Your pelvic floor is the area of your body between your legs. Fourteen muscles are woven together and run between your pubic bone and tailbone and between your two sitz bones. The pelvic floor muscles are responsible for bowel and bladder function, supporting your internal organs, and facilitating sexual health and pleasure. The muscles also work in concert with your transverse abdominal muscles (in your low belly), your diaphragm (at the bottom of your rib cage), and your back muscles to orchestrate a functional core system. The vaginal opening is at the front of the pelvic floor, the anus is towards the back, and the perineum is the space in the middle. Because the muscles of the pelvic floor surround the birth canal, the whole system can be a bit stressed following a vaginal birth. As educators, our priority is to help you minimize trauma to the pelvic floor! But in reality, even with the best preparations, women may experience a wide array of complications. Below is a summary of what you might experience and ways to heal.
Vaginal Care, Tearing, and Scar Tissue Massage
Many people are worried about perineal tearing or having an episiotomy (where a doctor cuts the perineum) during delivery. It is not uncommon for the perineal tissue to tear superficially during a vaginal birth for first time mothers. There are different degrees to which the tissue can tear: a 1st degree tear means the skin of the perineum superficially tore whereas a 4th degree means the tissue between the vaginal opening and anus tore completely. A 4th degree tear is pretty rare, though, estimated at about 3% of vaginal births. Tears near the vaginal opening and perineum will be examined following a vaginal birth and stitched. If you are not on an epidural you will receive a local anesthetic.
The vagina and perineum will be swollen and sore following a vaginal birth, whether or not you have stitches. For the first few days, it will be uncomfortable to wipe the vagina with toilet paper. You can use a peri-bottle (a plastic squeeze bottle provided by the hospital) to spray lukewarm water to clean yourself after using the toilet. You can look into healing herbs to brew a tea for the peri-bottle as well. You may also be given a numbing spray, like Dermaplast, by the hospital. Cold compresses can be applied on the perineum in the first 24 to 48 hours. Hospitals will typically give out ice packs for this purpose and those birthing at home have been known to make and wear pad-sicles: water or herbal-tea soaked menstrual pads that are frozen.
Once the initial swelling has gone down on day two or three, you may want to switch from ice to heat. You’ll want to ask for a sitz bath in the hospital. This is a round plastic bucket that fits into the toilet and can be filled with warm water or a tea brewed with healing herbs. Sitting in a sitz bath for a few minutes a few times a day can help promote blood flow and is very soothing. Some people encourage the use of Witch Hazel for the sitz bath unconditionally, while others suggest not using Witch Hazel if you have stitches, as it can dry out the stitches and make them less likely to dissolve.
Following the delivery of the placenta, your uterus takes on the job of contracting back to its pre-pregnancy size and shedding the lining it grew to nourish your baby. Imagine the largest period of your life! Some women choose to live in the hospital's mesh underwear or buy a pack of adult diapers to have on hand. Avoid tampons until you speak with your doctor at six weeks postpartum.
If you had stitches on or around the perineum you’ll want to massage the scar tissue once they are dissolved and you’re comfortable touching this area of your body. Scar tissue massage can help ensure that the fascia does not become restricted and cause trouble down the line. Pelvic floor physical therapists can teach you how to do this effectively and safely without causing injury or reopening the scar.
Pelvic Organ Prolapse (POP) is a condition where pelvic organs slip out of position. Uterine or bladder prolapse is most commonly experienced starting at weeks four to six postpartum when people regain more activity. Many women will describe the feeling of heavy pressure in their vaginas. If you are experiencing POP, reach out to a pelvic health professional for individualized treatment. In the meantime try to move more slowly and mindfully and do not hold your breath when moving.
Let’s be honest, there is never a good time to pee a little bit. Unfortunately, in pregnancy and after birth, sometimes simply getting up, changing positions, coughing, sneezing, or laughing is enough to stress the pelvic floor muscles enough to cause some leaking. While “common” this is not normal. Please please please, seek out help if you are suffering from incontinence from a trained pelvic floor physical therapist. In the meantime, resting, breathing well, and keeping a log of when and how much you leak is helpful. Besides incontinence, a small group of people will experience more troubling urinating patterns. If you notice urine retention, (for example, you do not urinate within the first 12 hours after delivery or are feeling a worrisome pain during urination) please contact your doctor or midwife.
Constipation and Hemorrhoids
Constipation and hemorrhoids can both stress the pelvic floor muscles dramatically. To help - minimize straining during bowel movements and never hold your breath while on the toilet! Do your best to avoid constipation through diet, hydration, posture, breath, and massage. Over-the-counter laxatives are generally contraindicated for breastfeeding, so focus on eating a diet high in fiber with lots of fresh fruit and vegetables. Psyllium seeds and prune juice are both great options as well. Drinking plenty of water and low sugar, decaffeinated beverages is also essential for moving stool! As a rule of thumb, to stay properly hydrated, you want to drink half your body weight in ounces per day. Using a tool like a squatty potty can help position the colon and pelvic floor to ease elimination. Breathing slowly, into your rib cage, not belly or chest, and taking your time is also essential. Taking your time to have a bowel movement can be hard with a newborn waiting for you, or a toddler outside the door, but it is so important.
Hemorrhoids are actually varicose veins in the rectum caused by increased blood volume. To treat hemorrhoids you want to follow the same strategies above in order to reduce the amount of pressure on the vein during bowel movements. Additionally, Witch Hazel pads or grated white potatoes applied to the anus can be helpful. Laying down or sitting on your side and treating the issue as quickly as possible will help. For stubborn hemorrhoids you may need a prescription cream from your doctor.
Postpartum Doulas and Pelvic Health Therapists
If all of this sounds like just too much to tackle on your own or if there comes a time when you know you need additional guidance, know help exists! You can find a postpartum doula with experience setting up sitz baths, making pad-sicles, cooking super nutritious foods, and reminding you to drink tons of water. You can find a pelvic health therapist near you, maybe even one that does house calls like Sneha Physical Therapy, who can help you cue into proper breathing, assess your pelvic floor contraction and release, and monitor your lifestyle for movement habits that can be altered to expedite your healing!
Ashley Brichter is the Founder and CEO of Birth Smarter, a platform that creates and curates relevant and inclusive education for expectant parents and the professionals who serve them. She is a childbirth educator, a birth and postpartum doula, lactation counselor and mom of two.