One of my go-to sayings is that my body didn’t look like Jessica Alba’s BEFORE I had children and it certainly doesn’t look like it after! Forget appearances and the pressure to look rail thin after popping out a “watermelon” though, because, after putting your body through heck and back with child birth, there’s a whole slew of potential issues. In fact, if you have noticed some VERY different changes going on, welcome to the club! Breezy Mama turned to Cindy Furey, owner of Comprehensive Therapy Services, Inc., a full service physical therapy clinic specializing in Women’s Health and Pelvic Floor Dysfunction, to find out when certain issues such as Stress Urinary Incontinence, Dysparuenia (pain with intercourse), Diastasis Rectusmean, Pelvic Organ Prolapse and more are NOT OKAY and mean it’s time to talk with your doctor and why.
Our bodies go through tremendous changes not only during pregnancy, but also in the post partum year. Yes, year! Your body may take at least a year or longer to recover and get back to being your body. During that time you may notice a few unpleasant things about your body that didn’t happen before you were pregnant or after your first child, but now everything has changed. You have plenty of options to resolve these unpleasantries, but you need to consult your obstetrician, ask a lot of questions, be realistic with yourself, make a few lifestyle changes and find a physical therapist that specializes in pelvic dysfunction and post partum recovery.
This is just a short list of issues that arise postpartum that need to be addressed.
1. Stress Urinary Incontinence (SUI) is common but not normal (20-67% of women during pregnancy). If your labor traumatized your pelvic floor muscles or perineum, yes, it is common to have some urinary leakage post partum. However, this should resolve by 6-8 weeks, which is considered physiological healing time for any tissue in our body. You should stay continent and have full bladder control when you laugh, cough, sneeze, lift and by all means, when you return to exercise.
If you are unable to stay dry with any of these activities, it is time to start your Kegels. You know, those exercise you do by contracting your vaginal muscles up and in. Your goal is to hold the pelvic floor muscles lift, up and in for 10 seconds, without holding your breath or contracting other muscles, and performing 10 repetitions, 3 X per day. If you can’t “find” these muscles, can’t hold 10 seconds, or continue to leak, discuss the issue with your obstetrician who can help you find a PT to evaluate and treat your condition. Studies show that 30% of women cannot contract the pelvic floor muscles and another 25% strain versus squeeze and lift. These are muscles, just like any other muscles, and we have lots of tricks to help you rehabilitate them. Besides Pelvic Floor Muscle exercises, aka Kegels, there is biofeedback, neuromuscular re-education and other core strengthening we can do in physical therapy.
2. Dysparuenia, otherwise known as pain with intercourse, is again, common but not normal. Any trauma to the pelvic floor muscles during labor and delivery can lead to post partum pain. By trauma we mean prolonged labor, quick labor, tearing, episiotomies, and instrumentation assistance, just to name a few. By 6-8 weeks post partum, the tissue should be healed. Now being “healed” and being “pain free” are two different things. Depending on the degree of tearing or trauma, pain free should come by 8-12 weeks. Pelvic PT expedites healing by decreasing muscle guarding, promoting proper coordination of these muscles, improving circulation, instruction in strengthening and conditioning exercises and offering other positional options. And believe me, there are lots of options out there.
When you are ready to get back to sex, be prepared with a great lubricant and lots of foreplay. Vaginal dryness is actually the number one cause of dysparuenia. During the post partum period, our estrogen levels are typically at an all time low. Our vaginal tissue is estrogen receptive, so without that estrogen the tissue atrophies, or thins, and becomes dry. Dryness equates to pain. Our preference is a glycerin free lubricant like “Slippery Stuff”, a silicone based lubricant like “Pink”, or a natural oil like Pomegranate Seed Oil. I would also stay away from latex condoms as latex is drying as well. Sex should always be pleasurable and pain free. If it isn’t ask for help before it turns into a bigger problem emotionally, mentally and physically.
