Welcoming a new life into the world is an incredible journey, but it brings about significant changes to a our bodies. One area that often experiences a lot of stress and transformation is the pelvic floor. Many expecting and new mothers have questions about what pelvic floor health during pregnancy and postpartum, why it’s so important, and how to care for it.

Today, I had the pleasure of speaking with Khyati Merchant, a dedicated physical therapist and pelvic floor specialist at Lotus Physical Therapy and Pelvic Health. Khyati shared her expertise on pelvic floor health during pregnancy and postpartum, addressing common misconceptions, offering practical advice, and highlighting when it’s crucial to seek professional help. Get ready to gain valuable insights that can empower you throughout your motherhood journey!

Listen to our interview here

Alicia Insley Smith: today I am interviewing a pelvic floor and physical therapy specialist who’s going to talk to us about pregnancy and postpartum. Khyati, welcome! Can you tell us a little more about Lotus Physical Therapy and Pelvic Health and what you specialize in?

Khyati Merchant: Thank you so much, Alicia. I really appreciate for giving me an opportunity today to be here.

And sharing some of the information that I have for this beautiful woman there. I’m Khyati Merchant. I’m a physical therapist at Lotus Physical Therapy and Pelvic Health. We specialize in pelvic health issues related to musculoskeletal point of view. More than that we also see other orthopedic related, like hip, lower back knee issues as well.

The special thing right now is we are mobile, so we travel to individual’s house for their needs and we create a physical therapy program for them at their own house.

Alicia Insley Smith: Yes. Alright, if it’s all right, I’ll start and ask you some questions. For expecting moms who are new to this, can you explain what the pelvic floor is and why it’s so important, especially during pregnancy and postpartum?

Khyati Merchant: Yeah pelvic floor is, as the kind of name suggests, it’s a floor based part of the pelvic area there. When we think about the pelvic bones, the bottom part is open.

That open part is made up of connective tissues, muscles and ligament. And that area is giving us the support for the organs that are sitting in our pelvic region that is bladder, bowels and female uterus. The pelvic floor, made up of muscles, ligaments, and connective tissues gives us the support for our pelvic organs.

Along with that, our. Bladder and bowels are meant for excretion process, continents of those urine and bowels as well. So it kind of functions with managing the control in those areas. It is also very much important for our sexual functions. And the third part is that it gives us stability for our pelvic hip bone, lower back area.

And it’s a one piece, one part of the core muscles that we talk about.

Alicia Insley Smith: What are some common misconceptions about pelvic floor health that you encounter?

Khyati Merchant: One of the biggest misconceptions that is changing pretty quickly with recent research. Still there are a lot of individuals, a lot of women think that pelvic floor therapy is nothing but doing kegels. It is definitely more than that. Our pelvic floor muscles are meant to work automatically in addition to the demands that we are putting on them, basically. And in addition to when we want them to work so there’s not just one way that those muscles need to function.

It is much more than that. So Kegel is basically, in terms of misconception wise, Kegel is not the only thing that we are thinking about. And also that many, many times they think that the pelvic floor issues are only for women, especially after childbirth, which is not the case because pelvic floor is part of men as well as women, and they also have the similar issues. Women do face these issues more because of the anatomy is one of the reason, one of the part of it. And they go through a lot of changes during their life with the childbirth, with menopause, perimenopause, and kind of hormonal changes pretty much every month.

So that is definitely the women are more prone, but men also has these issues. And it is not just child after the childbirth. It can be any time during the life cycle. In fact, kids can also have pelvic floor issues and absolutely. It’s a part of the body yeah. Okay.

And for kids, what? What would cause those issues? A lot of times if the kids are going through constipation, okay, they are bearing down a lot. If they have some kind of connective tissues disorders, okay. They have a very strong tendency of holding their urine Yes. And bowels and they don’t wanna go.

So that can create and believe it or not, it can cause. Rectal prolapse and those issues as well in the kids, which we don’t realize it many times. Like another misconception is a little bit of leakage of urine is absolutely fine after childbirth. 

Oh my gosh. But you want to recover out from that. It is not, it is normal, but it is not. Normal to continue with that, there are answers available.

