#AskTheExpert: Anastasia Uvarova: The Pelvic Floor Part 3 – Post-birth and Pelvic Floor Function For Life

We’re very pleased to have Anastasia Uvarova joining us again in the final article of this 3-Part series on the Pelvic Floor. Previously, we talked about how Pelvic Floor muscles change and adapt during pregnancy and in the actual process of labour and delivery. Today, Anastasia will cover the aftermath of delivery, before moving on to recovery and the return to normal daily activities.

With so many changes occurring and issues affecting our Pelvic Floor function during pregnancy, labour, delivery and post-birth, we guessed that you would want to hear quite a bit about it! So, we’ve done a three-part #AskTheExpert with Anastasia Uvarova on this topic, with: Part 1 covering the Pelvic Floor changes that occur during pregnancy and what it’s important to know during this stage of your life; Part 2 discussing the Pelvic Floor Before, During and Immediately After Birth and today’s conclusion to this series – Part 3 – telling you more about your Pelvic Floor Post-Birth and how to maintain healthy function for life.

What should I expect sensation-wise after giving birth?

There is no single answer to this question. This all depends on your mode of delivery, the length of the pushing stage, the use of instruments, the size of your baby, any tears that may have occurred and your pain threshold. Immediately after a vaginal delivery, many mums experience a very specific sensation of a heavy Pelvic Floor and they struggle to stop the flow of urine at all. This is normal at this stage, where your Pelvic Floor muscles were overstretched to their maximum and need time to “bounce back”. Pain can be present as well to various degrees and stiches can create an occasional burning sensation. After a caesarian section, pain is usually concentrated in the lower abdominal area. The sensation of an absolute inability to contract tummy muscles can occur, but this has a protective purpose: stiches need to heal in peace, without any force applied to them. Medical staff will advise you on effective and safe pain relief.

Do I have to check my Pelvic Floor after birth (from either a vaginal or a caesarian section)?

The short answer is: no, you do not have to. In Cyprus there is no unified protocol regarding Pelvic Floor aftercare specifically. Your doctor will ensure that any scars are healing well, no infection is present and if you have no major complaints, you will be discharged from maternal care. In many European countries such as France, it is a standard practice to send a woman for a Pelvic Floor specialist check-up and undergo a Pelvic Floor rehab program if necessary. However, from my experience, problems emerge later, after a woman has returned (or made an attempt to return) to usual daily activities. Suddenly, Zumba classes are causing her to leak and a 30 minute light jog will leave her with a bruised and heavy Pelvic Floor sensation for days. Exactly the same applies to caesarian mums. Diastasis rectus (abdominal separation) is more common after a C-section and pelvic pain can also affect C-section mums. So, if you feel that you are not reaching your full potential, recovery-wise, there is no harm in going for a check-up. 

Is there anything I can do to speed up my recovery?

It may sound paradoxical but in order to facilitate recovery, rather than doing something, you should just “hibernate” and give your body time to heal. Good hygiene, paced-activity and if at all possible, rest, are very important. The last thing that your Pelvic Floor or abdominal muscles need right now is to overload them with a prolonged upright position or a prolonged length of time sitting on your perineum. I do advise mums who have had a vaginal delivery to use “spanx” type or another supportive style of underwear in order to help support their back, inner organs and diaphragm. Special post C-section corsets are also available for the same reason. However, everything should be according to your comfort level: if you do not like it or it does not feel right there is absolutely no need to force yourself into a support belt. A small soft round pillow may be of help when sitting if you have perineal stiches.

I want to return back to my fitness routine, can I just hit the gym as before the pregnancy? Is there anything in particular I need to avoid doing/pay particular attention to, exercise-wise?

I have seen many women who have just put on their yoga pants and whizzed through their pre-birth fitness routine like nothing ever happened. I also know many mums who have said that they are planning on returning to their Pilate/yoga/cross-fit class next week and get up from the chair to the bed like they have been in a major accident. So, as a physiotherapist I use three “F’s” before a woman can start back to her full pre-pregnancy routine: Full Function First.  Everyday movement should be normal, pain-free and as effortless as they were before birth.  For those who like numbers, I suggest a minimum of 2 weeks after an uncomplicated vaginal birth and 6 weeks after an uncomplicated C-section, but it varies by individual case. Safe basic post-partum exercise can be initiated early, and pace should be increased slowly over the course of 4 weeks or so (again, this is a bit of a generalisation).  In addition, I urge women to check for diastasi recti before they start doing planks; the wrong exercise at the wrong time can have long-term consequences.

