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Pelvic Floor Physiotherapy after pregnancy

Should I see a Pelvic Floor Physio? When should I see a Pelvic Floor Physio? No one has suggested I should see a Physio….

If you have recently had a baby, you will have had either what we call a “Normal Vaginal Delivery” or an “Elective Caesarean” ( you chose to have a Caesarean) or an “Emergency Caesarean “(where a vaginal delivery proved too complicated and a Caesarean delivery had to go ahead).

Let’s think about all of these deliveries:

“Normal Vaginal Delivery”

A normal vaginal delivery is the delivery that follows an expected series of contractions over first stage of labour, that become established over a period of time. This time frame is longer for some and shorter for others. The contractions become closer and closer together as the cervix dilates and we reach the ultimate goal of “10 cms dilated”. At 10 cms dilated we move to second stage of labour, the “pushing phase” of labour when hopefully, our body starts spontaneously producing muscle contractions that push the baby out into the world. Finally the placenta is delivered. It sounds so simple, but for any woman who has had a “normal vaginal delivery”, it is not always so simple. There are as many versions of that delivery as there are babies born; no two labours are the same.

It is therefore perfectly understandable, for any women who has had a “normal vaginal delivery” to feel the need for individual guidance regarding pelvic floor exercise and recovery of abdominal muscles. A quick talk or leaflet at the hospital will not answer your own individual questions related to your unique delivery. These are the realities:

  • Any normal vaginal delivery puts a stress on the pelvic floor.  
  • Your pelvic floor muscles will be weaker after a delivery
  • Your deep abdominal muscle known as “Transversus Abdominis” may well be weakened by the pregnancy and delivery.
  • Abdominal muscle separation  (separation of “Rectus Abdominis” ) is normal but some need guidance with rehab. (see separate blog on Abdominal Separation)
  • Your Pelvic floor and abdominal muscles may not be co-ordinating together like they did before pregnancy leaving you vulnerable to low back pain and other issues.

If you have had a “normal vaginal delivery”, it is understandable that you might come in for a one off visit to learn basic pelvic floor and abdominal exercises targeted to you and your needs. Sometimes more follow up is needed. We know that many women think they are doing the right thing but might not quite be getting things right. So after your 6 week check, make an appointment or ask to chat to the Physiotherapist. We usually avoid internal vaginal examinations until after the magic 6 week mark when internal stitching and soft tissue injury will have healed and all other bleeding stopped. If you are very worried about something to do with your pelvic floor in the first 6 weeks, we can do modified examinations without actually examining internally in order to put your mind at rest and get you on track. Remember we have real time ultrasound to show you muscles from the outside so that you can learn correct exercise for you, individually.

What about more complicated “normal vaginal delivery” ?

This is the category that includes, 

  • forceps or vacuum assisted delivery, 
  • long second phase (pushing phase) of labour longer that 1 and a half hours.
  • 3rd or 4th degree tear (these are tears that go through to the anal sphincters)
  • Large baby ie baby 4kgs or more at birth. 

These deliveries have consistently been shown to cause more cases of pelvic organ prolapse.  (See separate blog with details about pelvic organ prolapse). Vacuum or forceps assisted births, prolonged second stage of labour and large babies  (4kgs plus) have also been linked to “obstetric anal sphincter injury” according to the Royal Australasian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).  These anal sphincter and prolapse injuries may not be obvious until later in life.  An obstetric anal sphincter injury is unfortunately associated with cases of inability to control wind and faecal incontinence.  So it is vital that you gain good information about YOUR pelvic floor to set you up for the future.  

 

If you have had a more complicated delivery and indeed any delivery, here is some advice for the early weeks post-delivery:

  • Let your family around you know that you need to rehabilitate your pelvic floor..like a sports injury!
  • Your pelvic floor needs feet up rest in the day;
  • When baby sleeps you sleep or at least put your feet up and rest.
  • For toddlers, when the new baby sleeps in the afternoon, encourage rest time or down time activities so everyone can rest. 
  • Partners need to be understanding on return home…no dinner prepared, no house tidied…..

Caesarean deliveries

If you have had a caesarean delivery, you still need to do pelvic floor exercises. Pelvic floor is weakened through the pregnancy and will need rehab. You will also have sustained separation of the abdominal muscles and may want guidance with exercise to regain abdominal strength. A Caesarean is, after all, a form of abdominal surgery so it is understandable that some women feel very weak as though they have lost all abdominal control. It is understandable that women will need to know how to exercise and how to get back to broader exercise safely.

General advice for all women regardless of type of delivery

It is normal for all women to want an overview of their pelvic floor, abdominal muscles and guidance with return to safe general exercise. We see a lot of Women who just want to know they are doing the right thing. They feel good, they feel fine, the delivery went well: they just need some guidance with rehab.

Some women have had pelvic pain in pregnancy and 5% of those women will have ongoing pain after the delivery. We encourage you to come and have an assessment if you have ongoing pelvic pain after delivery or any new areas:

  • sacro-iliac joint pain
  • coccyx  pain (see separate blog about coccyx pain)
  • pubic bone pain at the front of the pelvis and pain going into inner thighs 
  • deep gluteal/buttock region pain
  • hip pain
  • low back pain

Last but very much not least: return to sex

We also want to see women who are experiencing painful intercourse. Sex may be painful after a delivery for MANY reasons and this probably requires a blog of its own. Tight pelvic floor muscles may develop secondary to a sore episiotomy for example becoming more sore and leading to secondary tight muscles perhaps. Even women who have had caesareans can feel guarded and not so relaxed on return to sex. Just these 2 factors can lead to tight pelvic floor which goes on to cause pelvic pain. Watch this space for more information regarding why sex can difficult after a delivery and what you can do about it.

Finally

Probably all women who have a baby should have an individual assessment or their pelvic floor, abdominals and ability to return to general exercise. It would be wonderful if all women could have help if needed for any sexual health issue that might arise.
But this is unfortunately not routine in this country. Most women have to seek help when they need it. If you need help, come and find us. Contact us through the contact page or make contact at any of our locations. We look forward to meeting you and your baby!

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You may contact Caroline Bender or make and appointment with Caroline at either location. with Cee at Frankston The Sports Injury Clinic with Candice at Dromana Pinnacle (Thursdays)