Alicia Insley Smith: You mentioned leakage after childbirth not being “normal” to continue with. How long postpartum should a new mom consider it normal, and at what point should they seek treatment?

Khyati Merchant: It truly varies for each individual and each pregnancy. However, I wouldn’t wait too long. If you’re still experiencing leakage beyond 8 to 12 weeks postpartum, it’s a good time to seek professional help. There are definitely solutions available.

Each pregnancy is different. If everything feels. Fine to you. There are no lower back issues, hip issues, you feel like you’re very strong. You started doing running at three months. That is, I feel like it’s a little too early for a postpartum moment. Even if you’re recovering fine and good running does have a very high impact kind of exercise.

Alicia Insley Smith: Can you give us an overview of what to expect from a pelvic floor physical therapy consultation and first appointment?

Khyati Merchant: When you come for a consultation, we’ll start with a thorough history taking. We’ll discuss your concerns, past medical history, your birthing experience (duration of labor, any tears or interventions), and your current symptoms. This gives us a good understanding of your situation. If they are coming to a PT after about six to eight weeks of post vaginal birth, then we can try to do internal assessment of the pelvic region and the internal assessment.

There is no equipment or anything that we use, but before that, we want that area basically to have a healing time after the childbirth. During that session, we go through the lower back, hip and muscle strength.

We see how the posture is. Overall how the breathing pattern is, and those are the areas that we look for in terms of details to see how the pelvic muscles are working in coordination with the other joints and other muscles around it.

How was their birthing experience?

What was their, durations, especially the second stage of labor is important. Is there any or anything has been done? So those things gave, gives us a good amount of understanding about their current condition, their symptoms and things like that. Okay. Excellent. And then after that, we create, like once we are done with this objective, asking and talking, we do the objective assessment as we discussed earlier, and then we make a plan what will be better options for them many a times.

Creating a plan for once a week or once every alternate weeks, depending upon where the clients are, where the patients are. We go from there. Excellent. Makes sense. Having goals is good. Yes. Alright, so let’s talk a little about pregnancy and postpartum.

What are some simple exercises or stretches pregnant women can do to maintain pelvic floor health and are there any exercises they should avoid?

Khyati Merchant: Staying mobile and flexible during pregnancy is beneficial overall. It does help the public area. To create a little bit easier option more flexibility for the birthing experience. But hip circles and happy baby if they are comfortable doing those stretches.

They are very good stretches. Deep squats. I really love that, especially in the end stages of the labor. They’re pretty comfortable, I wouldn’t say comfortable. That is not the right word, but they’re good for them to get that flexibility going. So that is one thing. I really do think that one should keep their flank region, like a side of the trunk area to keep it more flexible and mobile as well, because.

As the baby is growing, it’s creating more stretching and flexibility, the lungs are getting an impact. So if that area is open, that allows the lungs to keep a little bit more breathable area and more mobility that will help with the delivery time.

And anything they should avoid?

It is very I would say individual because if I would say avoidance wise, if you are not used to of doing anything before pregnancy, and if you are going into the new start, like if you’re not used to of doing jumping and if you start jumping during the pregnancy, I would be cautious about it.

You wanna observe how you are feeling with it. If you are used to a lifting a hundred pound weight before pregnancy then you surely can continue as long as you know your body is tolerating and you are not feeling like shortness of breath. Your blood pressure is good. You’re able to feel like you’re activating your muscles appropriately.

There is no restrictions as such.

Alicia Insley Smith:

What about discomfort during pregnancy, like back pain or sciatica? Can physical therapy help?

Khyati Merchant: Absolutely. A lot of women have the back pain or the sciatica pain. Is there any anything in the physical therapy that would help them with those things? A lot of things. Absolutely, because when you are thinking about pregnancy during the pregnancy, our entire posture changes.

All the gravitational, like our line of pull is changing. So the muscles are primarily working before is changing in their, relying on more other areas for support. Those imbalance that is happening naturally in our body. Can create some issues in our lower back and hip.

