Conditions like loss of bladder control and abdominal separation (known as diastasis recti) to soreness during intercourse can cause women to feel pain. In fact, these changes are like an injury of sorts.
Recalls mum and movement coach Holly Kuzmiak-Ngiam, “Six months after my first birth, my period had returned and I ached in my pelvic area on the first two days of menstruation.”
Others, such as Prisca Hoo, a mum of two, simply could not “get back in shape after delivery even though I was back to my pre-pregnancy weight”. “My abdominals were not flattening out and I felt generally weak at my core,” she shared. “I realised I could have diastasis recti.”
Noting that a woman’s body undergoes massive changes during pregnancy, women’s healthy physiotherapist Tamara Gerdis, co-founder of Physio Down Under, says, “For example, her blood volume increases by around 40”to 45 per cent, her uterus grows to approximately 500 times her pre-pregnancy size and huge increases in hormones cause her ligaments to become more ‘stretchy’.”
Lucie Lamprey, a senior physiotherapist at UFIT Clinic, adds, “Her pelvic floor can also be affected. The growth of the baby means that the pelvic floor is required to carry a lot more weight on a daily basis. The pelvic floor can become weaker and stretched even before birth.”
“[During pregnancy, a woman’s] blood volume increases by around 40”to 45 per cent, her uterus grows to approximately 500 times her pre-pregnancy size and huge increases in hormones cause her ligaments to become more ‘stretchy’.”
It takes around six weeks for a woman’s blood volume and uterus to return to normal after she delivers a baby. Gerdis adds that ligaments can remain ‘stretchy’ for quite a long time post-birth, especially while a woman is breastfeeding, and her periods have not yet returned.
The type of birth a woman ends up having can also affect her recovery process. Pelvic-floor muscles are more at risk of injury when birthing large babies (babies over 4kg); the mother is pushing for longer than two hours; has a forceps delivery; or large perineal tears), she notes.
While the main effort of helping a woman recover happens in the post-natal period, pre-natal physiotherapy is useful, too.
Lamprey explains, “As mother and baby grow, posture has to continuously adapt to changes in the centre of mass and increased pressure to the internal organs. Anywhere between 50 and 70 per cent of pregnant women experience back or gluteal pain, closely followed by pubic symphysis pain. Physiotherapy can help in these situations.”
Prenatal physiotherapy can also boost your body’s ability to have a smoother pregnancy, birth and recovery period, she adds. This includes breathing techniques to help with your birth, various exercises to do during your pregnancy, ways to strengthen your pelvic floor for labour and recovery, and even how to perform perineal massage.
Getting checked by a female-health physiotherapist helped hasten Kuzmiak-Ngiam’s recovery. “The weaknesses I had, likely due to some torn muscle or connective tissue during delivery, were not apparent during external tests… An explanation was incredibly comforting,” she enthuses.
More women are aware female-health physiotherapy these days. Says Physio Down Under co-founder Monica Donaldson, “They are realising that they don’t have to live with embarrassing conditions like urinary incontinence. Women are starting to talk more openly with their friends about their pelvic-floor health.”
She adds that social media is giving women living in Singapore the confidence to request help for conditions that are common, but definitely not normal.
Generally, fees cost upwards of $150 per session if you see a private physiotherapist. Some public hospitals such as Singapore General Hospital’s Postnatal Assessment Clinic offer female health physiotherapy.
Four common postnatal issues in Singapore include:
1. Urinary incontinence
Urinary incontinence is the involuntary loss of urine during times of increased intra-abdominal pressure such coughing, sneezing, running, jumping on a trampoline and so on. This type of incontinence is called stress urinary incontinence.
The other type of urinary incontinence women can experience is urge urinary incontinence. This occurs when the bladder is overactive. This is often associated with approaching the toilet, coming home and putting the key in the door, or hearing running water.
Treatment for both types of incontinence is different, which is why it’s important to see a professional who can determine the correct management for your symptoms.
The abdominal muscles support the lower back and pelvis. If these don’t regain strength, they won’t be able to support the lumbar spine, pelvis and abdominal organs, which may cause the trunk to be unstable.
