Pelvic Floor Pain - How to Get Help with Postpartum Pelvic Floor Dysfunction

They say having a baby changes everything. For many women, some of the biggest changes take place in the body—specifically, the pelvic floor.

According to Dr. Deepali Maheshwari, DO, MPH, FACOG of Baystate Health, “Sixty percent of patients experience one or more pelvic floor disorders (PFDs) after delivery. As many as 25% of them continue to experience symptoms more than a year after delivery.” But, as Maheshwari notes, “While PFDs and their symptoms—including pain with intercourse or accidental loss of urine, gas or stool—are quite common, they are not normal and can be addressed.”

What is the Pelvic Floor?

Before we dive into the different types of PFDs, let’s first get familiar with what the pelvic floor is.

Located between your pelvic bone in the front and your tailbone in the back, the pelvic floor is made up of the muscles that surround your pelvic organs—the bladder, bowel, and uterus—and offer control over their functions. For example, when you squeeze to hold your urine, you’re engaging pelvic floor muscles.

While anyone can experience PFDs, the stress that pregnancy and childbirth put on the muscles is a major contributing factor to their development.

Maheshwari says, “During pregnancy and delivery, these muscles are stretched well beyond their normal range. While the result is a short-term injury, the effects can be long-lasting and if left untreated, can have a devastating impact on a patient’s mental health and quality of life.”

Types of Pelvic Floor Disorders

In the same way that childbirth is different for every person, how someone experiences PFD, if at all, can vary dramatically. That said, patients who have delivered vaginally, had an episiotomy, delivered a baby over 8.8 pounds, or whose delivery was vacuum- or forceps-assisted are more likely to experience a PFD.

The most common PFDs after delivery include:

• Infection or abnormal healing of a vaginal tear
• Stress incontinence
• Urge incontinence
• Fecal incontinence
• Pelvic organ prolapse

Here’s a look at the most common symptoms of and treatment for each.

Vaginal Tearing

Sometimes referred to as a perineal laceration, vaginal tearing occurs during delivery when baby passes through the vaginal opening, tearing the muscle and soft tissue around the area. Rated from first degree to fourth degree, tearing can be minor—just to the skin layer—or severe. The most severe tears involve tissue around the sphincter or, even more severely, the rectum. Fortunately, tears to this degree only occur in 3-6% of deliveries.

Many patients heal from their vaginal tearing without issues. The most common symptoms of this type of PFD include spotting or yellow discharge as the wound heals and any stitches dissolve in the weeks after delivery. In some cases, symptoms may last up to 12 weeks. Some patients may experience ongoing pain, or develop complications such as infection or wound breakdown.

Recommended treatment may include:

• 10- to 15-minute bath twice a day and gently patting the area dry afterwards
• a diet or use of laxative to keep stool soft
• use of a pain-relieving spray
• pelvic exercises
• pelvic floor physical therapy

For some complications, surgery may be recommended.

Stress Incontinence

Perhaps the most widely acknowledged PFD, stress incontinence is experienced by 45-60% of people during pregnancy and nearly 35% of people post-delivery. It involves the leakage of urine when coughing, laughing, sneezing, running, or lifting heavy items (including toddlers).

For the majority of people (75%), this PFD resolves on its own within a year of delivery. Treatment options include:

• pelvic exercises
• pelvic floor physical therapy
• an incontinence pessary (a silicone or rubber device inserted in the vagina to support the urethra and bladder wall)

There are also surgical options for treatment.

Urge Incontinence

Frequently experienced during pregnancy, urge incontinence is the sudden and intense need to pee. Leakage and an increased need to urinate may also be experienced.

Unlike stress incontinence, this PFD often isn’t the result of an injury but rather a symptom of an overactive bladder (OAB).

Maheshwari explains, “The core of the problem with OAB is that the bladder signals the brain that it’s full when it’s not. The urge to urinate can be quite frequent and strong, often disrupting sleep, and leakage is quite common.”

Treatment typically involves:

• avoiding foods that can irritate the bladder (i.e., caffeine, artificial sweeteners, alcohol, carbonated drinks)
• stopping fluid intake 2 hours before bed
• pelvic exercises
• pelvic floor physical therapy
• medication
• bladder training (a behavioral therapy that gradually teaches you to hold your urine over longer periods of time to prevent emergencies and leaks)

surgical treatment options if the above do not work

Fecal Incontinence

The accidental leakage of gas or stool, fecal incontinence can affect people who have delivered vaginally or by Cesarean with symptoms that can last years post-delivery.

Treatment options include:

• changing the consistency and frequency of stool through dietary changes, supplementary fiber or medication
• strengthening the pelvic floor through physical therapy

Additional advanced therapies, including surgical options, may be recommend in stubborn cases.

Pelvic Organ Prolapse

In cases where the pelvic floor is severely weakened, organs including the bladder, uterus and rectum, may slip down and out of their normal position. This is referred to as prolapse.

While not life-threatening, prolapse can be uncomfortable and may make passing urine or stool difficult. Often experienced as pelvic pressure or vaginal bulge, the majority of prolapse (75%) resolve on their own within a year of delivery.

Treatment options include:

• pelvic exercises
• pelvic floor physical therapy
• strengthening the core muscles
• use of a fitted pessary
• surgery

How to Start Pelvic Floor Physical Therapy

According to Maheshwari, “The good news in all this is that one of the most effective treatment options for PFD is pelvic floor physical therapy. Safe to do shortly after delivery, this type of therapy targets the pelvic floor muscles and can improve many conditions over time.”

Offered through Baystate Health, this unique PT typically consists of weekly sessions offered over 4-8 weeks. In many instances, internal vaginal work may be recommended.

Additionally, Maheshwari notes that there are self-directed muscle training exercises that women can perform on their own and that there are free apps—including Squeeze Time, Tat, My Kegel Pal and Kegel Trainer—available to make at-home training as effective as possible.

“Don’t suffer in silence.”

While many PFDs resolve on their own, for those that don’t there is help.

“Because PFDs don’t often get discussed, many women believe that nothing can be done for their condition,” says Maheshwari. “Nothing could be further from the truth.” She urges women to speak to their physician about any postpartum changes they are experiencing. “You’re not alone and treatment options are available. Don’t suffer in silence.”

Reach out to the Baystate Health team at 413-795-8764 for help with your postpartum pelvic floor disorder symptoms.