I knew I was going to go to physical therapy post-partum before I even had my baby. Why you ask? Because it was my third baby and I've had my kids relatively close in age. I’m also a women’s health physical therapist. Perineal re-education and core strengthening is a must post-partum especially if you've had more than one baby.
Post-partum recovery is never easy. Although I had a natural birth and was home from the hospital in less than 24 hours, I did not have a straight forward delivery. I was back on my feet quickly by necessity; with 2 older kids I wasn't really given much of a choice. My recovery, however, was pretty difficult. This is the inside story about my delivery and an intimate look at my healing and treatment that is available post-partum.
Babies are normally born face down. Billie came out sideways and this position put a lot of pressure on my coccyx, pushing it out of alignment and causing what I think was an internal hemorrhoid or possible microtear in my rectum. My strength and her small size made this delivery possible. The tail bone (coccyx) usually fractures in this scenario, but mine didn't - I was extremely lucky. There was also a small laceration on one side of the vagina that required a stitch.
Although I was mobile and functional post-partum things really hurt. I wasn't sure where the pain was coming from because everything was sore. I could feel soreness at the tailbone and also around my anus. Ironically I felt no pain in my vagina, but this was masked by everything else. I tried frozen witch hazel pads, perineum soaks, icing, getting pressure off the area, going commando for pain relief but ultimately was prescribed a steroid cream which worked wonders.
Things were significantly better 10 days into my recovery. I was actually surprised that the tailbone pain was gone and I had much less pain. I knew this did not mean I was in the clear. I was healing and there was an issue dormant just waiting to be uncovered. As I had suspected, a few weeks later I started to feel something at the scar on my perineum. I can't say that it was pain, but it was something that I was aware of which hadn't been there before. When you feel something down there you know it just is not right.
I made an appointment at 3 weeks post-partum to see my midwife because I was feeling something nagging in my vagina. Sometimes it was a dry, scratchy feeling, sometimes it was a sensation of urgency like I had to pee. I wanted to make sure I didn't have a urinary tract infection from wearing a pad for 3 weeks. My midwife assured me everything was within normal for the way a post-partum vagina should look. She took a urine culture which was negative for infection.
What was I feeling? What was the next step in my post-partum recovery? It was a no brainer for me, I got a prescription and scheduled a physical therapy visit at 6 weeks post-partum. I needed to find out what was going on down there. Aside from my perineal re-education as originally planned there was going to be a lot to work on.
The treatment was all encompassing. We worked on the pelvic floor muscles, pelvic alignment, my scar, rib cage alignment, diastasis correction and long standing issues were uncovered that were contributing to the pain.
I needed to release the pelvic floor muscles to establish a normal resting baseline to be able to contract and relax through a full range of motion. If the underlying muscles and connective tissue are tight they can restrict scar mobility. My scar and perineal body (insertion of the muscles) needed mobilization as well.
My body was totally out of alignment and unstable. With manual techniques including muscle energy, mobilization, and trigger point release, my sacrum and pelvis were realigned. I was then given targeted strengthening exercises to stabilize the sacrum. Without stabilization things would not hold in the correct place. These exercises are subtle movements and powerful; they go well beyond what you think of as exercise. They retrained my movement patterns and also addressed above and below the problem. Without proper stabilization of the pelvis and sacrum you can injure yourself getting back into exercise.
I re-educated the Transverse Abdominus and worked on my Diastasis Recti Separation. This involved hands on fascial release and energy work which cannot be achieved with corrective exercise alone.
We also restored correct positioning and mobility in the rib cage from a long standing issue and of course it tied into the problem. As we continued to peel back the layers, the heart of the problem emerged. The therapist had to do a rectal mobilization in order to get my coccyx back into alignment. This mobilization reproduced the pain that I had after birth. There was a lot of scar tissue caused by the laceration that I had on one side of the vagina. It's amazing how everything was connected.
I feel compelled to share my recovery to raise awareness about physical therapy treatment that is available post-partum. This work is so powerful and it can help on so many levels. If you are not feeling right at your 6 week check up, get a prescription from your doctor or midwife. Even if you had an uncomplicated delivery, the pelvic floor needs to be re-educated. You don't need to feel pain to have a dysfunction. This may not become apparent until you resume your activities, workouts, or running. There is so much you can work on.
· Re-educate your abdominals
· Close your diastasis
· Re-align the pelvis/sacrum
· Restore rib cage mobility
· Mobilize painful scars
· Release painful muscles
· C-section scar mobilization
· Establish a good strengthening program tailored to your body
· Pain free sex (should be at the top of the list!)
Working on my own case and receiving treatment inspired me. Every session I learned something new and gave me a renewed passion for women's health.