Pelvic pain is the number one diagnosis that we treat at our clinic. It always makes us a little sad when patients discuss their case with us and we find out that the pain started with child birth which was 15-20 years ago! Please address any ongoing pelvic pain issues with your doctor as soon as you can.
3. Diastasis Rectus (DR) is a split or softening in the abdominal wall. You may have noticed a bulge along the midline of your “bump” during pregnancy or a big soft spot in or around your belly button post partum. Both of these are indications of DR. Although not at all painful, it can lead to bigger problems in the long run like chronic back pain or a full herniation of the abdominal wall. According to Boissonault (1988), 53% of women have DR post partum.
You can test yourself to see if you have DR. First, lie on your back with your knees bent. Place one-two fingers width wise in your belly button. Raise your head and see if your fingers take up the space between the walls of your Rectus Abdominus, the muscles that give you that “6-pack” look. If you need to add a third or fourth finger to take up the space or feel your fingers fall further into a soft spot, you have DR. One or two fingers is considered a normal gap. You can also test above and below the belly button as DR can occur anywhere from the xyphoid process to your pubic bone.
Physical therapists have a bunch of tricks to mend the wall back together. Altering and improving body mechanics is paramount in recovery. We can also use Kinesiotape to facilitate closure along with the proper core exercises. If needed, you can be fitted with an abdominal binder, such as the Better Binder. A word of CAUTION: do not start any abdominal strengthening program without getting checked for DR. Doing improper exercises, breath holding or continued bulging of the abdominal wall can make DR much worse. Get checked today by a PT!
4. Pelvic Organ Prolapse (POP) is usually described as the feeling that “something is falling out” of the vaginal canal. You may feel bulging, pressure or heaviness in the perineum or vagina that progressively worsens through the day especially if you are on your feet, after bowel movements or with lifting. With prolonged labor any of the pelvic organs can be pushed out while pushing that baby out into the world. Pelvic organs include your bladder, uterus, rectum and small intestines or a combination of any of them. If you suspect POP, discuss it with your OB/GYN right away. Up to 50% of women have POP. By 6-8 weeks, the symptoms should subside. In some cases the supporting ligaments and connective tissue are overstretched and/or the pelvic floor muscles too weak to support the organs in their proper position. Pelvic PT’s treat POP conservatively with repositioning exercises, instruction in proper body mechanics, diet, and toileting techniques, strengthening exercises including the proper Kegel, and possibly refer you back to your doctor for a pessary fitting. If left untreated POP, can lead to pelvic pain, disrupted organ function, hysterectomy or pelvic reconstructive surgery.
5. Other Joint Aches and Pains that come with the Mom Territory. Let’s face it, our child bearing and child rearing can take a toll on our bodies. Being tired and worn out is one thing and common among all mothers, but pain is another thing. Pain needs to be addressed before it becomes something worse. Back pain (20% of pregnant and post partum women) may result from the strain of labor, sacroiliac joint misalignment, excessive strain from lack of support of the abdominal wall (DR) and pelvic floor (POP), or herniated discs. We typically see neck and upper extremity pain from nerve compressions, like carpal tunnel, and tendonitis, like De Quervain’s Syndrome, related to faulty posture and body mechanics while breast feeding and caring for our babies. Lower extremity pain syndromes like hip trochanteric bursitis, knee tendonitis, or plantar fasciitis are also common due to joint laxity, poor proprioception, residual weight gain, and muscle weakness. All of these aches and pains can be resolved and rehabilitated with PT designed to correct faulty mechanics, decompress nerves, stabilize joints, decrease inflammation, and strengthen muscles.
If you have any of these issues remember they are common but not normal. They might be embarrassing or awkward to discuss, but all of them are treatable. By the way, there are also plenty of other issues that can come up. Address those too! Please discuss them with your physician and seek out help from your local women’s health PT. To find a physical therapist in your area go to http://www.womenshealthapta.org/find-a-physical-therapist/index.cfm or ttp://hermanwallace.com/practitioner-directory or email me at firstname.lastname@example.org.