Childbirth is no picnic: 85% of women who deliver vaginally experience perineal trauma and a third of those women in the USA and UK require stitches.2 The thought of having another baby after having gone through a traumatic birth can be daunting, to say the least. Returning to sex can also seem like a feat, especially when pain is involved. Pain with sexual intercourse, medically known as dyspareunia, and pain in the perineum, are common experiences for postpartum women.1 According to Kettle C et al, up to 10% of women will have continued perineal pain at 3-18 months after delivery, up to 25% will have dyspareunia or urinary problems, and up to 10% will experience fecal incontinence.2 The severity and duration of the pain correlates with the severity of the tear.3 None of this is meant to scare you, but the statistics are significant: this is why all postpartum women need pelvic floor physical and occupational therapy. And for those of you who have had a traumatic birth and are contemplating another baby, but are scared to go through delivery again, here’s a great story to give you hope!
You may remember Sarah from a blog post I wrote last year. She is one of the 85% of women who experienced perineal trauma and one of the 25% who had dyspareunia. Sarah had a traumatic birth and sustained a significant perineal tear. Here’s a recap of her birth story.
Sarah reports she delivered her baby vaginally in lithotomy position (on her back with her feet in the stirrups, like in the movies). She felt a strong urge to push and started to bear-down. The nurse asked her stop and wait for the doctor. Twenty minutes later the doctor arrived. Sarah reports she pushed once and the baby arrived fast. She sustained a 3rd degree tear along the perineum, meaning that she tore from the perineal muscles down to her anal sphincter. Sarah stated she attempted intercourse once, sometime later, but stopped due to severe pain. During her evaluation with me, she described her pain as “like having razors” along the entrance of her vagina. She reported a “hard nodule” right at the entrance, which was painful during sex. Sarah had been unable to participate in sex due to this pain, and had felt discouraged about her plan to have multiple children. She had confided in her friend about her pain and her friend had encouraged her to seek pelvic physical and occupational therapy.
Cases like Sarah’s are all too common. Fortunately, Sarah initiated pelvic floor physical and occupational therapy, and was able to overcome the pain and discomfort. Within 11 treatments, she was able to return to sexual intercourse without any discomfort. In 2016, Sarah became pregnant with her second baby. We were all very excited about the news! She emailed me that she was concerned she would have a second traumatic birth. Her fears were understandable but I’m very glad she contacted me. I asked her to come in so that I could re-assess her and give her some helpful tools for the birthing process. The scar tissue from the 3rd degree tear with her first baby continued to no longer bother her – in fact, it looked good. Her pelvic floor and pelvic alignment was all within normal limits. To set her up on the right path for success with her second delivery, we went over the following; perineal massage, breathing techniques for pushing, different positions to deliver in, and things to discuss with her doctor, such as her birth plan.
Earlier this year, Sarah contacted me to let me know she had a successful birth. She reported that while she did sustain a 1st degree tear, it felt significantly different from her first delivery and she was quite pleased. She didn’t have the pain that she had with the first baby. Sarah had a follow-up visit with me at six weeks postpartum. Her 1st degree tear had healed and she had no pain or discomfort during the exam. She also reported that she had no pain with sexual intercourse, and that she felt confident that she could go through another delivery if she wanted to.
So, don’t let statistics and pain scare you. With the right treatment, you can overcome traumatic births and set yourself up for an easier path with the next birth.
To find a pelvic floor physical and occupational therapists in your area please visit here. To find a psychologist in your area who can help with the stress of a traumatic birth, please visit here.
References:
- Barrett G et al. Women’s sexual health after childbirth. BJOG 2000, 107 (2), pp. 186-195.
- Kettle, C and Tohill S. Perineal care. BMJ Clin Evid. 2008; 2008: 1401. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907946/
- Leeman L and Rogers R. Sex after childbirth. ACOG 2012, 119 (3), pp 647-655.
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical and occupational therapy?
Pelvic floor physical and occupational therapy is a specialized area of physical and occupational therapy. Currently, physical and occupational therapistss need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical and occupational therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical and occupational therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical and occupational therapists will take a detailed history. Following the history the physical and occupational therapists will leave the room to allow the patient to change and drape themselves. The physical and occupational therapists will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical and occupational therapists will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical and occupational therapists will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical and occupational therapists will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical and occupational therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical and occupational therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical and occupational therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical and occupational therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical and occupational therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical and occupational therapistss who work at PHRC have undergone more training than the majority of pelvic floor physical and occupational therapistss and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical and occupational therapistss focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical and occupational therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
Good content.
I had a similar experience with my first child. I had pain for over a year that didn’t allow me to have sex with my husband. When I asked my male family doctor about it the response I got was, “it is scar tissue and it will take awhile to heal, in the mean time there are other ways to have sex.” I was devastated by this response. I did not know about pelvic health physiotherapists and wish I did.