pelvic health, physical therapy, postpartum, pregnancy, Sex, women's health

The Postparty

Also known as postpartum. Also known as the part no one tells you about.

What’s normal, what’s not? What can be fixed, what can’t? Will my boobs ever look the same? Will I ever shower again? Read along to have a greater understanding of what unexpected things to expect and what to do about them.

Before we talk postpartum, we should talk pregnancy, labor and delivery for a sec. Because things experienced during these phases can determine how that postpartum life goes.


A few things that happen to your bod during pregnancy and possible consequences:

  • Ligaments loosen, you get a baby bump, and pain jumps right on that.
    • Like back pain, sciatic pain, pubic bone pain, even knee pain and other joint pain.
  • Weight gain
    • This increases the pressure on your pelvic floor and can lead to decreased control of your gas, bowel and bladder.
  • Varicose veins
    • You can develop these not only on your legs, but also on the vulva which can cause significant pain and discomfort.
  • Your abdominals are stretched to the size of 16 football fields (a slight exaggeration)
    • This can contribute to abdominal separation (diastasis recti), back pain, pelvic pain, decreased pelvic floor support and control.
  • Hormones
    • Need I say more?


Please don’t tell me if you were one of those who had a 30 minute labor and with half of a push the baby is here… Just kidding. I need your secrets. Or actually, will you just carry my next child?

Ok, back to business – in addition to your pregnancy experience, how you labored and delivered can have a major impact on your postpartum life.

  • Lonnnnnnng ass labor
    • During a long labor so much pressure is placed on the pelvic floor and likely accompanied by a long duration of pushing. This can lead to things like pelvic organ prolapse (your bladder, rectum and/or uterus moves downward into the vaginal canal and sometimes comes on out of vagina to get some fresh air), urinary incontinence, bowel/anal incontinence, constipation, hemorrhoids, etc...
  • Perineal/vaginal/rectal tears via episiotomy or natural tearing
    • Stitches or no stitches, this wound will develop some scar tissue that may be sensitive, tight, and/or painful.
  • Use of forceps or vacuum to deliver the babe
    • Could cause tearing, soreness, trauma.
  • Cesarean Section:
    • If you didn’t have a scheduled c-section, you endured some amount of labor (lots of pelvic floor pressure) and maybe even push attempts. So go back to the first bullet in this section as it applies here.
    • Scheduled or not: You had surgery. A rather large incision on your abdomen is major. There will be scar tissue development which can affect your pelvic organs (bowel and bladder function) and even intestinal mobility/motility.

and finally, POSTPARTUM

This is when reality hits. You have a baby(ies). You’re both wearing diapers. Your boobs stretch to unimaginable sizes. Walking is no longer second nature (maybe partly due to the huge pad between your thighs). And when you fart, you aren’t even sure where it’s coming from anymore. GLAM-OR-OUS.

So somehow you survive the first 6 weeks (or longer depending on your healing time) with a newborn and then your midwife or obgyn tells you that your vagina is ready for sex. Like something’s always gotta be coming or going. Vaginas work hard, y’all.

The thumbs up for sex comes about when it is observed that your tissue has healed from any tearing, the cervix has closed and your bleeding has stopped. So physically it may look like you’re ready, but mentally, hormonally…could be a different westside (complicated) story.

But let’s back-up a bit. From the moment you hold your baby in your arms, there are a lot of things that we begin to experience and wonder if this is the new normal. These include, but are not limited to:

  • Pooping on yourself (fecal incontinence). Do I even need to tell you that this is not normal?
  • Peeing on yourself (urinary incontinence). If pooping on yourself isn’t normal, then peeing on yourself isn’t either! It isn’t normal. Not even one drop.
  • Passing gas without meaning to: NOT NORMAL. Not even while doing yoga.
  • Painful sex (jumping back up to the 6+wk mark): NOT NORMAL.
  • Feeling like something is falling out of your vagina. No, no, no, ma’am, not normal.
  • Pelvic pain or genital pain or abdominal pain or hemorrhoids or constipation or diarrhea: None of it is normal. Zero.

However, these things DO happen and they are extremely common, but never for one single second should you say, “Well, I guess this is the new me. My new normal.” Don’t say it because it isn’t true! And if your doctor says that to you… run, Forrest, run and never go back (find someone new).

The reason a lot of these postpartum things occur can be due to our pregnancy, labor and delivery experiences mentioned above, along with following:

  • Breastfeeding:
    • Estrogen is key is keeping your vagina operating properly (well lubricated, good muscular mobility/strength) and when you are nursing, it is kept at bay (estrogen) because it interferes with milk production.
  • Stress and lack of sleep.
    • You have a newborn. You’ve forgotten what it feels like to lay your head on a pillow (unless you have a magic baby that sleeps through the night). Stress takes on a new meaning — Like, is that snot or slobber – is he sick?? What color was his poop when you changed him (every single time)? I dropped his paci on the bed and I think I gave it to him without washing it first. I don’t think she sanitized her hands before touching his feet (that are in socks and shoes). Carseat (that’s all I need to say). — Yeah, a whole new world of worry. So add this on top of getting zero sleep and your hormones have gone buck wild.
      • All of this nonsense causes estrogen and progesterone to decrease, which affect the health of your vaginal tissues, pelvic floor and lubrication production, as well as, your mental health.


It’s a lot, right?

Having a child is no joke. It takes some serious strength to go through all of that. Aren’t women amazing??

And we can continue to be amazing, pain-free, daily pooping, continent, hemorrhoid-free, pleasurable sex-having, humans if we get the right help!

If you experience anything mentioned here, please tell your provider or call a pelvic health physical therapist (PHPT) in your area to see what you need to do next. And even if you’re not experiencing anything weird, it will only do you good to pay a visit to a PHPT. Many times there are significant impairments that just haven’t manifested into a noticeable issue and we can help you nip those dudes in the bud!

And I need to add: Please let go of any embarrassment that is getting in your way of getting help. The longer you go, the longer it will take to fix and the longer you won’t feel like yourself. You have to take care of YOU to be the best for yourself, AND the best mom, wife, boss, coworker, athlete…It’s like the O2 mask on a crashing airplane scenario – you have to save yourself first so you can save others.

So go save yourself. And let me know if you have questions about how to do that.



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