And the pelvic area, which is a basic part of our poor muscle, is going through a lot because entire weight is going on those muscles. Definitely during those times, if the lower back issues, the hip pain that is constant following, preventing you from sleeping, then. From physical therapy point of view, it gives you a little bit of a nudge or a guidance in terms of which primary muscle that you can focus on, where you want to hold yourself a little bit better with your walking.

What are the alternative options that you can have? So the goal is basically. To work on the muscles that are shutting down because of a strain and imbalance that is created, be with the posture and allow those shutdown muscles to continue working and those who are working a little bit harder and heavier, we want those muscles to work in a balance so that they are not feeling overstrained.

We are trying to create a balance of those muscles. Many times the muscles are more tight and in spasm, so we try to reduce that trigger points in the muscles with different manual techniques different activities that we do that helps them to reduce that trigger points in the muscles.

Strive for the muscles to function appropriately. We do mobilization as well of the joints and spine. So that helps those joints and the muscles to move appropriately that allows them to more balance during those times. Makes sense.

Alicia Insley Smith: What are signs or symptoms that a pregnant woman should seek out physical therapy?

Khyati Merchant: Persistent pelvic heaviness or pain that interferes with your daily life, urinary or bowel incontinence, hip and lower back pain that prevents sleep. Many women are gonna feel a persistent pelvic heaviness and pain. Now heaviness I would say that you are going to feel that, but it should be comfortable to function.

It should be manageable. For you, it should not be miserable, that you cannot do anything. No. So that constant nagging irritation and pain No, that is a lot. So constant persistent pelvic pain if you are having incontinence issue during that time if you are feeling hip and lower back pain that is preventing you from sleeping.

You have tried all the sleeping pillows and a little bit of a hot pack and things like that and things are not working out. So those are the times. Painful intercourse during the time as well. And things like that.

But yeah, if it is. Persistently happening. Yes. Constipation difficulty emptying the bowel movement. Yes. Constipation does happen during that time. Yeah. But if you have difficulty emptying it, like you feel like repetitively you have the urge and you’re not able to do that, or you go to the bathroom and you feel like, haven’t emptied out enough, then those are the times definitely that you wanna look for.

More than just these sign and symptoms. I would also say that it is a good idea to understand how your pelvic floor is during, before basically just basically connecting with your body. And if you understand that, then it is good. But if you don’t have that understanding, then I would say that it is a good idea to know what exactly.

How is your pelvic area, how you would like to do the pushing and have your muscles are working during that time? How much is okay to push now? Yes. At that time you, you just wanna in the delivery time, you just wanna listen to your midwife or physician that you’re seeing, nothing else. But if you have a little bit of idea of how your body is, responding to the efforts that you’re putting it on. It is a more educational, educated step you are taking. For yourself. Makes sense?

Alicia Insley Smith: What is the difference between Kegels and proper pelvic floor activation? How can someone know if they’re doing things correctly on their own or maybe they shouldn’t be doing them?

Khyati Merchant: It is hard to say that if they are doing it correctly or not. From outside, but I would say Kegel, when we say Kegel. A kegel is nothing but activation of the pelvic floor muscles itself. So that is what it says and that is what the exercise is. What I would say is that what you’re, what you wanna look for when you are doing that exercise is that you are activating your muscles all the way from the pubic area in the front to the back of the rectal area.

So the entire floor part of that region that you are thinking about, the pelvic floor, you are lifting up towards your body, up into your abdominal area. And when you’re lifting it how far and how long you’re able to hold it. Are you holding your breath with that or not? That is a very important aspect. So we’re supposed to hold our breath or we’re not supposed to hold our breath. We are not supposed to hold our breath. Okay. So you, there are tendency of holding your breath. Yes. Many a times individuals will use all the other surrounding muscles, so glute muscles, the inner part of the thigh muscles that they will rely a lot on them to activate them.

The pelvic floor muscles, so that is incorrect a little bit. You wanna be able to activate just the floor muscles. When we are talking about the Kegels, you should be able to activate just the pelvic floor muscles with ability to continue with breathing. And as per the research, if you are able to do that 10 reputations, holding it for 10 counts each reputation.

That is pretty good. You have a good strength. Like I’m, I won’t be able to say strength, but you have good endurance. That is what I would say.

