What’s ‘normal’ after giving birth?

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Pregnancy and childbirth bring about many changes to our bodies. The process of recovery can be confusing and even overwhelming, and there is a great deal of misinformation out there.

Women come to InterMed Pelvic Floor Physical Therapy with many questions about their post-pregnancy bodies and symptoms. Our patients want to know if the changes are permanent. Will their symptoms ever go away, or do they just need to live with them as a new normal? What kind of recovery can be expected after giving birth? How long will that take?

The confusion often comes because some symptoms are considered normal for a period of time, and then become abnormal if they continue beyond that timeframe.

Our goal here is to answer questions and provide information about what is normal and to be expected with the three most common post pregnancy issues that result in a referral to Physical Therapy: bladder health and leakage, pain with sex, and Diastasis Recti Abdominus, a gap between your abdominal muscles.

What is considered normal bladder health after giving birth?
Urinary incontinence, or involuntary leakage of urine, is common for the first few months after giving birth. During the first 3 months, it’s normal to leak when you cough, sneeze, laugh, or lift your baby. It’s also normal to urinate more frequently or to have strong sudden urges. After the initial 3 months, normal urinary control should return. Some women see their symptoms gradually resolve, while others continue to struggle.

The strongest predictors of postpartum incontinence are:

  • Low pelvic floor strength
  • Incontinence prior to pregnancy
  • New onset of incontinence during pregnancy
  • Size of your newborn (greater than 6.6 pounds)

Women who do pelvic floor squeezes during their pregnancy and again at 12 weeks postpartum develop less incontinence than women who don’t do squeezes. Guidelines indicate that women who experience incontinence or other symptoms after 3 months would benefit from at least three physical therapy sessions focused on pelvic floor rehabilitation. Strengthening and coordinating these important muscles results in real positive changes for women.

Incontinence is generally treatable with physical therapy because it is a symptom of specific issues in the pelvic floor. As those issues are addressed, the incontinence should stop.

There is good research to support the benefit of seeking help. Studies have shown that women who receive pelvic floor physical therapy for incontinence after delivery continued to show benefits from treatment one year later. One study showed that pelvic floor training with biofeedback (a way for you to see how your muscles are working) resulted in an 88 percent improvement in symptoms.

No one is destined to leak after delivery. We often hear stories from patients who thought that they were supposed to leak because their mother did. If you find that you are still dealing with incontinence — even years later — ask for a referral. We’re here to help you.

Is sex supposed to hurt after having a baby?
During pregnancy, our pelvic floor muscles endure pressure as they support the growing baby. Our muscles also have to work harder to stabilize postural changes as the baby grows larger and heavier. During delivery, our pelvic muscles relax and stretch to allow the baby to be delivered. If the baby is large, or the delivery is difficult, these muscles can be injured. This can cause pain with sex. Returning to sex after having a baby can be a little scary. For the first few times, a little discomfort is normal, especially if there was a tear that required stitches.

Pain during sex is called Dyspareunia. Studies have estimated that 85 percent of women experienced pain on their first attempt at sex postnatally. For most, pain decreases over time. For one in five women, the pain persists beyond a year.

Discomfort with intercourse and penetration should not continue. If dyspareunia isn’t getting better, speak with your provider. We are happy to help you find comfort again.

Is it normal to feel a split in my abdominal muscles above my belly button?
As the baby grows larger, the abdominal wall and abdominal muscles stretch to make room. After delivery, the muscles return to their starting point, but the soft tissue between the muscles can stay stretched out. This soft tissue, the linea alba, connects the left and right rectus abdominus muscles, often called the “six pack.” When this happens, the weak area in the center is called a Diastasis Recti Abdominus, or DRA. It can appear as a raised ridge in the middle of the abdomen above or below the belly button and is more prominent when you strain. A DRA is not a hernia because the abdominal wall is intact, just stretched out and thinned.

Most women experience a DRA after delivery. For most, it will resolve or significantly lessen within 8 weeks. A DRA that is greater than 2cm (approximately the width of 2 finger tips side by side) is not normal and can contribute to a feeling of instability or back pain. Your physician can do a quick test to diagnose this common condition. Physical Therapy can help you to re-stabilize your abdominal muscles. It’s not enough to just strengthen – please don’t do crunches, as this can make the DRA worse. It’s important to learn to use your muscles in the pattern that supports core stability, and also gives your body the best chance of healing.

By Kate Bergeron PT, DPT, WCS; Jessica Clark, MPT; Nadia Sanchez, PT,DPT; Rosemarie Wagner PT,DPT