This happens when the uterus, bladder and/or rectum drops into the vagina. “It is the support of the organ that is an issue. Some 50 per cent of women are walking around with prolapses, but most aren’t aware that they have one, until the organ drops to the entrance of the vagina,” Gerdis says. Common prolapse symptoms usually involve perineal or vaginal heaviness or when a woman notices a lump or bulge at the vaginal entrance.
3. Diastasis recti
Commonly known as abdominal muscle separation, it can often mean a woman can continue to look pregnant, even months and sometimes years after delivering her baby.
Gerdis notes, “A gap bigger than 2cm occurs in over 60 per cent of all pregnancies in the third trimester, and in more than 30 per cent of post-partum women occurs when the connective tissue that joins the two sides of the rectus abdominus (six-pack muscle) stretches to accommodate the baby.”
This condition is usually treated with specific exercises. If not, diastasis recti can lead to pelvic dysfunction, lower back pain, instability and in extreme cases, inguinal or umbilical hernia, explains osteopath Daniele Caminiti, who practises at City Osteopathy and Physiotherapy.
The abdominal muscles support the lower back and pelvis. If these don’t regain strength, they won’t be able to support the lumbar spine, pelvis and abdominal organs, which may cause the trunk to be unstable. Caminiti points out that the woman will then will have to rely on her joints when moving, which might lead to degenerative conditions such as spondyloarthrosis or disc degeneration and, consequently, pain.
Surgery is an option in the most extreme cases, specialising in women’s health, she adds.
This refers to painful sexual intercourse. Reasons for painful sex can be due to perineal scar tissue or overactive pelvic-floor muscles ― both of which can be successfully treated via women’s health physiotherapy, Donaldson states.
If this occurs for the first time after having a baby, it’s often related to low oestrogen levels. Oestrogen levels remain low during breastfeeding which can lead to a dry vagina. She advises, “Using a good quality lubricant during the breastfeeding period can make things more comfortable.”
Pre- and post-natal women should follow these best practices at home:
1. Do correct pelvic-floor exercises
It is essential that women are performing their pelvic-floor muscle exercises correctly, Gerdis states. Studies have shown that up to 40 per cent of women don’t know how to activate their pelvic-floor muscles correctly. After learning how to do so from your physiotherapist, practise, practise, practise at home.
It is essential that women are performing their pelvic-floor muscle exercises correctly...up to 40 per cent of women don’t know how to activate their pelvic-floor muscles correctly. After learning how to do so from your physiotherapist, practise, practise, practise at home.
2. Practise suitable breathing exercises
“Most pregnant women switch to upper chest breathing because as the baby grows, it pushes on their diaphragms, making diaphragmatic breathing more difficult,” Donaldson says. “Postnatally, many women continue with this pattern of upper chest breathing, which can create overactivity of the upper abdominal muscles and increase intra-abdominal pressure. This can lead to weakness in our lower abdominals and/or contribute to pelvic-floor muscle dysfunction.”
3. Keep active
This means 20 to 30 minutes of daily moderate intensity exercise, for uncomplicated pregnancies, as recommended by the American College of Obstetricians and Gynecologists. Post-birth, resume regular exercising gradually. Do so after getting the all-clear from your obstetrician and physiotherapist.
If you are working with a physical trainer, consider someone who is knowledgeable about pre- and post-natal bodies and conditions. Kuzmiak-Ngiam, who founded Movement Labs, has not only received specialist training on perinatal fitness, but also works with several women’s health physiotherapists.
“With a client's permission, the physio can share crucial information or suggestions with me. I can then use the information to tailor a suitable programme for the client,” she notes.
Most of all, listen to your body, not your neighbour or social media! Noting that there will always be conflicting information and someone who will always have an opinion because they know best, Lamprey advises, “Please seek professional education to chat about options or concerns specific to you and your body.”
Physiotherapists to check out:
Physio Down Under Ask for Monica Donaldson or Tamara Gerdis, co-founders and female-health physiotherapists.
UFIT Clinic Ask for senior physiotherapist Lucie Lamprey, who also specialises in women’s health.
City Osteopathy and Physiotherapy
Osteopath Daniele Caminiti works with physiotherapist colleagues to manage a range of pre- and post-natal issues.
Physio Asia Ask for senior women’s health physiotherapist Danielle Barratt.
Founder and head trainer Holly Kuzmiak-Ngiam is a pregnancy and post-partum athleticism coach. She works closely with several women’s health physiotherapists.
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