Forest Trees

Pelvic floor recovery,
urinary incontinence, pudendal neuralgia and pelvic organ prolapse

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During pregnancy there are several anatomical and physiological changes that affect the position, tension and sensitivity of your reproductive and excretory organs and tissues. 

Your bladder will change position and shape, your pelvic floor muscles, vagina, and cervix will stretch and lengthen, and your pudendal nerve will be stretched, compressed and overstimulated. These changes happen to make space for your growing uterus and baby and to facilitate birth.  They are inevitable and natural occurrences that usually revert to normal within 2-3 months following birth.
 

However, they can cause conditions such as urinary incontinence (leaking urine) and weakened pelvic floor muscles (lack of control) or pudendal neuralgia (pelvic pain or numbness) which can be uncomfortable and inconvenient.

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As your tissues heal, most issues should gradually and naturally subside on their own, but they can linger and become long-term issues if they are not addressed. There is a lot you can do to support your recovery and help your symptoms subside quicker, so you can restore your pelvic floor health, reduce symptoms, or better manage any conditions that have developed.  As always, the most effective method for improvement is to apply holistic lifestyle strategies and seek medical intervention when required.
 

Pelvic floor recovery

Your pelvic floor muscles do an important job and it is important that they are supported

to best facilitate healing after pregnancy and birth, as well as to maintain their function and

health for the rest of your life.

 

Pelvic floor function

  1. Supports your internal organs (hammock of 3 muscular layers).

  2. Controls your sphincters (urethra, vagina, anus).

  3. Promotes sexual function (relaxation for penetration and contraction for arousal and orgasm).

  4. Provides stability of your core muscles and transference of force.

  5. Enables circulation of blood and lymph up through the pelvis.

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Pelvic floor health solutions

The health of your pelvic floor is important now during your postnatal recovery and also throughout the rest of your life. It is best achieved by applying a holistic approach, wherein you combine several different lifestyle strategies which will improve and maintain lifelong pelvic floor health.

  • Do pelvic floor exercises (Kegels) several times per day (contract and relax).

  • Exercise regularly using functional movement that moves your legs in all directions and both strengthens and stretches your pelvic floor muscles.

  • Do not strain when you go to the toilet.

  • Improve your posture and reset your pelvis to a natural, neutral position.

  • Exhale on exertion when standing, lifting or doing effortful activity.

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Urinary Incontinence

Urinary incontinence is when you cannot control your bladder and leak urine involuntarily. It is very common both during pregnancy and during postpartum recovery as it is often caused by a weakening of the pelvic floor muscles, which become overstretched during birth and also by damage to the pudendal nerve, which controls the opening and closing of the urethral sphincter.

It can be caused by several different factors relating to birth:

  • Weakening and stretching of the pelvic floor muscles and ligaments.

  • Shifted bladder position.

  • Damage to the pudendal nerve.

  • Epidural medication.
     

Symptoms of urinary incontinence

There are several types and symptoms of urinary incontinence, including:

  • Stress incontinence - leakage of urine when your internal pressure increases during coughing, laughing, sneezing, lifting etc.

  • Urge incontinence - leakage of urine when you feel a sudden urge to pee.

  • Overflow incontinence - inability to fully empty your bladder, which causes frequent leaking.

  • Total incontinence - frequent/constant leaking as your bladder cannot store and hold urine.

  • Post-void dribble - leaking when you stand up after finishing a pee.

 

It's possible to have a mixture of both stress and urge urinary incontinence. But the good news is that most of these conditions can be improved.

Solutions for urinary incontinence

Though postnatal urinary incontinence is a common postnatal condition, it is not a normal condition and you do not have to live with it indefinitely. In most cases it will resolve itself within 6-8 weeks after birth as the muscles contract and the nerves become less irritated. However, it can linger or become a long-term chronic condition if not addressed. Taking action to improve the health of your pelvic floor muscles and adjust your habits is key and there are many lifestyle solutions that you can apply which will improve symptoms.

 

  • Use incontinence pads rather than sanitary pads.

  • Take a change of underwear or set of clothes with you when you go out.

  • Know where toilets are located so you can find them quickly (use a smartphone apps).

  • Do daily Pelvic floor exercises (Kegels), to strengthen your pelvic floor muscles.

  • Do whole body exercises that strengthen and stretch your pelvic floor muscles.

  • Manage and reduce internal pressure by exhaling on exertion (exercise and lifting).

  • Correct your posture and set your pelvis in its natural neutral position.

  • Contract your pelvic floor muscles when sneezing, laughing or upon exertion.

  • Avoid high impact exercises such as jumping and running.

  • Do not strain when going to the toilet and treat constipation.

  • Practice bladder training: delay going to the toilet until your bladder is full (8 seconds pee). Don’t go to the toilet ‘just in case’ as this trains your bladder to not hold urine.

  • Medication or surgery.

Pudendal neuralgia

The pudendal nerve is the main nerve of your pelvis that controls movement and conveys sensation within your pelvic tissues. It runs from your lower back, through your pelvic floor muscles down to your perineum and relays signals from your brain to you genitals, anal and urethral sphincters, and other nearby soft tissues.

 

As it is responsible for most of the movement and sensation of your pelvic region the health of your pudendal nerve is crucial for urinary, and faecal continence (control) and sexual pleasure.

It can become damaged during birth resulting in a condition known as pudendal neuralgia which manifests as pain or numbness in the surrounding pelvic tissues. This is more common during difficult, prolonged or assisted labour/birth wherein the nerve has become compressed, irritated or inflamed.

