Post Natal

Description

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A post natal general check up is usually made in 2 sessions and is composed of:

  • Check of abdominal and pelvis muscle, c section, episiotomy , incontinence…
  • Check of abdominal area: check of diastasis (gap between rectus abdominus)
  • Check of good automatism when coughing, running,… (most of the time, after a pregnancy your transverse muscle is weaker than before leading to a lack of abdominal control. This weakness is one of the reason of pelvic pain, incontinence, urgency…
  • Check of c-section scar and teaching auto massage
  • Check of episiotomy or tear scar and teaching massage techniques
  • Check of strength, endurance and functions of pelvic floor
  • Osteopathy for movement and position of hip and pelvis bone, abdominal organ and diaphragm and breathing

Description

urgencyBoth pregnancy and labour traumatised the pelvi-perineo-urinary system. Multiple injuries and dysfunctions can occur. They are named vesical instability: 13 to 26% of women suffer from urinary problem after giving birth.

It can manifest as:

  • Urgency micturition is a sudden irrepressible urge to urinate 
  • Urinary incontinence by urgency is an involuntary urine leakage preceded by compelling urge to urinate, leading sometimes to complete urination. This type of incontinence is caused by an involuntary contraction of the bladder and it is not link to physical activity. It is named instable bladder or hyperactive bladder. It can appear in certain situation associated with reflex micturition such as incontrollable laugh, fear, orgasm…
  • Effort urinary incontinence: 30% to 50% of women suffer from this condition. Risk increase with number of pregnancy and age. It is characterized by urine leakage (not preceded by urgency) occurring when sneezing, laughing, coughing, and lifting or during physical activities (running, jumping…). In extreme cases, even walking can trigger it. This type of incontinence is due to a brutal abdominal pressure increase causing leaking through either hypermobility of the urethral canal (urinary canal) or sphincter failure (weakness of muscles blocking the urethra).
  • Mixt urinary incontinence is a combination of two above dysfunctionstoilet-1033443_1280
  • Dysuria with post-micturition residue: Dysuria is characterised by a difficulty to empty the bladder, with or without associated pain. This dysfunction is commonly overlooked because painless and with a progressive apparition. Dysuria is often associated with urine leakage when standing up afterward.

Description

mother-767686_1920Throughout the pregnancy, baby is supported by a hammock composed of the pelvis muscles, which also surround urethra, vagina and anus. Consequently, pregnancy imposed important pressure on these pelvis muscles leading to their weakening and distention.

During the labour, baby delivery as well as episiotomy or tear will stretch or cut the perineum from the vaginal part to the anal part. In some case, the tear can rip apart the external anal sphincter.

Anal continence is a complex mechanism:

As we eat, food is digested by our stomach then by our intestine to reach the last part named rectum. Two sphincters close the rectum: an internal one with an involuntary control and an external one with a voluntary control.

As the stools arrive in the rectum, it distends the wall which is supposed to trigger the need to go to the loo. When it is not possible to go, a voluntary contraction, of the external sphincter and of another pelvis muscle named pubo rectal muscle, diminishes the need.

After a while, the internal sphincter also contract but involuntary, allowing us not be forced to voluntary contract the external sphincter all the time without having to rush to the loo.

When the external sphincter or other pelvis muscles are teared, the voluntary contraction is not possible anymore. Consequently, the time between the stools entering the rectum and having to exit is drastically shortened, we speak of anal incontinence.

Rectum works as a tank collecting stool allowing a delayed elimination. However, if the rectal compliance is reduced, this tank is smaller and can’t conserve the stools compiling to eliminate them more frequently. On the opposite, if the rectal compliance is increased or if the rectal sensibility is impaired, stools will accumulate leading to anal incontinence by overflow.

Rectum static dysfunctions are often the source of anal incontinence. For exteriorised prolapse (in very long labour or following use of forceps) anal incontinence is also frequent.

A prolapse is  is a condition where organs fall down or slip out of place.

Types of prolapse

anal leakageIf it affects the front of your vagina, it is an anterior prolapse (cystocele). The bladder bulges into the front wall of the vagina

If it affects the top or your vagina, it is a prolapse of uterus or of cervix (hysterocele).

And if it affects the back part of your vagina, its a posterior prolapse (rectocele or enterocoele). The bowel bulges forward into the back wall of the vagina.

Sometimes you can have more than one prolapse. For instance, you can have a cystocele and a rectocele.

To know how severe your prolapse is , a number system is used, ranging from one to four, with four indicating a severe prolapse.

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What are the symptoms ?

