Every year millions of individuals birth babies, and every year millions of individuals plan and prepare for baby’s arrival! There is a whole industry dedicated to all the “things” parents “need” for baby. From feeding, to engaging, to clothing, to diapering, parents prepare for the arrival of baby. However, the planning and preparing for baby includes much more than things for baby which is often overlooked. Birthing individuals receive one postpartum check in with their doctor and are often sent on their way leaving these individuals to think that leakage, painful sex, and other challenges you may be experiencing “down there” after pregnancy and birth are normal.
Good news, because I sat down this week on the You, The Mother Podcast with Dr. Sara Reardon to chat about what is and isn’t normal about our “down there” after pregnancy and birthing. Sarah is a Doctor of Physical Therapy, a board-certified women’s health and pelvic floor therapist and mom of two. Sarah talks with us about how pregnancy and childbirth affect our pelvic floor muscles, different challenges we might encounter as a result, and some things we can do to improve these postpartum challenges. Sarah is saving the world one vagina at a time over on her Instagram page @the.vagina.whisperer, or you can head over to her website, thevaginawhisperer.com, where she has blogs, resources, a membership, community free guides.
Does Pregnancy and Childbirth Effect Our Down There?
It’s helpful to start during pregnancy because that’s really when our bodies start to change so drastically. It’s important to understand how much of a huge transformation our bodies go through, and it’s also beneficial to be proactive about this transformation. Going to a pelvic floor physical therapy, either during pregnancy and definitely after, is helpful because these changes can happen to everyone.
Your pelvic floor, which is like a basket of muscles that sit at the bottom of your pelvis, those muscles have the openings that help urine exit, help poop exit, and where babies are born for vaginal birth. They also help support your pelvic organs. During pregnancy, this pelvic floor hammock of muscles supports a growing fetus. You can imagine over the course of pregnancy as the fetus gets bigger and bigger, that muscle stretches and lengthens and tends to just get a little bit weaker naturally. Therefore, you often may experience some leakage during coughing or sneezing or throwing up during pregnancy because pregnancy itself changes the pelvic floor.
Regardless of whether you have a vaginal cis in birth, if you’ve been pregnant at any stage, you’ve had changes down there. Changes also happen then during childbirth. If you have a cesarean birth, you have a major abdominal surgery through your abdominal wall, which can result in scar tissue, abdominal muscle weakness, and then pelvic fluoride. You can have weakness from pushing for a long time or from a perineal tear, which is common in most vaginal births. So again, in childbirth we see another area where changes happen.
Pregnancy and/or Childbirth Created Some Changes Down There, Now What?
Once we get to postpartum, it’s like your body’s been through months of pregnancy, then the sprint of childbirth, and then we just go home with a thumbs up and a baby, and they’re lik everything looks good. It should be encouraged all postpartum individuals to go see a pelvic floor therapist. Pelvic floor therapists typically start seeing people around four to six weeks postpartum, and it’s not dissimilar to your postpartum checkup with the midwife or OB where they look at your abdominal wall for separation, for scar tissue around your scar or restriction. They will do a pelvic floor assessment to check for strength, for weakness, for prolapse, for scar tissue, and give you a roadmap, stretches or exercises you need to be doing so you know what to do if sex is painful, what to do if you’re leaking, if you have hemorrhoids or constipation, and work with you every week, every other week, or even sometimes just one or two sessions to help your body recover after a pretty major transformation.
Changes that can happen:
1. Leakage:
There’s a large percentage of people who experience it during pregnancy and postpartum. The research shows, if you experience urinary leakage or what is called incontinence during pregnancy, you have a higher chance of having it postpartum. Meaning if you are leaking at three months postpartum, you have a high chance of still leaking at 12 months postpartum. This is an important indicator to note so that if you’re leaking during pregnancy, you don’t have to wait to go see a pelvic floor therapist until afterwards. You can go ahead and learn what changes you can make. You can start strengthening your pelvic floor and be on kind of the proactive side so that once you are postpartum you know what to do. If at 6 weeks or 12 weeks postpartum you’re leaking, go ahead and start seeing a pelvic floor therapist again, because if you just think you’re going to wait it out, it may not get better. And sometimes it gets worse if you’re breastfeeding or if you have another pregnancy thereafter, or multiple pregnancies in birth. It’s like if we had an ankle sprain, you wouldn’t just keep walking on it and hope that it gets better. You’d probably see a physical therapist to help you rehab and strengthen and get back to doing the things you want to do without pain.
Hormones play a role in leakage as well. As women are aging and you have changes in estrogen and progesterone, they all can affect how plump and strong your pelvic floor muscles are, or your pelvic core tissues are. And those changes can also lead to incontinence as you get older or with aging. Which is another great reason to kind of be proactive and strengthen the pelvic floor even with aging instead of waiting for things to happen and then feel like it’s too late.
