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by Rosalina Mahendran   MSa-PT
Pelvic Health Physiotherapist
updated Oct 3, 2022


Many individuals are provided with continuous medical care, support and information while they are pregnant, however postnatally can be left feeling alone and clueless about how to recover from a vaginal delivery or cesarean section. Giving birth is no easy feat and takes time to recover, we want to tend to ourselves the way we would if we were recovering from an injury, even though our lives become consumed by the baby. Here we have curated a list of common health ailments in the first 6 weeks after birth and a timeline of how to manage and treat them.

 

What are some common symptoms after giving birth?

  • Vaginal/perineal pain
  • Cesarean Incision/Scar Care
  • Constipation
  • Hemorrhoids
  • Incontinence
  • Increased vaginal discharge
  • Vaginal Bleeding
  • Cramping
  • Sore breasts/nipples
  • Mood changes: Baby blues/postpartum depression
  • Hair loss/Skin Changes
  • Musculoskeletal issues: neck, mid back & low back pain, carpal tunnel syndrome, De Quervain’s tendonosis

 

Resting after giving birth

Specifically, the first 3 days postnatal should be spent minimizing activity and resting as cortisol levels are highest during this period. Resting allows our stress hormones to drop back to a normal level and promotes the healing process.

 

How can I soothe vaginal/perineal pain?

After having vaginal birth you may feel soreness and heaviness vaginally. Here are some strategies to help with managing perineal discomfort/pain:

  • Padiscles (pads made with witch hazel, aloe vera and then frozen)

-soothes the vulva/perineum

  • Sitting on a donut/ring cushion (donut/ring)

-takes pressure off the perineum

  • Placing legs on a wall/headboard and performing gentle Kegels (10% of your maximum strength)

  • Squirt bottle (rinse and clean the perineum)
  • Pat to dry with towel or toilet paper instead of wiping
  • NSAIDs (anti-inflammatory medications such as ibuprofen)
  • Place your index and middle fingers on perineum and apply pressure during a bowel movement (to avoid straining your stitches or perineum) 

 

How do I manage my cesarean section incision?

In order to promote optimal healing, you’ll want to support the incision site as much as possible. This may include:

  • Supporting your abdominal muscles through activity:

-Using a stool to get up onto bed
-Using BBQ tongs to pick things up off the floor or to reach for high objects
-Splinting the incision: use a pillow to put pressure on your scar to reduce pain with bowel movements/coughing/sneezing

  • Watch for signs of infection: pain, pus, swelling, redness, swollen lymph nodes, or a fever.
  • Keep the area clean (soap and water) and pat to dry
  • Desensitization of the scar after 1 week: light touch or touch with different textures in the area as well as increasing pressure over following weeks
  • Scar Massage: usually around 3-4 weeks post birth if you have noticed healing has started to occur (no open wound, minimal redness).
  • Try not to lift anything heavier than the weight of your baby in the first week postnatal
  • Over The Counter (OTC) pain medications: e.g. acetaminophen, ibuprofen
  • No driving for 3-6 weeks
  • No running or high impact activities for 6 weeks (standard)

-this restriction increases to 12 weeks, if any symptoms of pelvic floor dysfunction are identified prior to, or after attempting, a return to running.

  • No bathing or swimming for 6 weeks or until the wound is healed over
  • Light housework only for 6 weeks (no vacuuming)

 

How do I relieve my postpartum constipation and hemorrhoids?

To manage constipation and hemorrhoids following childbirth, you can use these following strategies:

  • Stool (knees are higher than hips)

woman-practicing-using-stool-for-bowel-movement-after-birth

  • “Blow as you go” strategy instead of straining

  • Increase water intake
  • Increase fiber intake (soluble fiber)
  • Over the counter Stool Softener
  • Sitz bath (for hemorrhoid pain)
  • Over the counter hemorrhoid cream
  • Diaphragmatic breathing – as taught by a pelvic health physiotherapist to decrease  the holding of tension through the pelvic floor muscles

 

How do I prevent/stop myself from leaking urine? 

“Peeing oneself” or leaking is referred to as incontinence. It is very common to experience incontinence in the first 6 weeks of recovery and beyond. Gentle Kegels starting at 10-20% of your maximum strength at week 1 postnatal and progressing 10% each week until your 6 week mark, can help improve your incontinence. If you find this painful at the site of your stitches, scale back until it is pain free. At the 6 week mark, consult a pelvic health physiotherapist to confirm that you are performing them correctly and at the right parameters.