  • a sensation of a bulge or something coming down or out of the vagina, which sometimes needs to be pushed back
  • problems passing urine – such as slow stream, a feeling of not emptying the bladder fully, needing to urinate more often and leaking a small amount of urine when you cough, sneeze or exercise
  • discomfort during sex
  • some women don’t have any symptoms..

What are causes ?

Prolapse is caused by weakening of tissues that support the pelvic organs. Although there’s rarely a single cause, the risk of developing pelvic organ prolapse can be increased by:

  • your age – prolapse is more common as you get older
  • childbirth, particularly if you had a long or difficult labour, or gave birth to multiple babies or a large baby – up to half of all women who have had children are affected by some degree of prolapse
  • changes caused by the menopause – such as weakening of tissue and low levels of the hormone oestrogen
  • being overweight, obese or having large fibroids (non-cancerous tumours in or around the womb) or pelvic cysts – which creates extra pressure in the pelvic area
  • previous pelvic surgery – such as a hysterectomy or bladder repair
  • repeated heavy lifting and manual work
  • long-term coughing or sneezing – for example, if you smoke, have a lung condition or allergy
  • excessive straining when going to the toilet because of long-term constipation

How is prolapse treated ? What to do to prevent it ?

Description

women healthAfter surgery abdominal surgery (C-section, appendectomy…), the surgeon cut through different layer of muscles, fascia and organ. Thanks to the scaring process, these layers will close completely. Unfortunately, it also create new link between these layers called adhesions.

These adhesions are problematic as they prevent movement and the normal function of the different tissue. For example, an adhesion between muscular tissue and organ will diminish the contraction of the muscle and may trigger pain.

Description

Throughout the pregnancy, your belly and abdominal muscles are weaker and stretch to create space for your baby.

women healthWhen these abdominal muscles are too strong before the pregnancy or the belly developed too quickly, the linea alba between rectus abdominis (6 packs muscle) tears leaving a gap above and below your belly button. It is named Diastasis.

To know if you have a diastasis, after giving birth, you have to lie down on your back with knees bend and feet on the floor. Put 3 fingers underneath your belly button and press gently. Raise your head, if your fingers are blocked, there is no diastasis. If your fingers go deeper, there is a diastasis.

Warning: do it only once as the repetition of this test can increase the diastasis

Do not hesitate to ask to our women physiotherapist to evaluate precisely the gravity of the diastasis and to have start treatment to reduce it and to prevent other associate inconvenients.

  • Description

    A large variety of pain can appear after delivery, your whole body having suffer a massive trauma throughout the pregnancy and labour.pelvic pain

    • Ano-rectal pain, often link to difficulty to eliminate stools, require bowel habits and postural education
    • Sacral, coccyx (tailbone) and thoraco-lombar-abdominal-pelvi-perineum pains result from postural and biomechanical change occurring over the pregnancy: shoulder inside, increased lordosis (lower back arch backward), abdomen shift forward, hips in external rotation (feet outside like a cowboy)
    • Pain related to pudendal nerve: it is characterized by a perineal pain often on one side, similar as a burning sensation with sometimes pain inside the anus. These symptoms are aggravated in sitting position and relived in standing/lying position. It can also be associated to a pain around vaginal orifice
    • Pain due to episiotomy scar or suture break, increased in sitting position and during sexual intercourse
    • Pain at external anal sphincter level, due to injury, tear, large episiotomy. It presents as an intense and punctual pain trigger by bowel movement and sometimes in sitting position
    • Abdominal pain: C-section scar are one of the cause but rectus addomini diastasis lead to dysfunction of abdominal muscles and may result in pain while performing simple movement and task of life.

    Treatments

Description

It is well known pregnant women and new mom are constipated (you can find on our YouTube channel and blog various video/articles on the causes and how to prevent it)

pelvic floor rehabilitationThere are several causes:

  • Pregnancy hormonal changes slow down bowel activity creating constipation within the intestine.
  • After giving birth, C-section scar, tear and episiotomy make it extremely painful to have a bowel movement. In this case, we speak about terminal constipation.
  • Furthermore, pressure creating during labour lead to haemorrhoid and consequently painful bowel movement an again a terminal constipation.
  • Finally, growing uterus push rectum backward creating an angle with the anus compromising stool expulsion.

Treatments

Description

swollen legsThanks (not really) to your hormones, diameter of you veins increase. Furthermore, a new venous system develops for your baby and the weight of your growing baby press on the biggest vein of your body the vena cava.

The combination of these 3 elements prevents the blood to come back normally from your lower limbs to your legs, creating sensation of heavy legs, welling and varices.

On a long term, the lack of blood return will lead to accumulation of adipose cell commonly named cellulite.

 

Get In Touch.

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