Energetic, knowledgeable, and ever-compassionate, are the immediate — on-the-outside things – you recognize about Rock Valley Physical Therapy’s Nicolle Cabalka, PT, DPT, Clinic Manager, North Liberty, IA.
Then mention Kayden William Cabalka, a handsome and strapping lad born April 17, 2025, and a loving mother’s heart goes aflutter, and her eyes start to sparkle.
“An amazing experience,’’ Cabalka said of becoming a mother.
Bearer of a light-up-a-room personality, Kayden’s mom earned her undergraduate degree from University of Northern Iowa and her Doctor of Physical Therapy degree from Des Moines University.
Cabalka has worked her way to the forefront in the world of pelvic health, dedicated to the well-being of the bladder, bowel, and reproductive organs, including the muscles, ligaments, and tissues of the pelvic floor. She joins Emily Pospischil, PT, DPT, OCS, ATC/L, Clinic Manager at Physicians’ Clinic of Iowa’s 29th Street (Cedar Rapids) location as two forces in pelvic health in the Cedar Rapids-Iowa City corridor.
As a pelvic health expert, Cabalka can better the lives of those dealing with such issues as pelvic organ prolapse, urinary and fecal incontinence, urgency, and frequency, and a variety of prenatal and postpartum issues.
Today, Cabalka is back at work, “Making Better Lives.’’ She shares her expertise as to what expectant mothers can do during pregnancy and postpartum to handle pelvic health issues that come their way.
• Appreciate the process:
“Being a professional and having a grasp of what might come my way, I came to realize we really don’t know what is going to happen until it does,’’ Cabalka said of her pregnancy and giving birth. “It’s indescribable until you have been through it, but it was all worth it.’’
• Get to know/understand your body:
“I was happy that I knew my pelvic floor so that I could relax and allow for the baby to come out,’’ Cabalka said. “I also knew certain ways I could turn and maneuver to help the process. I worked with midwives and had several comments about my breathing and my ability to relax my pelvic floor. I had several positive comments on that.’’
• Stay active during pregnancy:
“I’m so glad I was active, and I tell that to everyone I treat,’’ said Cabalka, who worked the day before she delivered her son. “If you don’t stay somewhat active and have enough strength you will peak-out. Labor and delivery are a marathon no matter how long it takes.
• Your bladder can be trained:
“This is huge,’’ Cabalka said. “Everybody thinks since there is a baby in here that you are going to (constantly) go to the bathroom, that you must get up at all hours and go. There are steps to take. “The bladder works on a cycle that consists of two urges,’’ Cabalka continued. “Ideally, we wait until the second urge to empty the bladder. If we are emptying all the time prior to the second urge or “just in case” or just because it is convenient, we are not allowing our bladder to fill up before emptying. This can cause increased frequency of urination, leakage, etc. If we consistently wait for that second urge, it can help prevent having to go as frequently. Sometimes this can’t be avoided in pregnancy depending on where baby is positioned but the longer you can wait the better.’’
• Postpartum: Baby is here:
The postpartum period begins after childbirth and may be considered for up to 12 months after birth. Postpartum is considered two phases including puerperium (delivery lasting roughly 6-to-8 weeks until the placental site is healed) and the fourth trimester (which can last up to 12 months).
• It’s common, but not normal to have urinary leakage after giving birth:
“Just because it’s common DOES NOT MEAN it is normal,’’ Cabalka said emphatically. “There is 100 percent something that mothers can do about it, and they don’t have to go the rest of their life leaking when they cough, sneeze, or jump. It also doesn’t matter if you had a baby six weeks or 60 years ago. We/I can help.’’
• Rest is vital: Take the first week for you and the baby:
“Everyone kind of laughs at this because things are new and getting used to the baby and its schedule is a change and a challenge,’’ Cabalka said. “Catch up and sleep. Rest… You want to get back and do all the things and your body wants/needs to do, but you must rest and your pelvic floor – which has taken a beating – must heal. Even if you had a C (Cesarean)-section, your pelvic floor still held a baby for nine months. You might not have had the tearing, but it still held a baby and no longer has that weight and is still trying to figure things out.’’
• Start slow, then increase movement:
“You must consider all that is going on in your house and you must take care of your baby. Make sure all is safe and secure there and that you have had enough rest,’’ Cabalka said. “I began week two with a walk around the block with the dog and I recommend something of that nature as a start to being active.
“Personally, that walk felt great and was the perfect start for me. You can follow that up with some stretching and then work on deep core activation. Gradually progress to other exercises, but make sure – and this is important – to listen to your body,’’ she adds. “Common signs to stop what you are doing include increase in vaginal bleeding, new pains, or discomforts in the pelvic region, urinary or fecal incontinence, or pressure or bulging in the vagina. The most important thing is if you are unsure if it is safe or if you are doing too much, ask for help to avoid overdoing things. It’s also important to note everyone heals at different speeds. What one person may be able to do in two weeks, another person may not and that is OK.
“I also did some pelvic floor therapy (strengthening and coordination exercises for pelvic floor muscles and surrounding areas) since I had a lot of tearing. Deep core exercises were helpful. I was in a lot of pelvic pain and sought (physical therapy) help at week two. It’s never too early to start with mobility, especially if you are experiencing pain. The walks – around the block in the early stages – were signs of success to me. I had a really good turn at four-to-six weeks. I was walking further, pushing the stroller, and doing body-weight strength training. Do what your body will allow but keep moving.’’
• Six weeks: A lot is happening: OBGYN visit; time for physical therapy:
“At six weeks there is usually a visit with your OBGYN to see where things are,’’ Cabalka notes. “You wait for that good report, then you go back to what you have been working on, and you gradually increase it with whatever your body allows.
“This is where physical therapy should kick in if you haven’t already started with it. You are stronger and you are mentally ready – if all is well with your baby – to move forward. It is an important time. It’s where we – therapists and patients – can assess everything, work on strength, on core and a variety of other things that are beneficial.
“I would recommend (pelvic health physical therapy) once a week and then we can work once every other week. Again, it depends on home and on the baby, but we can improve overall health, strengthen the pelvic floor, and get you back to whatever your goals are for yourself. For me, this is new in that I have a better understanding – having just gone through it (childbirth) – of what my patients have been through. I believe it makes me a better therapist.’’
• Homework is always good:
Cabalka says the world is hectic for all new mothers, but says she shares with her patients that homework – any exercise outside Rock Valley’s walls – is always a promising idea.
“Finding that floor and core is a constant,’’ she said. “Anytime, when there are a few minutes, like when the baby is resting, it’s a good time to improve your core. Personally, I find feeding Kayden a great time to work on my coordination of my pelvic floor and core. It allows me a guaranteed time to work on it each day. It’s a process, one if you get out in front of it will better serve you in the future. But don’t be afraid to seek help.’’
To contact Nicolle Cabalka, call (319) 665-2555. No referral needed.
By: Johnny Marx, Storyteller