Monthly Knowledge Drop - November
Each month we'll share answers to our favorite pelvic health questions submitted via email & Instagram! To submit a question for next month, email us at contact@ladybirdpt.com.
This month, we’re answering:
What’s the difference between SI joint pain and sciatic pain?
Why is leakage so common after childbirth?
I gave birth three months ago and sex is still super painful which makes me not want to have it. Is there anything I can do about that?
Eeeek I’m 38 weeks pregnant and just learning about pelvic floor PT! Am I too late??
1. What’s the difference between SI joint pain and sciatic pain?
Sacroiliac (SI) joint pain and sciatic pain are commonly confused, but correctly determining the cause of your pain makes a huge difference to planning appropriate treatment. Read on for some basics to help you determine the difference between the two!
SI joint pain is pain stemming from the sacroiliac joint. There are two sacroiliac joints in the pelvis, one on each side of the pelvis where the hip bone (or ilium) meets the sacrum (the flat bone at the back of your pelvis). Sacroiliac joint pain is common during pregnancy and postpartum due to postural and hormonal changes, as well as changes to activity level and movement patterns. SI joint pain typically feels like sharp, sudden pains on one side of the low back or upper buttocks area. The most common site of pain is near the dimple in the low back. SI joint pain may refer into the glute or down the back of the thigh. This pain does not go past the knee and typically presents as a fleeting pain associated with some sort of sudden movement. Common aggravating movements include getting in and out of a car, rolling over in bed, putting on shoes and socks and walking up stairs.
Sciatic pain, on the contrary, stems from the sciatic nerve which is made up of nerve roots L4, L5, S1, S2 and S3. This nerve pain can feel achey or burny, and refers from the low back back, through the glute, all the way down the leg and even into the foot. This pain is often exacerbated by movements at the lumbar spine. This can include bending forward, bending back, twisting and rotating. In severe cases, sciatic nerve pain can cause numbness and weakness in the effected leg.
Though both pains can impact the low back, glutes and upper thigh, they have two distinct origins and benefit from different treatment approaches.
2. Why is leakage so common after childbirth?
Roughly 1 in 3 experience urinary incontinence following a vaginal birth and roughly 1 in 6 following a cesarean birth. A number of factors contribute to postpartum urinary incontinence, including progressive stress on the pelvic floor during pregnancy, trauma to the pelvic floor and support muscles during birth, hormonal changes, postural changes, tissue tearing and more. Not to mention, urinary incontinence is common in folks who have never experienced pregnancy, including middle school and high school athletes.
The factors listed above impact pelvic floor and surrounding muscle strength, flexibility and control. Impairments in strength, flexibility and control in the pelvic floor and surrounding muscles contribute to difficulty with bladder control, resulting in urinary incontinence. This, alongside sleep deprivation, stress, changes to diet and fluid intake as well as bladder and bowel habits is why leakage is so common after childbirth.
Important note: Pelvic floor exercise during pregnancy can help to reduce the likelihood and severity of incontinence during and following pregnancy. Just because incontinence is common does not mean it’s not treatable. Additionally, time is not enough to treat urinary incontinence. A 2016 longitudinal study found that “among those who had reported UI (urinary incontinence) at 3 months, 76.4% reported it at 12 years” if not seeking treatment.
So what’s the moral of the story? Leakage is common, but treatable. Additionally, work can be done during pregnancy to reduce the likelihood it develops in the first place. If you’re concerned about or experiencing urinary incontinence, consider seeing your local pelvic floor PT.
3. I gave birth three months ago and sex is still super painful which makes me not want to have it. Is there anything I can do about that?
YES! First of all, it’s never too late to address symptoms associated with pregnancy and childbirth, including pain with sex. Dyspareunia, or pain with sex, is common following childbirth but it’s also treatable. To treat pain with sex appropriately, we first need to understand the cause of the pain.
But before we get into that, let’s pause for a moment. As a child, you only have to touch a hot stove once to learn you don’t want to do it again. That’s because it hurts. We don’t typically desire activities that cause unwanted pain. Decreased libido is incredibly common in folks experiencing painful sex because of that same reason. Addressing the pain helps to reduce the fear-tension-pain cycle which in turn can help to increase your desire to have sex in the first place.
Now, what causes pain with sex postpartum? There are a number of contributing factors. Some of the most factors for postpartum painful sex include scar tissue, muscle guarding and hormonal changes. I’ll break them down below but for an even deeper dive, click here.
Hormonal changes: Folks who are breast or chestfeeding will have decreased estrogen at the vaginal opening which can lead to sensations like burning or stinging at the vaginal opening as well as vaginal dryness. If that sounds familiar, consider talking to your OB or midwife about starting a topical estrogen cream. Topical estrogen has been found to be safe to use for folks who are lactating and even those with estrogen-dominant cancers.
Muscle guarding: If you’re afraid something will hurt, your body will try it’s best to prepare you for that pain. If you’re afraid penetration will hurt, your pelvic floor will clench to protect you. This clenching increases the likelihood and severity of pain and triggers a cycle of clenching, hurting and clenching more. This is specifically why we don’t recommend you grit your teeth through pain. Instead, consider seeing a pelvic floor PT who can teach you exercises to reduce the clench and teach you how to use tools like vaginal dilators.
Scar tissue: Perineal tearing and c-sections create scarring in the pelvic floor and abdomen. Scar tissue isn’t as flexible as non-scarred tissue and as a result can cause pain. Manual therapy, lube and scar massage can make a huge difference.
It's important to keep in mind that pain with sex is often multifactorial. Seeing a pelvic floor PT can help you identify the cause of your pain and the best course of treatment for you.
4. Eeeek I’m 38 weeks pregnant and just learned about pelvic floor PT! Am I too late??
Literally never. It’s literally never too late.
While I do typically recommend a pelvic floor PT evaluation for folks during pregnancy even if they’re feeling great (read more about why in this blog post), PT is equally, if not more important after childbirth. The first thing I recommend if you’re learning about PT very close to your due date is to schedule your postpartum PT appointment now. Pelvic floor physical therapy clinics across the country, as well as in Austin, TX, routinely have 6-12 week waitlists. The earlier you call to schedule, the earlier you’ll be able to be seen.
As far as prepping your pelvic floor for birth, it’s never too late to start. When I see patients during pregnancy who are feeling great but interested in preparing their pelvic floor for birth, we typically discuss:
pelvic floor relaxation for birth
push preparation
perineal tear risk reduction
postpartum recovery timelines
That’s why I put all of that information (and more!) into a self-paced, online course. As long as you have a few hours, you can learn everything I think every pregnant person should know heading into birth.
Thanks so much for reading this month's knowledge drop! Don't forget to submit your questions for next month at 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.