I have had vaginal stiches; do I just leave them as they are? 

Firstly, good hygiene is a must and a post-partum check-up to make sure healing is on track and no infection has occurred. Stiches create scars, and scars can impair the mobility of your tissues and create a variety of unpleasant sensations. I often work with post-operative scars and if a person can reach for them comfortably, (on a shoulder for example), I will teach them how to self-scar release. The same goes for your perineum: if a scar creates problems, I will teach a woman how to work with it providing all other sources of possible inflammation have been excluded by the doctor. 

What about a C-section scar?

What it is important to remember about caesarian scars is that there is more to it than meets the eye. You may have a barely visible scar but since several layers have been stitched (your womb, muscles, fascia and skin), pain, discomfort and adhesions may be present at the deeper, invisible, layers. Therefore, I encourage women to self-release and massage their caesarean scar in a way that goes deeper than the skin. It also helps them to overcome fear of their scar (yes, I have mums who are afraid to touch it!) and help reduce sensations such as numbness, itchiness and pulling.

How can a Pelvic Floor dysfunction post-birth affect my sexual life? 

A question that many are afraid to ask but everyone wants to hear the answer! The good news is that in the majority cases things will get better with time. It is important to remember that hormones are also in play and they affect the Pelvic Floor muscles and vagina in particular. It is normal to experience some discomfort, dryness and initial pain but things should get progressively better. Most mums will be able to enjoy a normal sex life after some time and here, timeframes vary greatly. A lot of patience, mutual understanding, extra lubricants and time will help you to get back to normal. However birth trauma, in both the physical and psychological sense, can make it much harder to be intimate. If pain persists or makes it impossible to initiate, continue or complete a sexual act and if pain, burning and pulling is persisting post-intimacy and affects your relationship, seek medical advice. Reasons for this can vary greatly: from organ prolapse, fistulas, inflamed scars and a misplaced uterus, to undiagnosed bleeding and infection. In these cases, a multi-professional approach is best.

I would like to conclude this series by advising any woman, whether you are a mother or not, that it is important to recognize the unique structure of your body and its complex function. Our Pelvic Floors are our ultimate support muscle that serves us for life and allows us to function in an anatomical context (regulating the exit of bodily contents, childbirth etc.) as well as a social one (the ability to stay continent and enjoy intimacy for life). It deserves recognition and needs to be taken care of via regular exercise routines and a healthy lifestyle. Investing regular time and effort now, to help sustain healthy Pelvic Floor, will pay off in the long run! 

Thank you Anastasia, for taking the time to answer our questions and for  informing our readers about the necessity of caring for our Pelvic Floors, from the time before we get pregnant, throughout pregnancy and birth, delivery, post-birth and our future lives. It’s so easy to ignore problems in this area and to not seek the help that we need… we hope that this three-part series gives a lot of you the impetus needed to go get checked and seek multi-professional help to improve your muscles in this area – for an easier birth, fewer problems post-birth and an intimate, incontinence-problem-free future!

Anastasia is a practicing, qualified Physiotherapist and Clinical Pilates Instructor, with a special interest in musculoskeletal (MSK) dysfunctions in pregnancy, Pelvic Floor dysfunctions and post-partum rehabilitation. She acquired her training from the University of Bradford, UK and later the Pelvic, Obstetric and Gynecological Physiotherapy Association, UK. Working for five years as an MSK Physiotherapist and after having two children of her own, Anastasia has seen firsthand the extended physical struggles women can experience post birth as a result of poor Pelvic Floor function. Anastasia’s passion about this subject has motivated her to raise more awareness of woman’s health and continence issues in Cyprus. Anastasia has written several Physical Health- and Fitness-related articles for the online media in both Russian and English and has presented this topic in a number of public presentations for both professionals and the general public. She believes that a gradual and individual approach to physical well-being in pregnancy and post birth is the key to helping avoid many complications later in life.

A-Z Physio Health offers a professional consultation and treatment on pelvic floor, musculoskeletal dysfunctions and clinical Pilates (private and groups) in pregnancy and post-partum. You can find and contact us on Facebook @azphysiohealth, visit our website www.azphysiohealth.com or call 22446988 for more information.

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