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Photo by Sharon McCutcheon on Unsplash
Photo by Sharon McCutcheon on Unsplash

Pelvic pain during the postpartum period is common, even for those who had a “perfect and easy” pregnancy, labor and delivery. Often times, healthcare providers will tell women that the pain “will get better with time,” however it's important to advocate for yourself and seek out care if you feel like you need it. Read my previous article about advocating for your postpartum care here.

Common types of postpartum pelvic pain and what you can do at home:

Vaginal Dryness

After delivery, your estrogen levels drop and progesterone levels stay high, especially if your are breastfeeding.

What you can do:

A simple solution can be drinking more water and using a water-based lubricant, read my previous blog on choosing the right lubricant for you.

Muscle and skin pain

General muscle pain in and around the pelvic floor, back, and hips is expected after delivery, as is skin pain around the genitals and perineum, especially if you tore or had an episiotomy during the delivery.

What you can do:

  • Apply ice packs at the perineum to reduce pain and swelling.
  • Perform Kegel exercises to increase local circulation and promote healing.
  • Keep the area clean with a perineal irrigation bottle and sitz baths to reduce infection risk and help tissue healing.
  • Sit on a doughnut cushion to relieve pressure on the perineum.
  • Keep bowel movements soft to reduce stress on the pelvic floor and any torn tissues with stitches.

Pubic Pain

Sometimes the pubic symphysis joint can be separated or sprained during delivery. When this injury happens, pain can be felt in the pubic bone, sacroiliac (SI) joints, glutes or thighs. You might have difficulty and pain with turning in bed, transitioning from a seated to standing position, getting in and out of a car, or with weight-bearing activities.

What you can do:

  • Contact a pelvic floor therapist
    Oftentimes, those with pubic symphysis pain may require advanced manual techniques to restore normal alignment, reduce muscle spasm, and perform stabilization exercises that will strengthen the area without causing further pain. Getting a referral for an evaluation from a pelvic floor therapist will help guide you get the care you need and the guidance you'll need through this process.
  • Modify Activities
    Avoid positions that make your pain worse. If certain activities cause pain, for example, standing on one leg while slipping a shoe strap over your heel, sit down instead.
  • Keep legs together when rolling over in bed or getting out of the car, imagine you are wearing a tight mini-skirt. Try getting into bed "on all fours" and then lying on your side, rather than sitting in bed and lifting her legs up. Avoid positions with legs separated very wide: deep squat, child’s pose, butterfly stretch.
  • Pillow between the legs when you sleep on your side at night. Gently squeeze the pillow when you roll in bed.
  • Wear a support belt
    Get a compression belt or maternity support to help stabilize your pelvis. We like the Serola belt and sell them at Femina PT. Wear the belt when up and about, especially with exercise and household chores.
  • Gentle Exercise
    Cut out high impact exercise when experiencing pain. Instead, try walking, swimming, and gentle yoga.

Tailbone pain (coccydynia)

With tailbone pain, pelvic pain is mostly felt when sitting.

What you can do:

  • Sit with proper posture on the “sitting bones” rather than slouching onto the tailbone.
  • Sitting on a wedge cushion with a tailbone cutout can help reduce pressure on the area
  • Contact a pelvic floor therapist. Pelvic floor muscle spasm is a primary cause of tailbone pain and you may need manual therapy from a trained pelvic floor therapist to help calm the muscles of this area.

Vaginal scar pain

Scars from tearing or episiotomies can stay tender and sensitive for quite some time. The pain can prevent one’s ability to insert tampons, tolerate gynecological exams, or have penetrative sex.

What you can do:

Perform perineal massage the scar site and the perineum with your fingers or a vibrator. Use plenty of lubricant (water based lubricant, or a body-safe oil like organic coconut oil). Contact a pelvic floor therapist, a midwife, or a doula if you need help!

Nerve Injury or Entrapment

In rare cases postpartum pelvic pain can be due to nerve injury or entrapment from delivery, causing pain or incontinence.

What you can do:

Make sure you attend all your postpartum visits with your medical practitioners and also watch your own symptoms of pain and incontinence. If you feel like things are not improving, bring it up to your healthcare team.