 

Why am I bleeding vaginally after giving birth? 

Vaginal bleeding, otherwise known as lochia occurs during the first few days after delivery (both vaginal birth and cesarean). During this time, your body eliminates excess blood and tissue from your uterus. It is common to have light bleeding through vaginal discharge, for up to 6 weeks. If you are soaking a pad in 1-2 hours, passing blood clots bigger than a quarter or it is still bright red past the first few days, contact your doctor.

 

How do I manage sore nipples/breasts from breastfeeding?

If you are experiencing issues with breastfeeding it is encouraged to consult a lactation specialist. Some general recommendations to relieve breastfeeding pain are:

  • Ice pack/warm compress (anecdotal evidence for cold cabbage leaves)
  • Gentle breast massage
  • Lanolin cream for cracked nipples
  • Wearing a comfortable, supportive nursing bra.

 

Can I get rid of my stretch marks or dark marks?

Unfortunately, stretch marks may not ever completely disappear however, they can fade into a white/silver colour. Dark marks (also known as melasma) however, do fade with time as cells turn over and your hormone levels regulate. Some things that may help minimize skin changes are to protect it from the sun, avoid hair removal like waxing around the affected area, and by using milder facial products.

 

Why am I losing hair after giving birth?

The prenatal shift in hormones can cause a surge of hair growth but by a couple months after birth, hormones change once again causing you to lose the hairs you had grown earlier. This will begin occurring within two months after delivery and by the one year mark, your hair should return to its prepartum state.

 

Postpartum depression vs. postpartum blues

Postpartum blues or “baby blues” is common after giving birth with approx. 70-80% of new mothers experiencing negative emotions and mood changes that can be related back to hormonal changes.

Common symptoms include: sadness, unexplained crying, anxiousness/restlessness, trouble sleeping, irritability, and decreased concentration. These symptoms usually resolve on their own and generally do not last more than 2 weeks. If these symptoms persist longer, it would be classified as postpartum depression and you are encouraged to reach out to your family doctor. It is also important to know that there may be support groups provided by the hospital you delivered at, for postpartum depression and other perinatal mood disorders. For more information please refer to: https://www.camh.ca/-/media/files/ppd_clinical_overview-pdf.pdf

Postpartum Depression Programs:

Markham:

https://www.oakvalleyhealth.ca/clinics-departments/mental-health/womens-wellness-services

Toronto:

https://unityhealth.to/wp-content/uploads/2021/02/Postpartum-Depression-and-Anxiety.pdf

Burlington:

https://www.halton.ca/For-Residents/Children-and-Parenting/Pregnancy-and-Prenatal-Health/Depression-and-Anxiety-During-Pregnancy

 

How can I manage other types of postpartum pain?

A few common musculoskeletal conditions can appear postpartum including: low back, mid back, neck and wrist pain. In order to manage these impairments, it’s important that you consult a physiotherapist, so they can assess the problem and determine the appropriate diagnosis and treatment.

Some examples of common strategies to prevent musculoskeletal pain are:

-lift with your legs and not to always use your back when picking up the baby.
-set up the right positions for breastfeeding (e.g. if you’re sitting, use the proper supports to help you sit up straight).
-bring your baby close to you when picking them up as opposed to outstretched arms.

We have included general exercises to help with common postpartum ailments. Click here to download

 

How do I return to my pre-baby weight? 

Your body is expected to go through changes after giving birth, such as weight loss or weight gain. Some women will shed the baby weight in 6 weeks while others may take months. Some considerations for the different changes to the body can be: diastasis rectus, nutrition changes, activity levels, breastfeeding, water intake and sleep. Be kind to yourself on your journey as it takes time to rebuild your body to prepartum levels. Seek the support you need to be able to optimize the many different facets that contribute to a healthy weight loss. This can include but is not limited to: pelvic health physiotherapy, nutritionist/dietician, personal trainer, group fitness classes (postnatal fitness), and family members, just to name a few.

We have included a 6 week recovery timeline of what to do during the waiting period between your delivery and when it’s time to see your doctor and pelvic health physiotherapist. This way you can take control of your health and get better, faster!

 

6 Week Timeline For Postpartum Recovery: 

Day 1 – 3 

  • Rest ONLY

Cortisol levels are high during this period. Increased activity (e.g. going up and down stairs multiple times) can cause cortisol to remain high which delays recovery and healing.

