Healthy Pelvic Floor For A Healthy Life: The Importance Of Healing After Birth. The biggest concern I see with moms and women at my practice stem from not healing and restore their core and body after childbirth. Most women after childbirth get cleared by their MD, midwife or OB at 6 to 8 weeks after delivery. As long as the uterus is done “bleeding” they get cleared to go back to exercise, ease back into the gym, return to intercourse, pretty much they are told to ease back into everything they were doing prior to pregnancy. This is a huge problem. The body is still healing at this point.No matter how the baby came out of your body: be that vaginal or cesarean birth, it is a massive event. The muscles, the skin, the fascia the organs all stretched out over 10 months. So to think that you will be back to “normal” or ready to hit the gym at 6 to 8 weeks would be pretty impressive.
So I tend to see women after they have injured themselves and possibly not even through child birth, many times they attempt to get back to a routine or exerted themselves more heavily. The intervals I see those injuries are at the 4 months, 7 months and 18 month mark. Between then as well, but these are the most common. At 18 months many moms are either pregnant again or worried about being pregnant because things never felt the same after round one.
These injuries are mainly due to the body not being ready for whatever activity the mom has returned to. Common injuries that were not necessarily present or at least symptomatic after birth but occurred within the first 1-3 years after birth are:
- Prolapse: Where organs protrude/fall into the vaginal canal. Either the front wall (bladder falls in), uterus descends, urethra protrudes down, rectum buldges into the back wall of the vagina. Now some decent of these organs into the vaginal canal occur after pushing a baby out or carrying a baby for 10 months. Hence we need to support these organs recoiling and shrinking back into the body after childbirth. (Let me tell you crunches are not the answer for this)
- Diastasis Recti: This is where the two “6 pack ab” muscles separate and the linea alba tissue between those abs stretches and things out. You may feel like you have a hole in your stomach.
- Other common things that bring women in the door include discomfort when returning to sex,
- peeing their pants when they exercise
- constipation and trouble fully passing the stool
- stiff and achy joints: midback, ankle, hips, SI pain, neck
So these are really the common things and by no way am I saying they are normal. Common does not equal normal.
The wrong thinking and really standard of practice in America is to be cleared for everything even though the body has not been guided to heal.
When you have a baby you have scar tissue either in your perineum (right where the baby came out of the vaginal canal or across your stomach if you had a birth by cesarean section). Please don’t be fooled, if you had a c-section your pelvic floor is absolutely affected too. There are fascial connections between abdominal fascia and pelvic floor fascia. This means that being cut open in one place can make tightness and pain in another. So having scars can be painful, numbing and irritating and therefore you probably don’t want anyone near them. A lot of times we ignore them or don’t touch them because there is a lot of emotion that is wrapped up into the scars.
I want to briefly tell you that the reason scars are so important to address is because birth scar are directly at the area of the pelvic floor and deep core muscles known as the transverse abdominus and if there is scar tissue present there then the muscles can’t fully contract, so that can contribute to a weak core. The core is the most important force absorber in your body. If your core is weak you will wear out all your other joints faster. So you may have little niggly aches and pains or wake up with perpetual stiffness.
Often times what I see in my practice in older women that could have be prevented is simply the fact that they never rebuilt their core. So they typically show up with achy hips, backs and knees and possibly leaking pee with exercise or racing home to use the toilet. And then when they get to their late 50’s and in the 60’s they are thinking about joint replacements, maybe bladder slings. This is all because their cores were never restored after having babies.
I have seen this even further down the line in 80-100 year old’s who are all in diapers and in wheelchairs. And often this causes skin break down and ulcers and eventually is the large contributor to death. I don’t say this to completely scare you. I say this because we all want a good end of life and quality of life and we don’t really think of what we do now as a factor but it totally is.
My biggest piece of advice for America is to follow what France does and ensure all women get specialized physical therapy to rehabilitate their pelvic floor and their abdominal wall. Right now its takes women advocating for themselves but I would love to see ob’s, midwives and physicians not clear women at 6 to 8 weeks and only say, you are ready to go to the expert pelvic floor Physical Therapist who can guide you and help you heal appropriately to get back in the gym and other life activities safely. No matter when you had your baby, be it 6 months or 16 years ago, getting an evaluation by a Pelvic Expert Physical Therapist will give you the tools to know how to effectively build and use your core