Alicia Insley Smith:

Diastasis recti is a common pelvic floor dysfunction after birth. Can you explain what that is and how it affects the body?

Khyati Merchant: So dialysis is recti is a thinning of our “six-pack” muscle that what we talk about rectus abdominis. And that is absolutely normal to have it after the pregnancy. It all women will have that as a postpartum duration. We want. To see is that how that deeper muscles are activating after the delivery, how you are reactivating those muscles back in action and.

Many a times that is what they say. Give yourself a good rest and then gradually get back on working. So intention is that the initial rest time allows your body to heal and when you are ready, those muscles are working with you, the deeper muscles working with you for doing all the other activities that you are doing.

Diastasis recti is nothing but thinning of the kind of a rectus abdominis muscle, which is a six pack muscle at what we talk about.

And, that is absolutely normal for the postpartum or during the pregnancy that to go through. But what it affects us is that it changes the pressure in our abdominal system, how we are creating it. With the help of other deeper primary muscles and the diastasis recti if you have it for a longer time. That being said that you are probably using your rectus, like a superficial muscle of the abdominal wall of way too much. 

You’re relying on that and you’re not relying on your core. Deeper abdominal muscles. So that is what it says. Now, there are many research has been coming out right now and they are questioning whether it is normal or not and things like that. Yeah, there was a wave of okay, as a cystic is normal, and there was a wave of oh my God, it is absolutely not normal.

And now again, it is fine to have that because as I said, like age postpartum, women will have that. But at the same time, you wanna see how you are working with your other core muscles to support you and in coordination with the other kind of hip and your back muscles to create balance in your trunk and your hip mobility.

So the intention is to create good pressure. Around our abdominal area, while we are expecting our body to function the way we want. Diastasis recti is normal, but it does affect all the postpartum body. Whether you wanna be alarmed with the, not with that or not, that is where you want to see how you can work on it and things like that.

So I won’t say that if you have Diastasis recti or if you’re conning, you just cannot do any exercise or you would not be recommended to do any curl ups and things like that. There are ways that you can do curl ups with it. When you’re doing the conning and things like that, are you activating your pelvic floor well or not?

Are you using your other deep muscles appropriately or not? And things like that we need to assess. Okay. So if you do have that conning, is there a, is that when you need to see someone to get back in balance? I would definitely say that.

Alicia Insley Smith: So if someone has coning (visible bulging with diastasis recti), is that when they need to see someone to assess how you’re using your muscles?

Khyati Merchant: Yes, if you notice coning, it’s a good idea to have a professional assessment. It can indicate an imbalance in how you’re using your pelvic floor, abdominals, and even other connected muscles throughout your body. Remember, everything in our body is interconnected. From pelvic floor to abdominals. To your shoulder muscles and things like that. All of them, like your neck muscles, how you are using your foot muscles, they are connected. Everything is absolutely connected very well in our body. And as I was saying earlier, pelvic floor muscles are not just meant to work on demand that you ask them, but it needs to work automatically on the demand that we are putting it on them.

Alicia Insley Smith: How does physical therapy help with the healing process for diastasis recti? Do you do different stretches for that? Do you, what, is that look similar to any other physical therapy appointment or is there something specific for that?

Khyati Merchant: Our goal in postpartum physical therapy is to assess how your pelvic floor muscles are working in coordination. It is different in terms of, you know where you are in your journey and what is the goal. Okay. So in terms of, if I’m looking for postpartum women, our goal will be to see how you are working with your pelvic floor muscles, along with your other deeper abdominal muscles and how appropriately they are working while you’re doing those exercises.

So a coordination of one particular exercise is going to be very important to, understand and giving a feedback because by a therapist for those who are doing, because it is important for them to get back on the right track at earliest. If they have a tendency of using incorrect muscle, they get their work done.

Our body is always very nice to get the work done, but if they have a wrong habit of using the muscles in an incorrect way, they will continue to do that. So later on in the future, maybe five years, 10 years down the road, it can create an issue for them. In terms of doing the exercise appropriately, that is what we are looking for.

However, at the same time a little bit different than what we usually see are therapy sessions for the other ortho related issues I would say that what we are looking for is that, as I said how the coordination is, how the muscles are functioning. How your pelvic floor muscles are.

