Scar mobility: perineal and Cesarean
Scar tissue mobilization can reduce scar tissue and ease any discomfort, pain or sensitivity if you have had an episiotomy, perineal tear or cesarean birth. If you have had an episiotomy or a perineal tear, the scar tissue around the area can become tight and may become attached to layers below. This may cause discomfort during intercourse and during activity. Scar tissue from a c-section can cause numbness, pain, and tightness in the lower abdomen, restrict bladder mobility, or restrict superficial nerves. It can also be difficult to activate your abdominal muscles, leading to subsequent feelings of weakness or back pain. After your 6 week check with your OBGYN or Midwife, schedule a 6 week postpartum check with a pelvic floor physical therapist. Once the scar has healed, we can begin scar tissue mobilization and restore the mobility and function of the muscles surrounding the area.
Diastasis Rectus Abdominis (DRA)
Rectus Diastasis is the separation of the rectus abdominis muscle (6 pack muscle) that occurs during pregnancy. It may cause a bulge to occur when a pregnant woman attempts to move, especially visible when going from lying to sitting. The connective tissue (Linea alba) joining the two strips of muscles (rectus abdominis) down the middle of the abdomen stretches due to the growing uterus. Every woman’s abdominal muscles will widen and stretch to varying degrees during pregnancy. This is what the muscles are designed to do. Women may notice discomfort with stretching of the Linea alba at any time throughout pregnancy, however particularly in the 3rd trimester. An essential part of the management for rectus diastasis in the first 6-8 weeks postpartum is the use of a compression garment (abdominal muscle support) such as, Tubigrip (‘boob-tube’ type elastic fabric band) or SRC shorts. In addition to a compression garment, it is often a good idea to have a thorough assessment by a pelvic health physical therapist, who will create a specifically tailored exercise program. A variety of ‘core’ exercises can be prescribed depending on which exercises create a satisfactory instant reduction in your separation and if present, minimize herniation or coning/bulging. We will also work on pelvic floor muscle coordination and function, managing pressure, strengthening of muscles surrounding the core including the low back, and hips. It is never too late to begin rehab of your abdominal muscle separation.
Postural related neck and back pain are common postpartum. Due to the shift of your center of gravity extra strain is placed on your postural muscles in your back and neck. Although your baby is no longer in your uterus, these postural changes can remain and continue to cause pain and dysfunction. Many tasks postpartum involve leaning over and looking down to feed and care for you baby and this along with lack of sleep and no time for exercise can contribute to ongoing pain. PT can help restore your spinal alignment, strengthen your postural muscles, modify your daily activities and get you feeling like yourself again.
Pelvic Organ Prolapse (POP)
Pelvic Organ Prolapse (POP) is the slipping of one of the pelvic organs out of place causing the descent of one or more of the vaginal walls. The 3 most common organs to lose support are the bladder which pushes on the anterior wall of the vagina (traditionally termed a cystocele), the rectum pushing on the posterior vaginal wall (rectocele) or the uterine descending down the center of the vaginal canal (uterine prolapse). Some risk factors for having POP include history of a vaginal birth (particulary with forcep/instrumental delivery), family history and genetics, joint hypermobility/connective tissue disorders, being overweight or obese, chronic coughing or constipation. The main symptoms include feeling or seeing a vaginal bulge, feeling heaviness or a dragging sensation vaginally (often feels like you are sitting on a ball), low back ache, having to split or use your finger to manually assist with defecation, and in severe cases bleeding or infection. Other urinary symptoms include a slow stream, feeling like you have not completely emptied your bladder, increased frequency of urination during the day (more than 10x), needing to tip your pelvis forward or backward to urinate. Some bowel related symptoms may include constipation. fecal urgency or incontinence, or a feeling of incomplete bowel emptying. Other symptoms may include pain with intercourse often described as a deep thudding or hitting sensation or feelings that vaginal penetration is impeded. Pelvic floor Physical Therapy should be offered to all women with POP as a first line of management. Even if surgery is indicated in the future, beginning pelvic floor Physical Therapy before surgery can help optimize your pelvic floor and improve post op outcomes. Pelvic floor Physical Therapy for POP may include:
- Education on normal bowel and bladder habits and techniques to minimize the strain on the pelvic floor muscles
- Lifestyle changes which can include proper lifting mechanics, breathing, avoiding constipation, proper pressure management during every day activities to reduce the strain on the pelvic floor muscles
- Regain control over your pelvic floor muscles- learn how to properly contract and relax your pelvic floor muscles at the right time. Depending on what your pelvic floor needs we may work on coordination, strength, endurance or power.
- Manual therapy for the pelvic floor muscles and muscles surrounding the pelvic floor when needed
- Exercise to help
Following your 6-week check with your OBGYN or Midwife, everyone should attend a 6-week post-partum check with a Pelvic PT. The aim of the 6-week check is to assess the state of your body postpartum and make a plan to achieve your goals. At your appointment we will go through your birth story, ask questions about your bladder, bowel and sexual health, any pain you are experiencing, and answer any questions you have about the postpartum journey. Following this we will go into an objective assessment to assess your posture, strength, function and breathing patterns and investigate any pain you have. We will check for diastasis rectus, and assess your pelvic floor muscles. Depending on what you are comfortable with this can be internal or external or none. With the pelvic floor muscle assessment we are looking for healing of any scars. Levator ani avulsion, prolapse, pelvic floor muscle strength, endurance, coordination and tone. This is not limited to the immediate postpartum period. If you have ever given birth (vaginally or by cesarean) you are considered postpartum and can be treated for any issues related to your pregnancy or delivery. It is never too late to be screened for perineal restrictions/scar tissue, POP, diastasis recti, tailbone pain and suboptimal movement patterns that include the neck, hips and back.