Pregnancy And Postnatal Recovery

Pregnancy can be an exciting (and challenging!) time in your life. As your body undergoes hormonal and postural changes, at Body Logic Physiotherapy Pelvic Health our post graduate trained physiotherapists can help you stay fit and healthy throughout your pregnancy and help your recovery after childbirth.

Back and Pelvic Pain During Pregnancy And Following Childbirth

Back and pelvic pain is common during pregnancy and after giving birth. Some studies suggest over 50% of women have low back or pelvic pain in pregnancy. While this may be scary, if managed well for most it will not impact on the pregnancy. For the majority of cases this will recover within three months of the birth of the child, but in a small group pain persists beyond that time frame.

Although the common belief is that pelvic pain is due to laxity of the pelvic ligaments (ie “loose joints”), there is actually little evidence for this. In fact, there is more evidence that the changing body postures, low or very high physical activity levels, stress levels, depressed mood and sleep deprivation may combine to increase sensitisation of the tissues around the pelvis, thus resulting in  pain.

Our physiotherapists are able to help you understand the factors that may be important in your case and design a management program, including pelvic floor and abdominal muscle exercises as well as addressing lifestyle factors, to help improve your symptoms.

There are many myths surround low back and pelvic girdle pain in pregnancy. Let’s explore some of those.

The Myths

✖    Back pain in pregnancy is a sign you have damaged structures

✖    Pain in your pelvis means your ligaments are lax and pelvis is unstable

✖      If you have back or pelvic pain it means your core is weak

✖    If you have back or pelvic pain you should rest and avoid exercise

✖      If you have pain, you just have to live with it

✖    Exercise during late pregnancy is dangerous

The Facts

✔      The stuctures of the low back and pelvis are really strong and don’t become unstable during pregnancy

✔      Back and pelvic pain in pregnancy and the postnatal period is common

✔      Most back pain that commences during pregnancy or the postnatal period gets better

✔      The predictors of back and pelvic pain during pregnancy are things like poor sleep, stress, low mood and inactivity.

✔      Keeping active and strong during pregnancy is recommended as it reduces the risk of gestational diabetes and preeclampsia and helps your recovery after childbirth

✔      Pelvic floor exercises during pregnancy reduces the risk of back pain, pelvic pain, urinary incontinence and prolapse after birth

✔    Pelvic floor and abdominal exercise in pregnancy reduce the risk of tummy separation or rectus abdominus diastasis

✔      Urinary incontinence is common but not normal after having a baby and can be improved with the correct exercises

✔      Pain with sex postnatal after baby is common but not normal and can be helped

So If you have low back or pelvic pain in pregnancy or the postnatal period, don’t suffer in silence. Contact us for an assessment and management plan.

Pregnancy And Postnatal Exercise Programs

Research shows that exercise during the childbearing years is very important for physical and mental health. Our pelvic health physiotherapists can work with you to provide you with an individualized strengthening and conditioning or Clinical Pilates  style program, to help you reach your personal goals.

Pregnancy Physiotherapy

During pregnancy, exercise has shown to reduce the risk of:

  • Gestational diabetes
  • High blood pressure and pre-eclampsia
  • Musculoskeletal pain (such as back, hip and pelvic pain)

Pregnancy exercise also helps:

  • Maintain muscle strength and flexibility
  • Reduces the risk of anxiety and depression
  • Improves sleep quality

It is the perfect time to be working on your pelvic floor strength.

As your body changes throughout the pregnancy, our physiotherapists can tailor each exercise session for your individual needs, in a safe and supported environment.

Postnatal Physiotherapy

Following the birth of your baby, whether that is by vaginal birth or caesarean section, pelvic health physiotherapists can assist you in your recovery.

Some common symptoms new mothers experience that we can help you with include:

  • Leaking urine or faeces
  • Heaviness/dragging feeling in the perineum
  • Pain in the low back or pelvis
  • Pain with intercourse
  • Neck and upper back pain
  • Wrist pain/numbness

Returning To Exercise After Birth

Many women like to return to exercise and sport after having a baby and our pelvic health physiotherapists are the best placed to design a safe graduated exercise program to help you meet your goals.

Before designing a program, our physiotherapists will do a  comprehensive assessment including specific assessment of your pelvic floor and abdominal muscles. Assessment of the pelvic floor can be performed via real-time ultrasound or a vaginal examination, depending on your needs and preference.

