You had a baby (or 2!) last month (or last decade!), and now you just don’t feel right “down there.” Suddenly strange new sensations are occurring between your legs, like a feeling of heaviness, or wetness, constipation (or the dreadful opposite- anal leakage), painful intercourse or uncomfortable sitting, or urinary incontinence. Most of these feelings are pretty normal right after a baby is born, but if they are not resolving or resolved by 4-6 weeks post-partum, something that may need further attention is likely going on.
These strange new sensations have a variety of causes, like pushing for a long time, pubic symphysis injury, perineal tearing or stress from a traumatic birth. During a long pushing stage, there is a lot of downward pressure over an extended period which may stretch or damage the muscles, nerves, pelvic organs or connective tissue. This can result in many of the symptoms we’ve described.
Occasionally, the pubic symphysis, the bony joint in the front of the pelvis gets injured from extreme positioning required to deliver a baby. When this happens, a woman might have pain getting into or out of the car or the bathtub, might feel unstable when walking or have lower abdominal pain that spreads into the inner thighs, especially when standing on one leg, or going up and down stairs. Usually, the treatment for that involves deep abdominal strengthening, complemented by manual therapy to improve alignment.
When forceps or vacuums are required for delivery or the vaginal tissue is unable to stretch enough to accommodate the baby, perineal (the area between the vagina and the anus) tearing may occur. Quite often (especially if the tearing is minor), our amazing bodies have the capacity to heal these without a problem, but sometimes, especially when the tearing is more extensive, there is much we can do to accelerate healing and decrease pain or the risk of anal symptoms. Normal healing time for the perineal tissue is 4-6 weeks, so after that, it is time to begin gentle scar massage on the perineum. If your midwife or OB-Gyn has assured you the tear is healed, don’t be worried if the discomfort is a little sharp- that is a normal sensation when dealing with scar tissue in the perineum . Click on this link to get more information about how to do scar massage on a perineal tear.
The pressure inside the abdomen is high during pregnancy, and even higher during the pushing stage of a delivery. This results in a shift in the position of the bladder, rectum or uterus that is more likely to be worse with more pregnancies. Quite often this shift is minor and women don’t notice any symptoms. When the shift is more severe a woman may notice feelings of wetness, pressure, discomfort (like a tampon that’s been left in the vagina), bubbles with urination or be able to see or feel a new object at the vaginal opening. The treatment for this usually involves being able to contract the pelvic floor with breathing and effort as well as postural changes. Sometimes a women needs to relax the muscles before strengthening them, especially if pain is present.
Finally, when birth is traumatic, the stress, pain and worry can cause guarding in the pelvic floor muscles, just the same way stress can cause guarding in the shoulder muscles and lead to headaches. This muscle tension can cause symptoms like painful intercourse, bladder issues and constipation. The answer to this is learning how to relax the the tension in the pelvis and pelvic floor muscles. Use visualizations like letting your pelvis melt and the energy flowing down your body into the ground.
Help is available for post-partum weirdness between your legs! If these suggestions aren’t helpful, call today for a personal evaluation of your pelvic floor and learn ways to get yourself back in shape and back on track. Visit www.breathedsm.com for more information. Breathe. Physical Therapy & Wellness is located at 2614 Beaver Ave in Des Moines, Iowa.