Common Postpartum Issues (Part 2)
Welcome back, Bestie! Today, as promised, we’re back with another chat about issues a lot of postpartum moms face. Last time, we touched on shoulder/upper back pain, diastasis rectus abdominis (DRA), low back pain, and Dequarvain’s tenosynovitis and now, we’ll talk about cesarean scar tissue, stress urinary incontinence (SUI), prolapse, tailbone pain, and episiotomy pain. Let’s get into it!
Common Postpartum issues:
Cesarean scar tissue: For those folks that underwent a cesarean section (c-section) during birth, recovery may look a bit different than it would after a vaginal delivery! C-sections are typically performed by creating what is called a Pfannenstiel incision (lower abdominal incision that goes side-to-side, rather than up-to-down). During a c-section, the surgeon cuts through seven different layers of tissue–it’s no wonder that healing takes some time. As the tissues heal, scar tissue may form. This is a completely normal part of the healing process, but scar tissue can result in restricted movement in the abdominal structures. Pfannenstiel incision restrictions can restrict bladder mobility, leading to urinary symptoms such as urinary urgency and urinary frequency (1). It can also make mobility of stool through the colon more difficult, leading to bowel or digestion issues (2). Finally, adhesions related to cesarean section have been associated with chronic pelvic pain (3).
While you should be provided with basic information like how to keep your scar clean and avoid infection, it’s unlikely that you’ll be provided with information on how to manage your cesarean scar while you’re at the hospital. It is important to talk with your provider about your scar healing at your follow-up visits and to see a pelvic health specialist if you have any concerns (or even if you don’t!). Your pelvic health physical therapist can perform manual therapy on your scar, helping to mobilize it, while also teaching you how to appropriately perform mobilization yourself, at home. You should be briefed on the signs of infection (such as redness, heat, and fever) and should not be using lotions or oils over the area if it is not completely closed. Once cleared by your provider, mobilization is a key component in allowing the abominable region to become as functional as possible.
SUI: Studies show that SUI affects up to 18% of postpartum folks. This gives you a 1 in 5 chance of urinary leakage after delivering your baby (4). Combine 40 weeks of increased pelvic pressure with hours and sometimes days of labor, pushing, and delivery itself and you’ll undoubtedly have some pelvic floor trauma. The stretching of the PFMs and other pelvic structures make SUI a common visitor after birth.
While the research is mixed when it comes to preventing SUI using pelvic floor muscle training (PFMT) in the antepartum population, it strongly suggests that postpartum PFMT reduces SUI (5). Your pelvic health physical therapist can work with you on performing a proper pelvic floor muscle contraction (Kegel), and create a PFMT exercise regime just for you. They might even use some biofeedback to aid in your Kegel performance.
Prolapse: Similarly to some of the other common postpartum issues, prolapse can occur due to the stretching of pelvic structures over the 9-10 months of pregnancy and the delivery experience (6). Laxity of the ligaments and other structures of the pelvis can lead to downward descent of these structures. This downward descent can even lead to other issues, including poor emptying of the bladder and bowels. To learn more about the details of prolapse, reference our chat on it here.
The good news is that pelvic floor physical therapy can help! Prolapse can be improved with appropriate PFMT (7,8). Your therapist might also work with you on positioning, biofeedback, splinting, and hip/core strengthening exercises, all of which have been shown to improve symptoms of prolapse (9).
Tailbone pain: Tailbone pain, or coccyx pain, is common after giving birth. This is because, during delivery, excess pressure is placed on the structures of the pelvic region as the baby moves through the birthing canal. The ligaments that connect to the tailbone can be strained, resulting in the coccyx being more mobile than usual. Folks often have a difficult time sitting or moving from sitting into standing, due to pain.
Tailbone pain may resolve on its own, but there are some treatment techniques that can improve symptoms. Sitting on a wedge-shaped cushion and focusing on correct posture can both have a positive impact on your pain (10). Further, exercises that target the hip extensor muscles (such as the gluteus maximus) may help to place the coccyx in a better position and resolve discomfort. Of course, ice and/or heat can ease symptoms and working with a pelvic health specialist is your best bet for finding the treatments that will work for you (10).
Episiotomy or tear pain: Episiotomies are common during vaginal delivery when the provider feels more space is necessary for the delivery of the baby. Tearing of the tissues around the vulva/vagnia is also common and the grade/severity of the tear will determine the amount of time it takes to heal. Once episiotomy cuts and/or tears are healed, sometimes pain can remain. This may be due to the scar tissue present in the region. Sometimes this can lead to pain with sitting or having intercourse.
A pelvic health specialist can teach you manual therapy techniques for improving tissue restrictions or scar tissue associated with any tearing of the perineum during birth. Sometimes, sitting on a ball or dilator can help to resolve tight spots, especially after using a hot pack to calm the tissue (11).
If you’re a postpartum parent, I’d love to hear about your experience! Have you dealt with any of the issues we talked about and if so, what did you find worked best for your symptoms? Also, what do you think–should we do a “part 3?” Let me know!
XOXO,
Your Pelvic Bestie
References:
Paul D. Silva, MD; Sarah A. Suarez, MPAS, MS. A Case of Disabling Urinary Frequency and Pelvic Pain Due to Postoperative Uterine Adhesions. Wisconsin Medical Journal. 2016; 115(1).
Poole JH. Adhesions Following Cesarean Delivery: A Review of Their Occurrence, Consequences and Preventative Management Using Adhesion Barriers. Women’s Health. 2013;9(5):467-477. doi:10.2217/WHE.13.45
Moro F, Mavrelos D, Pateman K, Holland T, Hoo WL, Jurkovic D. Prevalence of pelvic adhesions on ultrasound examination in women with a history of Cesarean section. Ultrasound Obstet Gynecol. 2015 Feb;45(2):223-8. doi: 10.1002/uog.14628. Epub 2014 Dec 26. PMID: 25042444.
Zhang L, Zhu L, Xu T, Lang J, Li Z, Gong J, et al. A population- based survey of the prevalence, potential risk factors, and symptom specific bother of lower urinary tract symptoms in adult Chinese women. Eur Urol. 2015;68(1):97–112. https://doi.org/10.1016/j.eururo.2014.12.012.
Harvey MA. Pelvic floor exercises during and after pregnancy: a systematic review of their role in preventing pelvic floor dysfunction. J Obstet Gynaecol Can. 2003 Jun;25(6):487-98. doi: 10.1016/s1701-2163(16)30310-3. PMID: 12806450.
Dietz HP, Bennett MJ. The effect of childbirth on pelvic organ mobility. Obstet Gynecol. 2003 Aug;102(2):223-8. doi: 10.1016/s0029-7844(03)00476-9. PMID: 12907092.
Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD003882.
Bø K. Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World J Urol. 2012 Aug;30(4):437-43.
Culligan PJ. Nonsurgical management of pelvic organ prolapse. Obstet Gynecol. 2012 Apr;119(4):852-60.
Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014 Spring;14(1):84-7. PMID: 24688338; PMCID: PMC3963058.
Kaur N, Rana AK, Suri V. Effect of dry heat versus moist heat on Episiotomy pain and wound healing. Nursing & Midwifery Research Journal. 2013;9(1):21-33. doi:10.1177/0974150X20130103
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives
