Kim Zoellick was six months pregnant with her second child and reaching for a shopping cart when she felt a twinge in her hip and lower back. She couldn’t grab the cart. “What is happening to me?” she wondered.
A family nurse practitioner, Zoellick was on her feet constantly caring for others. At home, she was also looking after her 9-month-old daughter. She’d felt a nagging pain in her back for a while, but nothing severe. That moment in the store made her realize she needed care for herself, so she sought out physical therapy.
“I did it all the way until I delivered my second,” Zoellick said, who later found she’d experienced diastasis recti. “[Physical therapy] brought immense relief. It’s really saved me a lot of struggle to know what to do and a lot of well-being.”
Zoellick knows her lingering pain was a direct result of grueling labor and delivery. Luckily, physical therapy aided her recovery, but for a number of moms, their postpartum pains go untreated.
“Many women think these problems will go away on their own,” rather than seek help, said Chicago-based physical therapist Heather Alaniz, DPT, OCS. “To be honest, [that’s because] these problems are embarrassing!” Alaniz wants moms to know pains related to the birthing process are a normal part of pregnancy, labor, and childbirth. Here’s a run-down of the top postpartum issues Alaniz treats in her practice, and how to address them.
1. Urinary or fecal urgency, frequency, and/or incontinence
If you experience a sudden need to use the bathroom on a regular basis, you have urinary or fecal urgency and/or frequency. In the case of urinary incontinence, you have leaks throughout the day. That means you might find yourself peeing when you laugh, cough or put other stress on your bladder, or if you can’t make it to the restroom on time. Likewise, if you experience bowel leakage you cannot control, you may have fecal incontinence. Some moms experience urgency, frequency, and incontinence.
How to Treat It
Alaniz says urinary or fecal urgency and/or incontinence is the number one postpartum complaint she treats in moms. With any urinary issues, she’ll work with a patient to strengthen their pelvic floor muscles through kegels and bladder retraining. “Over 60 percent of people do kegels wrong or do kegels when they shouldn’t be doing them,” Alaniz said, so she recommends moms interested visit a clinic to get a pelvic floor exam and, if needed, learn kegels from an expert.
Bladder retraining begins with creating a schedule for peeing (yup) but is shown to decrease bathroom trips over time as muscles strengthen. For fecal issues, Alaniz works with patients on exercises that strengthen anal sphincter – the muscles that control bowel movements – and examines their diet.
2. Abdominal separation
Abdominal separation often occurs when your pregnant belly puts pressure on your abs causing a gap between your rectus abdominis muscles. Moms with this condition report their stomach almost looks curved like it’s carrying a baby, even months after giving birth. “More concerning is it can contribute to trunk/core instability leading to low back, hip, abdominal, and even lower extremity pain,” Alaniz said.
How to Treat It
Strengthening your core through exercise is key, but some forms of ab work can do more harm than good. That’s why, again, Alaniz recommends meeting with a physical therapist to learn specific core and ab strengthening exercises to treat abdominal separation. Alaniz also says learning and practicing proper body mechanics for everyday activities motherhood demands – such as picking up and putting down your child for a diaper change – combined with pelvic floor work aid recovery.
3. Pelvic organ prolapse
Pressure from childbirth can weaken or loosen the muscles surrounding your pelvic organs (uterus, bladder, and rectum). When a mom has pelvic organ prolapse, she may feel pressure or fullness in her pelvic area caused by one or more of the pelvic organs pressing into or out of the vagina.
How to Treat It
For the majority of moms Alaniz sees, pelvic floor strengthening exercises will relieve pelvic organ prolapse. However, “if it’s more severe, a removable device (called a pessary) is inserted into the vagina to support the pelvic organs,” Alaniz said. “In rare cases, surgery is required.”
4. Pelvic pain and/or painful sex
Vaginal tearing or an episiotomy during childbirth often cause pain in your pelvic area, which may make sex painful. No matter what type of birth a woman has, it’s possible a mom might experience this issue due to hormonal changes and tender floor muscles, Alaniz said.
She also notes that typically your doctor or midwife will recommend avoiding sex for up to six weeks postpartum to allow for pelvic rest and healing. “Once you feel ready to try sex again, it is normal to have pain and discomfort the first couple of times but after that, it should get better,” Alaniz said. “If it doesn’t, then tell your doctor and go see a pelvic floor physical therapist.”
How to Treat It
Alaniz guides patients through mobility exercises engaging both the abs and pelvic floor muscles. Lots of stretching and “making sure [moms] not only can perform a kegel but also relax those muscles” is also part of the treatment. Pain can be reduced with physical therapy, she said.
When to see a doctor
“Anyone who is experiencing urinary or fecal urgency, frequency, or incontinence; symptoms of pelvic heaviness or discomfort; and other postpartum issues such as low back pain and shoulder pain pelvic pain, should first see their doctor,” Alaniz said.
In the best case scenario, moms would share these symptoms with their OB or midwife at their six-week postpartum checkup, and receive a prescription for physical therapy. But there’s so much going on physically and emotionally as a women transitions to motherhood, symptoms can be missed or glossed over.
A mom herself, Alaniz gets it: “Who has time after having a baby and getting used to motherhood, or if it’s not your first child getting used to having another child around, to take the time to address these issues?”
Whatever stage you are in, if you find yourself coping with postpartum pain, know you are not alone. The best advice Alaniz has for moms dealing with such issues is to not put off visiting their OB or midwife and go see a pelvic floor therapist. In her work as a physical therapist, Alaniz sees women years out from childbirth who are still struggling with these same issues. And, she adds, “These issues tend to show up again after you have more children and, very commonly, after menopause when hormones change. They are much harder to treat when they are chronic issues, so address them now!”
Pelvic floor physical therapy can be home-based depending on the severity of your symptoms. Three to four visits to work with a physical therapist may be all you need to treat and prevent issues, Alaniz says.
In Zoellick’s case, she visited the physical therapist regularly but now does her exercises from the comfort of her home. She knows the self-care she practices in managing her pain make her a better nurse, wife, and mom. “To this day, I still try to do my postpartum core exercises every day,” she said. “I try to encourage anyone who has the time or resources to go to physical therapy, it’s such a benefit.”