For many new mums, any pelvic pain experienced during pregnancy disappears upon meeting your little one. However, whether you immediately feel a reduction in pain or not, the legacy of pregnancy means your pelvic floor will take time readjusting. Whether you birthed vaginally or via caesarean section, the muscles in your pelvic floor will have been stretched and weakened and it’s important to understand the impact this weakening can have on your body and why you still may be experiencing pelvic pain.
During pregnancy, your body goes through many biomechanical changes, including adapting your posture to make up for the weight of your growing baby. This increases the pressure on the sacroiliac joint (SIJ): the joint connection between the spine and the pelvis, responsible for providing stability to the body and reducing the load of the trunk to the lower limbs. The stability of the SIJ is due to form closure whilst force closure relates to the forces which act across the joint to create stability. Relaxin and progesterone, hormones produced in pregnancy to help expand the pelvis in preparation for birth, have an impact on force closure as they cause the ligaments across the joint to become lax and therefore unable to keep the pelvis in its optimum position. This is what causes pelvic pain during pregnancy and as it takes time for these hormones to leave your system after birth, is why pelvic pain can continue after pregnancy.
But before you start panicking about the state of your pelvic floor, remember – it takes 500 days for your body to fully recover after pregnancy. Don’t expect your pelvic floor and body to be back in shape quickly, no matter what Insta-mums may appear to do!
Below, we look at symptoms to look out for which could be the result of a weak postnatal pelvic floor. If any of these conditions or symptoms are familiar to you, it’s a good idea to talk to your GP, NHS women’s Health Physio or ‘Mummy MOT’ specialist as soon as possible: the sooner you start restoring your pelvic floor, the better!
YOU MAY HAVE A WEAK PELVIC FLOOR IF YOU HAVE ANY OF THE BELOW SYMPTOMS:
Pain during intercourse (dyspareunia) or putting in a tampon | Once you’re back on board with sex again (often the last thing you feel like doing after having a baby!) you’ll probably find it feels different. The vagina may be wider and depending on the type of birth you had, feel sore and swollen. Another clue something may not be right with your pelvic floor is if it hurts to put a tampon in. These pains should lessen over time but if they don’t, it’s worth having a professional give an internal examination to check your pelvic floor out. Again, these are not normal symptoms to live with. Also, please bear in mind that this pain is also possible following a caesarean and may be a sign that the scar tissue is knitting together uncomfortably, creating adhesions below the surface of the skin.
Pelvic Organ Prolapse (vaginal or rectal) | When the pelvic floor is weak, it’s possible for your internal organs to descend. Physiotherapist Sue Croft describes it as such: ‘Vaginal prolapses occur when there is a relaxation of the fascial walls and other ligamentous supports of the vagina causing the bladder, uterus and bowel to descend. The prolapse can be mild, moderate or extend beyond the opening of the vagina.’ Literally, your internal organs dropping down and out. Pelvic organ prolapse can occur in women who haven’t experienced pregnancy or childbirth but it is more common in those with children, especially if labour was particularly long or you had a multiple birth. Symptoms of prolapse include:
● A feeling of heaviness around your pelvis (lower tummy and genitals) or vaginal discomfort
● Pain or numbness during sex
● Seeing or feeling like there’s something coming down into your vagina
● Stress incontinence
A pelvic prolapse is a painful and serious thing to deal with: if any of these symptoms have you thinking, make an appointment with your doctor asap. Once you know what’s going on, Mama Wellness have many treatments and fitness programmes to help. It is repairable.
Diastasis Recti (abdominal separation) | When pregnant, your uterus will have pushed your stomach muscles apart – this is very common & affects 100% of women. Generally, the muscles should come back together on their own within 8-9 weeks of your baby being born. There are many factors to why this may not happen, such as little space (2 years or less) between having babies, genetics, age, multiple birth or large baby. It is worth checking with a Mummy MOT practitioner to see if this has happened and how wide the gap is (measured in fingers – a separation of up to two fingers is normal). Abdominal separation can lead to pelvic pain, lower back pain, poor posture, bloating, constipation and a ‘pooched’ tummy.
HOW TO REDUCE POST-NATAL PELVIC PAIN
Exercise | Yes, once again, we’re telling you how important pelvic floor exercises are. They really are the difference between feeling too nervous to cough and having a worry-free life with the bonus of a strong core to help with lifting your little one, great posture and a good sex life! As well as making Kegels (pelvic floor exercises) part of your everyday life, once you’re fully recovered postnatally, taking up other forms of exercise is a great way to work your core and in turn, your pelvic floor. However, make sure any exercises you do don’t cause your abdominal muscles to ‘dome’ – this includes sit-ups and crunches. Whilst your pelvic floor is repairing itself, it makes sense to take the advice of a trainer with experience of working with post-natal women who know what to look out for and which exercises to avoid.
Do be aware though that pelvic pain can sometimes come from muscles that are too tight (hypertonic) and further doing exercises to tighten them will cause more pain and not solve the problem. An overused pelvic floor can cause pain when opening bowels, urinating, during sex etc. This is why having a Mummy MOT expert to perform an internal pelvic health assessment is a good idea.
Reduce heavy lifting (especially anything repetitive) | The extra downward force puts increased pressure on your pelvic floor. If unavoidable, try and find someone who can help with the lifting as often as possible.
Eat Well | Nutrition plays as big a part in a strong pelvic floor as exercise does in supporting your body’s’ healing. In general, anything that makes digestion easier is good if you’re experiencing any kind of pelvic floor disorder. If you suffer from stress incontinence, make sure to drink plenty of water daily, limit or cut out caffeine and try to avoid acidic or spicy foods. A food diary tracking what you eat and any discomfort you feel will help you understand which foods aggravate your digestive system and in turn, impact on your pelvic floor.
Breathe | Properly. When breathing in, your diaphragm should move down and abdominal wall move forward: when breathing out, your diaphragm should move up and abdominal muscles move back to their original position. Breathing correctly will strengthen your deep abdominals and is an effective part of your pelvic floor repair programme.
Caesarean Section Scar Massage | Even once your scar has healed on the surface, the scar tissue underneath will continue knitting together across the layers which were cut through. This adhesion of tissues grows outwards over time in your abdomen and pelvis and can hinder the normal gliding of tissues during movement and digestion. 38% of women who suffer from pelvic pain suffer because of these adhesions. Therefore, massage is important to mobilise the scar tissue and help prevent any future issues.
Mama Wellness can help! Nina offers a comprehensive Mummy MOT service involving consultation, assessment, massage and movement prescription. Check out the page for more information.