When in doubt, pelvic floor therapy!

Pelvic floor therapists are trained to evaluate and treat pelvic pain before, during and after pregnancy. A good pelvic floor therapist will teach you all the skills they know including scar desensitization and mobilization techniques, ways to lengthen and strengthen pelvic floor muscles, and safe exercises to regain your strength. Give Femina PT a call today and schedule an appointment.

References:

ACOG, 2005. Your pregnancy and birth. Washington, DC: Meredith Books.

Al Hakim M,. Katirji B. 1994. Femoral mononeuropathy induced by the lithotomy position: a report of five cases with a review of literature. Muscle Nerve 17:4 466.

Babayev M., Bodack M.P., Creatura C. 1998. Common peroneal neuropathy secondary to squatting during childbirth. Obstet Gynecol 91:5 830-832.

Haslam, J., Laycock, J. Therapeutic management of Incontinence and Pelvic Pain.
Therapeutic Management of Incontinence and Pelvic Pain. 2nd edition. Halsam and Laycock.

Ley L., Ikhouane M., et al. 2007. Neurological complication after the “tailor posture” during labour with epidural analgesia. J Gynecol Obstet Biol Reprod 36:5 496-499.

Massey E.W., Cefalo R.C. 1979. Neuropathies of Pregnancy. Obstet Gynecol Surv. 34:7 489-492.

Ronchetti I., Vleeming A., et al. 2008. Physical characteristics of women with severe pelvic girdle pain after pregnancy: a descriptive cohort study. Spine 33:5 145-151.

Snow R.E., Neubert A.G. 1997. Peripartum pubic symphysis separation: a case series and review of the literature. Obstet Gynecol Surv 52:7 438-443.

Stephenson, R., O’Connor, L. 2000. Obstetric and Gynecologic Care in Physical Therapy. New Jersey: Slack, Inc.

Tetzschner T., Sorensen M., et al. 1995. Pudendal nerve damage increases the risk of fecal incontinence in women with anal sphincter rupture after childbirth. Acta Obstet Gynecol Scand 74:6 434-440.

Tetzschner T., Sorensen M., et al. 1997. Delivery and pudendal nerve function. Acta Obstet Gynecol Scand 76:4 324-331.

Wong C.A., Scavone B.M., et al. 2003. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol 101:2 279-288.

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Who gets vaginal dryness?

Women can have vaginal dryness for a variety of reasons and at any age. Dryness is most common after menopause due to the loss of hormones such as estrogen and progesterone.

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Benefits

What Our Patients Have to Say

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Testimonial by P.M.

I was hopeful but frankly skeptical when the doctor treating me for Interstitial Cystitis recommended that I go to Heather for physical therapy. Medication and diet helped control my IC symptoms, but I had never heard of physical therapy being used to treat IC. The education and treatment I received from Heather was a revelation. She explained that the pain I experienced with IC had helped create a cycle of muscle guarding which affected the entire pelvic area. I had no idea of the amount of tension being held there. No wonder my husband and I had not been able to have sexual intercourse for years!

Read more: Testimonial by P.M.

Testimonial by A.W., age 32

I wanted to let you know that my pelvic floor held strong and gave me no trouble whatsoever in my trail race this morning (12 miles)! In a way, I felt like I ran better than ever because my core feels so rock solid from all the exercises you have me doing. That was especially valuable on the technical downhill - I just flew down the trail because I had confidence in my balance and form. Thank you for helping me get back to doing what I love.

-- A.W., age 32
(completed Post-partum Renewal Program using the InTone biofeedback/stim unit)

Testimonial by Fritzette H.

I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

-- Fritzette H., 3/24/16 via Yelp!

Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

-- Julie T., 12/4/16 via Yelp!

Testimonial by Jackie W.

I was in multiple car accidents a decade ago, and I have been to many physical therapists through the years without success. They found the root of my lower back pain problems and after nearly a decade of barely being able to walk I finally can again without pain. They are also the best pelvic floor pts and the only ones who found the connection between my pelvic floor and lower back problems. If you need help with physical pain, they are your answer.

-- Jackie W., 1/19/17 via Yelp!

Testimonial by J.B.

My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

-- J.B.

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