Fourth Trimester Pelvic Floor Healing

Expectations... not met

One of the hardest parts of the 4th trimester is that you do not even know there is one. So much preparation and attention is given to your pregnancy and delivery, and often very little information is provided about aftercare for a new mom. One week after delivering my son, I was exhausted, overwhelmed, and still in pain. It burned when I peed. I was scared to poop. My vagina was still bleeding. And I could barely sit because of the pain. I did not know what to expect after childbirth, but this situation was not it.

Mamas transition, too

The fourth trimester is often considered a time of transition for a newborn from the womb to the world. However, it is also a time of transition for a woman as her body is healing and recovering from the past 10 months of pregnancy and then labor/delivery. During this time the pelvis, abdominal muscles, and vagina are also healing. Below are some strategies that can help recovery.

Ice is your BFF

Trauma to the vaginal tissues from a vaginal tear or episiotomy can cause pain with peeing and pooping and difficulty sitting. For the first several days, ice is your best friend. Use an ice pack, bag of frozen peas, or a pad-sicle (a witch hazel soaked pad that you freeze and wear in your underwear) on the vagina for 20-30 minutes. This will help decrease swelling and inflammation. Sitting on a cushion and taking a sitz bath can feel soothing to healing tissues. You can also start performing kegels on day one following delivery. This may be the last thing on your mind, but performing these exercises early on and often can actually increase blood flow to the vaginal area to promote healing. Following a vaginal tear or episiotomy, scar massage can start 6 weeks after delivery by using small amount of vitamin E or coconut oil and gently massaging the healed incision for a few minutes a day.

The 411 on peeing

Peeing may be difficult and painful initially due to the anesthesia, healing tissue, and shock to your pelvic floor muscles. Drinking plenty of water, walking around, running water, or soaking in a warm bath can help relax your muscles and initiate your stream. Use a squirt bottle to spray warm water on your vagina during and after urination and then pat dry with tissue instead of wiping. Urinary leakage may occur immediately after delivery as well. This should gradually improve and be completely resolved at 3 months.

The 411 on pooping

Drinking plenty of fluids will help get you back to pooping normally. To avoid straining when you poop, use good positioning by placing your feet on a stool, leaning forward, and exhaling as you gently bear down. This helps relax your pelvic floor muscles and prevent hemorrhoids, prolapse, or damage to incisions. Stool softeners or fiber supplements may also be helpful in the early days, especially if you had any anesthesia.

The 411 on c-sections

Following a cesarean section, taking care of your scar and retraining your abdominals right away are essential.  Most women may benefit from using ice over the incision site for 1-2 weeks and an abdominal binder for 2-6 weeks after surgery. You can also start to perform gentle belly breathing, start walking around (making sure you stand upright and not slouch), and do gentle abdominal and pelvic floor muscle contractions to initiate regaining muscle strength and function. Immediately following a C-section, perform scar massage using two fingers placed 3-6 inches away from incision and make small circular motions to promote blood flow. Once the once scar heals around 4-6 weeks, start massaging directly over scar.

Focus on your baby (and you!)

As you start to get more rested and initial healing has taken place, gradually increase your activity levels. Start taking longer walks, progress your pelvic floor exercises to performing 8-12 contractions 3 times a day of quick and endurance holds, and wait until about 6 weeks before attempting more vigorous activity, including having sex.

The 3 months following the birth of your child can be exhilarating, exhausting, adventurous, and overwhelming. So much focus is put on this tiny beautiful human being, rightfully so, but make sure you are also getting the nourishment, care and healing you need. My hope is that this info helps heal not only your vagina, but also your heart and soul during this tender fourth trimester.

Want to chat one on one about YOUR specific needs postpartum? Schedule an online session to chat with one of our Pelvic Health Therapists!

Sara Reardon PT, DPT, WCS is the owner of NOLA Pelvic Health and founder of The Vagina Whisperer, a resource for online pelvic health education and therapy to help women worldwide with pelvic health conditions. She is a board certified women’s health physical therapist with a special interest in treating pelvic pain and pregnancy and postpartum conditions. She is a mom, wife, Saints fan and wanna be yogi.