Following the assessment, your physiotherapist will discuss the findings and create a specific exercise program that aims to meet your individual needs and provides a safe avenue to the return to exercise and achieving your specific physical goals. This could include:

  • pelvic floor muscle training
  • strengthening of the abdominal muscles
  • general body strengthening
  • cardiovascular fitness advice
  • postural advice

Rectus Abdominis Diastasis (abdominal muscle separation) Rehabilitation

Stretched or weakened abdominal muscles during pregnancy or after having baby are common.  However, getting the correct advice early in pregnancy can help minimise this. In some women the rectus muscle separates during pregnancy and this can be called a rectus abdominus diastasis or diastasis of rectus abominus. Some separation of the rectus is normal, and this should start to close after you have given birth. In some women the separation is greater, and recovery takes longer, some women notice that the muscles appear to “tent” or “dome” when they sit up and a gap can be felt between the stomach muscles.

Separation (diastasis) of rectus abominus has been associated with larger babies or twins, poor posture and weakness of the lower abdominal muscles.

A specific exercise program started early in pregnancy or in the postnatal recovery period can help recovery. It is important not to worry about this separation as it doesn’t increase a persons risk of back and pelvic pain and with the right care and for most people it resolves over time

Painful Intercourse Following The Birth Of Your Baby

Pain with sexual intercourse is common after having a baby. It is normal for your perineum to feel sore if you have had a vaginal delivery, especially if you have had a tear or episiotomy and stiches. This usually improves within 6 to 12 weeks after birth, but if it is not settling physiotherapy including perineal ultrasound may aid recovery.

It is normal for the vagina to feel drier than usual after childbirth. This is linked to lower oestrogen levels compared to during pregnancy. For breast feeding mothers the levels of oestrogen are lower than those who are not breastfeeding.

There is no right or wrong time to start having sex. Usually most women wait until after their six week check up with their doctor, but some women wait longer. It is not unusual to feel less like sex than you used to at this time. After giving birth, you are often feeling tired from looking after a tiny baby. Don’t rush into it, if sex hurts it won’t be pleasurable. If your vagina feels dry, try a lubricant. It is important to talk about this with your partner rather than just avoiding sex. A common understanding can help people deal with it together.

In 20% of women the pain with sex may become persistent and/ or severe and this can affect sexual relationships, desire and libido.

There are many causes of painful sex incuding:

  • sensitivity of the area of the stitches that has caused some scar tissue
  • increased tension in the pelvic floor muscles
  • involuntary contraction of the pelvic floor muscles during vaginal penetration, which is known as vaginismus.
  • increased sensitivity in the vulval /vaginal area, known as vulvodynia which is a condition where the region just outside the vagina is painful with light touch or without any provocation at all.

Our physiotherapists are able to help you understand the factors that may be important for you and design a management program including learning how to relax the pelvic floor muscles and desensitise the sensitive tissue at the vaginal opening to help improve your symptoms.

Assessment

During pregnancy or after you have had your baby, a thorough assessment is essential to understand your problem. Our physiotherapists will take a thorough history, screen for factors that could be influencing your problem and establish your goals for treatment.

Following this we will conduct a comprehensive assessment of your condition including assessment of your abdominal muscles and the ability to perform correct pelvic floor muscle contractions.

Assessment of the pelvic floor muscles can be done fully clothed using real-time ultrasound. For a more comprehensive assessment of pelvic floor muscles a direct assessment can be performed via a vaginal assessment. This method is recommended for an accurate assessment of the strength of the pelvic floor muscles and for any one experiencing pain. The method of assessing your pelvic floor muscles is always your choice and will be thoroughly explained and based on your consent.

Following the assessment, we will explain to you in simple terms the factors that may be impacting on your problem and design a collaborative treatment plan to help you achieve your goals.

Management Of Mastitis And Blocked Milk Ducts In Breastfeeding Mothers

While an incredibly happy occasion, having a new baby can be a challenging time for many new mums who choose to breastfeed but experience difficulties with development of mastitis and nipple trauma.

Ineffective attachment (also called latch) is often one of the main causes, which can lead to bacteria tracking back into the breast from a traumatized nipple and/or poor drainage of the breast during feeding.  Seeking help from a lactation consultant, child health nurse or midwife is recommended to address the underlying causes of poor attachment and repeated infection.

Therapeutic ultrasound treatment has also been shown to be clinically effective in treating blocked milk ducts that may be limiting effective milk flow during feeding and potentially progressing to mastitis.

Our physiotherapists can assist you in the management of mastitis, we know that it is important to have prompt treatment for mastitis so please let our receptionist know that you have mastitis as we will try and find you an urgent appointment.

For any further pregnancy and postnatal recovery questions, or for anything else, get in contact with our friendly team today!