National Parent's Day
Hi friends, happy National Parent’s Day (a few days early)!
National Parent's Day is this Sunday, July 26th. This holiday was established back in 1994, and serves to recognize the “uplifting and supporting role of parents in the rearing of children.” The reality of parenthood often sets in after delivery of your bundle of joy.
You just spent roughly 40 weeks pregnant and the focus was mainly on you as the “oven.” Now that you’ve delivered, focus often switches from you to your baby. They are no longer protected in the safety of your womb, and they aren’t being directly nourished by your body and your immune system.
Let’s face it, our bodies do amazing things during pregnancy—I mean, you grew an entirely new human being! But along with that, comes several changes to your body. These changes don’t magically return to normal after delivery. That’s why, the American College of Obstetricians and Gynecologists (ACOG) has started to recognize the “fourth trimester.” Yay!
The 4th trimester is the time period between giving birth until 12 weeks after delivery. Keep in mind, while the 4th trimester may also end, your body will always be “postpartum.” Some changes may never return to pre-baby ways, but that doesn’t mean your body shouldn’t be functioning properly. Peeing your pants is never normal—even if it’s just a few drops!
Let’s take a minute to look at some common beliefs many have about postpartum care:
“A six week check up after delivery is all a new parent needs.”
“Urine leakage will stop automatically.”
“Prolapse will not affect me until I am older.”
“Scar tissue and pain will go away on it’s own.”
“If I do a few Kegels, any problems ‘down there’ will go away.”
Are these true?
Unfortunately, these are all myths. But don’t be discouraged, most pelvic floor problems are treatable without surgeries and extensive medications when treated early. These muscles act just like any other muscle in our body and may need some retraining. When you have a knee surgery, often times the muscles don't get stronger and the pain doesn't go away instantly. We spend time caring for and rehabbing our knee to get stronger and to help to pain go away. The pelvic floor muscles are the same way after birth--let's face it, they just suffered the same degree of trauma as having surgery!
Many of these issues aren’t talked about between women and their healthcare providers, and when women talk with other women, they often joke about their problems to cope. Help is out there!
There are so many issues that need to be addressed postpartum. Your healthcare provider should be addressing these issues at postpartum visits:
Mood and emotional well-being
Infant care and feeding
Sexuality, contraception, and birth spacing
Sleep and fatigue
Physical recovery from birth
Chronic disease management
There are so many different things to manage after pregnancy, but today we’ll focus on the pelvic floor muscles.
Why are the pelvic muscles affected by pregnancy and childbirth?
First and foremost, the pelvic floor muscles are put under great stress during delivery. They have to be able to stretch wide enough to allow the baby to come out. When the don’t stretch properly, you may experience perineal tearing. The muscles may also be cut purposefully by your doctor in a procedure known as an episiotomy.
But even if you don’t have a vaginal delivery, you still aren’t out of the woods. The pelvic floor muscles act as a hammock to support all of our pelvic organs. During pregnancy, the baby grows in your uterus and the pelvic floor muscles must adapt to increasing pressure being put on them, which can cause problems with the way they work.
What are some of the common problems following pregnancy and delivery?
Tailbone pain (coccydynia): The tailbone can be fractured or dislocated during delivery. The pelvic floor muscles attached to the pubic bone in the front and the tailbone (or coccyx) in the back. When the muscles are being stretched during delivery to allow the baby to come out, this can pull on the tailbone.
You might have excruciating pain around your tailbone or find it hard to sit down if your tailbone is broken or you have an avulsion.
Some things to try are sitting on a ball or yoga blocks to take pressure off of the tailbone. Seeing a pelvic floor physical therapist who is trained in coccyx mobilization can also help get rid of the pain and any other related symptoms.
Urinary leakage/urgency: While it may be common for women to have urinary leakage with coughing, sneezing, and jumping or even have to rush to the bathroom to avoid leaks, these are signs that your body is not functioning optimally. Having a delivery that requires instruments like forceps makes you 20 times more likely to have urinary leakage after delivery.
Your pelvic floor muscles control peeing. Your muscles may be weak, tight and unable to contract/relax, or they may not be doing the right thing at the right time causing leakage. You may hear providers or others tell you “to do your Kegels” to make this problem go away.
