As a pre-natal and post-natal pelvic health physiotherapist, I often get asked by pregnant moms as to when they should come in for their post-natal pelvic floor appointment. The answer? Sometime in the 6-8 weeks postpartum is great for most people.
What’s especially important, however, during that 6-8 weeks before you come to see me or my pelvic floor physiotherapist colleagues is that you care for your pelvic floor as you recover from giving birth. Here’s what you can do for wonderful you.
Your pelvic floor has done an AMAZING job of bringing your baby to world so you really want to give it the TLC that it deserves. Whether you’ve had your baby vaginally or by Cesarean, your perineum might feel sore, swollen and fatigued. You can help reduce these symptoms by using the acronym R.I.C.E.: Resting, Icing, Compression and Elevation. In the past, you may have been advised to practice the R.I.C.E. principle when you’ve strained a muscle; the same principle applies to your pelvic floor after you give birth. In addition, you also need to try to avoid constipation postpartum, and I’ll explain why that is critical later.
Resting is absolutely essential in order for you to recover quickly. A lot of women expect to get back to their pre-pregnancy state as soon as they deliver. However, just think that it took 9 months for your body to get to where it is so it may take another 9 months for your body to recover completely. It’s really important to take it easy at the beginning and to ease back into things slowly. In the first 12 weeks postpartum, also known as the 4thtrimester, it’s not a good idea to push yourself even if you feel great because you may find yourself regressing. I recommend that you do a lot of deep breathing, light walking, and resting during this period. In the first two weeks after you give birth, consider lying down or napping for at least 30 minutes, twice a day. Your body, your core, and your pelvic floor will be much happier once they’ve had adequate rest.
In addition, consider planning ahead for receiving support during the first 2 weeks after your baby is home so you don’t have to mobilize much. Consider organizing around-the-clock help ahead of time with respect to meals, cleaning and caring for your baby. If you have family around who can give you a hand, excellent! However, if this option is not available (as some of us live far away from our families, or family dynamics would mean more stress than support), you might consider the support of a postpartum doula. To be honest, I had never heard of a post-partum doula until recently. I thought that all doulas did was assist birthing moms. However, since I found out what postpartum doulas do, I really wish I had had the service of one when I had my children.
You might consider icing your bottom to help reduce swelling and pain in the days following your birth. Some moms find it helpful to sit on an ice pack while they are feeding. Ice should be applied for 20 minutes every 2-3 hours until pain and swelling go away. It’s important to note that you don’t want to put ice directly on the skin, so use a thin barrier, like a towel between your skin and the ice pack.
Other than ice, a “padsicle” (not a popsicle!) also provides the same benefits as ice with the added benefit of a healing agent such as alcohol-free witch hazel, aloe vera or sitz bath tea. A “padsicle” is a sanitary pad that has been squirted with one of the above healing agents and has been frozen for at least 2 hours in the freezer. Some moms prefer to prepare a whole bunch of “padsicles” before they give birth.
How to make a padsicle
Some moms find it helpful to use compression underwear to support their pelvic floor and their lower abdominal muscles during the first 4 weeks post-partum. Since the pelvic floor may be strained at this point, giving your pelvic floor some compression will provide it with much needed support while it’s trying to recover, especially if you have another little one to care for and you absolutely need to mobilize frequently. I’ve heard a lot of good things about the Baobei maternity and postpartum underwear because most compression underwear only provides abdominal support. The Baobei supports both the abdominal AND the pelvic floor. The only drawback is they are quite pricey (about $75 Canadian once you have done the conversion) but I am not aware of more budget friendly alternatives in Canada. Please comment below if you know of any!
You may consider elevating your pelvis while you are lying down to help reduce swelling. Elevation facilitates the draining of pelvic fluid back to your heart which helps swelling to go down faster. You can elevate your pelvis by lying on your back, either with your feet up the wall or with a pillow under your bottom. You might also consider doing this while you are icing your bottom at the same time which is 20 minutes, 2-3 times a day.
Constipation management is super important postpartum because constipation causes you to strain your pelvic floor. Your health care provider will probably prescribe some sort of stool softener which will help to pass your stool more easily. However, if you have been prone to constipation in the past you may also want to try:
- Drinking at least 2-3 L of water a day, especially if you are breastfeeding
- Having plenty of fibre in the form of cooked veggies, nuts, fruit, chia seeds, flax seeds, etc.
- Avoiding dairy and wheat if your digestive system is sensitive to them
If you have tried all of the suggestions above and still suffer from constipation, you may want to consider seeing one of our prenatal and postnatal naturopaths or nutritionists to determine the root cause of the problem.
In closing, I would like to say that if you are to follow all of the suggestions above, great! However, if you are only able to do one or two of them, your pelvis will still benefit. These suggestions are meant to speed up the healing process and make you feel better – they are not meant to give you more work and stress you out even more. At West End Mamas, we know how hard being a mom of a newborn baby can be, and we are here to support and cheer you on.
Mia Dang (PT) is a registered physiotherapist with a special interest in pelvic health. She has a Masters degree in Physiotherapy from McMaster University (2009). Mia is also a member of the Women’s Health Division of the Canadian Physiotherapy Association. Since 2018, she has helped women with labour preparation, pregnancy pelvic girdle pain, postpartum pelvic floor rehabilitation, incontinence, pelvic organ prolapse, frequency & urge and pelvic pain.