After delivering a child (vaginally or through Cesarean-section), your body has been through countless changes in a relatively short period of time. During this post-partum period, you may notice that you are leaking urine, difficulty starting the flow of urine, pain throughout the pelvis or hips/back, pain with sex, pain throughout your scar (cesarean-section scar or vaginal scar), or feelings of instability throughout the pelvis. You are not alone! Even though women may talk about these symptoms as their “new normal” after giving birth, they may be delighted to hear – THERE IS HELP, and no one has to live this way. Post-partum can be a beautiful but challenging time. Let us help make it a smoother transition for you!
Symptoms
After two months:
– Urinary/fecal incontinence
– Urinary retention
– Painful sex
– Hip/back pain
– Scar pain
– Instability in pelvis
Causes
Regardless of type of delivery, pregnancy can create a wide number of problems for the pelvic floor muscles. The weight of the baby alone pressing down for 9 months on the pelvic floor is enough stress to cause the muscles to lengthen and weaken. When the pelvic floor muscles need to be recruited again to contract, most times they are too weak and will spasm.
Vaginal delivery can create weakness in the pelvic floor musculature, which can lead to urinary or fecal incontinence, pelvic floor muscle spasms, or even low back pain. Pelvic floor muscle spasms as a result of weak muscles or delivery itself can linger and lead to painful sex or pain throughout the low back and hips. Vaginal delivery may also result in tearing of pelvic floor muscles or an episiotomy (cutting of the muscles to widen the birth canal). The scar can create a lot of discomfort for women and if not taken care of properly with manual scar massage, can lead to numerous issues including painful sex.
Patients who have had a Cesarean section may experience pain and tissue restrictions around the Cesarean scar and may also experience any one of the symptoms above. The weight of the child and its strain on the pelvic floor during pregnancy and possible labor prior to the Cesarean can also stress the pelvic floor musculature.
Diagnosis
Your physical therapist will perform a thorough evaluation to assess your symptoms. Being the evaluation will be internal and external, you and your therapist will work together to ensure your comfort throughout the entire process. Internal assessment will evaluate the nature of any vaginal scarring, muscle tightness/tenderness, spasms, and if appropriate at the time, strength. External assessment will evaluate the Cesarean section scar mobility, surrounding musculature, low back, hips, pelvis alignment, and abdomen. If your therapist feels you may need further examination or testing, she will refer you to an MD.
Treatment
Treatment for post-partum symptoms will depend on how you present. For example, if you present with scar restrictions (whether vaginal or Cesarean section scar), your therapist will work on moving the scar and reducing the rigidity, thereby releasing restrictions to promote a healthier and less painful lifestyle. Internal manual techniques will focus on reducing any muscle spasms through gentle focused pressure. External manual techniques will also be applied to decrease surrounding tissue tightness. Exercises will be progressed as appropriate to restore pain-free function and mobility.