February Knowledge Drop
Each month for our newsletter, the Lady Blurb, we'll share answers to some 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:
Can pregnancy make my prolapse worse?
Why do I have pain after sex but not during?
What are the best exercises for c-section recovery?
Can pregnancy make my prolapse worse?
The short answer is yes, it’s possible, but that doesn’t mean it absolutely will. The reality is we cannot predict how a future pregnancy will impact your prolapse symptoms, and recovery will not be necessarily harder following a second pregnancy. There are things you can do after your previous pregnancy and even during your subsequent pregnancy to prevent a prolapse from worsening. Do NOT let someone tell you just to wait until you are postpartum if you are concerned about managing prolapse during and following pregnancy. One of the biggest myths about pregnancy is that you should just wait until after you’re done having babies to fix anything.
General recommendations for preventing the worsening of a prolapse during subsequent pregnancies include the following:
Manage constipation and avoid straining (holding your breath).
Strengthen not only the pelvic floor and deep core muscles, but the muscles that support them like the glutes, hip rotators and hip flexors.
Contract your pelvic floor with coughing, sneezing and lifting.
Take a birth prep class so you have a better understanding of how pushing affects your pelvic floor and different ways to breathe while pushing.
Consider a pessary.
See a pelvic floor physical therapist to create a personalized plan for you to help you rehab after your previous pregnancy and prehab for your subsequent pregnancy. For folks struggling with prolapse symptoms, we recommend seeing a PT postpartum, prior to your next conception and during your subsequent pregnancy.
Why do I have pain after sex, but not during?
There could be a few reasons why people with vaginas have pain after sex! This can depend on where the pain is and what type of discomfort/pain it is.
Deep, achey pain could be that the pelvic floor muscles haven’t let go after orgasm. An orgasm is a rhythmic pelvic floor muscle contraction and typically afterwards your muscles relax. When they don’t, it’s like you’re clenching your fist all day long. If you clench your fist for a moment bit, it might not hurt. But if you hold clench it tightly for 5 minutes straight, it’ll start to ache pretty quickly. If this happens, try deep breathing and some gentle stretching afterwards and see if that helps!
If the pain is more at the opening and feels more sharp it could be a hormonal issue. This pain often gets better when you stop body feeding, but you can consider speaking with your medical provider about using a topical hormone cream to address this pain as well.
To figure out what exactly is going on, see a pelvic floor physical therapist who can point you in the right direction!
What are the best exercises for c-section recovery?
Believe it or not, the exercises you would do are no different than if you had a vaginal delivery. Regardless of the method of birth, you were still pregnant which causes a sustained stretch of your abdominal muscles. Additionally, some people who have a c-section push during labor, so they may have stress to the pelvic floor muscles from labor despite a cesarean birth. Even if you didn’t do any pushing, you were still pregnant and which creates pressure on the pelvic floor muscles. As a result, your core and pelvic floor still need strengthening.
You can start as early as a couple days postpartum with gentle breathing, pelvic floor and abdominal muscle engagement. Early on you want to reconnect to the muscles as it might feel like you don’t have a core at all. (I promise, you do!)
The only thing that needs to be added in to a recovery program following a cesarean birth as compared to a vaginal birth is c-section scar massage. You are typically cleared for this around 6 weeks postpartum. Even if you’re not having pain or discomfort at the scar, the goal is to get the tissue moving like any other tissue so that it doesn’t adhere down and cause other problems.
If you don’t know where to start, a physical therapist can teach you how to work on the scar tissue so you know what it’s supposed to feel like. They can also start you on an exercise program that's specific to your needs.
Thanks so much for reading this month's knowledge drop! Don't forget to submit your questions for next month in the comments below or by emailing contact@ladybirdpt.com.
Ready to take control of your pelvic health? Contact us here or call us at 512-766-2649 for a free phone consultation to learn more about how pelvic floor PT can help you.
By Dr. Jessica Chastka, PT, DPT, WCS
Jessica (she/her) earned her Bachelor’s in Exercise Science from the University of Louisiana at Monroe, while playing softball. She received a Doctorate in Physical Therapy from University of Texas Medical Branch in Galveston in August 2015. In 2019 she became Board Certified in Women’s Health, through the American Board of Physical Therapy Specialists.
For the last five years she has been working as a pelvic floor physical therapist, treating people who have pelvic pain, leakage, urgency, frequency and constipation. This includes the pregnant and postpartum population as well as people with chronic pain. She is passionate about making her patients feel heard and seen, validating those who feel that their problems are not worth mentioning because everyone has them or because embarrassed to talk about them.