We do the assessments in with, in standing, we in a different positions to see how the muscles are coordinated. If there is any prolapse issues, especially after birth. We try to manage that with the pressure system, how the pelvic floors are working with lower back and the hip pain and things like that.

So those are the different detailed, that specialized detailed work that we do with the pelvic floor population for postpartum.

Alicia Insley Smith: Excellent. And last little few questions. What is one piece of advice you would give every pregnant woman regarding pelvic floor health?

Khyati Merchant: I would definitely say, if you need it, you must have it. The reason is that when we go through any kind of surgery, if it is a shoulder replacement or a knee replacement, doctors are going to send you to a physical therapy. And our pelvis, there is no active. Excuse me. There are no active movements happening, so we don’t realize how they’re doing it appropriately or not.

But at the same time, your pelvis has gone through a lot during pregnancy, during delivery, and after pregnancy as well, during the postpartum. A hundred percent. I would say one time women should go for physical therapy. Or understand their pelvic area. Absolutely. 

Alicia Insley Smith: And then my last question for you. If someone is hesitant or embarrassed to talk about their pelvic floor issues, what would you say to encourage them to seek help?

Khyati Merchant: It’s understandable that it feels very personal. Start by talking to someone you trust – a close friend or family member. You need to have a woman you can talk to. When you go and talk to any friend or any sister, very close things that you mention to them.

You talk to them first. See how that feels to you, that is a first step towards it. And the second is that even though in their mind, if they have a perception of. It is not right. It is very private and things like that. Yet it is very normal. It is very natural. Every one in their life is somewhere or the other time will have these issues.

You are not alone. Pelvic Floor Health is important for everyone.

We might have a perception of okay, how can I talk to somebody about this? Any issues that we talk about, like incontinence, sexual, intimacy and those things. But they go through that. So you might feel like you are all alone. But you are a hundred percent not all alone. More than 80% of women will have some, or the other time of an incontinence issues. They like, there are.

So they will have these type of issues. So they need to talk to somebody who they feel close to first, and then get an understanding of how that feels to them, to give them an opportunity to. Talk to a right provider about it. Okay. Another thing that is, that I would like to say is that join some group or kind of have a conversation in not just a conversation, but actually reading about those areas as well.

There is an American Physical Therapy Association that has a lot of websites, lot of page about pelvic health in our Charlotte area. We have a greater Charlotte pelvic collaboration. They do have blogs about the public health that they can read. So yeah. Excellent. So we will link to those.

On the bottom of this blog so that they can find those resources.

Alicia Insley Smith: How can our listeners find you online if they want to connect with you?

Khyati Merchant: You can find me on my website: www.lotusptph.com. It is www dot lotus L-O-T-U-S-P-T-P-H. That is physical therapy pelvic health.com. So it’s www.lotusptph.com.

I’m also on Instagram as @lotusptph. That you may see me here and there. Doing little videos Lotus PTPH and keep yourself strong. Keep yourself healthy. Those exercises do matter. It’s not just about the pelvic floor, it’s about your entire body. So continuing with your exercises is very important. I would say.

Alicia Insley Smith: Thank you so much for speaking with us today, Khyati!

Khyati Merchant: Absolutely!

And if anyone listening has questions, there’s a comment section at the bottom or you can get in touch with Khyati or myself and we will try to get the answers for you. All right. Thank you. Thank you.
https://www.lotusptph.com/ https://www.instagram.com/lotusptph/

Taking care of your pelvic floor health during pregnancy and postpartum is an essential aspect of your overall well-being. Khyati’s expert insights highlight the importance of understanding your body, addressing concerns proactively, and seeking professional help when needed. Don’t hesitate to connect with Lotus Physical Therapy and Pelvic Health for personalized support. Whether you are looking for prenatal physical therapy here in Charlotte or postpartum recovery pelvic floor support in Fort Mill SC she can guide you. We’ll also link to the resources Khyati mentioned below.

American physical therapy association https://www.apta.org

the Greater Charlotte Pelvic Collaboration https://www.charlottepelvictherapy.com/

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