How can Physio help me after having a baby?
As you may be aware, being pregnant and giving birth can cause quite a strain on your body. Not only does your pelvic floor weaken from carrying the weight of a baby and from birthing naturally but your body also undergoes many changes during pregnancy, which can cause pain and dysfunction! Ligaments soften around your back and pelvis, which can predispose you to pain and instability; enlarged breasts can round the shoulders; stomach muscles separate and weaken; and this is just to name a few problems that can occur!
But first of all, let’s talk about the pelvic floor. What is it?
The pelvic floor is a group of muscles that sits between your legs. Men and women both have them. In women, they run from the pubic bone to the tailbone. They support the rectum, uterus and bladder in place and help close the front and back passage to keep you dry.
So when they become weak from pregnancy and natural birth, you can get problems like:
• Leaking with coughing, sneezing, lifting, bending, exercise (this is called stress incontinence)
• Desperate urges to rush to the toilet to wee (this is called urgency)
• Problems making it to the toilet in time (urge incontinence)
• Prolapse (this is when one or more of the pelvic organs starts to fall down into the vagina)
• Bowel control problems
Certain birthing factors can weaken these muscles further. So what are they?
• Having a large tear through the vaginal muscles (episiotomy, 2nd, 3rd or 4th degree tear)
• Long 2nd stage of labour, over 1 hour (from when your cervix is fully dilated until birth)
• Having a baby over 4kg
• The use of forceps or a vacuum during delivery
• Twin or multi-baby pregnancy
• Having birthed 4 or more children
Does having a caesarean protect the pelvic floor?
Yes, somewhat. However, the pregnancy itself is enough to weaken these muscles so ladies who have a caesarean still are at risk of pelvic floor problems.
What can be done about a weak pelvic floor?
It is important to protect your pelvic floor from extra strain in the first few months postpartum. How you get in and out of bed, how much you lift, what exercise you do, how you manage your bowels can all impact on your pelvic floor. It is important to get specific advice from a Women’s Health physio to help you manage.
Pelvic floor strengthening exercises given under the guidance of a physiotherapist are also very important. A physiotherapist-guided program can optimise your outcomes and be customised according to your needs.
So what about pelvic pain, what can be done about that?
Pelvic pain at the pubic bone or tailbone is very common during pregnancy and less so postpartum. It occurs because the hormone relaxin gets released into your system during pregnancy to help soften the ligaments at the back and pelvis so that the baby’s head can pass through the pelvis more easily during delivery.
Unfortunately, the relaxin can de-stabilise the pelvis, which means every time you walk, roll and move, there is extra movement and torsion happening at joints that are usually very stable. This creates considerable pain and inflammation at the joint space. Sometimes the pelvis can also shift out of place as well, which is very painful and debilitating.
Pelvic pain is often managed with some exercises, manual therapy and advice. Sometimes you may also be prescribed an SIJ belt, which helps compress the pelvis to stabilise it.
What is stomach muscle separation?
During pregnancy, it is natural for the six-pack abdominal muscles to separate as the baby and uterus expands. Sometimes this separation is larger than normal, which can cause back pain and even umbilical hernia.
After giving birth, this separation should return to less than a 3cm gap within the first few days. If it is any larger than this, you will need specific advice, exercise and abdominal support to help close the gap.
Stomach muscles that stay apart can cause significant lower back pain, umbilical hernia and aesthetic issues, so it is important to get sorted!
If you have pelvic floor weakness, pelvic pain or stomach muscle separation, having a postpartum physiotherapy review can get you back on track and feel confident again.