What New Moms Should Know About Pelvic Floor Disorder
After giving birth vaginally to two large babies, one well over ten pounds, I learned the hard way about pelvic floor disorder. Luckily, my physical therapist helped me immensely, but I received this intervention over two years after the birth of my first child and only after I pestered two different gynecologists for a referral. I was lucky. In America, new moms learn woefully little about their postpartum pelvic floors and receive barely any help addressing postpartum injuries. This is an egregious oversight.
What is Pelvic Floor Disorder (PFD)?
Pelvic floor disorder is a broad term that encompasses urinary or fecal incontinence, pelvic organ prolapse, and pelvic pain. Many moms are familiar with urinary incontinence - the leaking of urine, especially during coughing or sneezing. However, few new moms have heard of pelvic organ prolapse, which is when the bladder, uterus, vagina, rectum, or small intestine begins to prolapse, or fall, from its normal position.
How Common is It?
Good statistics on the prevalence of pelvic floor disorder are hard to find because the term is a catch-all for many different conditions. The incomplete statistics are also a result of women not knowing anything is wrong and a taboo against openly talking about parts of the body considered private.
Nonetheless, a 2008 study examined the prevalence among American women. The study authors found that 23.7% of women had at least one PFD. This equates to roughly 1 in 4 women.
The authors also noted that this number was likely an underestimate because it did not include women who had been successfully treated and because the study’s results were based on self-reported symptoms rather than a physical examination, which is considered a more accurate method of data collection. Therefore, we can safely conclude MORE THAN a quarter of all American women have a pelvic floor disorder.
PFD can have multiple causes. Studies have shown that childbirth, age, and body mass index are three of the most common risk factors. Childbirth can damage the structures supporting the pelvic floor, advanced age can cause atrophy of muscles, which further exacerbates any previous damage, and a high body mass index puts undue pressure on the pelvic floor.
Although not all women with PFD have given birth, vaginal childbirth is an independent and strongly predictive risk factor. The more babies a woman has birthed, the higher her chance of some form of incontinence, pain, or prolapse. For example, in that 2008 study, 6.5% of women who had never given birth reported urinary incontinence, whereas 23.9% of women who had given birth vaginally three or more times did.
This shouldn’t unduly worry new moms. Giving birth doesn’t mean you are guaranteed a disorder, but it does mean you should be especially diligent about checking the state of your pelvic floor and about seeking out medical professionals if you suspect a problem. Early intervention might help prevent greater problems after menopause.
Studies have shown that childbirth, age, and body mass index are three of the most common risk factors.
How to Check Yourself
If you are a new mom, you might be wondering, now what? How do I know if I have incontinence or prolapsed organs? Since pelvic floor disorder is under-discussed before childbirth, many moms panic when they first encounter the terminology.
First, incontinence is usually obvious. If you pee yourself a little (or a lot) when jumping, laughing, or sneezing, you should speak to your doctor about this. As for prolapse, the easiest way to check is by looking. Can you see a bulge at the vaginal opening? Do you feel heaviness in your vagina?
You should also ask yourself the following questions:
- Is my vulva easily irritated?
- Is inserting a tampon painful?
- Do tampons easily fall out of place?
- Do I strain when urinating or having a bowel movement?
If you answered yes to any of these questions, bring this up with your doctor who can provide a more thorough examination.
What Should You Do?
Personally, I freaked out when I discovered my pelvic floor disorder. I had no idea what to do or if my body would ever recover and revert back to “normal.” With some disorders, like pain, a full recovery is possible. With other disorders, like prolapse, symptom management is a more realistic expectation.
If you suspect something is wrong, don’t freak out. Instead, write down your symptoms and observations, then make an appointment with your doctor and get a referral to a pelvic floor physical therapist. A physical therapist will discuss options with you.
More likely than not, she will teach you how to Kegel properly. This step is crucial because you need to learn how to contract and relax your pelvic floor muscles.
Your physical therapist might also prescribe certain exercises that will help build strength and mobility without overloading your pelvic floor.
If you suffer from prolapsed organs or incontinence, you can also ask about a pessary. Pessaries are internal vaginal supports that come in different shapes and sizes. Currently, Poise Impressa® is the only over-the-counter pessary in America, but your doctor can fit a range of reusable options.
Eventually, burdensome conditions like prolapse might require surgery to reposition prolapsed organs and supplement damaged support structures. Surgery is not an option until you are done having children and should not be considered until conservative options - such as exercise, body weight management, and pessary use - have been tried first.
Every new mom should be offered postpartum physical therapy.
New Moms Need to Talk to Each Other
I belonged to a few moms’ groups when my babies were young. When moms get together, we inevitably start to share our birth stories. I was surprised how many moms admitted to some sort of problem "down there," even if they didn’t have a term for it. Some moms revealed that they wore pads when working out because they leaked urine while doing burpees or jumping jacks. Other moms struggled with persistent pelvic pain.
Although both incontinence and pain are common, they shouldn’t be treated as the inevitable consequences of childbirth. Instead, moms should know their options and learn how to manage these symptoms. While we are in a hurry to lose the baby weight, we often forget about all that our bodies have gone through. We shouldn’t jump into a vigorous workout routine without first paying attention to our pelvic floors.
It is absurd that I had to demand treatment. I believe every new mom should be offered postpartum physical therapy to address possible pelvic floor disorder, a service some other countries offer. Unfortunately, I can’t see this happening in the United States. Therefore, ask for treatment, demand better care, and don’t forget to take care of your pelvic floor as you care for the baby that passed through it.
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© 2018 M Riley