Kegels are exercises to strengthen the pelvic floor and can help many women. However, if you have any pain in your pelvic region, DON’T PERFORM KEGEL EXERCISES! This can make your pain worse. You may also think you are doing Kegels, but if you are not doing them properly, they will not improve your symptoms. Great news: pelvic floor physical therapist are specially trained to help you learn to perform pelvic floor muscle contractions properly!
Fecal leakage/urgency: Urinary leakage is often joked about, but fecal leakage is often not talked about. Fecal leakage means you are unable to hold in gas or poop when you need to. This happens for the same reason as urinary leakage--the pelvic floor muscles are weak and/or they aren't doing the right thing at the right time. Your pelvic floor muscles need to be able to contract to hold poop and gas in and they need to be able to relax to let you alleviate yourself.
Pain with sex or penetration (like a tampon or to have an exam): Remember, don’t do Kegels if you are having pain. Pain is very common following pregnancy and delivery, but again is not normal! Your body is trying to tell you that something isn’t right. Pain is most often caused by tight and overactive pelvic floor muscles. A pelvic floor physical therapist can help to relax these muscles, and also strengthen them once the pain has been controlled.
Pain can also be caused by perineal tearing. Once cleared by your physician, you can perform scar mobilization to your scar to improve pain and mobility. You may also find that making your own padsicles can help relieve pain.
There are many steps you can take to help decrease pain with sex and increase pleasure. Some prep work prior to having intimacy again can really help after having a baby. Lubricants like coconut oil, can be helpful in decreasing pain with sex. Other items like OhNut can help to reduce pain with sex. (Use the promo code "MYPFM" for a discount!)
Not all sex positions are created equally. Different positions may be more comfortable and avoid causing pain after having a baby. Remember to wait for clearance from your physician before having sex postpartum.
Watch this instagram video from Jeanice with more tips for pain-free sex postpartum.
Prolapse: Pregnancy and delivery puts massive amounts of stress on the pelvic floor. Sometimes this stress can tear muscles, ligaments, and tendons in our pelvic floor. When this happens, we have less support to hold up our pelvic organs. If the organs are heavier than their support system, they can start to fall into the vaginal canal—we call this pelvic organ prolapse (or POP). Prolapse can cause other pelvic issues such as urinary and fecal incontinence.
The bladder, uterus, or rectum can all descend into the vagina. There are different stages, or severity levels, of prolapse. Again, a pelvic floor physical therapist can help to manage symptoms. The stronger the pelvic floor muscles, the most support for those organs.
If you feel heaviness or pressure “down there” you make be experiencing prolapse. Check out our Instagram post to learn how to check for prolapse.
Try lying down with your pelvis above your heart. This allows gravity to pull the pelvic organs back into the proper positioning. This idea is why many women with prolapse have worsening symptoms throughout the day when they have been up on their feet and an improvement in symptoms when they wake up after having been lying down all night.
Painful C-section Scars: Cesarean section scars can often be painful and sensitive to the touch. Scar massage and desensitization techniques can be very beneficial in improving tissue mobility which decreases pain and sensitivity. You can learn how to do scar massage and desensitization techniques in our new postpartum course below.
For any of these postpartum issues, don't just accept them as your new normal. Talk with your providers and let them know your concerns and what you are experiencing. And ladies, if your provider isn't listening to you, find someone who is willing to help. Help is out there!
A few red flags that you may experience in the 4th trimester which warrant contacting your physician immediately are:
Unexplained bleeding or pain
Fever, chills, night sweats
Unexplained weight loss or gain
Confusion or altered mental status
Depression or suicidal thoughts.
So what now? Check out these resources to help with your 4th trimester recovery. Talk with your doctor about any and all concerns you may have and check out these resources:
Ask your healthcare provider for a referral to a pelvic therapist to help to address any pelvic floor symptoms.
Find a pelvic therapist on your own at myPFM.com. We have links to 4 free searchable databases under Find a PT.
Take our self-paced online course “Postpartum Pain with Sex”
Watch our short Instagram video with 9 Tips on Early Postpartum
Check out all of our online educational courses
Visit our YouTube channel for videos about the pelvic floor muslces!
Sign up for our email newsletter!
Check out our Amazon store for products to help your pelvic floor
Visit our Instagram page for more on pelvic health and pregnancy.
What experiences do you have with your 4th trimester and postpartum journey? Please join the conversation in the comments section below.
By Emily Reul, PT, DPT