Leakage of urine either under specific loads such as running, coughing, sneezing, lifting, jumping (stress urinary incontinence) or due to urgency (racing to get to the toilet) - is not normal.
Leakage of stool or wind, staining on your underwear or difficulty wiping clean after a bowel motion is not normal.
Treatment is available and, once you have been assessed fully to find the cause of the problem, is likely to include pelvic floor exercises, temporary activity modification/technique changes, lifestyle management and/or the use of pessaries.
Symptoms of heaviness, dragging, downward impulse with running, discomfort with sex or feeling bulges or lumps vaginally where they haven’t been before may indicate that you have a pelvic organ prolapse. This occurs when the fascia and ligaments (non-stretch tissues) that support the uterus, bladder and bowel in their correct positions, are stretched or torn allowing the organs to sit in a lower position than normal.
The earlier this is treated post-natally, the better result we get. Some women get full recovery with good management.
Treatment involves pelvic floor muscle coordination, endurance and strength work, deep core coordination, the use of inversions, lifestyle/exercise modifications and the use of pessaries.
Post-natal pelvic pain is really common but, traditionally, is rarely treated because it's seen as a normal aspect of post-natal recovery. This approach is fine if the pain settles down rapidly and causes no issues with bladder and bowel filling/emptying, sexual intercourse, wearing clothing, exercising as you wish or any other aspect of life. However, if you are having persistent that is not settling naturally, treatment is available.
Post-natal pelvic pain can occur from numerous sources:
Low oestrogen levels when breastfeeding
Tight/sensitive perineal scar
Tight pelvic floor muscles – common post caesarian section or if there is damage to one portion of the pelvic floor muscles – the other muscles of the pelvic floor can compensate and get over tight
Pelvic organ prolapse
Pelvic girdle pain (PGP) – including sacroiliac joint pain or pubic symphysis pain. PGP typically resolves spontaneously after the pregnancy however, in some people it will persist, or reappear once you start loading more with exercise, running etc.
Treatment is available for all of the above and will be very individualised dependent upon the cause of the pain, but may include topical hormone treatment, specific massage/muscle release techniques, breath/mindfulness/relaxation work, very specific muscle training (to teach muscles how to relax), prolapse treatments as above, deep core coordination, taping, use of stability belts, and many other things.
4. DRAM/Abdominal Muscle Separation/RAD/DRA
All these terms describe the same thing. It is not a total separation of the muscles but a lengthening of the fascia that joins the right and left muscle compartments together. It occurs in 90% + of all pregnancies to some degree and mostly spontaneously recovers within a few weeks post partum. For a more detailed explanation please read the Abdominal Separation Blog.
It should always be checked in the early days post-birth and followed up at 6 weeks if present. If you didn’t have it checked in hospital do the following to check yourself:
lay on your back with legs straight out
bring your chin up onto your chest
with 1,2 or 3 fingers pointing down towards your toes, feel down the length of your abdominals in the midline
if there is a “separation” you will feel a gap between 2 walls of muscle or a softness under your fingers
Ideally the gap should be less than 1cm with a firm midline. If the gap is less than 1cm but the midline is soft you need to get treatment. If the gap is any larger than 1cm you should also get checked to see if treatment is necessary.
Treatment involves re-coordinating the pelvic floor and deep abdominal muscles with your breath and functional movements.
5. Carpel Tunnel Syndrome and De Quervain's Syndrome
Carpel tunnel syndrome during pregnancy is usually caused by fluid retention limiting the space in the front of the wrist where the nerves pass through a “tunnel”. This puts pressure on the nerves and causes the classic signs of pins and needles and/or numbness and/or weakness in the hands. It may occur on one side or both.
Post-natally it should spontaneously resolve as your fluid levels return to normal.
If it persists, it needs treatment. Persistent carpel tunnel syndrome can be related to posture and positioning, handling techniques of the baby, hormonal fluctuations, strength, neck and back mobility and deep core stability.
De Quervain's syndrome is caused by an inflammation of the sheaths that wrap around the tendons of the thumb in the area of the wrist and lower forearm. The classic test to identify it is to tuck your thumb into the palm of your hand and wrap it with the fingers of the same hand then tilt your hand down from the wrist to put the thumb tendons on stretch.
It is commonly caused by picking up your baby with your thumb in an outstretched position and rarely settles spontaneously in new Mum's because you can't avoid the aggravating activity.
Treatment is available and usually includes ice, anti-inflammatories, using a thumb spica brace and altering your lifting/carrying technique.
6. Back pain
Generalised back pain/aching is really c
ommon post natally due to the postural changes of pregnancy, lack of core strength, generalized weakness, fatigue etc. If it is bothersome or persistant or more than a passing ache at the end of the day you should get assessed for a specific exercise programme to retrain your posture and deep core function.