3 post-birth pelvic issues
Pregnancy and birth are joyous times in a woman’s life, as we anticipate the arrival of our babies. Unfortunately, pregnancy and birth can sometimes put too much strain on our bodies, and we can be left a little worse for wear 'down there'. Heba Shaheed outlines the three most common issues new mothers face: abdominal separation or “mummy tummy”, pelvic organ prolapse, and incontinence. Heba Shaheed is a women’s health physiotherapist and the founder of The Pelvic Expert, and shares her expertise.
Incontinence is really common post-birth affecting at least 30% of women. Usually the incontinence is a direct result of a prolapse. Sometimes it is because of a weakness of the pelvic floor muscles. 1 in 3 women will have bladder control issues post-birth and 1 in 8 women will have bowel control issues post-birth, especially if she has had an anal sphincter injury or 3rd/4th degree perineal tearing during her labour. Women may leak with a cough, sneeze, laugh, jump or run and this is known as stress incontinence. Or they may leak due to urgency, which is known as urge incontinence; sometimes they can have both. The great thing is physiotherapy can cure 84% of cases, and it can be as simple as doing your pelvic floor strengthening exercises.
About 30-50% of women are affected by prolapse post-birth. During pregnancy, the extra hormones make the connective tissue in women’s bodies laxer to allow for childbirth. In some women during birth, this connective tissue overstretches and doesn’t return back to its original tightness. This means that the pelvic organs being held up by this connective tissue are sitting lower than they should be. If a woman has a forceps or vacuum delivery, her risk of prolapse goes up even more. Women with prolapse will experience symptoms like: • Lower back pain. This is because the uterus attaches to the lower back via ligaments and if the uterus is sitting lower there is more tugging on the lower back joints from inside. • Pelvic pressure or feelings of heaviness or dragging sensations. • Sensation of a bulge vaginally. • Leaking from the bladder. This is because the bladder and urethra are sitting lower than they should be. • Incomplete emptying of the bladder. This is because the bladder sits lower than it should, and a little pocket of the bladder can form and store urine. Women with prolapse would benefit from having a support device called a pessary inserted vaginally, and more importantly they need to engage in strengthening exercises. The pelvic floor muscles need to be strong to provide support from underneath to support the prolapse.
Abdominal separation (diastasis recti)
During pregnancy or labour, the abdomen can stretch to a point where the linea alba, a membrane between the abdominal muscles, can split. This is normal and allows for your baby and your uterus to grow. The degree of separation can vary from woman to woman, based on hormone changes, age, genetics, body type and size, size of baby, multiple babies, repeat pregnancies, etc. Abdominal separation is very common in pregnant women, with 2 out of 3 women having some degree of it. It is acceptable to have a separation of less than 2cm, which isn’t too deep. However if the separation is more than 2.5cm and deep, this will need support and strengthening. The gap should shrink after birth with time, and can be helped with an abdominal support – but this should only be worn in first 3 weeks after birth. After that, it is incredibly important to strengthen the core muscles with functional exercise, with a focus on breathing through the diaphragm, and engaging the pelvic floor and deep tummy muscles.