It Doesn’t Have to Hurt ‘Down There’
Treating Postpartum Pelvic Pain
By Julie Bagshaw
A trend I’ve observed since becoming a full-time pelvic health physiotherapist is that a lot of my clients who come in for an assessment are in pain… pain that extends beyond the timeframe that would be consider normal for tissues to heal (~12 weeks). After giving birth, for example, during the first couple of weeks postpartum, as your body heals, some amount of pain is expected. But, it is not okay, and is actually considered a pelvic floor dysfunction, if the pain continues for extended periods of time. This has motivated me to do some more learning! Last fall, I was grateful to attend a two-day course entitled, ‘Clinical Skills for Treating Pain,’ and I have A TON of great information to share!
Let’s take a step back and start with the definition of pain. According to the International Association for the Study of Pain, pain is defined as: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” (1)
Let’s look at this definition more carefully:
Pain includes both sensory AND emotional experiences
Pain is associated with actual OR potential tissue damage – meaning, you don’t need any injury to feel pain
To be clear, pain and our pain system are actually good things. Think of your pain system as your body’s ‘alarm system.’ When our brain interprets that we are in ‘danger,’ it ensures that we feel pain and that motivates us to take notice and make a change (e.g. don’t hold your finger on a hot stovetop!).
But, when pain goes on longer than what is reasonable for normal tissues to heal, we need to pause and ask ourselves, ‘Why?’
When our brain interprets that we are in ‘danger,’ it ensures that we feel pain and that motivates us to take notice and make a change
The answer is that we need to consider the whole person – the emotional, social, immunological, and cognitive aspects of an individual person and determine why our brain is continuing to send that danger signal. Are you stressed? Do you catastrophise? Are you scared to move? Have you experienced a trauma? Do you feel shame? Do you feel you can’t cope? All of these things can make your alarm system more sensitive. As physios, we call this taking a ‘biopsychosocial approach’ to treatment, or considering the WHOLE person.
Let me give you a fake, but common example to explain the biopsychosocial approach more clearly:
Jane is a 32-year-old mother of one, who is 8 weeks postpartum. She experiences a 2nd degree perineal tear during her labour and is finding intercourse very uncomfortable now. Her goal is to be able to enjoy intercourse again. When I assessed her in clinic, she reported pain when there was pressure applied to her perineum and tight internal pelvic floor muscles. We dedicate some physio sessions to lengthening these muscles and were able to successfully move them into a more relaxed state. She has a home exercise program to complement our treatment in the clinic, but continues to come back each week and report that she feels the same.
What I haven’t told you yet is that Jane also reported that it is traumatic every time she has a vaginal exam due to a past experience that was uncomfortable, she is very stressed about doing a good job raising her new baby, and she is anxious about having intercourse, given her long and painful labour experience. She has not been sleeping well and her marriage has been suffering.
She has been struggling to find a balance with the new baby and her partner, as they are currently all sleeping in the same room. Although there is some actual tissue stress to her pelvic floor muscles due to the labour process, it’s clear there are many other life factors that are causing Jane’s ‘alarm system’ to be more sensitive. We could continue to treat the local pelvic floor tissues, but until the other stressors
in Jane’s life are managed we may not achieve Jane’s goal.
Jane is not alone. Persistent pain can happen to anyone and it doesn’t just happen after you give birth. The AMAZING thing about our bodies and minds is that we CAN change and heal because of a concept called ‘bioplasticity.’ This refers to our brain’s ability to change and form new connections and meanings. Essentially, we can train and desensitise your internal alarm system, so that it doesn’t go off as easily or as often!
The AMAZING thing about our bodies and minds is that we CAN change and heal because of a concept called ‘bioplasticity’
You will notice that at Vital Physiotherapy, we ask all of our clients to fill in a series of questionnaires when they come in for their first visit. This is because we want to consider the WHOLE person in our treatment plan. We want to work with you to best-achieve your goals, and sometimes, that isn’t just by stretching or strengthening your pelvic floor muscles. Treatment options such as Qi Gong, yoga, body remapping, breathing techniques and referrals to mental health professionals are all considered, as we develop your individualised treatment program.
Thanks for sticking with me to the end! I hope you enjoyed this short education on pain, and know that if you have been experiencing pain for a long time that, first, you are not alone and, second, you don’t need to continue to live in pain! There are many, many treatment options available to you!