The 4th Trimester: Postpartum Pain is Common but not Normal, Part 2

In Pregnancy and Postpartum Pelvic Health by Courtney EdgecombLeave a Comment

By: Courtney Edgecomb

In Part 2 of my 2-part post I will cover different therapeutic strategies for postpartum pain. 

As a new mom, self-care and appropriate medical attention is critical to ensure you stay as healthy as possible for your little one. I am sure it is daunting to find time for yourself at the moment, but it will help you adjust to a pain-free life with a newborn. Finding a way to incorporate self-care into or around attending for your newborn can help you check it off the list! So, where do you start with self-care as a mother?

All new moms should have an evaluation with a pelvic floor physical therapist within a year of delivering. However, if you have pain we recommend seeing a pelvic floor physical therapist sooner, as early as 6 weeks. In Part 1 of this series, we covered the drastic ways your body changes throughout pregnancy and childbirth, and sometimes the body doesn’t always magically heal on its own. A pelvic floor physical therapist will perform an evaluation to determine which muscles, connective tissue, scar tissue, nerves, joints, or movement patterns are contributing to your pain. Your PT can also assess for diastasis recti and pelvic floor motor control (correctly moving your pelvic floor muscles on your own). By talking about how and your pain bothers you, your PT will uncover the specific motions, activities, positions, and postures that are the underlying factors. From there, various physical therapy treatments for postpartum women can include:

  • Manual therapy and nerve glides
  • Therapeutic exercise (and no, not everyone needs to do Kegels!!)
  • Neuromuscular re-education to address movement patterns and control over your muscles
  • Body mechanics (especially with a growing baby on your hands)
  • Postural re-education
  • Guided and progessive diastasis correction exercises
  • Self care strategies
  • Coordination of care with your other medical care providers (when needed)

While we recommend that all postpartum women see a pelvic floor physical therapist, there are a few things new moms can tackle now to reduce discomfort. Here are some take-home tips:

  • Topical hormonal creams
    • Seek consultation from an OB/GYN for guidance on topical hormone treatments that may be right for you. This will help vulvar tissue healing which can be perpetuated by the lack of circulating estrogen if you are breastfeeding. 
  • Lubricants
    • Using lubricants during sexual activity can reduce dryness and irritation. Look for a water-based lubricant such as Slippery Stuff. Coconut oil is a good alternative.
  • Scar mobilization
    • Using the tips of your fingers and a small amount of lotion if needed, move you hand over your scar in all directions with a moderate amount of pressure. Perform this a couple times a day for up to 5 minutes. Scar mobilization helps increase tissue mobility, decrease sensitivity, and realign the scar tissue from a C-Section, episiotomy, or tear. If this causes pain, stop and seek consultation with a medical provider. 
  • Proceed with caution when it comes to Kegels 
    • Kegels are not appropriate for everyone with pelvic pain or dysfunction, and it is best to be assessed by a pelvic floor physical therapist to determine if they are right for you! 
  • Diaphragmatic breathing
    • Lie on your back in a comfortable position. Place one hand on your belly and one hand on your chest. As you inhale, the hand on your belly should rise first and much more than the hand on your chest. As you exhale, the hand on your belly should fall. Repeat. Perform this at least one time a day for 3-5 minutes. Diaphragmatic breathing helps to calm the nervous system, stretch the pelvic floor muscles, and decrease tension.
  • Meditation
    • Guided meditations can be found on YouTube or through various apps like Headspace, Calm, Simple Habit. Daily medication can help calm the nervous system, decrease tension, and reduce pain. 
  • Foam rolling
    • Use a foam roller to self-massage the muscles and connective tissue in your lower back, buttocks, thighs, groin, and hips. Roll for about a minute per area/side. Foam rolling helps to increase blood flow, loosen muscles and connective tissue, and decrease pain.

As you have seen through Part 1 and 2 of this blog, postpartum pain is common, but not natural. At PHRC, we have a team of therapists who are ready to help you through the postpartum journey! A pelvic floor physical therapist will be able to adapt your treatment for appropriate postpartum care and the lifestyle changes that come along with caring for a newborn. A PT will guide you towards safe and effective exercises that won’t aggravate your pain or increase strain to your pelvic floor. Postpartum yoga and pilates isn’t always the best place to start, especially when any of the symptoms in Part 1 are relevant. Typically it is best to calm those symptoms, reduce tissue dysfunctions, improve motor control, and restore pain-free activity. Whether your goal is to return to exercise or sit on the ground to play with your baby,  a PT will help you reach your goals with a tailored plan of care. At PHRC, we also help manage your team of medical providers so that all angles of your needs are met! And if you wish, your bundle of joy can tag along to appointments at PHRC!

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