A guest blog from Gemma Richardson
When you’ve just had a baby, it can be an overwhelming time. This bundle of joy has just been presented to you, which you must now look after, and on top of that your pelvic region and specifically pelvic floor may feel like it’s been dragged over a holly bush!
So, what’s going on with your pelvic floor? First, let’s talk about what the pelvic floor is.
The pelvic floor is a hammock of muscles that go from the front of your pelvis to the back. This hammock supports the pelvic organs (bladder, bowel and uterus). Within the pelvic floor are holes (sphincters) which connect to the bladder and bowel. The pelvic floor wraps around these holes. When working correctly it close these holes to prevent leaking of urine, passing of wind or faeces; during times of impact, i.e. lifting, coughing, sneezing, running etc.
The postnatal pelvic floor
After childbirth there is damage to the pelvic floor. This is caused by 2 factors: birth, particularly if you needed stitches or instruments to deliver the baby; but also, the fact that the pelvic floor had 9 months of increasing weight going through it. Therefore, if you had a caesarean section you are not immune from pelvic floor problems. You may have also noticed symptoms of pelvic floor weakness during pregnancy, such as leaking urine when you coughed or laughed.
During the first few weeks after a vaginal delivery there will likely be a lot of swelling and discomfort around the pelvic area. Treat it as you would any other area in your body that had sustained an injury. For swelling, ice packs wrapped in a damp towel over the area, for 10 minutes at a time, every 2 hours can help alleviate some symptoms. If there is discomfort whilst sitting, then you can get a “doughnut” cushion which will help relieve the pressure. Take painkillers if you need them. Finally, the key thing to do is rest! Your pelvic floor has been damaged and it’s important that it’s treated kindly.
Pelvic floor exercises
As soon as you can, start doing pelvic floor exercises, this is where you are activating that hammock of muscles. A simple way to do this is to imagine you are trying to stop yourself from passing wind and holding for a few seconds, without holding your breath. A good time to do these initially is when you are feeding the baby, this way you’ll definitely do a few each day. I could write a whole article on pelvic floor exercises and their importance, but in this early period please just try and do them, even if you’re not having any symptoms. For specific guidance on pelvic floor exercises, it is recommended that post-natal women see a specialist Women’s Health physiotherapist.
After delivery there will be increased laxity in the pelvic floor, this means it’s very stretchy. A bit like an elastic band that’s been overstretched. This is partly due to the birth, but also due to the hormonal changes during pregnancy, therefore, not strictly limited to vaginal deliveries. What this means is that in the 4th trimester, in addition to the fact that the pelvic floor has being damaged; meaning the muscles are likely not going to be working well enough to close the holes connecting to the bladder and bowel; the muscles have been over stretched and sometimes they are not able to fully support the pelvic organs. Therefore, because there is less support, you are at risk of the pelvic organs descending, leading to a prolapse. I’m not trying to scare you, it’s just important to be aware of what you’re doing!
What problems might you encounter
Day to day this means that you need to be careful with things that will put an increased load on the pelvic floor, such as lifting, e.g. the car seat, shopping etc; or importantly, returning to exercise earlier than you are ready to. During this time the most important exercises you need to be doing are pelvic floor ones!
Even if you feel fine in yourself and are desperate to get back to exercise, high impact exercise such as running, is not recommended for the first 3-6 months. And even at that stage, that’s assuming you are symptom free.
Another thing to consider is emptying your bowels. During pregnancy it is common to have constipation, again due to the changes in hormones. Post-natal women often avoid emptying their bowels due to pain and the change to their routine. To protect your pelvic floor, it is really important to avoid straining to empty your bowels. Drink plenty of fluids and invest in a small stool to rest your feet on, so your knees are higher than your hips. This puts the bowel in a better position to empty. Take your time and focus on breathing. For more tips you can find some good resources on bowel emptying on YouTube, or contact a Women’s Health physiotherapist.
Symptoms to be aware of
Symptoms to watch out for at whatever stage you are post-natally are:
- signs of pelvic floor weakness, such as leaking urine, passing wind or faeces
- prolapse symptoms such as heaviness or dragging in the pelvic area or a bulge underneath
- pelvic, hip or back pain
When you return to exercise if any of these above symptoms start, you need to stop or reduce intensity and seek guidance from a specialist Women’s Health Physiotherapist. This is to prevent doing yourself more damage. Taking a few more weeks to recover properly early on, could mean a lifetime symptom-free. It is not normal to wet yourself!
It’s vital to appreciate what the body has been through over the last 9 months. Unfortunately, it does not just bounce back despite what you may see on Instagram or on TV! As a final thought let your body recover, get started on pelvic floor exercises as soon as you can and if you have any concerns see a Women’s Health physiotherapist who can help manage and prevent any problems.
About the author
Gemma Richardson is a specialist Women’s Health Physiotherapist, based in the Midlands. She has years of experience treating ladies during pregnancy and post-natally. She also treats ladies across the UK online, with her programme called Pelvic Floor Restore, which is for those experiencing or wanting to prevent pelvic floor weakness. To learn more about this you can access her free online masterclass and join her free Facebook group.