I once visited a friend who’d recently become a new mom, and I naively asked how she was doing. “Sometimes, when my husband and I have sex now,” the very candid mother told me, “It feels like I just gave birth again.” My friend’s husband overheard the comment and looked up for a moment, proudly grinning, taking it as a compliment. We both laughed at his reaction and moved on to a new topic.

Although she was pretty open about it, most women don’t want to talk about injuries to their most private parts. So, if you’re experiencing a postpartum injury, it may feel lonely and scary. Plus, some women think there’s not much they can do anyway, other than kegels during their “free time”, so what’s the point?

There’s a lot you can do though. Dr. Jennifer Evans, a Doctor of Physical Therapy, a Board Certified Women’s Health Clinical Specialist (one of only ten in California), and a Certified Pilates Instructor shares seven common injuries and how you can help your body to heal.

1. Back pain. It seems like everything you do, while taking care of your child takes a toll on your back—lifting the carseat, taking them in and out of their crib, leaning over to change them. First, keeping good posture helps. Also, placing a big pillow behind your lower back when sitting helps. When you’re about to lift your child from their crib, try to first move them a little closer to your body, rather than lifting them from the middle of the crib. Also, try to bend your knees, keep your back flat, and pull your abdomen towards your back to reduce stress on your back. Last, try strengthening your back, by getting on your hands and knees, then lifting your opposite arm and knee at the same time, while drawing your belly button toward your back.
2. Pain during intercourse. It’s a good idea to wait six weeks after delivering your baby, before having sex. When breastfeeding, estrogen is suppressed, which means lubrication is also suppressed. So, you’ll also want to lube it up. If you’re still sore after that, it’s a good idea to see a professional so they can check that your scar isn’t too stiff and the muscle isn’t tight in response to injury. Estrogen cream and/or a massage of the area can help with circulation. Also, relaxing is really important—once a woman feels pain, she clenches in anticipation of the pain, which can actually make the pain worse. To help end this cycle, Dr. Evans sometimes uses vaginal dilators. The woman starts by practicing kegels and relaxation around a very small dilator (the size of a pinky) and moves to increasingly larger dilators, until she reaches one the size of her husband.   Then, she knows she can handle it.
3. Tearing. After getting stitched up, you’ll want to keep the tear clean. You can rinse the area, with water from a squirt bottle, after peeing. Dr. Evans also recommends a lot of ice, on-and-off at the hospital, starting the day you deliver. You can soak and freeze a pad or sit on a diaper with ice in it. Then, starting the day after child birth, Dr. Evans recommends starting to contract the muscles of your pelvic floor, to help with circulation, which helps with healing. Squeeze for as long as you can, but don’t squeeze to the point of feeling pain.
4. Separation of the pubic bone. Both the Sacrum and the Coccyx, have to move to make room for your baby to exit. This can lead to pain, pressure, bruising and misalignment. A Women’s Physical Therapist can get you re-aligned, check for a muscle spasm, and do a medium pressure massage of the area. Once you’re cleared to exercise, you can begin strengthening. Dr. Evans suggests starting with Kegels and also doing reps of drawing in your belly button. It may be tempting to do more, soon after delivery, but it’s really important to wait until your exercise restrictions have been lifted. Dr. Evans also suggests keeping track of your bleeding—it should decrease over time. If it increases, you’re over-doing it.
5. Urinary incontinence (leaking pee). Ligaments, hormones and muscles contribute to continence. Labor can cause your ligaments to stretch out and can leave muscles torn and weak. On top of that, your body reduces Estrogen production to support breastfeeding. Strengthening your muscles allows your muscles to squeeze better (and keep you from peeing) and also takes some pressure off of your tendons, which also helps. For treatment, Dr. Evans first does an exam to make sure a woman is contracting the correct muscles, she’s not holding her breath, and she’s not contracting other muscles. She then typically prescribes 60-80 kegels per day, typically for six weeks. She prescribes quick kegels, to help with sneezing, coughing or laughing. She also prescribes holding kegels (up to 10 seconds), to help with endurance. If the woman had a weak squeeze, she may benefit most from doing the kegels lieing down, at first. If she had a stronger squeeze, she may benefit more from sitting or standing kegels. Last, when she’s ready, Dr. Evans also likes pilates-based exercise to strengthen the pelvis.
6. Bowel incontinence. Dr. Evans suggests eating lots of fiber and taking a stool softener to avoid constipation and to prevent straining against a tear. Pain medications and narcotics can also be constipating, so medications should also be consistent with treatment for bowel incontinence. After that, the same kegels described for urinary incontinence will help.
7. Rectus Diastasis (separation of the abdominal muscles). Surgery is an option, but often exercise works, so why not try that first? You have three types of abdominal muscles—the deepest are your transverse muscles which lie horizontally across your abdomen, your obliques are against your sides, and the rectus go up-and-down along the middle of your abdomen. If you try to strengthen your rectus when they’re separated, they’ll stay separated. Instead, work on your transverse muscles first, which help hold everything together. Start by drawing in your belly button, while exhaling (as though a corset were pulling them in). You can also try planks on your knees. As your transverse muscles get stronger, you can start working on your obliques, for example, doing side planks on your knees. Dr. Evans recommends waiting on any crunches or rectus exercises until you don’t see anything popping out (like a hernia), anymore.

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Thank you to Dr. Evans for taking the time to share these helpful tips. For more info on her, her practice (located in Ventura, CA), or the diagnoses discussed above, visit: http://www.powphysicaltherapy.com/. If you enjoyed this article, please follow Mama Lovejoy on Facebook, @MamaLovejoy1 on Twitter, Instagram, Tumblr or Periscope, and share the info with your friends.