December Knowledge drop
Each month for our newsletter, the Lady Blurb, we'll share answers to some pelvic health questions you've submitted. The questions below were taken directly from you! To submit a question for next month, comment below or email us at contact@ladybirdpt.com.
**The answers to these questions are not meant to be used as medical advice. These answers are not meant to take the place of a skilled physical therapist or discussion with your medical provider. If you are experiencing concerning symptoms, please contact your physician.**
This month, we’re answering:
1. What can I do about perineal pain postpartum?
2. I’m 39 weeks pregnant and just learning about pelvic health. Is there anything I can do in this next week to prepare my pelvic floor?!
1. What can I do about perineal pain postpartum?
Perineal pain is incredibly common after childbirth, particularly following vaginal birth, however it can also occur after a cesarean. Some common causes of pain include perineal tearing and instrument assisted birth, but it’s important to remember that all birth creates some degree of trauma to the pelvic floor. After childbirth, this tissue heals and ideally by week 3-6 perineal pain has significantly improved. But what if it doesn’t and after 6 weeks of healing you’re still in pain?
If you’re still in pain after 6 weeks, the first step is to ensure your tissue is healing as expected. For those who experienced tearing and/or stitching, your provider will want to assess the healing site at your 3 and 6 week postpartum visit. In the case of infection or granulation tissue, medical management may be a required first step. However, most often when pain continues beyond 6 weeks, tissue healing is not the problem and there is no sign of infection. In this case, pain is likely due to some combination of scar tissue restrictions, pelvic floor muscle spasms, nerve healing and suboptimal movement patterns that your body has adopted as a result of the pain.
What can we do about this?
See a pelvic floor physical therapist who can evaluate you and determine what’s contributing to your pain and create a treatment plan to get you feeling better.
Consider pelvic floor relaxation techniques like diaphragmatic breathing, child’s pose and happy baby pose.
Use tools like the pelvic wand to address scar tissue restrictions and muscle spasms in the pelvic floor.
If you have perineal discomfort during penetration, make sure to use lube!
Remember, while it’s important to be assessed by your provider if you’re experiencing pain past 4-6 weeks postpartum, it’s very common for healthy tissue to cause pain. Assuming your provider has assessed your perineum and found no sign of infection or other cause for concern, your pain is likely a result of scar tissue, tight muscles and healing nerves. This pain is common and very treatable. This will not be your forever but may require a little extra TLC.
2. I’m 39 weeks pregnant and just learning about pelvic health. Is there anything I can do in this next week to prepare my pelvic floor?!
First of all - don’t fret! If you’re just learning about your pelvic floor right before birth or after you’ve given birth, all is not lost and you didn’t lose your chance to support your pelvis. All too often people learn about their pelvic floor later in their reproductive journey and it’s so common to feel overwhelmed, particularly when you’re on a time crunch. So please know that no matter where you are, whether you’re a day before your estimated due date or 10 years after your youngest was born, it’s not too early or too late to get started.
With all of that said, back to the original question. The answer to whether there is anything you can do in your last week of pregnancy to prepare your pelvic floor for birth is a resounding yes! The number one thing I’d recommend if you’re short on time and want to do some pelvic health prep is this: learn how to diaphragmatically breathe.
A diaphragmatic breath is a deep breath that occurs with a diaphragm contraction. Your diaphragm is a broad muscle that sits that the bottom of your rib cage. Its primary function is to help you breathe. Your diaphragm contracts and draws downwards towards your pelvis as you breathe in, and relaxes and rises back to its resting position as you breathe out. Your diaphragm does this with every breath you take, but the deeper the breath the more diaphragmatic movement. Most of us take shallow, chest breaths throughout the day. Learning how to take a deep belly breath and allowing your diaphragm to fully descend is truly the building block of a happy pelvic floor.
So how does the diaphragm impact the pelvic floor? This is what’s supposed to happen when you breathe:
As your diaphragm descends with a full diaphragmatic breath, your pelvic floor moves downwards towards your feet.
As you exhale, your diaphragm rises back to its resting position and your pelvic floor rises back to its resting position, as well.
Your diaphragm and pelvic floor move together like a piston.
The greater the excursion (movement) of your diaphragm, the greater the movement of your pelvic floor.
But like I previously said, most of us take shallow chest breaths throughout the day which means that we don’t get that reciprocal pelvic floor/diaphragm movement. When we take a shallow breath in, not a whole lot happens at our pelvic floor. When we breathe out, it’s the same. And breathing like that all day long, as well as a number of other lifestyle factors can really limit our pelvic floor coordination and range of motion. Learning how to coordinate a diaphragmatic breath can help address underlying pelvic floor muscle tension, weakness and improve pelvic floor coordination. Those three variables (tension, weakness and coordination) are at the root of the vast majority of pelvic floor muscle dysfunction.
Diaphragmatic breathing is also a building block for perineal massage, push preparation, and is the first postpartum exercise I recommend people begin within the first couple days postpartum. So if you only have a short while left, this is where I recommend you start! Check out this youtube video for a movement flow in various positions to help you really feel your pelvic floor move as you breathe.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.