Postnatal Conditions

Pelvic Floor Check

We encourage a consultation with a women’s wellness physiotherapist with specific maternity training from six weeks postnatal after each and every birth (although we are happy to do it later on too).

In the one hour 1:1 session we will assess the strength of your pelvic floor and teach you how best to activate these very important muscles. We can also discuss with you any issues you may be experiencing around incontinence, perineal tearing, muscle avulsions and reduced sensations . We can also grade any prolapse and support you through the management of this whilst measuring any separation of the abdominal muscles.

We can also discuss and guide you through some of the challenges of feeding, bathing and holding a newborn. For some women getting back to the exercise they love is a priority and we will use our advanced training (and own experience!) to get you back to running, cross fit, pilates and everything in between in a safe and timely manner.

If you have had a Caesarean birth we will check the strength through the abdominal musculature and guide you how to safely increase how much you can lift. We can also guide you on scar massage and mobilisation.

We know it can be hard to look after yourself when you are tired, busy and juggling life at home but doing this health check early will help you in the months and years ahead.

If you have any questions, please feel free to contact us and we can guide you as to what will be involved.


Perineal tears and OASIS

What is it? The perineum is the region between the vagina and anus and plays an important role in your continence and sexual function. It can be injured during childbirth either through tearing or an episiotomy (cut) and is generally repaired at the time of birth.

We know from working on the maternity unit of a leading Sydney hospital that not everything goes to plan during a vaginal birth and we are here to support you through your diagnosis of a perineal tear. Some tears (Grade 3-4 OASIS injuries) affect the muscles around the anus which can lead to symptoms of faecal incontinence and or constipation which can be difficult to manage alone. Often these issues aren’t investigated for many years and can lead to significant changes to how you are able to live your life. Your women’s health physiotherapist can help guide you through the initial stages of your condition and help you gain confidence and continence as you build up strength, learn how to best manage your bowel symptoms and retrain your body.


Abdominal Separation/ Diastasis Recti / DRAM

What is it?

During pregnancy, your abdominal muscles have to stretch forward to accommodate your growing baby and when they can’t stretch forward any further, they will start to separate through the connective tissue down the centre (linea alba).

This is a normal thing to happen in most pregnancies and the extent of which varies from person to person and has nothing to do with weight gain or what you’ve been eating.

How do I know I have it? 

You may notice a gap or space down the centre of your abdomen. You may notice some increased doming or bulging when you sit up or move in bed. You may even see some protrusion through the centre of your abdomen. Typically it is not a painful condition.

This separation is measured post birth and widths and depths are measured using fingers as well as the amount of doming through the separation. It’s not just about the width!


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Postnatal pelvic girdle pain

Whilst many women have a substantial reduction in their pelvic girdle pain in the first two weeks after birth a substantial proportion will have ongoing issues over the following months and sometimes years. We realise that the challenges of motherhood differ from the challenges of pregnancy and we want to guide you through those challenges whilst using a combination of education, hands on treatment and exercise to build your strength. We understand that prolonged pelvic girdle pain can be associated with other symptoms such as prolapse, urinary urgency or stress incontinence which we will investigate and manage with you.


Incontinence

Urinary Incontinence      

What is it?

Leakage of urine can affect women across many stages of their life and is not just something that happens with the elderly. It can be differentiated into two main types Urge incontinence and Stress Incontinence (although you can get both together too).

It is important to realise that incontinence can affect males also but we will focus on the female anatomy here.

Stress incontinence is leakage of urine due to a physical stress or load on the body. This might be quite a high load like running and jumping or can be quite a light load like bending forward or lifting a small weight. You may leak with laughter, coughing and sneezing too.

The pelvic floor is made up of connective tissue (fascia and ligaments) and muscular tissue (pelvic floor muscles), and together this creates a sling of support at the base of the pelvis to support the pelvic organs, ie. the uterus, bladder and rectum.

Stress incontinence occurs when the downward pressure of load is greater than the upward pressure of the pelvic floor.


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Pelvic Organ Prolapse

What is it?

Pelvic organ prolapse is the descending of one of your pelvic organs in your pelvic cavity. There are many classifications involving the specific organ that is dropping and the location it is dropping towards. Most commonly this is the bladder, bowel or uterus descending towards or out of the vaginal canal. This can happen after childbirth or can be related to ageing which causes increased stretch to your ligaments and fascia (connective tissue). It can also occur as a result of trauma or surgery.

What are the signs and symptoms?

  • Heaviness or dragging sensation around the vagina
  • A palpable lump or bulge around the vagina which often worsens with exercise, loading, and time as the day goes on
  • Back pain with an associated dragging feeling
  • Difficulty emptying your bladder or bowel
  • Leakage without stress or urgency
  • Symptoms that improve after lying down – it often feels better in the morning

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Haemorrhoids

Haemorrhoids are dilated veins in your rectum – both inside and outside the anus. They can cause bright red bleeding, pain with opening your bowels and discomfort in sitting. They are more common in pregnancy (and can pop out during labour) and can be exacerbated by straining to open your bowels. Physiotherapy management is focused on advice regarding bowel dysfunction, developing the right stool type for you (soft sausage with cracks) and giving advice around education about how to manage the discomfort that can be associated with haemorrhoids and associated conditions. We will also guide you on how to build strength in your muscles without straining through your pelvic floor so you can get back to the exercise that you love safely with longevity in mind.


Carpal Tunnel Syndrome of new mums

Carpal Tunnel is a common condition postnatal that can be a continuation of symptoms prior to giving birth or can be a new condition that occurs due to the demands of motherhood.

The increased fluid in a pregnant women’s hands can cause added pressure around the nerves of the wrist causing various symptoms including:

  • Pins and needles or numbness or throbbing in the hands and wrists making it difficult to hold your baby and change their nappy
  • Worsening symptoms at night especially if you sleep in the ‘foetal position’
  • Swollen fingers
  • Difficulty holding objects, or performing fine motor skills which can lead to challenges with feeding your baby and settling them in their bassinet

Management of this condition requires thorough education in regards to wrist posture for feeding, carrying and nappy changing of your newborn. As your baby gets heavier the problems tend to become greater! If you are to see a surgeon or doctor about this we will liaise with them to ensure that you have the best in evidence based treatment.


DeQuervain’s Tenosynovitis of motherhood ‘Mummy’s Thumb’

DeQuervain’s is a painful condition that often occurs to new mothers on the thumb side of the wrist. The pain and sometimes swelling can be associated with lifting and carrying your newborn as they get heavier.

It is caused by a new repeated movement such as lifting a baby which can overload the tendons causing inflammation around the thumb and wrist. It requires prompt treatment to reduce the inflammation, education around healthy wrist postures and possibly splinting/taping to reduce the ongoing irritation.