Sunday, July 28, 2013

What to Expect When You're Expecting - What They Don't Tell You

This post is dedicated to all of my patients who are moms, both new moms and those whose children are now grown. One of the biggest questions I hear when treating moms who have pelvic floor dysfunction is "Why didn't anyone tell me this could happen?" Often it is after many years of dealing with embarrassing issues like urinary or fecal incontinence, and possibly after surgeries that may have been unnecessary. So, I am here to tell you what can happen to your pelvic floor as a result of pregnancy and child birth. This is not done to frighten anyone, but to educate you about your body and the changes that it will undergo, so that you can make informed decisions should these issues arise.

First off I will say that everyone responds differently to pregnancy and childbirth. I have a friend who has 4 children and we have talked about pelvic floor issues and urinary incontinence and she says she
has never had any issues. I also have patients who have problems after the birth of their first child, so just know that the issues I'm discussing today COULD happen to you. It doesn't mean that they WILL.

Today I will be discussing a few of the more common things that could happen due to pregnancy and childbirth.

Urinary Incontinence
This is something that you may encounter during pregnancy as the baby grows larger and puts more pressure on your pelvic floor muscles and your bladder. The weight of the baby inhibits your pelvic floor muscles and keeps them from being able to appropriately contract and hold back urine when you do things like cough or sneeze. The baby may also be kicking you in the bladder, or just generally putting pressure on your bladder which causes urine to come out because the pelvic floor can no longer effectively do its job.

This is something that can resolve after delivery and there is no longer pressure on the bladder and pelvic floor, but since the pelvic floor muscles are weakened due to the weight of the baby over 9 months, it can be an issue that persists well after delivery and often gets worse over time. Many women wonder why they have urinary incontinence even though they had a C-section and the reason is the weight and pressure of the baby still weakens the pelvic floor even if you don't have a vaginal delivery. If you do have a vaginal delivery that just further stretches and weakens the pelvic floor. So it is common for women to have urinary incontinence especially with high impact activities like running after having a baby.

Vaginal Tearing
First degree tears are what occur when damage is limited to the posterior aspect of the vaginal opening and the superficial perineal and vaginal tissues. Often these tears heal well on their own without requiring stitches.

An Episiotomy is a surgical cut given by the caregiver into the woman's perineum, usually around the crowning phase of a vaginal birth or with the use of forceps. The cut is regarded as equivalent to a second degree tear of the perineum, since it divides the pelvic floor muscles and will usually need to be repaired with stitches.

Third or fourth degree tears are more extensive tears of the perineum, that include the vaginal skin, the underlying tissue and the pelvic floor muscles (similar to a second degree tear).  In addition, a third degree tear extends to reach the edge of the anus, without going through to the anus while a
fourth degree tear will extend completely through to the anus to the tissues of the rectum.

Fecal Incontinence
Third and fourth degree tears increase a woman's risk for anal incontinence which includes the inability to hold back gas as well as fecal incontinence. At our clinic we have a protocol with local OBGYNs to encourage them to refer women that have had third and fourth degree tears for pelvic floor physical therapy as soon as they have been cleared to resume regular activity and intercourse which usually occurs about 6 weeks postpartum. Often women end up coming to physical therapy a couple of years of their delivery and they have slowly developed issues with fecal incontinence where they initially notice staining of their underware if they have more liquid or soft stool and this can continue to the point where they are unable to contain more formed stool. Many patients report embarassing situations where they did not know they had passed stool until the noticed an odor, because they also lacked sensation and were unable to tell they had passed any stool.

The most important thing to know is that though these things are common, they are NOT NORMAL! Many women feel like this is just the price they pay for having children and they just have to deal with it for the rest of their lives. This is just not the case! A pelvic floor PT can help you to rehab your pelvic floor and get your body back to the way it was before pregnancy.

Come back for the next installment of What to Expect When You're Expecting - What They Don't Tell You where I'll be discussing more issues that can occur with pregnancy and delivery.

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