How do you know if your pelvic floor is damaged after birth?

What happens during postpartum period?

The postpartum period is a significant transition for new mothers, both physically and emotionally. One crucial aspect often overlooked is pelvic floor health. After childbirth, many women experience changes in their pelvic floor, which can lead to various issues. This guide will help you understand the importance of pelvic floor management and provide practical tips for recovery.


What is Pelvic Floor?

Pelvic floor is not just muscles in pelvic floor.

The pelvic floor is a group of muscles, ligaments, and tissues that support the pelvic organs, including the bladder, uterus, and rectum. During pregnancy and childbirth, these structures undergo significant stress and stretching. It’s essential to recognize that postpartum recovery involves restoring strength and function to this area.


Why Pelvic Floor recovery is important during the postpartum period?

During the pregnancy and delivery, the hormone relaxin increases, causing the pelvic ligaments and muscles to loosen. This prepares the body for childbirth but can also lead to instability in the pelvic area. As the baby grows, additional weight puts pressure on the pelvic floor, stretching and straining the muscles and tissues.

The delivery process can cause trauma to the perineal area, stretching or pulling the ligaments that support the pelvic organs, potentially leading to an avulsion. Additionally, the nerves in the perineum can become damaged or stretched during childbirth.


The common pelvic floor issues after the delivery

Urinary Incontinence

Urinary incontinence after childbirth can be caused by a combination of physical and hormonal factors related to pregnancy and delivery.

Some of the main causes include:

  • weakness of pelvic floor muscles, damage to nerve ( damage during labor and delivery),
    particularly from the pressure of the baby’s head on the pelvic nerves or from an epidural) can affect the ability to control urination.
  • Hormonal change :After childbirth, hormonal shifts can affect bladder function.
    For instance, the hormone relaxin, which helps the body prepare for childbirth, can weaken the pelvic floor muscles, making them less effective in supporting the bladder
  • Birth Trauma or Tears
    Etc.

 


Prolapse

 

Post-delivery prolapse occurs when the pelvic organs (such as the bladder, uterus, or rectum) drop or bulge into the vaginal canal
due to weakened pelvic floor muscles.

  • The symptoms of prolapse after childbirth can vary depending on the severity of the condition and the specific organ involved, but common symptoms include  a feeling of heaviness or pressure in the pelvic region and vaginal bulging or a visible lump
  • These symptoms may worsen over time, especially in the afternoon or evening

 

 

 

Pelvic Pain 

Pelvic pain after delivery can occur for various reasons related to the physical changes and stresses that occur during pregnancy and childbirth.
The symptoms of pelvic pain after delivery can vary in intensity and duration, and can affect different areas of the pelvis.

  • Localized pain in the Pelvic Area  – pain or discomfort in the lower abdomen, near the pubic bone, or between the hips.
    This pain can be sharp, aching, or throbbing.
  • Certain movements, like standing up from a sitting position, walking, or climbing stairs, may aggravate pelvic pain.
    This can be caused by muscle strain, ligament relaxation, or residual issues from childbirth.

 

Sexual pain   

Many women experience pain during or after intercourse following childbirth,

  • which may result from vaginal tears, scarring, pelvic floor muscle weakness, or tension. During vaginal delivery, the perineum (the area between the vagina and anus) may tear or an episiotomy (a surgical cut) may be made to help with the delivery.  The muscles of the pelvic floor support the bladder, uterus, and other pelvic organs.
    These muscles stretch significantly during delivery, and in some cases, they may weaken or become dysfunctional.
  • This can lead to vaginal dryness, a feeling of looseness, or even pelvic organ prolapse. Such changes can contribute to pain during intercourse.
  • After childbirth, hormonal shifts, particularly a decrease in estrogen levels, can affect vaginal lubrication and elasticity.
    This can lead to vaginal dryness, making sex uncomfortable or painful. Estrogen levels often take time to return to normal,
    particularly if a woman is breastfeeding.
    Emotional feeding and emotional issues can cause sexual pain as well

 


DRAM ( Diastasis)

DRAM (Diastasis Recti Abdominis Muscles),  is separation of the connective tissue between the rectus abdominis, becomes stretched and weakened.
it can cause visible bulging or Pooch in the abdomen,  often seen when you engage your abdominal muscles, especially when you are sitting up or standing.
It can appear as a bulge or ridge running down the middle of the abdomen.
Generally, the width of the gap decreases with recovery from the delivery

If  size of the DRAM is severe, it can cause

  • Weakness of core & Lower back pain
  • Poor posture
  • Pelvic Floor dysfunction
  • Difficulties of Physical activities which requires core strength

 

 

 

 


How Do I know if My pelvic floor is damaged after the delivery?

