Post-Partum Pelvic Floor Care

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POSTPARTUM PELVIC FLOOR CARE

In the weeks and months following childbirth, you’ll notice your body begin to turn back to a more normal state, but keep in mind that some changes can be lasting. Many women, for example, find that their hips are a little larger than they used to be and their breasts have drooped a bit. For some, the vagina and uterus will be slightly wider than before, while for others, even their shoe size may go up a touch (for that, you can blame the added weight you carried for flattening your arches, along with the hormone relaxin, which makes bones in the hips and pelvis more elastic but which can also can lead the bones and ligaments in the foot to spread out).

Another unfortunate consequence that many new mothers experience is either temporary or more lasting bladder dysfunction. Pregnancy puts a tremendous amount of pressure on the pelvic floor, which can weaken your muscles or, in some cases, do the opposite and create extra tension. Either way, the symptoms are less than desirable:

Symptoms of a weakened pelvic floor:

Urinary incontinence, urgency or increased frequency of urination
Stool and gas incontinence
Pelvic organ prolapse, or the dropping of your organs through your vagina
Sexual dysfunction

Symptoms of pelvic floor tension:

Constipation
Painful intercourse
Pelvic pain
Inability to empty your bladder completely
Painful urination

In addition to these, there are possible orthopedic effects that can rise to the level where they’re more than simply mild inconveniences. Some of the more common symptoms include:

Potential Orthopedic Effects

Low Back Pain
Sciatica
Pelvic Girdle Pain
Pain in the hips, groin or pubic area
Wrist/hip other orthopedic symptoms

Understanding What’s Common, What’s Normal And What You Can Do About It

Think of everything you just had packed in down there: An 8-pound baby, all that amniotic fluid, a placenta – it’s no wonder your bladder and bowels act a little confused before, during and after childbirth. Some of the most commonly encountered issues include:

Leaking

Urine leakage is common, even after you’ve come home from the hospital, but what’s not normal is for that leakage to continue. If you find that you’re experiencing episodes of wetness more than 3 months after giving birth, it could be a sign that you have a weakened pelvic floor or support system. Don’t wait and hope that things will resolve on their own – talk about it to your doctor or physical therapist. Even if your symptoms are only mild or occasional, because our muscles continue to weaken as we age, things could get worse as you get older.

Other Urinary Issues

If it’s been more than a few weeks after delivery and you find that you have an inability to control your bladder, the urgent need to go, the inability to empty your bladder fully, bladder pain or signs of infection, your body could be telling you that there’s something wrong, including potentially serious conditions like pelvic organ prolapse. These aren’t small inconveniences – urinary issues can significantly affect your quality of life. Fortunately, there are a number of treatment options that can make a real difference for you.

Bowel Issues

Like other problems, you can blame this one on weakened muscles and changing hormones. Bowel issues after childbirth can include everything from constipation to increased gas to fecal incontinence. Complicating things are pain medications – these are notorious for causing constipation, which is a problem in its own right but which can also lead to added pressure across your pelvic floor, anal fissures, impaction or even pelvic organ prolapse. Sure, bowel issues can be embarrassing to talk about, but a frank conversation with your doctor is a heck of a lot less embarrassing than living with the problem long-term.

Pelvic Organ Prolapse

This occurs when the muscles or tissues that support the uterus, rectum and bladder become weak or loose, resulting in one or more of the organs to press into or through the vagina. You may feel a sense of pressure or bulge in the vagina, and you might experience aches or discomfort in the pelvic region. There can be other side effects, too, like constipation, urine leakage or the inability to empty your bladder or bowels. The good news is that there are treatments to correct the problem, and seeking help right away is important because Pelvic Organ Prolapse can worsen over time.

Diastasis Recti

Also known as DRA, this is a condition where the large muscles of the abdomen separate during pregnancy but fail to come back to the midline after delivery. It actually isn’t limited to new mothers – anybody can get it – though it is more common in women who have just given birth. Side effects include a weakened core, lower back pain, constipation, urine leakage and the feeling that you still “look pregnant.” Treatments usually include pelvic floor and deep stomach muscle exercises, and physical therapists are great at helping you address your DRA, though surgery is also an option if the problem persists.

Painful Intercourse

Pain during sex doesn’t only occur because you just pushed out a cantaloupe-sized human being (but boy, is that a factor!); hormonal changes can also play a role. Some hormones can cause things like vaginal dryness that make penetration difficult and uncomfortable, and since you produce less estrogen when you breastfeed, you may find that tissues in your vaginal area become thinner, which can also produce pain. Between the dryness, scarring, muscle and nerve damage, it’s no wonder that sex isn’t always the pleasant experience it used to be before motherhood. Most of these problems tend to resolve with time, but if they continue, don’t rob yourself of the joy you used to have – talk with your doctor to find a solution that’s right for you.

Hints & Tips For Recovering From Childbirth

Recovery takes time and patience, but there are some things you can do to help make your return to normal go a lot more smoothly:

Give yourself the rest you need

It sure isn’t easy keeping up with a newborn, but your body needs time to recuperate, too. Especially in the first two weeks after birth, you can support your body’s natural healing processes by minimizing the effects of gravity – spend time off your feet, either lying down or sleeping, particularly at the end of the day. Try to match your own sleep schedule with your baby’s, and see if you can breastfeed while you’re reclining.

