Check out this juicy article written by a physical therapist. It conveys everything I talk to women about. It’s time to start caring for yourself NOW.

The issue of baby weight hangs heavy on the minds of many postpartum women, with images of famous moms like the impossibly fit model Gisele Bündchen, who had her second child last year, seared into their brains.

But more women and health professionals are turning their attention to changes beyond weight. Pregnancy and labor cause significant strain on muscle and bone structures. Some research shows that stretched, weakened or torn muscles and misaligned bones may seem simply annoying at first, but can develop into debilitating disorders years or decades later.

More women in the U.S. are having babies older and in some cases spacing pregnancies closer together, giving the body less time to recover. There has also been an increase in fertility treatments such as in vitro fertilization, which lead to more twin pregnancies that add to the physical strain on women’s bodies.

“It’s a massive physical challenge” to have a baby, says Jessica McKinney, director of the Center for Pelvic and Women’s Health at Marathon Physical Therapy and Sports Medicine based in Boston. Abdominal muscles lengthen significantly during pregnancy, the spine moves into an exaggerated S curve, caesarean section can leave internal scar tissue, and the hammock of muscles in the pelvis that support organs and bones, called the pelvic floor, stretches or even tears, she says.

Left untreated, the changes can cause problems down the road, from pelvic and low back pain to incontinence and other issues.

Courtney Freck, an avid runner who lives in Sterling, Va., started having sharp hip and back pain while running about a year after the c-section birth of her second daughter. Doctors weren’t sure what was wrong. Eventually, she consulted a women’s health physical therapist who pointed to her weak core muscles and her lingering diastasis recti, or the separation of her “six-pack” muscles. The separation occurs in almost all pregnancies and often doesn’t resolve on its own.

“I just thought it was one of those things, you have a baby and things never go back,” says the 36-year-old purchasing manager for a health-care company. She did exercises to strengthen her interior abdominal muscles and pelvic floor. She is now training for a marathon, running about 25 miles a week.

To reduce diastasis recti during pregnancy, physical therapists recommend avoiding sit-up movements that rely on the external abdominal muscles. Instead, they suggest women get out of bed by lying on their sides and pushing themselves up with their arms.

With a new baby to care for, women often ignore seemingly small things like pain, says Ms. McKinney of Marathon Physical Therapy. Patients think “I have to throw myself at the altar of motherhood,” and it’s normal that my body doesn’t work as well, she says.

To explain why so many of their patients don’t seek treatment until years after they gave birth, many health professionals that focus on musculoskeletal issues during and after pregnancy tell a similar tale.

“I will hear, ‘After my first pregnancy I occasionally leaked as I coughed’ ” or I had some pain, but I didn’t see it as a problem, says Secili Destefano, a physical therapist and director of research for the American Physical Therapy Association Section on Women’s Health. Then a woman ages, her muscles start to deteriorate and her hormone levels change. “And now your body is doing things you don’t want it to,” she says, and finally you go to a doctor.

If a woman seeks help earlier “we can use simpler treatments,” such as physical therapy in lieu of surgery to repair a weakened pelvic floor or pelvic organ prolapse, says Linda Brubaker, an urogynecologist and dean of the Stritch School of Medicine at Loyola University Chicago.

Dr. Brubaker recommends every woman ask her doctor or nurse to check her pelvic floor strength at the 4-to-6-week postpartum checkup. The pelvic floor is “the center of the universe,” because it supports so many organs and bones, she says.

Even c-section scarring can be treated to prevent pain. Any internal scar can adhere to other parts of the body while healing, hampering muscle movement or causing pain years later, says Debra Goodman, a physical therapist in Albany, N.Y. She massages scar tissue once it has healed to keep skin and tissue mobile, she says, noting improvement can happen “even 20 years later.” About 30% of births happen via c-section in the U.S.

Women are regularly told by doctors to do Kegel exercises to strengthen the pelvic floor during or after pregnancy, but many women do them incorrectly, pushing out instead of up and in or contracting the wrong muscles, says Colleen Fitzgerald, medical director of the Chronic Pelvic Pain Program at Loyola University Chicago.

Many of these issues get little attention among women and some obstetricians for a complex web of reasons. A spokesman for the American Congress of Obstetricians and Gynecologists says there is a “tremendous amount of information that must be conveyed” at a postpartum visit and that doctors refer patients to specialists when they find problems with the pelvic floor. Obstetricians rely on prenatal classes to train patients in Kegel exercises, he said.

Exercising too hard too soon can lead to problems including pelvic pain, say some doctors and physical therapists. Women can exercise as they normally would during pregnancy and after their 4-to-6-week postpartum checkup as long as they don’t have pain, say most health professionals.

If a postpartum woman has weak core muscles or a large diastasis recti, running or other pounding exercises can be problematic. Hold off until you know you have stable core strength, says Marianne Ryan, owner of MRPT Physical Therapy in New York City. However, women can start doing pelvic floor and breathing exercises in the days following labor if it doesn’t cause pain, says Ms. Ryan.

Symptoms that are often linked to unresolved injuries during childbirth are common in the U.S., especially as women age. Almost 40% of women 60 to 79 years old report symptoms of some type of pelvic floor disorder, which includes incontinence and pelvic organ prolapse, when organs press against or descend into the vaginal walls causing a sensation of pressure, according to a 2008 study from the Journal of the American Medical Association.

In the study, the more children a woman gave birth to the more likely she was to have symptoms. Overall about 24% of U.S. women who aren’t currently pregnant had such symptoms, according to the study that reviewed medical data for 1961 women 20 and older. Obesity was also a risk factor. Some research shows these numbers are likely to increase in the coming decades as the population ages.

“I felt really accomplished that I had good pregnancies,” says Karen Ivas, a 56-year-old Mansfield, Mass., resident and mother of five. “A week after I delivered I was in my jeans.”

But in her early 50s she started to experience minor incontinence issues. “I didn’t think too much of it,” says Ms. Ivas, until she realized she couldn’t live “without having to worry about where the next bathroom was.”

One doctor she consulted said, “Oh that’s the way it is. A lot of people have your problem,” she says. She had surgery to lift her uterus and other repairs, but it didn’t resolve her problem, she says. More recently she has found some relief from regular trips to a women’s health physical therapist, doing hands-on therapy and other exercises.

“I had more than one OB and nobody ever said anything to me about pelvic health,” she says.”

Write to Sarah Nassauer at sarah.nassauer@wsj.com

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