Assessment with a Pelvic Floor Physical Therapist: A specialized therapist can perform a thorough assessment, including an internal exam if appropriate. They will evaluate muscle tone, strength, endurance and coordination.

Self Assessment : check if you have urinary incontinence symptoms. especially with physical activities which give you strong pressure on lower abdomen like laughing, jumping and running. Check if you have heaviness or discomfort or pain on your perineum area.


How long does it take for the pelvic floor recovery?

We generally expect that six weeks postpartum is the right time for recovery following delivery. Most women can regain normal pelvic floor function after injuries related to childbirth. However, recovery can vary depending on factors such as the conditions of the pregnancy, the type of delivery, and any trauma experienced during pregnancy and deliver.


What kinds of exercise will be helpful for pelvic floor recovery?

(Source : Return to exercise post pregnancy, Philipp Inge   Jessica J Orchard   Rosie Purdue   John W Orchard, 2022), doi: 10.31128/AJGP-09-21-6181
Link :Exercise after pregnancy (RACGP)
https://www1.racgp.org.au/ajgp/2022/march/exercise-after-pregnancy

How to Treat Carpal Tunnel Syndrome?

What is Carpal Tunnel Syndrome?

carple handThe carpal tunnel is an area in our wrist on the palm side where tendons that help our fingers grasp and flex run. The bones of the wrist form the floor of the tunnel, while a strong fibrous ligament acts as the roof. Inside the tunnel, along with the tendons, there’s also a nerve, an artery, and a vein. The nerve, called the median nerve, enables movement and sensation in the thumb, index finger, middle finger, and part of the ring finger. Carpal tunnel syndrome occurs when pressure builds up on this nerve for various reasons.


What are the symptoms of Carpal Tunnel Syndrome?

Numbness or a pins-and-needles sensation in the hand, especially around the thumb, index, and middle fingers, is one of the most common symptoms of carpal tunnel syndrome.

Wrist pain is also common, and symptoms often worsen at night. People may wake up feeling like their hand is asleep and need to shake or move it to feel normal again. Many also notice weakness in their hand, making it difficult to grasp objects or causing them to drop things frequently.


What are the causes of Carpal Tunnel Syndrome?

Carpal tunnel syndrome is caused by pressure on the median nerve within the carpal tunnel. The most common causes include:

  • Frequent wrist movements, especially bending, straightening, or awkward gripping
  • Poor ergonomics from using a computer or performing tasks inefficiently
  • Using tools or equipment that cause a lot of vibration
  • Swelling and inflammation in the wrist
  • Arthritis, whether rheumatoid or osteoarthritis
  • Injuries like fractures or sprains
  • Changes related to pregnancy

How Do I know If I have Carpal Tunnel Syndrome?

  • If you’re experiencing the signs and symptoms of carpal tunnel syndrome mentioned above, a health professional can confirm the diagnosis.
  • The gold standard for diagnosing carpal tunnel syndrome is nerve conduction studies, but in many cases, it can be confirmed by healthcare providers, including physiotherapists.

How can physiotherapy help with carpal tunnel syndrome?

  • Splinting: Our physiotherapists can prescribe splints to keep your wrist in a neutral position, helping relieve pressure on the nerve. This is particularly important at night when it’s harder to control wrist position.

  • Ergonomic Advice: You can reduce symptoms by avoiding certain wrist positions and activities that increase pressure in the tunnel. Getting your computer setup assessed and improved can also make a big difference.
  • Wrist and Finger Exercises: Moving your tendons within the tunnel can help relieve pressure on the nerves and reduce swelling.
  • Swelling Management: Your physiotherapist can teach you techniques to manage swelling, including the use of heat and cold, as well as some massage techniques. A compression glove might also be beneficial.

  • Nerve Gliding Exercises: Nerves can become tight or restricted just like muscles. If your median nerve is restricted, your physiotherapist may show you exercises to help it glide from your neck all the way down to your fingers.
  • Strengthening: If your muscles have weakened due to nerve compression, your physiotherapist can guide you through strengthening exercises for your thumb and fingers. This will help prevent dropping things!
  • Surgery: A small percentage of people with carpal tunnel syndrome may require surgery. If conservative treatments don’t relieve your symptoms, especially if numbness is constant and weakness is severe, seeking a specialist opinion is recommended. Nerve conduction studies may be performed first to assess the level of nerve compression. If it’s severe, a surgeon might cut the fibrous ligament over the tunnel to relieve pressure. Physiotherapy can support your recovery and rehabilitation if surgery is needed.

What Can I do at home?

Listen to your body and find the activities that aggravate and try to minimize or avoid these activities. If you find activities that give you relief then do these.

