After you have given birth to your baby there are a number of conditions which you may suffer from. It is advisable for all women who have recently had a baby to visit a women’s health physiotherapist for and postnatal assessment. During this session the physiotherapist will assess your lower back and pelvis to make sure these areas are functioning well and also assess for the following conditions;
Diastasis rectus abdominis (DRA)
The six-pack muscle which runs from your rib cage to your pubic bone has two main portions, one slightly to the left and one slightly to the right, it is joined in the middle by some connective-tissue called the linear alba. What happens in a DRA is that the linear alba separates and the two portions of the rectus abdominis muscle move apart. A recent research study using ultrasound assessment found that 100% of women at 35 weeks of pregnancy had a DRA. It was also found that 40% of these women still had a DRA at six months postpartum.
DRA can lead to pelvic floor dysfunction compensatory movement patterns and faulty breathing, which can contribute to postpartum lower back and pelvic girdle pain and urinary incontinence. A women’s health physiotherapist can assess your DRA specifically looking at the depth, length and width of the separation as well as your ability to create tension in your abdominal muscles and reduce the separation you may have.
Other research has recently shown that the gap that exists from a DRA does not have to fully close as long as you can create tension through the abdominal connective-tissue. The only way to do this is through corrective exercises prescribed by your women’s health physiotherapist.
Having a DRA can also cause difficulty in going to the toilet such as opening your bowels. The ability to properly contract your abdominal muscles helps in passing stool and a DRA can significantly affect this leaving you with constipation. Your women’s health physiotherapist will be able to teach you ways in which you can ease this constipation and also advise you on foods and drinks to consume to reduce any bowel related symptoms.
Once the women’s health physiotherapist has assessed the impact of your DRA on your core stability and movement patterns they can start to teach you strategies around activating your pelvic floor and abdominal muscles in order to prevent problems from lifting your baby, getting out of/turning in bed and doing everyday tasks such as putting your baby in the pram or putting the car seat in the car.
The next most common problem in women after having a baby is urinary incontinence. This can often be a deeply embarrassing problem and not many women talk about suffering from this problem. However, it is a lot more common that you think. Up to 32% of women suffer from incontinence with 45% of mothers suffering from urinary incontinence within seven years of giving birth.
This incontinence can happen after a natural birth, especially if you have had forceps used. Even women that have had a C-section that causes abdominal and breathing pattern dysfunction can suffer urinary incontinence.
It’s not just incontinence of urine that women suffer from, 1 in 5 women over 40 also suffer from faecal incontinence. So it is imperative that you seek the help of a women’s health physio therapist to prevent these unnecessary and embarrassing problems. The most obvious thing that you can do is perform Kegel manoeuvers or what we would call pelvic floor exercises. The National Institute for clinical excellence (NICE) guidelines suggest you need three months of supervised pelvic floor training from a Women’s Health Physiotherapist after giving birth to treat and prevent urinary incontinence. There are other things that your Women’s Health Physiotherapist can advise you on are using pads or the use of a pessary during the day or for getting back in to the gym or playing sports.
Pelvic organ prolapse (POP)
This is more common than many women think with 50% of mothers who had a natural birth suffering from a POP. There are numerous organs that could prolapse into the pelvic floor including the vagina, the womb orthe rectum. Your Women’s Health Physiotherapist will be able to assess this for you and give you the right treatment and advice on what to do.
POPs can be classified as follows:
- Grade 0 – no prolapse
- Grade 1 – more than 1 cm above the hymen. Grade 1 prolapses needn’t be a concern
- Grade 2 is classified as prolapsed tissue being one centre metre away from the entrance of the vagina.
- Grade 3 prolapse is where you start to see tissue protruding 1 cm or more out of the vagina.
- Grade 4 is when there is complete exposure of the vagina
Grade 1 and 2 POP are reversible with diligent use of pelvic floor muscle exercises and lifestyle advice. A grade 3 POP cannot be reversed with just pelvic floor muscle exercises however the symptoms can be managed and the prolapse can be halted with pelvic exercises. A grade 4 POP will require a referral to a consultant gynaecologist.
Regardless of whether you have a DRA, UI or POP your Women’s Health Physiotherapist will be able to give you the right treatment including manual therapy and prescribing the correct pelvic floor and abdominal exercises. Your exercises will be progressed from lying on the treatment table to functional activities such as lifting your baby, putting the car seat in the car or putting the pram in the boot of your car.