Postnatal

After birth of your baby, our specialist team can support you to rebuild and strengthen your pelvic floor

Seek urgent medical advice if:


•    Your stitches get more painful
•    There is a smelly discharge
•    There is red, swollen skin around the cut (incision) or tear- you can use a mirror to have a look
Any of the above symptoms could mean you have an infection.

Please contact MAU on 01782 672300 within 28 days of giving birth.

Please contact the Perinatal Pelvic Health Team on 01782 672777

For non-urgent concerns, please contact the Perinatal pelvic health team and we will be happy to advise

Caring for your perineum and your stitches following childbirth

Sometimes a doctor or a midwife may have needed to make a cut in the area between the vagina and anus (perineum) during childbirth. This is called an episiotomy.  

An episiotomy makes the opening of the vagina a bit wider, allowing the baby to be born more easily. Sometimes a woman’s perineum may tear naturally as their baby comes out.  

Up to 9 in 10 first time mothers who have had a vaginal birth, will have some sort of tear, graze or episiotomy. Stiches should heal within 1 month of the birth. 

Coping with Pain 

It is common to feel some pain after an episiotomy or perineal tear. 

Painkillers such as paracetamol; can help relieve pain and is safe to use if you are breastfeeding. 

It is also considered safe to take Ibuprofen while you are breastfeeding, but check with your doctor, midwife or obstetrician first. Aspirin is NOT recommended. 

It may be necessary to treat severe pain with stronger prescription only painkillers such as codeine. This may affect your ability to breastfeed safely. Your GP or midwife can advise and support you with this. 

Good hand washing and hygiene is important. Clean your wound with water. Unperfumed soaps can be used for general washing in that area & change your sanitary towels regularly.  

Exposing the stiches to fresh air can help the healing process. Taking off your underwear and lying on a towel on your bed for around 10 minutes once or twice a day may help. 

It's unusual for pain after an episiotomy to last longer than 2 to 3 weeks. If the pain lasts longer than this, speak to a doctor, midwife or health visitor, and ask to be referred to the Pelvic Health Clinic for a follow up appointment. You can also use the self- referral link on the homepage to  access the service. 

Useful links:

Postnatal UHNM leaflet

POGP booklet – Perineal healing after a vaginal birth 

POGP booklet  - Fit for the future

POGP booklet - Exercise and advice after pregnancy

RCOG-Perineal tears and episiotomies in childbirth          

 NHS episiotomy and perineal tears              

 MASIC

  Birth Trauma Association          

 

(Please note UHNM does not take responsibility of accessibility of external websites and documents)                                                                                          

In the UK, a third or fourth degree tear (also known as obstetric anal sphincter injury- OASI occurs in about 3 in 100 women having a vaginal birth. It is more common with a first vaginal birth, occurring in 6 in100 women, compared with 2 in 100 women who have previously had a vaginal birth.  

If you are newly pregnant following a previous OASI, your community midwife will refer you to the perineal clinic to discuss your preferences for this delivery. You may be offered an endoanal scan to assist you with your decision. The specialist perineal/ pelvic health midwife will discuss these results and available options with you.

More information can be found in the UHNM – Endoanal scan-

Patient information Leaflet 

If you have recently sustained an OASI, an appointment will be arranged for you to be seen in the Perineal Clinic at around 6-12 weeks after the birth of your baby. This will be to check that you are recovering well from your recent injury.  

Please follow hygiene, constipation & pelvic floor advice covered in previous section. If you have any non -urgent concerns or questions with regards to your healing, please contact the Perinatal Pelvic Health Team who will be happy to advise.  


Within 28 days of your baby’s birth if: 
•    Your stitches get more painful 
•    There is smelly discharge 
•    There is red, swollen skin around the cut (incision) or tear -you can use a mirror to have a look. 

This could mean you have a perineal infection. Seek URGENT medical advice. Please contact MAU on 01782 672300  

Further information: 

Care of third and fourth degree tears

RCOG perineal tears hub: www.rcog.org.uk/tears 


Mothers with Anal Sphincter Injuries in Childbirth (MASIC): https://masic.org.uk

Birth Trauma Association: www.birthtraumaassociation.org.uk

Bladder and Bowel Community: www.bladderandbowel.org 


 (Please note UHNM does not take responsibility of accessibility of external websites and documents)                       


 

Avoiding Constipation postnatally

Going to the toilet 


Keep the cut and the surrounding area clean to prevent infection. After going to the toilet, pour warm water over your vaginal area to rinse it. 
Pouring warm water over the outer area of your vagina as you wee may also help ease the discomfort.  


