:

Cesarean Birth Scar Pain

The scar of a cesarean may be intimidating to touch. It may create fear of activating the core muscles and avoidance of exercise which is important for mental health. As pelvic floor therapists, we can help by educating a postpartum individual how to gently desensitize their scar and then following that, teach them scar mobilization techniques. Additionally, we will work on the scar tissue ourselves using gentle techniques, eventually progressing to deeper scar tissue massage. 

Vaginal Birth Perineal Pain

If a mother gives birth via a vaginal delivery, it may result in a perineal tear, which is graded on a 1 - 4 scale. Depending on the severity of the tear, it may cause pain, urinary leakage or fecal leakage. Once the tear heals, it creates scar tissue which may still continue to be painful to the touch. This contributes to pain with intercourse. In addition to the sensitive scar tissue, the pelvic floor muscles may begin to hold tension as a result of this pain. As pelvic floor therapists, we can help to desensitize the scar tissue at the perineum, mobilize the scar and manually release tension in the pelvic floor muscles. 

Urinary Leakage

Urinary leakage is one of the most common issues you’ll hear after a mother gives birth. It can be embarrassing, depressing and cause anxiety about fear of leaking out in public resulting in isolation. Pelvic floor therapists can help by performing an evaluation and pelvic floor exam to assess the cause of the urinary leakage. The misconception about urinary leakge is that kegels are the answer. However, it’s often not that simpl –  kegels may exacerbate the issue for certain individuals, which is why a thorough exam by a pelvic floor therapist needs to occur. 

According to this 2022 study, stress urinary incontinence was the reason the affected women experienced anxiety and depression. In addition, the more severe the symptoms of stress urinary incontinence were, the more negative impact to both physical and mental aspects of health-related quality of life was seen. Pelvic floor therapy can help to resolve urinary leakage, thus helping to improve the state of one’s mental health.

In summary, our physical state influences our overall mental and emotional state. 

Recognizing this connection, we guide our patients towards techniques such as therapeutic exercise, mindfulness, breathwork, and meditation, coupled with counseling and when necessary, therapy and medication. In the checklist of postpartum care, pelvic floor physical therapy should hold a well-deserved place.

As you navigate this transformative period, consider activities that bring you joy and fill your cup – whether it's journaling, dancing, enjoying a solitary walk, simply fulfilling your basic needs by making sure you are getting enough to eat and drink, taking a shower or prioritizing your health needs. Additionally, if you have any pelvic floor issues that are contributing to anxiety or depression, please seek the help of a pelvic floor therapist. When we fill our own cups, we have more to offer those we love.

 Remember, taking care of yourself is not a luxury but a necessity. It's an investment in your well-being and, by extension, your ability to nurture and care for your family. By addressing our physical, emotional, and mental needs, we not only heal but flourish as mothers.