By Anna Scammell
Masters-trained Women’s Health & Pelvic Floor Physiotherapist
Since pregnancy and childbirth is such a transformative time physically, it’s critical that every woman knows how to look after her pelvic floor. This isespecially pertinent in the event of a perineal tear, episiotomy or instrumental vaginal delivery (forceps or suction).
Optimising your pelvic floor recovery following childbirth will help to prevent unwanted issues, such as prolapse https://www.thewholemother.com/prolapse-all-your-questions-answered/, incontinence or pain with intercourse.
Here are 16 Strategies to Help Optimise Your Pelvic Floor Recovery:
1. Know the Details of Your Labour.
Often there is so much going on during the birth of your babythat women don’t know to ask the details of their birth. So make sure you find out:
- If you had a tear and if so, where is it and what grade is it.
- If you had an episiotomy.
- If forceps or suction were used.
This information is important to give to your Women’s Health Physiotherapist down the track.
2. Personal Hygiene.
- Make sure you keep the area clean and dry.
- Wash your perineal area with water (no soap) and gently pat yourself dry after a shower.
- After urinating pat the area from front to back with toilet paper.
- Avoid rubbing the area.
- Wash the area with water after you use your bowels.
- Change your sanitary pad every 4-6 hours.
3. Ice and Compression.
The vaginal area is likely to be inflamed and swollen after childbirth so ice and compression will help to reduce this and provide pain relief. A good idea is to ask the nursing staff to put some of your maternity pads in the freezer. Put the cold pad inside a supportive pair of underpants to provide some comfortable compression.Ice is in particularly important intermittently in the first 48 hours after birth, but if it is soothing for you then continue to use it when you go home.
Once you are able, I also recommend wearing a compression garment (SRC recovery shorts) to provide your pelvic floor and abdominal muscles with support.
4. Pain Relief
Your doctor will prescribe you with pain relief when you leave hospital. Make sure you take it if the area is painful.
5. Start Gentle Pelvic Floor Contractions Day 1
A key strategy to maximizing pelvic floor recovery is starting gentle pelvic floor contractions the day after giving birth (even if you have had stitches). This helps to increase circulation to the area and reduce swelling. Gentle pelvic floor exercises also help to re-activate neural pathways to these muscles to regain strength and motor control over time. I recommend doing little bits often, so 4-5 gentle pelvic floor contractions each time you feed your baby. Focus on gently lifting the pelvic floor and then releasing the muscle completely. Breathing into your belly between each contraction can help to achieve complete relaxation.
The key to pelvic floor exercises is doing them correctly. Hopefully you saw a Women’s Health Physiotherapist during your pregnancy to teach you this, but if not, you can download my FREE Pelvic Floor Guide here: https://www.thewholemother.com/freebies/. As the days and weeks progress work back up to your normal pelvic floor regime pre-birth.
It is a common misconception that women who have a caesarian section will be free from pelvic floor issues. The weight of the baby in utero on the pelvic floor can be enough to create pelvic floor weakness postpartum. As a result, pelvic floor exercises after birth are essential for all women.
Prioritise rest in the first 1-2 weeks after birth to eliminate gravity from adding extra downward pressure on your pelvic floor. It’s important for you to both move about as you feel comfortable and spend some time lying down/sleeping to encourage healing of your pelvic floor or c-section. If you experience any vaginal heaviness or dragging sensation, make sure you spendtime off your feet, especially at the end of the day. If you are able to breastfeed your baby lying down, then this is another good chance to maximize rest.
Optimal posture and body awareness in these early days will also set you up for a better pelvic floor and core recovery. Make sure you sit & stand upright, lengthening your spine and gently drawing your shoulder blades back. It is important to get into good postural habits as soon as possible after you have your baby. This is because an upright position (rather than slumped) isthe optimalposition to start exercising your pelvic floor & deep abdominal muscles.
8. Mindful Movement.
Be mindful of the way you move to avoid putting pressure through your stomach and pelvic floor. Examples are:
- Roll to one side to get out bed instead of sitting straight up
- Avoid lifting your suitcase, pram or other children in the first few weeks.
I recommend doing a pelvic floor contractionbefore you lift your baby in and out of their bassinet or car seat.
9. Avoid Constipation/Straining.
In order to promote healing of your pelvic floor, it’s important that you do not strain to use your bowels. Ensure you keep your diet high in wholefoods, especially fruit and veggies, and drink 2-3L of fluid (especially water). This may involve organising your partner or family to bring healthy meals into hospital to ensure you are getting adequate nutrients and fibre, as we all know that hospital food can be less than desirable!
It may be a good idea to use a laxative in these early days after childbirth, to soften your bowel motion and prevent straining. Your nurse should provide you with a laxative, or otherwise ask. If you are prone to constipation, continue using the laxative when you get home.
