Postpartum Pelvic Floor Health

Issues with Incontinence, Pain, and Prolapse After Pregnancy

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Dr. Mom Explores how to manage bladder problems and pain follow pregnancy.

Childbirth is an incredible physical accomplishment for the female body! Women work hard to grow, carry and birth their babies and approximately 1 in 4 women experience pelvic floor symptoms because of it. In a vaginal birth, the work of pushing brings the baby down from the uterus, through the vaginal opening in the pelvic floor muscles, and into the world. Crowning is when the muscles and ligaments of the pelvic floor, and the surrounding skin, are stretched to their maximum.

After the baby is born, the pelvic floor muscles have to close back up and resume their normal duties of supporting the pelvic organs from below and controlling urine and stool. This can be difficult if there’s been perineal tearing, or other injury, at the time of birth.

If pelvic floor recovery has gone well, by 6 weeks postpartum, a woman should no longer be experiencing problems related to her pelvic floor and should be able to slowly resume sexual intercourse and gradually begin to exercise again. The following are signals from the body that pelvic floor recovery is not complete:

Bladder Control Problems After Pregnancy

The involuntary loss of urine is the most common pelvic floor problem for women after childbirth. There are two main types called stress and urge. Stress incontinence is when urine leaks out when the bladder is under pressure, such as during a cough or a sneeze. Commonly, women who return to high impact exercises before their bodies are ready, will experience stress incontinence during running or jumping.

Urge incontinence is when urine leaks out on the way to the bathroom. It is often associated with ‘urinary frequency’, which is going to the bathroom more than every 2-3 hours (or 6-8 times during the day).

Other bladder signs include having to sit on the toilet and wait for urine to come, standing up and having more urine dribble out, or the sensation that the bladder hasn’t fully emptied after urinating.

Bowel Control Problems After Pregnancy

Being unable to control gas or stool could be a flag that the pelvic floor is not working properly. Other bowel signs that the pelvic floor is not working optimally include chronic constipation, a feeling of heaviness in the rectum, and the sensation that the bowels aren’t fully empty after a bowel movement.

Pelvic Organ Prolapse After Pregnancy

Sometimes after pregnancy and childbirth, the pelvic floor has a difficult time supporting a woman’s pelvic organs from below. When this happens, women can experience a sensation of vaginal heaviness, especially when standing for long periods, or carrying heavy loads. Some women describe this sensation as if there is a tampon in, when there isn’t.

Other signs that a woman may have prolapse are if she notices a bulge vaginally in the bathroom when wiping, is unable to keep a tampon in, or finds intercourse unpleasant due to something being in the way.

Pain after pregnancy

 

Back Pain

The pelvic floor is one of a woman’s “core” muscles, so if pain persists for more than a few weeks after birth, it could mean that the abdominals and pelvic floor are not supporting her as well as they could be. One study found that in a group of women with chronic low back pain, 96% also had pelvic floor dysfunction!

C-section Scar Pain

In the case of a Caesarean birth, the incision should be healed by the 6 week mark. If a woman is still experiencing pain, pulling, or sensitivity to touch after that, the scar tissue and surrounding structures may need some attention.

Sexual Pain After Pregnancy

It is never normal for sexual intercourse to be painful for a woman. The pelvic floor muscles surround the vagina from its opening all the way up to the cervix. If those muscles aren’t able to relax enough to allow for intercourse, a woman may experience pain externally, internally, or both.

How Does the Pelvic Floor Change with Age

Contrary to popular belief, leaking urine is not a normal part of aging. None of the symptoms listed above are. A very common pattern is that after pregnancy and childbirth, women begin to experience minor pelvic floor symptoms that rapidly worsen once they become perimenopausal. For this reason, all women with pelvic floor symptoms should address them while they’re young so that the issues don’t advance to the point of needing surgical treatment later on.

Kegels To Help Strengthen Your Pelvic Floor

A Kegel is a pelvic floor muscle contraction. To correctly contract these muscles, try the following cues:

  • Imagine you are stopping the flow of urine mid-stream
  • Imagine you are stopping gas from coming out
  • Imagine you are picking up a small object with your vagina and pulling it up

If connecting to the pelvic floor is easy for you, then try these types of contractions daily:

  • Contract maximally and hold for 10 seconds, relax fully, repeat 5 times
  • Contract as fast as you can and fully relax as fast as you can, repeat 10 times

Research has shown that up to 50% of women are not able to connect with the pelvic floor muscles properly. If that is the case, or if you’ve been doing these exercises for several weeks and your symptoms are not improving, consider seeing a Pelvic Physiotherapist to figure out why. In the same way that someone with knee pain would see a Physiotherapist to regain full movement, strength and function, a woman experiencing pelvic floor dysfunction should see a Pelvic Physiotherapist to treat symptoms and regain function.

 

 

Learn More from Dr. Mom

The effect of pregnancy on the pelvic floor
Sexually Transmitted Infections
What to Expect From your Prenatal Visits
Folic Acid During Pregnancy, Do I really need it?
What are the most effective types of discipline?

 

This post was authored by Jillian Palmer is a Pelvic Physiotherapist and a Mom of four wonderful children. She is passionate about improving the quality of care for women in pregnancy and postpartum. Her Pelvic Physiotherapy practice in Edmonton, Alberta, serves women throughout the lifespan struggling with pelvic dysfunction. You can find her @yeg_pelvicphysio and @pine_health_yeg

 

 

References:

 

Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and Trends of Symptomatic Pelvic Floor Disorders in U.S. Women. Obstet Gynecol. 2014 Jan; 123(1):141-8.

Dufour S, Vandyken C, Vandyken B. Mechanical Low Back Pain: An Orthopaedic Problem, a Urogynecological Problem, or Both?

 

 

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