When you're pooing, you may find it useful to place a clean pad on the cut and press gently. This can help relieve pressure on the cut. 
When wiping your bottom, make sure you wipe gently from front to back. This will help prevent bacteria in your anus infecting the cut and surrounding tissue. 


If you find pooing is particularly painful, ensure you are eating plenty of fruit, vegetables, and are maintaining a fibre rich diet. Make sure you are also drinking enough (between 6-8 cups of clear fluid daily). Taking laxatives may help. This type of medicine is usually used to treat constipation and makes poo softer and easier to pass. 


 You may be taught simple ways to enable you to pass a stool without straining. This involves adjusting your posture on the toilet and using special breathing patterns to keep you relaxed and improve the efficiency of your bowel movement.  


Do not strain  

  • Sit fully on the toilet: do not ‘hover’  
  • Have your feet apart and raised up on a stool/ support, ideally with knees over hips in a squatting position ideally at 35’ angle, with your arms resting comfortably on your legs.   
  • Keeping your tummy relaxed; don’t tighten your abdominal muscles  
  •  Avoid breath holding; try to have a relaxed breathing pattern, breath out when you feel like pushing, think of Moo to Poo 
  • Some women may find it helpful to support the perineum (the area between the anus and the vagina) when emptying their bowels. 
Useful links:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POGP Improving your bowel function                                                                                                             
POGP- Bowel Health 

NHS- Bowel Incontinence               

NHS Constipation 

Bladder and Bowel- Faecal Incontinence

Digestive health- Constipation                                                                                                                    
NHS The Eatwell Guide                                                                                                                                      

(Please note UHNM does not take responsibility of accessibility of external websites and documents)        

Postnatal Pelvic health information

It is important to allow your body time to recover from labour and any type of birth. Start pelvic floor exercises as soon as you can and continue daily.


If you have any concerns with bladder, bowel, prolapse, gap in your tummy muscles or any ongoing back or pelvic pain complete the self-referral link on the homepage.


After week 1 pain management and wound care:

After week 1 after birth week one bladder care:

 

 

Click the link below:
Pelvic floor exercise programme

 

 

The Pelvic floor muscle forms a sling from the front (pubic bone) to the back (tail bone) of your pelvis and support the organs within it. They also play a role in controlling your bladder, bowel and sexual functions.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pregnancy can put extra strain on your pelvic floor muscle as it supports your growing baby during pregnancy and stretches during labour. Having strong pelvic floor muscles means you’ll be less likely to have issues like stress incontinence after your baby is born.  

This can include: 

  • Leaking when coughing, sneezing, lifting or running.  
  • Less sensation when having sex.  
  • Reduced control over passing wind.  
  • A prolapse which is where one or more of your organs can press against the vaginal wall causing a bulge. 

 

Evidence shows completing your pelvic floor exercises can help to reduce the risk of developing the above symptoms. 

Pelvic floor exercises:

 

Pelvic floor muscle training:
  • The correct way to contract your pelvic floor muscles is tighten from back to front as if you’re trying to stop wind and wee.
  • You need to be able to draw those muscles upwards and forwards from the back passage towards the bladder. Imagine a plane taking off or an elevator rising.

You can do these exercises lying down, sitting or standing. With practice, they can be done anywhere and at any time: 

Pelvic floor exercise programme:

There are two types of squeezes to do:

Long squeezes:

  • Tighten your pelvic floor muscles as described above, keep holding them tight, then release
  • and let them fully relax, think of it like turning up a dial. Make sure you breathe normally throughout keeping all other muscles relaxed.
  • How many seconds or how many breaths in and out can you hold the squeeze?
  • Repeat the long squeezes, with a rest in between, until the contraction isn’t as strong or you can't feel the muscle relax. 

How many times can you repeat the squeezes?

Quick squeezes:

  • Quickly tighten your pelvic floor muscles, then immediately let them go again. Think of it like a switch.
  • How many times can you do this quick squeeze before the muscles get tired?
  •  Always let the muscles fully relax after each squeeze. If you can’t feel the muscles relax then the chances are the muscles have become tired.

How many am I aiming for?

