While pregnancy can be a joyful time emotionally, it can also be strenuous on the body physically. The normal changes that the body undergoes during pregnancy and delivery, (including vaginal and c-section), can predispose the body to pain and discomfort. The hormone relaxin which is produced in your body during pregnancy make the ligaments and connective tissue prone to instability. Research has shown that anywhere from 50% to 70% of pregnant women experience low back and or pelvic girdle pain. While these symptoms may be considered a common side effect of pregnancy, it should not be considered acceptable.
Pregnancy and vaginal delivery are considered to be one of the main risk factors in developing urinary incontinence because pregnancy and childbirth may cause damage to the ligaments, pelvic floor muscles and nerves supporting the area. It is estimated that between 20% and 67% of women have incontinence both during pregnancy and after childbirth.
Common symptoms that are treated include:
- Low Back Pain
- Pubic symphysis dysfunction-This is pain mostly around the pubic area and worsened with certain weight bearing activities such as climbing steps, getting in and out of a car and even turning in bed. It some women it can radiate to the upper thighs and perineum
- Sacroiliac joint pain-This is pain that initiates in the glut or butt, but can also refer to the hip, groin or leg. Symptoms can be worse with walking, stair climbing and even sitting can make you feel like you are higher on one hip than the other. Certain pregnancy belts may help give support, but if there is a potential muscle imbalance, the belt could make the pain worse. You can be educated on what to do at home to help alleviate the pain before wearing certain types of belts
- Hip joint pain
- Sciatica-This is the nerve that is located along the piriformis muscle which is found in your glut or butt muscles. This may feel like a line of pain from the butt down into the back of the leg. An extensive evaluation will be performed on the back as well to help rule out any other nerve involvement such as disc or referred pain from the back or lumbar spine
- Neck pain/Thoracic spine dysfunction or pain-Sometimes faulty postures during pregnancy can lead to muscle strains in other parts of the body, such as the upper mid back or neck
- Swelling in the legs
- Urinary leakage
- We can also give recommendations on how to make labor and delivery easier to help prevent further pain after delivery by suggesting certain positions to labor, pending doctor approval of course
- Perineal massage can also be taught which involves the pregnant client or partner learning how to massage the perineum around the vagina to help prepare for childbirth. The intention is to prevent the use of forceps or potential tearing or episiotomy to promote less damage to the pelvic floor during delivery.
Once the baby is born and mom has been cleared to return to previous activities including exercise and sex, we recommend a checkup be completed by a women’s health physical therapist. This will involve checking both the external muscles such as the abdominal muscles, low back, hip and postural muscles along with the internal pelvic floor muscles. This can help address any concerns, or check for any potential issues that could arise in the future. An internal pelvic exam will be performed to check for any vaginal or perineal pain as a result of tearing or episiotomy. The strength of the vaginal or pelvic floor muscles will also be assessed to establish the right home exercise program to help avoid potential harm or future pelvic floor dysfunction.
Conditions that are screened:
- Diastasis Recti-This is the separation of the abdominal muscles that can occur during pregnancy. Latest research has shown that having the “gap” is not quite as important as how the muscles below are functioning. There is definitely a progression with regard to exercises that should be followed when restoring these muscles in the post partum period. The goal is “never to do a crunch again” but instead to learn the right way to engage the muscles so you can return to the exercises you enjoy doing. Sometimes “baby boot camps” out there may be progressing new moms with exercises such as planks and crunches before the muscles are ready, which can interfere with the abdominal muscles closing naturally. Understanding the progression of exercises along with the right way to engage the muscles will facilitate this closure safely and effectively. We can screen for this and work with your particular goals in mind, to get you back doing what you love!
- Residual pregnancy pain, such as low back pain, hip pain, mid back pain, leg pain
- Perineal pain-This can arise from tearing or episiotomy during delivery. Prolonged scar tenderness and limited scar mobility can contribute to pain during intercourse. The pelvic floor muscles surrounding the perineum can become tight and painful as well. Scar massage can help alleviate the pain along with learning how to relax the pelvic floor muscles to regain normal tone
- Urinary issues-This can involve urinary incontinence or even fecal leakage with activities such as running, lifting objects, sneezing or coughing. Urge incontinence or urgency may occur which involves the feeling of having to go the bathroom when the bladder isn’t full. In cases of pelvic pain, there may be difficulty initiating urination, as the muscles remain tight and unable to relax to allow emptying of the bladder
- Pelvic pain-This can be as a result of perineal pain and discomfort as mentioned above, or can be from a number of musculoskeletal conditions such as tight or weak muscles, hip pain, back pain, lower abdominal pain, nerve irritation and even restricted scars from previous surgeries. Constipation can also play a part in pelvic pain
- C-section scar-As a result of surgery, scars in some cases can become adhered or “stuck” which can cause pain with activity. After undergoing a C-section, some women may feel the need to protect the area, resulting in poor posture and limited lumbar mobility. This could lead to low back pain, or pelvic pain from decreased mobility over time. Scar tissue massage as well as the right exercises can decrease or eliminate symptoms that can be common after c-section surgery
- Pelvic Organ Prolapse-As a result of pregnancy and childbirth, the pelvic floor muscles that support our organs such as the bladder, bowel and uterus, can become stretched and weakened. These organs can start to slip downward or out of place. Some women who have this describe feelings of pressure along the perineum during activities, while some have no symptoms at all. In some cases it can make intercourse uncomfortable. Rehabilitating the pelvic floor muscles can help prevent or avoid worsening this condition.
Check out our Postpartum Power Up page! We discuss the importance of why all moms should receive women’s health physical therapy after baby! We will do the initial evaluation, and then discuss our findings and plan of action together. Every plan is individualized and specific to those needs that are important to you. Performing the right exercises while incorporating the pelvic floor and abdominal muscles correctly will help you recover faster from childbirth and return you to your previous activities. It doesn’t matter if your baby is 6 weeks old or 16, it’s never too late!