The 4th Trimester: Healing Essentials

Cristin T. Zaimes, DPT, Owner, Oceanside Physical Therapy


(Applies to Vaginal and Cesarean Deliveries)

Deep breathing is the key. The health of the pelvic floor is connected to a normal deep and diaphragmatic breath.

  • Inhale slowly and keep your pelvic floor relaxedExhale, and gently contract your pelvic floor muscles.  Feel your perineum, (skin between vagina and rectum), drawing up into your body with a contraction and relaxing down on the inhale.  It is a vertical sensation, visualize an elevator moving up and down.

  • Check out these links for diagrams and videos:


  • A Healthy Bladder operates like this: Urinate every 4 hours, Light yellow.  A slight pressure sensation signals a full bladder.  You do not have to answer this immediately and when ready, calmly go to the bathroom.  Sit down, relax your muscles and begin to urinate.  Good stream, fully empty and continue on your day.

    • Dysfunctional Bladder: Urgency, > 6-7 bathroom trips per day, > 0-1 nightly trips, Slow or interrupted stream, hesitancy to start a stream, leakage, pain with fullness or urination. Usually a sign of muscle dysfunction or nerve damage.

  • Normal Bowels: Varies but a predictable bowel movement is ideal every 1-2 days.  A pressure in the rectum should signal your need to evacuate.  The best evacuation occurs when you respond promptly to this signal but have the ability to hold off.

    • Dysfunctional Bowels: Any pain, the need to strain, pellets or loose stool, leakage and extreme urgency, irregular or infrequent bowel movements.

  • Learn more on how to sit for proper evacuation and improve the gut here:


  • Attention to Vaginal or Abdominal scarring will help you heal better and avoid common dysfunctions associated with scarring. The layers of skin adhere and become “stuck together” which can contribute to pain, sensitivity and pelvic floor dysfunction.  Once the stitches are removed, massage your scar gently and then move the skin up, down and side to side.  Do not avoid touching this area.


  • You have been through a trauma and need to heal. Healing requires real food, protein, veggies and rest.  This is not a time to restrict your calories.

    • Go for Protein first- keep it simple

    • Minimize Processed Food

    • Add Veggies

    • Keep your gut moving. Regular bowel movements with good consistency are an important marker that you are helping your recovery.


  • Many of your deep postural stabilizers are not functioning optimally. It is important to promote healing and proper activation patterns of these muscles again.  This is a crucial step to avoid injury and further problems in the future.

  • Start with #1 Restoring the pelvic floor and breath in the first 2 weeks. Then progress slowly, activating the surrounding muscles with the pelvic floor.  Check out our videos on Youtube as a place to start (Search Oceanside Physical Therapy- Folder Exercises). It takes AT LEAST 6-8 weeks to heal.  I do not advise higher impact exercise prior to this period.  If you are not sure about what to do.  WE CAN HELP.  We can give you the best program for what your body is ready for.

Discuss physical therapy with your provider if you experience the following:

  • Urinary or Fecal Leakage

  • Pain with intercourse (once cleared by your provider)

  • Constipation

  • An abdominal separation: place 2 fingers just above your navel. Lift your head up and if you feel a space between your stomach muscles, this is called a Diastatis Recti.  You should discuss exercise with a PT.

  • ANY Hip, Back, Neck or Pelvic Pain. Prioritize yourself!

Taking care of yourself is the best thing you can do for your family!  Congratulations! It is truly an amazing process. Please let us know if you have any questions or we can help in any way.