  • Long squeezes: the aim is to work up to 10 second holds, repeated ten times.
  • Quick squeezes: contract for one second, relax for one second and repeat this up to 10 times.
  • Complete the above 3 times a day. Slow squeezes followed by fast squeezes make up a ‘set’. You should notice an improvement in 3-5 months 
  •  It's important to keep breathing normally while you do these exercises. Make sure you do not pull in your stomach when you squeeze. When breathing in, breath in through your nose out through your mouth.
  • Once you’ve achieved this and your symptoms have resolved, you can drop down to once per day or three times per week for life-long maintenance.

In everyday life you may find the Knack technique helpful.

The knack technique is when you tighten your pelvic floor muscles before and during certain activities to reduce strain on your pelvic floor muscles and prevent leakage of wee are poo. You should use this technique when you: cough, sneeze, laugh or picking something up. 

It is easy to forget to do your pelvic floor exercises, it can help to do them at the same time every day, or time them with mealtimes. Setting alarms or reminders on your phone or using the squeezy app can be helpful.

See attached links for useful resources:

POGP -Pelvic Floor Exercises for Women

POGP-Fit for Birth 

Pelvic floor muscle exercises and advice - A guide for trans men, trans masculine and non-binary people (who were assigned female at birth).

POGP-Fit for pregnancy 

POGP-Management of urinary incontinence 

(Please note UHNM does not take responsibility of accessibility of external websites and documents)

Let your midwife know if you feel you need support with strengthening your pelvic floor or self-refer using the self-referral link on the home page.

Return to exercise after delivery is recommended but it should be gradual and should not involve high impact exercise too quickly. It is advised to wait until at least 6weeks after your delivery to ensure healing and vaginal discharge (lochia) have stopped.


Remember that the hormonal changes that begun in pregnancy can still affect your ligaments and joints for 6months or more postnatally. Ensure that you have comfortable supportive clothes and bra when exercising and are well hydrated, especially if you are breastfeeding.


If you have any concerns regarding urinary or faecal leakage (incontinence), gap  in your tummy muscle (diastasis recti) or ongoing low back or pelvic pain. It is advised that you seek help and support from your GP or local women’s health specialist physiotherapist prior to starting exercise.

 

Useful links:

Physical activity for women after childbirth

Your guide to return to running following childbirth

POGP exercise after pregnancy 


POGP Aqua Natal Guidelines: guidance on antenatal and postnatal exercises in water


POGP- Fit for the Future   

Advice and guidance for exercise in the childbearing years                                                                                 

Pelvic Floor Dysfunction

Pelvic floor dysfunction (PFD) is used to describe conditions that are caused by the pelvic floor muscles not working as they should.


Symptoms can include:


•    Urinary incontinence - leaking of wee.
•    Urge incontinence - urgency to wee more than seven times a day.
•    Anal incontinence – leaking of poo or wind.
•    Pelvic organ prolapse - one or more of the pelvic organs start to come down into the vagina.
•    Pain or discomfort during sex.


Pelvic floor dysfunction can be common, but they do not have to be your new normal and it should not be accepted that it’s a normal part of pregnancy and giving birth. Symptoms can occur but should only last for a short time and should be mild.


The most common symptom to experience during pregnancy and after birth is urinary incontinence (leaking wee).


•    It occurs in around 40 to 50 per cent of women and birthing people as pregnancy progresses and immediately after birth.
•    Around 25 per cent of pregnant women and birthing people can also have anal incontinence (leaking poo).
Please complete the self-referral form on our home page if you like further support with your symptoms

Stress urinary incontinence 

The most common type of incontinence is stress incontinence. It is caused by physical stress on your bladder that can make you leak wee. It often happens when you cough, sneeze or exercise. Common causes include weakened pelvic floor muscles, examples include pregnancy and childbirth.  

Urge incontinence  

Urge incontinence is when you feel a sudden and very intense need to pass wee and you are unable to delay going to the toilet. There are often only a few seconds between the need to urinate wee and the release of urine. There can be several reasons as why this happens for example drinking fluids that can irritate your bladder such as caffein and fizzy drinks.

                                                                                          

                                                                  

Management is key. This can include good bladder and bowel habits, making lifestyle changes and pelvic floor exercises 

POGP- Management of urinary incontinence 

(Please note UHNM does not take responsibility of accessibility of external websites and documents)

You might have bowel incontinence if you cannot control when you poo. Symptoms of bowel incontinence include:


•    poo leaking out without you being able to stop it
•    feeling like you need to poo, but not being able to get to the toilet in time
•    not being able to get fully clean after going to the toilet
Management is key. This can include good bladder and bowel habits, making lifestyle changes and pelvic floor exercises 

Useful links:

POGP-Improve your Bowel Function

 

(Please note UHNM does not take responsibility of accessibility of external websites and documents)

 

Prolapse is common affecting 1 in 12 people. Normally the pelvic organs (bladder, bowel, uterus and vagina) are supported in our pelvis by ligaments, fibrous tissue and the pelvic floor muscles. A prolapse occurs when one or more of these organs slips or bulges down towards the vagina due to weakness of the pelvic structures. Causing the feeling of ‘something coming down’ or vaginal heaviness or a dragging feeling. The bulge might be felt inside or outside the vagina. Prolapse can cause bladder, bowel or sexual symptoms. Having a prolapse can also affect how your bladder and bowel function and can also make sex uncomfortable.


