September Knowledge Drop
Each month for our newsletter, the Lady Blurb, we'll share answers to some pelvic health 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:
1. 3 weeks postpartum and pooping has been horrible due to an excruciating hemorrhoid. What can I do?
2. I've had an awesome pregnancy so far but my chiropractor recommended pelvic floor PT for birth prep. How can PT help?
3. Is there anything I can do to manage c-section pain at 5 months postpartum? It’s still hurting every day.
1. 3 weeks postpartum and pooping has been horrible due to an excruciating hemorrhoid. What can I do?
Hemorrhoids (and fissures) are the ultimate pain in the ass and are common following childbirth. This article cited that up to 40% of postpartum people experience hemorrhoids and anal fissures, with risk factors including constipation during pregnancy, instrumental delivery and straining duration of more than 20 minutes. Hemorrhoids can be extremely painful but often improve on their own with time and a little help. If you’re struggling with hemorrhoids, I recommend seeing a pelvic floor physical therapist for a personalized approach to managing your pain. In the meantime, here are some things you can consider:
Keep your stool soft and your bowel movements consistent. Keeping your stool soft reduces irritation of the hemorrhoid. You can do this by considering a stool softener, eating a high fiber diet, staying hydrated and adding movement to your day. Fiber, stool softeners and hydration will keep your stool consistency soft and malleable and adding movement stimulates the bowels which can help maintain regularity of bowel movements. The longer stool sits in your rectum, the more water is absorbed and the firmer stool gets. The firmer stool gets, the rougher it is on your hemorrhoids at it exits the rectum.
Avoid pushing and straining on the toilet. Pushing and straining can irritate hemorrhoids. As a general rule of thumb, go when you have the urge to go and don’t force it when you don’t. Other ways to support healthy bowel movements without pushing or straining include using a squatty potty, taking deep belly breaths on the toilet and giving yourself up to 10 minutes to have a bowel movement but not waiting much longer than that if it doesn’t happen. Check out these 7 tips for managing constipation.
Ice packs, sitz baths and Tucks. All three of these help with pain management and inflammation. Sitting on a small ice pack can help reduce swelling, though make sure you’re using an on/off schedule of roughly than 10 minutes on 10 minutes off. Sitz baths can help reduce pain, soothe angry tissue and calm sore muscles. Tucks pads, which are wipes with witch hazel, help cool and soothe tissue after toileting.
Manual therapy. I already mentioned pelvic floor PT above, but manual techniques like bowel massage and releasing pelvic floor spasms can help reduce pain associated with hemorrhoids. Particularly for folks who struggle with hemorrhoids chronically, consider checking in with your local pelvic floor PT.
2. I've had an awesome pregnancy so far but my chiropractor recommended pelvic floor PT for birth prep. How can PT help??
First of all, all the love to your chiro. I love me a cross-specialty referral during pregnancy. Shout out to Austin’s amazing prenatal chiros including (but certainly not limited to) Pure Light Chiropractic, Sprout Chiropractic and Empower Family Chiropractic, just to name a few. While pelvic floor physical therapy, and physical therapy in general, is most typically thought of as a way to solve an existing problem, we can play just as big a role in prevention, particularly during pregnancy.
Preparing for birth with a pelvic floor PT can help you reduce the risk of urinary incontinence and pelvic pain postpartum, as well as reduce the risk of perineal tearing during childbirth while improving postpartum outcomes. Pelvic floor PT, due to the prioritization of education during pelvic floor PT appointments, has also been shown to help improve postpartum mental health. PT helps achieve these goals by getting to know you and your goals, doing a thorough physical evaluation, and creating a plan.
Working with a PT during pregnancy takes place over a series of visits where your PT gets to know you and creates (and iterates) on a plan to work towards your goals. When you come to see a physical therapist during pregnancy, they’ll start by talking to you about your vision for the remainder of your pregnancy, your birth and postpartum recovery. They’ll also ask you questions about your current activity level and what you want to return to after childbirth. Starting at your first visit and continuing over the next few, they’ll assess the way you move, your balance, check you for a diastasis recti, check out your abdominal, lower body and pelvic floor strength and control, and may recommend a pelvic exam which is never required and can be performed internally or externally. After each visit, your PT will send you home with homework to directly address whatever they’ve found during your visit.
If you’re feeling great, we recommend coming in for your first visit sometime between 20-25 weeks and planning to be seen every few weeks until childbirth, subject to change based on what your PT finds. If you want to learn more about birth preparation, check out our self-paced birth prep course!
If you have the resources, managing pelvic health during pregnancy can help improve your birth outcomes and postpartum recovery.
3. Is there anything I can do to manage c-section pain at 5 months postpartum? It’s still hurting every day.
Yes. 100%. Absolutely. In a previous blog post we referenced a 2020 prospective cohort study, roughly 25% of participants still had scar pain at 3 months following birth. You are not alone and there is so much that can be done to address pain.
Oftentimes when people experience scar pain after a cesarean their primary concern is that something is wrong, that there’s tissue damage or something hasn’t healed. While it’s important to assess your scar for signs of an infection, most often not scar pain is a result of muscle and nerve irritation around the scar. If you’re noticing redness, heat, swelling or a sudden worsening of pain around your scar, please start by contacting your medical provider. If none of those are the case, stick with me.
Assuming no infection or wound healing set backs, your scar should be fully closed within 4-6 weeks. Scar tissue continues to strength over the course of the next year. Pain should improve over the first 4-6 weeks, and pain in the absence of infection continuing past the 6 week point can be treated with physical therapy. If you’re still experiencing c-section scar pain past 6 weeks, whether it’s been 5 months, a year or longer, this is what I recommend:
Begin with seeing a pelvic floor physical therapist. A pelvic floor PT can help you evaluate the cause of your pain and create a personalized approach for getting pain under control. When I see folks for c-section scar pain, we typically see significant reductions in pain within 3-4 visits, regardless of how long they’ve been in pain.
C-section scar desensitization: Scar desensitization techniques can help to calm down angry nerves and highly sensitive scars. If thinking about touching or massaging your scar makes you queasy, start here. This is often where we start during PT visits, particularly for folks who can’t bring themselves to work on their scar at home.
C-section scar massage: Scar massage techniques help address muscular, fascial and nerve related scar pain. There are a number of scar techniques that can be used to improve blood flow and tissue mobility around the scar, thus reducing pain.
And if you’re reading this in your early postpartum recovery weeks, here are proactive measures you can take to help your scar heal.
Working with a pelvic floor physical therapist can help address sexual dysfunction, bowel and bladder concerns and help you prepare for pregnancy, birth and postpartum recovery. Contact us here to learn more about setting up an appointment with us, today!
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.