  • Wear a splint to support your wrist for up to 3-6 weeks. You may find wearing it at night or when it is most irritated is enough.
  • If your hand is swollen follow the advice from your physio and keep your hand elevated and keep the fingers moving.

Physiotherapist Jewel OH

Pelvic Prime & Physiotherapy

How do you deal with urinary incontinence?

What is Urinary incontinence ?

Urinary incontinence is involuntary loss of urine.

The symptoms are vary : some has occasional dribbles, some has complete loss of bladder control, resulting in fully wetting their pants.


Common types of Urinary incontinence

Involuntary loss of urine during physical activities that put pressure on the bladder

Involuntary loss of urine associated with urgency

Mixed symptoms of Stress urinary incontinence & Urgency urinary incontinence


Stress Urinary Incontinence

Involuntary loss of urine during physical activities that put pressure on the bladder, such as coughing, laughing, or running.

In more severe cases, even simple movements like standing up or rolling over in bed can trigger leakage.


Urgent Urinary Incontinence

Involuntary loss of urine associated with urgency

Urgency= sudden strong desire to urinate with, inability to defer

ex. leakage that occurs when a person experiences an overwhelming desire to void but can’t make it to the toilet in time.


Less common types of Incontinence

When a person is unaware of the leakage until it has already occurred

Involuntary leakage of urine that happens right after urination is completed.

Also known as bedwetting, it involves involuntary urination during sleep.

This occurs specifically during or after sexual intercourse.


What are the Causes of Urinary Incontinence?

The Causes of Stress Urinary Incontinence

The cause of Stress urinary incontinence is Insufficient Uretheral Close pressure during increase in Internal Abdominal pressure.

It could be due to issues with the urethra itself or problems with surrounding structures, such as the pelvic floor muscles.

uretheral issues

  • Weak uretheral sphincters
  • Poor blood supply in uretheral area
  • Scarring of uretheral wall. etc.

surrounding issues

  • Poor bladder neck support due to
  • Pelvic floor muscle – strength weakness, poor endurance, poor co-ordination
  • Poor Pelvic floor fascial support of urethra

These issues could be triggered by pregnancy, childbirth, gynecological surgeries, abdominal surgeries, hormonal changes from menopause, aging, and other factors. Additionally, poor urethral closure function can be worsened by obesity and hormonal changes.


The Causes of Urgent Urinary Incontinence

The most common cause of Urgent urinary incontinence is Detrusor overactivity.

Overactive Detrusor :

  • The detrusor is a muscle in the bladder wall. The primary function is to contract and help expel urine from the bladder during urination.
  • An overactive detrusor muscle contracts even while the bladder is filling with urine
  • Uretheral relaxion Incompetence : Leakage happens due to urethral relaxation the bladder is filling with urine, in the absence of raised intraabdominal pressure or a detrusor contraction.

Does incontinence go away its own?

Since the causes of incontinence can vary, the potential for self-improvement depends on the specific factors involved.

Temporary incontinence, such as that caused by childbirth, a urinary tract infection (UTI), or the acute recovery phase after abdominal or gynecological surgeries, may improve on its own.

Chronic incontinence usually requires more sustained treatment based on a proper diagnosis. Treatment options may include lifestyle changes, pelvic floor exercises, and bladder training, among others.


How to Treat Incontinence?

Once you understand the types and causes of your incontinence, you can begin treatment.

  • Stress Urinary Incontinence : Pelvic floor exercise >= 3 months, supervised pelvic floor muscles training is strongly recommended. Research suggests that supervised pelvic floor exercises result in significantly better outcomes compared to unsupervised exercises. Additionally, it’s important to understand whether your pelvic floor needs relaxation exercises, contraction exercises, strengthening exercises, endurance exercises, or functional exercises
  • Urgent Urinary incontinence : bladder retraining lasting a minimum of 6 weeks. Training correct patterns of frequent voiding, Improve control over urgency and reduce incontinence episodes, Increase bladder capacity, Restore patient confidence to leave the house.
  • Fluid adjustments , Caffeine adjustment,
  • Constipation management
  • Other life style intervention : ie weight loss

When do you need to see a Pelvic health professionals?

  • When incontinence persistent or getting worse despite the pelvic floor exercise or life style intervention
  • When the pain or discomfort are combined, (should visit a health professional as early as possible)
  • Nontonal incontinence (should visit a health professional as early as possible)
  • 6 weeks post partum
  • Post Gynecological surgeries or abdominal surgeries.
  • If you feels difficulties in daily living or basic exercises

 

Jewel OH
Physiotherapist | Director | pppclinic.com.au