There are different types of prolapse, its common to have more than one type of prolapse at the same time. 

Front vaginal wall (cystocele)  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This is the most common. The wall supporting the bladder bulges down. This can cause problems with emptying the bladder, causes frequent urine infections, increases how desperately you need to empty your bladder (urgency).  

Back vaginal wall prolapses (rectocele)  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


The wall supporting the rectum bulges down into the vagina contributing to bowel symptoms. This can cause symptoms such as difficulty emptying the bowel, controlling wind and the speed that you need to go to the toilet. 

 

 

 

 

 

Uterine prolapse

Uterus moves down towards the cervix. Symptoms might include feeling something coming down. It can often be felt or seen with a mirror. It might be uncomfortable inserting tampons, obstruct sex and cause pain or discomfort.  


Risk factors of prolapse include pregnancy, childbirth, being overweight, heavy lifting, age, family history, constipation, cough, previous pelvic surgery. 

Management is key: 

This can include good bladder and bowel habits, making lifestyle changes and pelvic floor exercises 

Useful links:

POGP-Pelvic Organ Prolapse

(Please note UHNM does not take responsibility of accessibility of external websites and documents)                                                                        

Some women or birthing people may develop pelvic pain in pregnancy. This is sometimes called pregnancy-related pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD). 


Pregnancy related pelvic girdle pain (PGP) is common, but it is not normal or expected during pregnancy. PGP describes any pain that you feel around your pelvis. 
 
You may find it difficult to walk, taking weight on one leg, pain when separating your legs and clicking or grinding of the pelvis. 


We used to think it was down to increase in the hormone relaxin making the joints loose, this is no longer the case.  Your pelvis remains strong throughout pregnancy.


When you experience pain, it does not always mean the pelvis is ‘damaged’. Pain and emotions are processed in the same part of the brain. There are a lot of changes that happen during pregnancy which naturally heightens the nervous system. It can make the body behave in a protective way, it can mean the muscles feel tight and movements can feel difficult, restricted or painful. This can last longer than it should do and can lead to a sensitised nervous system. 

See below for more information on how to improve your PGP: including management, how physiotherapy can help your symptoms, exercises, positions of ease during pregnancy and labour and after baby arrives.

 

If you have symptoms lasting more than two weeks, or interferes with normal day to day life let your midwife know or use the self- referral link  on the home page.

Useful links:

POGP- Pregnancy related pelvic girdle pain for mothers to be and new mothers 

POGP- Pilates

POGP Aqua natal and postnatal guidelines 

RCOG-Pelvic girdle pain and pregnancy

If you have symptoms lasting more than two weeks, or interferes with normal day to day life let your midwife know or use the self- referral link on the home page.

(Please note UHNM does not take responsibility of accessibility of external websites and documents)        

Your stomach muscles- Diastasis rectus abdominis

In pregnancy the abdominal (six pack) muscles stretch to give room for the baby to grow. For some women these muscles stretch to the point of separating along the midline (linea alba). The separation is called diastasis recti. You may notice a gap in your abdominal muscles, especially when sitting up from a lying position, you may see a visible dome or peak shape. Most women do have around two fingers width gap after pregnancy, and it should come back together within a few months.

However, if its more than two fingers width and a visible bulge appears ask to be referred for a physiotherapy assessment. 
 
What can you do to help? 


Avoid strenuous activity that causes your abdominal wall to bulge, avoid heavy lifting, avoid straining on the toilet, avoid sit ups until you’ve been formally assessed. When getting out the bed, log roll (turn on your side) rather than bending in the middle. If coughing, cross your arms over your abdomen and squeeze your pelvic floor. 

Any concerns regarding your stomach muscle use the self-referral link on the homepage.

 

 

Useful links:

POGP- Pelvic girdle pain and other common conditions 

(Please note UHNM does not take responsibility of accessibility of external websites and documents)