Sunday, September 1, 2013
What to Expect When You're Expecting - What They Don't Tell You Part 2
So, what better time to finish discussing what to expect when you're expecting than Labor Day?
Again, these issues don't happen to everyone, but they are things that commonly occur, so you should be aware of them and know what you can do if they're happening to you.
To add to the things that they don't tell you can happen after childbirth is really painful bowel movements. Even if you didn't have any tearing into the anus and rectum, the surrounding areas have undergone trauma and will be swollen and sore. You will likely have hemorrhoids from pushing during delivery.
I have had patients who told me that their first bowel movement after delivery was more painful than childbirth itself. I have heard the words "It was like pooping concrete" from several patients. Many of my patients felt terror at the thought of having a bowel movement after delivery. I say this not to scare you, but to warn you and give you techniques to lessen or prevent your discomfort.
I think that doctors often tell you to use stool softeners after delivery, but often new mothers are so overwhelmed they don't realize how vital this information can be. To decrease your pain, you should keep your bowel movements as soft as possible and avoid straining. You should eat foods high in fiber — including fruits, vegetables and whole grains — and drink plenty of water. Remaining as physically active as possible also helps to keep things moving through your digestive tract and reducing the risk of constipation. As I discussed in another post, proper positioning to have a bowel movement can also decrease the need to push or strain. Using a stool when sitting on the toilet to keep your knees above your hips can put your pelvic floor muscles in a better position to allow for easy elimination.
Pelvic Organ Prolapse
Pelvic Organ Prolapse occurs when any of the pelvic organs descend below their normal position in the pelvic cavity. This can occur after a difficult and prolonged labor, and due to hormone changes that cause laxity of ligaments supporting your organs. You may feel a pressure in the vagina or notice that after you have had to push to have a bowel movement that something may be coming out of your vagina. If this is happening to you, you should tell your doctor. Some of your symptoms may resolve as your hormone levels change, but these symptoms also suggest that your pelvic floor has become weak and is no longer supporting your internal organs. An exercise program to strengthen your pelvic floor is needed to get your muscles back in order and to decrease your symptoms.
Even if you had a C-section, you may experience pain when you begin having sex again. Many doctors wait to release a woman to resume sex until 6 weeks post-partum to give the area time to heal. You can have swelling, bruising and scar tissue in the area that contribute to pain and it is normal to have some pain or discomfort the first few times you try sex after giving birth. However, if your pain continues for a couple of months after you start having sex again, it is time to speak up to your doctor. Sometimes stitches don't heal properly or you may have scar tissue that needs to be massaged or released.
The moral of this story is that you shouldn't ever feel like changes in your body after baby have to be permanent and that there is nothing that can be done. Speaking up with your doctor earlier rather than later can prevent moms from suffering unnecessarily for years. In other countries women are sent home after delivery with a prescription for PT to rehab their pelvic floors. Unfortunately in the U.S. moms often have to be their our own advocates, but fortunately for you, you now know that the first step is asking your doctor to refer you to a Pelvic Floor Therapist to get your body back on track.