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Symptoms of pudendal neuralgia

https://www.nhs.uk/conditions/pudendal-neuralgia/

 

The main symptom of pudendal neuralgia is pelvic pain. Any of the areas supplied by the pudendal nerve can be affected. The pain may:

 

  • Feel like a burning, crushing, shooting or prickling sensation

  • Develop gradually or suddenly

  • Be constant – but worse at some times and better at others

  • Be worse when sitting down and improve when standing or lying down

Other symptoms can include:

  • Numbness and pins and needles in the pelvic area

  • Increased sensitivity to pain – you may find just a light touch or wearing clothes uncomfortable

  • Feeling as though there's swelling or an object in your perineum – often described as feeling like a golf or tennis ball

  • Needing to go the toilet frequently or suddenly

Solutions for pudendal neuralgia

https://www.nhs.uk/conditions/pudendal-neuralgia/

 

  • Avoiding things that make the pain worse, such as cycling, constipation or prolonged sitting – it may help to use a special cushion with a gap down the middle when sitting and try constipation treatments.

  • Medicines to alter the pain - these will normally be special medicines for nerve pain, rather than ordinary painkillers like paracetamol.

  • Physiotherapy - a physiotherapist can teach you exercises to relax your pelvic floor muscles (muscles that you use to control urination) and other muscles that can irritate the pudendal nerve.

  • Painkilling injections- injections of local anaesthetic and steroid medication) may relieve the pain for a few months at a time.

  • Decompression surgery - if something is pressing on the pudendal nerve, such as a piece of tissue, surgery to move it away from the nerve may help improve your pain.

  • Nerve stimulation - a small device is surgically implanted under the skin to deliver mild electrical impulses to the nerve and interrupt pain signals sent to the brain.

Pelvic Organ prolapse

The pushing and pressure required for labour and vaginal birth may have caused further issues, wherein your pelvic floor muscles become weakened and can no longer provide the support that they should. This causes your reproductive and excretory organs to slip down out of their normal position and descend towards the outside of your body. This is known as a pelvic organ prolapse and there are several different types depending upon which organs/tissues are affected.

Types of pelvic organ prolapse

https://www.nhs.uk/conditions/pelvic-organ-prolapse/

 

The 4 main types of prolapse are:

  1. The bladder bulging into the front wall of the vagina (anterior prolapse).

  2. The womb bulging or hanging down into the vagina (uterine prolapse).

  3. The top of the vagina sagging down – this happens to some women after they have had surgery to remove their womb.

  4. The bowel bulging forward into the back wall of the vagina (posterior wall prolapse).

 

Pelvic organ prolapse will usually be classified on a scale of 1 to 4 to show how severe it is. With 1 being a mild prolapse that may be treatable with a few lifestyle changes and 4 being a severe prolapse that will likely require medical intervention. It's possible to have more than 1 of these types of prolapse at the same time.

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Symptoms of pelvic organ prolapse

A pelvic organ prolapse may be diagnosed shortly after giving birth by your midwife or GP or it may develop in the weeks and months after birth. It may be mild and present with no symptoms, in which case, it may be discovered during a routine medical examination such as cervical smear test. Or it may develop later on in life following a subsequent pregnancy/birth or during perimenopause and menopause (due to oestrogen decline) and especially if your pelvic health was compromised during birth and not fully addressed and recovered.

If you experience any of the symptoms below then you may have a pelvic organ prolapse (POP).

  • A feeling of heaviness around your lower tummy and genitals.

  • A dragging discomfort inside your vagina.

  • Feeling like there's something coming down into your vagina – it may feel like sitting on a small ball.

  • Feeling or seeing a bulge or lump in or coming out of your vagina.

  • Discomfort or numbness during sex.

  • Problems peeing - such as feeling like your bladder is not emptying fully, needing to go to the toilet more often, or leaking a small amount of pee when you cough, sneeze or exercise (stress incontinence).

 

https://www.nhs.uk/conditions/pelvic-organ-prolapse/

Solutions for pelvic organ prolapse

  • See your GP and request a referral to a women’s health, pelvic health physiotherapist or gynaecologist.

  • Avoid lifting heavy objects.

  • Do not strain when going to the toilet - improve bowel health and habits.

  • Lose weight if you're overweight.

  • Do pelvic floor exercises (Kegels).

  • Use a vaginal pessary to support the walls of the vagina (fitted and prescribed by a medical professional).

  • Surgical repair.

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Red flags - when to seek help

 

It is vital that you take care of yourself and focus some of your attention on your recovery so that you can spot any warning signs and seek medical attention when required.  Familiarise yourself with the list below and make sure that you tell your midwife, health visitor or GP immediately if you experience any of these symptoms, as they could indicate a problem that requires further investigation or immediate treatment.

  • If you have followed the advice to restore your pelvic floor and are still experiencing urinary incontinence 2 months after birth.

  • Inability to feel or control your pelvic muscles when doing pelvic floor exercises 2 months after birth.

  • Chronic ongoing pain in your pelvic region.

  • Pain that gets worse when you sit down.

  • Pain during sex and intercourse.

  • Any sensation or signs of a pelvic organ prolapse or a lump in or around your vagina.

How you can support your partner

You can support your partner by ensuring that they practice good habits for pelvic health and by being mindful of how any conditions may affect their desire and comfort during sexual intimacy. Below are some ways that you can be supportive:

 

  • Ask them what you can do to help and best support them.

  • Purchase incontinence pads.

  • Be prepared to modify your sexlife.

  • Research and read up on their condition so that you can better understand and support them.

  • Encourage them to see their medical practitioner if they have any concerns and symptoms.

  • Help them find a women’s health physiotherapist to be referred to for treatment.

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