Don’t neglect personal hygiene

Whether you’ve delivered vaginally or via C-section, you’ll want to take extra care to keep yourself clean and dry. See our suggestions for scar care following caesarians – you’ll want to make sure the incision heals properly. For vaginal deliveries, you’ll want to wash your perineal area with water and gently pat yourself dry after showering (and make sure to avoid soap). In fact, as a general rule of thumb, you should treat yourself gingerly to avoid irritation and encourage healing – when you urinate, pat instead of wiping, wash yourself with water after having a bowel movement (again, no soap!), and make sure to change your sanitary pad frequently, every 4 to 6 hours if not sooner.

Use Ice and Compression

You can help control inflammation and pain in the vaginal area by applying ice with gentle pressure. A clever little hack is to put your maternity pads in the freezer, then wear them inside a supportive pair of underwear. You may also want to consider using compression shorts to give your pelvic floor and abs additional support.

Pain Relief

There is nothing noble about suffering after childbirth. If you’ve been prescribed pain medications, take them as needed – after all, you’re going to need all your strength to properly care for your newborn. Of course, many of your aches and pains won’t require prescription-strength meds to handle, but check with your doctor to find out which over-the-counter pain relievers make the most sense for you.

Practice Good Posture

Keeping your body aligned ensures that you’re delivering the proper support to your pelvic floor and abdominal muscles, which can assist with recovery and protect against developing or worsening bladder and bowel conditions. Sit and stand upright, with your shoulders drawn back and your spine lengthened. And remember that good posture is important when using the bathroom, too – refer to our tips on healthy toileting by clicking here.

Be Aware of the Way You Move

As your body heals, you’ll want to avoid putting too much pressure on your abdominal muscles and pelvic floor. Try to avoid standing for long lengths of time and keep from movements that require you to balance yourself or stand on one leg. When you get out of bed, try rolling to one side instead of using your abs to sit up, and when standing from a chair, try pulling yourself by grabbing the arm rests rather than just tightening your stomach. It’s also a good idea, at least for the first few weeks, to try and avoid lifting anything heavier than your baby.

Avoid Constipation

You’ve probably gotten the idea by now that we’re really, really against constipation – and for good reason. Constipation can spell real trouble for your pelvic floor, and the pressure it creates can slow down or even reverse the recovery process. Make sure you drink plenty of fluids, eat lots of high-fiber foods, and consider a fiber supplement or laxative if you need a little extra boost in that department.

Try Diaphragmatic Breathing

A great way to relax your pelvic floor – and your whole body, too – is to practice a simple technique called diaphragmatic breathing. While lying on your back, place one hand on your chest and one on your abdomen by your belly button. Slowly take a deep breath in and focus on trying to get your hand on your stomach to rise while keeping the hand on your chest still. As you breathe out, the hand on your stomach should then lower. Repeat this for 5 – 10 minutes a day, concentrating on breathing into your belly rather than your chest, and imagine your breath moving down through your body to your pelvic floor. (Note: Watch our video on how to perform diaphragmatic breathing here, along with other great videos of exercises for your pelvic floor.)

Start Doing Your Pelvic Floor Exercises

Kegels and other pelvic floor exercises are especially important for your recovery, whether your birth was vaginal or caesarian. The National Association for Continence has created an entire Pelvic Floor Health Center, including detailed instructions for performing Kegels and other movements that are designed to gently increase the strength of your pelvic floor and abdominal muscles – it’s an exercise program that can last a lifetime.

Return Slowly to Exercise

Some women who’ve just given birth are in a rush to get back into their pre-pregnancy shape, but it can be counterproductive to try and take on too much, too soon. During the first 6 weeks postpartum, try to focus on gently working your pelvic floor and abdominal muscles, practice good posture and begin light walking. Between 6 and 12 weeks, you can up the ante with postnatal Pilates or yoga, low impact aerobics, more vigorous walking and light weight training. Over the next three months, you can gradually increase the intensity of your workouts and begin light jogging. At the 6 month mark, you should be ready to begin more traditional exercise routines, but pay attention to your body and make sure that you don’t push yourself too hard – healing takes time, and there’s no reason to rush.

Making Use Of A Physical Therapist

You already know how important it is to continue following up with your doctor following childbirth, but did you know that working with a physical therapist can also be a great way to speed along your recovery? If you only think of physical therapists, or PTs, as helpful for things like sports injuries or orthopedic problems, you may be surprised to learn that there are a number of physical therapists who specialize in things like the treatment of urological, colorectal and urogynecological conditions. Pelvic PTs can evaluate your pelvic floor muscle strength and function, and then they’ll work with you to develop an exercise regimen that balances and strengthens your back, hips, pelvic girdle and pelvic floor. They can even help with bladder and bowel problems like incontinence and pelvic organ prolapse. In many other countries, being seen by a PT after delivery is considered the standard of care – there’s no reason why you shouldn’t benefit from their expertise, too. After all, your body has been through a lot, and a PT can help you determine if you’re on the right track to recovery – and sent you on a better path if you’re not. You’ll learn important exercise and stretches to get your pelvic floor in shape again, and they’ll help you address any issues that you may be having. A great time to learn more about PTs in your area is at your 6-week checkup with your doctor – just ask and they’ll help you find a qualified practitioner near you. One thing to keep in mind is that many insurance carriers don’t cover postpartum physical therapy, so if payment is a barrier, ask if they might have more affordable options for new moms.