  • Padsicles can be utilized for pain, pressure etc.
  • Donut Rings can be used to take the pressure of the perineum when sitting
  • To clean the perineum use a squirt bottle
  • First BM and for the next little while:

For Vaginal Delivery: Splint your perineum/stitches. If you’ve had a vaginal birth, wrap toilet paper around your index and middle finger and and place pressure up on the perineum (the tissue between the rectum and vagina) to help with bowel movements.

For Cesarean-section: use a pillow to put pressure on your scar to help with any pain with bowel movements/coughing/sneezing

– Use a stool (knees higher than hips) every time
– No straining!  Instead use “Blow as you go” (when having a bowel movement). Exhale out loud and as act if you are blowing out a candle so that you are putting less force through your pelvic floor (this strategy will be used whether you have a c-section or a vaginal delivery)
– HYDRATE and eat foods that move bowels easily (soluble fiber)
– Over the counter stool softeners can also be used as well as fiber supplements

  • Try to keep the baby crib/bassinet close to you so you do not have to get up and walk around multiple times
  • If you’ve had a C-section:

– Keep a stool close to your bed so it’s easy to get in and out
– IF you need to pick up anything – use BBQ tongs to help reach for things so you don’t stress the incision

Week 1

  • Gentle Kegels can be started (20% of your strength) (1 set of 10 reps, 3x/day)

– Make sure you perform diaphragmatic breathing and Kegel on the exhale (relaxation is just as important for the pelvic floor)
– Alternatively, place your legs on the wall and perform Kegels to help with fluid drainage out of the pelvis

  • Walking as tolerated. Look for changes in symptoms such as: urinary/fecal leakage and increased heaviness or pain in the pelvic/abdominal region.

Week 2 – 3 

  • Start gentle exercises (prenatal/postnatal yoga)
  • Walking at tolerated level
  • If stitches are healing well, increase Kegels to 30-50%  (2 sets of 10 reps, 2x/day with a 2-3 min rest between sets)
  • Gentle core strengthening Click here to download exercises.  It is advised to contact a pelvic floor physiotherapist for a check-in and program prescription at this time
  • C-section scar should be healing well (no seepage or scab) and the scar should be pain free touch (use a wet towel and try moving it in different directions)

Week 4 – 5

  • If stitches are healing well, increase Kegels to 70-80% (2 sets of 10 reps, 2x/day with a 1 min rest between sets)
  • Continue increasing physical activity tolerance (start light and progress accordingly).

– No abdominal strengthening for both vaginal and c-section deliveries (i.e. crunches) Safe abdominal exercises are included here.
– Upper body exercises: Vaginal delivery = no limits; C-section = body weight
– Lower body: gentle and body weight only
– Continue with prenatal/postnatal yoga and mobility work

Week 6

  • Check up with midwife/obgyn
  • Check up with pelvic physiotherapist: Rehab starts and increase in activities is initiated

 


Pelvic Health Physiotherapy in Your Area

Cornerstone Physiotherapy offers it’s well-regarded Pelvic Physiotherapy program in Toronto, North York, Burlington and Markham. If you’re unsure whether one of our experienced pelvic physiotherapists can help you, we offer a free 10 min phone consult. Contact us today and get us on your team!

 

References:

American College of Obstetricians and Gynecologists. “Exercise during pregnancy and the postpartum period.” Clinical obstetrics and gynecology vol. 46,2 (2003): 496-9. doi:10.1097/00003081-200306000-00028

Clinton, Susan. GI Dysfunction and the pelvic floor. August. 2018, PowerPoint Presentation.

Davies, Gregory, et al. “Exercise in Pregnancy and Postpartum Period.” Journal of Obstetrics and Gynecology Canada, Vol. 25, no. 129, 2003, pp 516-520 DOI:Ihttps://doi.org/10.1016/S1701-2163(16)30313-9

Dufour, Sinead. Pregnancy and the pelvic floor. Nov. 2018, PowerPoint Presentation.

Lee, Lily et al. “Management of Spontaneous Labour at Term in Healthy Women.” Journal of obstetrics and gynaecology Canada : JOGC = Journal d’obstetrique et gynecologie du Canada : JOGC vol. 38,9 (2016): 843-865. doi:10.1016/j.jogc.2016.04.093

Ross, Lori Elizabeth, et al. Postpartum Depression: A Guide for Front Line Health and Social Service Providers. Centre for Addiction and Mental Health, 2005.

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