The way you sit on the loo will also help you to avoid straining. Click here to see how: https://www.thewholemother.com/my-top-tips-for-treating-constipation-improving-gut-health/
10. Support your Perineum.
Manually supporting your perineum (vaginal area before anus) when you are using your bowels is a good idea if you have had stitches. To do so, fold over toilet paper and hold it on your perineumapplying some pressure with your fingers. You may also want to support the area with your hand when you sneeze, cough or laugh.
11. Reconnect to your Vagina.
It is common for women to disconnect from their vaginal area after pelvic floor injury or a traumatic birth, as the area feels different/strange/uncomfortable and they don’t feel like themselves. It’s really important to recognise that your body had just achieved an amazing feat of giving birth, and your vagina is not meant to bounce back and feel “normal” straight away. Disassociating or ignoring your downstairs area can contribute to dysfunction down the track. So know that your vagina is likely to feel or look different to before you had your baby for awhile, and this is OKAY! Your pelvic floor is currently healing, just like any other muscle needs to heal after an injury. The ability of your pelvic floor to heal and recover will be heightened by the amount of care & attention you give it.
I recommend eventually getting a small mirror and looking at your vagina. It’s important to accept what you see. This might sound daunting to many, but your vagina is an incredibly primitive part of your body, and should be treated with the same respect as any other area.
12. Breathing and Relaxation.
Another effective way to reconnect with your vagina is to comfortably lie down on your side in a relaxing environment (ie. when your baby is sleeping), close your eyes and start breathing into your belly (rather than chest). This allows your diaphragm to descend and helps relax your pelvic floor.As you do it, imagine the breath moving down into your pelvis, to your pelvic floor, bringing healing energy to it. This technique is called diaphragmatic breathing.I recommend doing it for 5-10 minutes daily.
Breathing and pelvic floor relaxation is also really important to help prevent the development of pelvic floor tension or overactivity, which can occur as a protective response to birth injury or trauma. Because pelvic floor overactivity can lead to pain with intercourse, I recommend all women prioritise diaphragmatic breathing.
During the day, it is also a good idea to bring your awareness to your pelvic floor. Are you sucking it in without even realising? If so, breathe into your belly and soften through your stomach, letting your pelvic floor muscles relax. Remember the aim of pelvic floor recovery is not to suck it in all day long.
13. Women’s Health Physiotherapist Assessment.
At 6-weeks postpartum it is essential that every womanhas an assessment with a Women’s Health & Pelvic Floor Physiotherapist. We specialise in pelvic floor recovery and perform thorough internal assessment of your muscles. We will assess for pelvic floor tension or overactivity, pain, prolapse, pelvic floor strength, endurance, motor control, and set you up with an exercise program specific to you. We will also provide manual therapy for the treatment of pelvic floor overactivity or scar tissue, and give you lifestyle advice.
14. Self-massage for scar tissue.
After your 6-week check up with your Doctor and your scar has healed, I recommend regularly massaging your scar with your thumb/fingers using a natural lubricant or oil tohelp soften the scar tissue. This is because scar tissue and increased sensitivity in the area can lead to tension and pain in the pelvic floor muscles. Your Women’s Health Physio can teach you how to do self-massage.
15. Return to sex without pain.
Returning to intercourse following childbirth will be different for every women depending on multiple factors, but is not safe until after your 6-week postpartum check up with your doctor. For some women they may not be ready for several months.
Whilst sex for the first time may feel uncomfortable or different initially, it should not be painful. If it is, make sure you stop and do not push through any pain. Instead speak to your Women’s Health Physio to assess why this might be the case.
16. Returnto exercise safely.
How and when you return to exercise post-birth is very important for your pelvic floor recovery. Your Women’s Health Physio will guide you on this as every woman’s birth experience and pelvic floor is different.
Some Guidelines are as follows:*
- 0-6 weeks: Focus on pelvic floor and gentle core muscle exercises, postural exercises, gentle walking and stretching.
- 6-12 weeks: Postnatal Pilates or yoga, low-impact cardio exercise like walking, swimming and light strength training.
- 3-6 months: Progress core work and Pilates, gradually increase intensity and duration of low-impact cardio & strength training, introduce light jogging.
- 6+ months: Progress all of above, introduce higher-impact exercise like jumping, running if that is a goal of yours.
*It is imperative that you do not experience any vaginal heaviness (prolapse), bladder leakage, pain or abdominal doming during or after any exercise.
For more information on the safe return to postpartum exercise grab my FREE Guide here: https://www.thewholemother.com/freebies/
Anna Scammell is a Masters-trained Women’s Health & Pelvic Floor Physiotherapist in Sydney, and Founder of www.thewholemother.com. Anna consults out of Sevenways Health Centre in North Bondi, offers home visits to women around Sydney and online consults. She combines her 10+ years of clinical experience, evidence based knowledge, and passion for health & wellbeing. Anna’s mission is to educate, empower & inspire as many women as possible to be the best version of themself during their childbearing years and beyond.