What to expect from your postpartum body: weeks 2-4

Up next in our “What to expect from your body postpartum” series, we will cover 2-4 weeks postpartum. Below you will find information on what to expect in terms of healing, when to contact your healthcare provider or seek treatment from a pelvic floor PT, and how to safely begin returning to exercise. 

You survived!

Congratulations! You’ve survived your first couple of weeks as a momma! Even though you might continue to feel a long way from “normal” again, your body should be starting to recover from childbirth, and certain basic activities will be a bit easier! You might start to notice some signs of life “down there” when you kegel, and pooping should no longer feel like you’re birthing another child. It’s true that pooping is one of the worst parts of being immediately postpartum, but by 2 weeks your bowel movements will begin to feel less uncomfortable and you can consider discontinuing the use of stool softeners. You should be experiencing little to no constipation and should be able to void with little to no straining. The same will also ring true for your bladder.

Urinary leakage

That urine leakage that you likely experienced immediately postpartum should be less frequent or not present at all. You might still be urinating more frequently if you have significantly increased your hydration for nursing. However, you should still only be voiding urine every couple of hours. You should also be able to fully empty your bladder when you void. If you are feeling that you have to pee again as soon as you stand from the toilet, chances are you’re having some dysfunction in your pelvic floor. On the bright side, pelvic floor PT can help!

The go-ahead to exercise

If you are experiencing continued constipation, excesses straining with bowel or bladder voiding, or are having urine leakage or increased urgency, we recommend you see a pelvic floor physical therapist for a consultation. There’s a chance you could be experiencing pelvic floor tightness, weakness, muscle incoordination, or the trifecta of all 3.  An evaluation by a pelvic floor PT can help determine which of these issues you are having, and a specific treatment plan can be developed to help you return to normal. If you are one of the lucky ones who is not experiencing any of these symptoms, then you are safe to start returning to gentle exercise. 

What exercises can you do?

In this 2-4 week postpartum stage, we recommend very light, low intensity exercises that will begin to activate your lower abs and pelvic floor, but will not over stress these tissues. This can include swimming, walking, gentle yoga, simple lower abdominal strengthening, and kegels. At this stage, you are still protecting the tissue and allowing it to heal. It is important that you do not exceed the level of activity that the tissue can handle. This means that if you experience urinary leakage, pelvic pain or pressure, or low back/SI pain with any activity it is probably more than your tissues can handle at this point in time. Higher level activities like Crossfit, running, powerlifting, or HIIT classes are not recommended at this time as it takes 12 weeks for our muscles and ligamentous tissues to heal. If you are having a hard time determining what is appropriate, seek guidance from a pelvic floor PT. The staff at NOLA Pelvic Health offer both in clinic and online sessions, and we are always more than happy to help.

To help get you started, we have included several videos for basic lower abdominal strengthening exercises that are safe and beneficial at this stage. We have also added postural exercises and stretches that can be done to help relieve some of that nursing related neck and shoulder pain. (Scroll to see examples). Speaking of nursing, let’s discuss some of the things you can expect at this stage.

Vaginal dryness

Vaginal dryness… man oh man. Who knew your vagina could feel like sandpaper that’s been left in the desert for years?! It’s awful, but guess what? It’s normal. The hormones that are circulating through our bodies while we are nursing often cause pretty significant vaginal dryness. This can lead to painful intercourse and general vaginal discomfort. For this, we recommend using vitamin E oil daily on your vulvar tissues. This will help lubricate the tissue and make intercourse more comfortable, when it is safe to resume intercourse at around 6 weeks postpartum. 

Focus on your mental health

Lastly, but most importantly: your mental health. This season of life is exhausting. It’s emotionally, mentally and physically draining. You might have days where you don’t even recognize yourself anymore. The hormonal changes you’re going through might have you on an emotional rollercoaster with so many ups and downs that you many wonder if you will ever feel “level” again. That is normal and OK. You are not alone. However, if you feel like this emotional rollercoaster gets to be too exhausting, seek the help of a mental health professional and speak to your OB about the possibility of medication. Remember, you cannot take care of that sweet baby unless you are first taking care of you!

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Emily McElrath PT, DPT, MTC, CIDN is an orthopedic and pelvic health physical therapist with a passion for helping women achieve optimal sports performance. She is an avid runner and Crossfitter and has personal experience modifying these activities during pregnancy and postpartum. She is certified in manual therapy and dry needling. When not working, Emily enjoys time with her husband and two kids.

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Sara Reardon