2. Painful Intercourse:
There are so many barriers to wanting to have sex postpartum. From childcare to sleep deprivation to resentment with your partner, we do not need another reason for not wanting to have sex with our partner. If you have been sold the idea that intercourse is painful postpartum and that it’s normal and just something we must deal with, that is untrue. Research shows that 9 out of 10 people have pain with sex the first time they have sex after giving birth, but there are some things you can do to help and if those things don’t help, check in with a pelvic for therapist. The first thing you can do is use a lubricant. Use a water-soluble lubricant that is not irritating, that doesn’t tingle or sparkle or glitter. It should just be like a boring old lube. This not to say that you are not wet enough for your partner, but you typically have vaginal dryness after birth if you’re breastfeeding or lactating because your estrogen levels are lower and that causes vaginal dryness.
You may have some scar tissue or scar restriction from your cesarean scar or your perineal tear. Either of those could cause pain with intercourse. Doing a little work to soften your scar, working with the pelvic PT to soften your scar can help tense pelvic floor muscles. Stress and tension can also create pain. The pelvic floor muscles where you hold your tension by clenching your glutes, if you had a birth injury that causes tension down there, or that’s just where you hold tension is in your hips and pelvis, doing some stretches, working with a therapist to do internal massage to those muscles can all help take away tension. That can help minimize pain with sex.
There are many reasons postpartum mothers may not be up for intercourse after that six week, all good from your doctor, and if that is you, you are not alone! But don’t let painful sex be a reason for not having sex! Check in with a pelvic floor physical therapist.
3. Prolapse:
Prolapse is when that hammock of muscles that we talked about earlier is not supporting your pelvic organs as well. It could be your bladder, your uterus, or your rectum. That hammock is just a little bit weaker than we would want, and it tends to feel like something’s falling out of your vagina. It can feel like there’s a bulge at the vaginal opening or that you have to strain to empty your bladder or strain to poop. These organs aren’t in the ideal position anymore because that hammock is a little bit weaker. Some things you can do to improve this is stop straining. This is common with a lot of moms as they push when they pee, or they do what I call “power peeing.” When you pee, you should just be sitting, relaxing, taking some breaths, and your bladder really does the work to push the urine out. But oftentimes as moms, we’re in such a hurry that we push when we pee to get it over with as quick as possible, but then that causes our muscles to be even weaker, which could lead to prolapse. The same thing with constipation. If you have a hard time emptying your bowels, if you strain during bowel movements, that chronic straining or pushing could also lead to prolapse, which can weaken your muscles over time. When people go back to exercise, running, or weightlifting too soon after birthing their muscles aren’t as strong as we need them to be, to carry that load which ends up in prolapse as well. It is important to stop straining and making sure that you get on a pelvic for strengthening regimen.
Sometimes people need external support. That could be like a little a support garment, some people even use spanks. That could also be internal support like a device called a pessary. There are definitely things you can use to help as you’re doing your strengthening regimen.
There’s research to show that prolapse can improve one grade. Prolapse is graded on a scale of zero to four with zero being no prolapse. Most people have around a grade one where there’s a little bit of weakness there, but it doesn’t necessarily mean that like something’s falling out. Grade two is where the prolapse is almost to the vaginal opening when you bear down, and grade three or four is where the organs are completely out of the vaginal opening. With grade three or four it’s recommended that you have surgery. Patients still see a pelvic floor PT for therapy before and after surgery. Grades one and two, you can improve your prolapse an entire grade of strength by strengthening with therapy.
The biggest thing is you can prevent prolapse from getting worse. You change your habits and keep up with the maintenance that you have to do to keep your muscle strong. Make sure that you go talk to your pelvic floor therapist on how to properly do your Kegels.
4. Diastasis Recti:
Diastasis Recti is an abdominal separation at the midline of the belly. During pregnancy, this can look like a little football in the middle of your belly when you’re getting off the couch or getting out of bed and then postpartum, it can look that way as well. It feels like you can put your fingers down towards your guts, like right around your belly button. That separation is common during pregnancy because your abs are expanding and your body’s trying to make room for baby. But what happens is it doesn’t necessarily resolve on its own postpartum.
This requires working with moms to do a lot of core strengthening, managing their pressures by not straining with lifting or pooping or peeing, and really giving them guidance on kind of how to strengthen their abs without overdoing it, and really to help them make the diastasis better.
One important thing to note, be sure to check in with a pelvic floor physical therapist or go check out Dr. Sara’s courses and guides to make sure you are doing your Kegels correctly! Strengthening our down there is important, but it is important we are doing it correctly! Go check out Dr. Sara Reardon on her Instagram and be sure to check out her website for courses, free resources, and her membership community!
Supporting You, The Mother,
Abbey Williams, MSW, LSW
