What You May Not Expect After Expecting

By Melissa Nassaney, MS, PT, DPT, Women’s Health & Pelvic Health Clinical Specialist

Having a baby, for many expectant women, begins with the maternal journey of self-discovery centered around various changes that are happening to their body while it accommodates the physical demands of growing a tiny human. Often moms-to-be find more enjoyment in tracking their baby’s changes as they grow from a raspberry to a watermelon throughout the 42 weeks of gestation. Eventually, the focus tends to shift towards the preparation for birth and the arrival of the little one. Life after pregnancy and delivery may present its own unique set of changes and challenges. With shifts in hormones, crazy sleep cycles and postpartum fatigue, it’s no wonder that a woman could become a little skeptical about the changing relationship between her and her body.

In the first 6 weeks after delivery, a variety of unfamiliar symptoms may be experienced while recovering from the birth. Common and treatable conditions such as back pain and pelvic girdle pain can present during and/or after pregnancy, however pelvic floor issues can arise. This can be an extra nuisance and unwanted surprise. For some of us, it is during pregnancy that we may experience our first problem with urinary control, whether it’s with a frequent urge to urinate or accidental leakage (incontinence). This may also be the first time we learn about or start to do ‘Kegel’ exercises (pelvic floor muscle exercises) to manage these symptoms. The 2 most common conditions a mom can experience early on are incontinence and pelvic organ prolapse. These conditions are often due to muscle injury or strain, temporary nerve injury from the pregnancy or delivery, or perineal laceration from childbirth.

Incontinence is accidental leakage of urine or stool that may occur with coughing, sneezing or exercise or may be associated with a strong urge to “go” or going to the bathroom frequently. Urinary and fecal urgency is very common right after delivery. Urinating “just in case “or going with the first sensation of urge may lead to symptoms that feel like an overactive bladder and ultimately interrupt your normal daily activities or even sleep. More than 89% of women experience some form of incontinence after childbirth. This includes both cesarean and vaginal births.

Pelvic organ prolapse (POP) is a drop or descent of pelvic organs into the vaginal canal or out of the vaginal opening. It could be one or more structures such as the uterus/cervix, the bladder, urethra and the vagina itself or the rectum. POP can be asymptomatic for many however some women will first notice a bulge in the vagina or perineum or feel a heaviness or pulling in the lower abdomen, low back or perineum. Symptoms may feel worse after exercising, lifting or straining to have a bowel movement.

Pelvic floor issues are very treatable and can be done so conservatively. To prevent these during pregnancy, it can be helpful to perform pelvic floor muscle exercises several times a week. Maintaining a healthy weight during pregnancy and avoiding prolonged sitting and straining during bowel movements also help. Kegels are exercises will strengthen your muscles and in turn may help to reduce incontinence, restore control and improve the support to your pelvic organs. Kegels are typically safe to do in most situations except if you are experiencing pelvic pain including vaginal or rectal pain, abdominal pain or back pain, all of which would necessitate further medical evaluation from your obstetric provider. Both during pregnancy and postpartum, efforts should be made to avoid constipation and stool straining in order to minimize additional stresses on the pelvic floor muscles and pelvic organs.

It has been well established in medical literature, that pregnancy and childbirth are associated with decreased pelvic floor muscle strength and endurance. Other risk factors that can contribute to incontinence and prolapse are forceps assisted delivery, trauma to the pelvic floor muscles and obesity. Regardless of whether your birth experience occurred vaginally or by cesarean, after delivery, your pelvic floor muscle strength and function may continue to be impaired for a short time and for some, pelvic floor issues may persist months or even years after the birth of your baby. If you notice changes in your bladder or bowel control, or experience symptoms of prolapse be sure to tell your doctor, especially if it has been > 3 months after delivery with little to no improvement with typical Kegels. However, mild to moderate prolapses may take 3-6 months to resolve. Ultimately, it is best to get checked out sooner rather than later.

For most women, pelvic floor muscle strength should return within 2 months after delivery. While it may be common for women to experience incontinence or prolapse symptoms early post-partum, it is not normal for it to persist longer than the 4th trimester. Committing now to supporting your pelvic floor during pregnancy and after birth can optimize your recovery over the next several months but more importantly, impact your future pelvic health. Ideally, you should be able to look forward to the obvious; sleeping on your belly, seeing your toes again, and not peeing your pants…

If you would like an evaluation and assistance strengthening your pelvic floor, during or after your pregnancy, please contact me at Performance Physical Therapy.