Once the swelling and inflammation has gone down. Tearing or incisions have closed and superficially healed. The tissue has to continue going through a healing process which includes relearning how to function.
To better understand the long term effects we need to understand the roles of the pelvic floor.
The pelvic floor has four main functions...
- To keep pee and poop in
- To let pee and poop out
These functions are influenced by the flexibility, contractility and coordination of the muscles and tissues of the pelvic floor. But they are also influenced by what is happening above and below the pelvis, daily movement patterns, and your habits.
A vaginal delivery not only stretches the pelvic tissues of the pelvic floor, but also widens our hips and pelvic joints changing how the forces travel through the body.
The pelvic muscles and tissues are attached to and support these joints. Your pelvic joints are affected by positioning, external forces from people pulling on your legs, or your inability to feel how hard your pushing from an epidural. So if your pelvic joints are injured the tissues that are attached to them can also be injured or guard to protect.
These changes can have lasting affects on the structure of your pelvic bowl and may alter the strength-tension relationship in the muscles supporting the joints and organs, most importantly the pelvic floor. The body needs to compensate by shifting your posture or you may unconsciously alter how you perform a task.
This results in changing forces within our trunk and pelvis.
When this occurs the functions listed above can be altered resulting in
- Urine or fecal leakage
- Urine or fecal urgency
- Pelvic pain - front or back
- Back pain - anywhere in the back
- Painful sex
- Reduced sexual arousal
- Constipation, etc.
The longer the body compensates, guards, moves in less than desirable patterns the more the tissues will tighten, weaken and become imbalanced.
- That pesky twinge with sex now being a sharp chronic pain with sex.
- No leakage with coughing or sneezing to every time you have a cold you have to wear a pad.
- Once your baby starts to grow and get heavier your back aches or you can't bend over to lift the babe up because it hurts your pelvis so much.
- Whenever you lift your leg to go up the stairs or get dressed you have pain in the front of the pelvis.
Really the list can go on and on.
The contractility and flexibility of the pelvic floor muscles in particular are most influenced by a vaginal birth and just like the short term risks, medical intervention can result in more dysfunction.
For example, an episiotomy rips more resulting in a fourth degree tear. This means the laceration affects all the muscles and tissue between the vagina and rectum, including a large junction point of pelvic floor muscles and ligaments. When this happens not only is the scar going to be bigger, which may cause increased adhesions and reduced flexibility and guarding in the tissues and muscles, but also weakness in the anal sphincter. Resulting in increased risk of uncontrollable gas loss or fecal incontinence. On top of pelvic pain, prolapse and urine incontinence.
These issue will not be helped with just Kegels, ladies!
On a more global scale, the length of pushing during birth, regardless of medical intervention can increase the risk of pelvic floor dysfunction.
As I mentioned in Part 2, a short labor may not allow the time for the tissues of the pelvic floor to relax and stretch to expand for baby. On the other hand a long labor and pushing can overstretch the tissues.
Not being able to relax may cause tearing, resulting in scarring. Leading to pain or inability to contract or relax the pelvic floor muscles.
Either of these can mean muscle guarding, muscle weakness, muscle spasm - which can all lead to incontinence and pain.
Over stretching the tissues also means increased risk of prolapse. What this means is your pelvic tissues are unable to support your pelvic organs and either your bladder drops into the vaginal canal, cervix or uterus drop into the vaginal canal or the rectum drops into the vaginal canal.
Prolapse is highly influenced by the support you are able to provide to the pelvis through muscular, fascial tensioning and proper pressures. This is really where the weakness of the core, pregnancy posture and any other trauma that occurs to the pelvis from vaginal delivery is be highlighted as a problem.
Another injury that is rarely spoken of is nerve damage. This can be caused by:
- The amount of force placed into the pelvis during pushing
- The position of the baby
- The position of mom
- Any external forces on mom (think partner holding onto one leg and nurse holding on the other leg while moms on her back)
- Medicalization such as epidural so mom can't feel how hard she's pushing, or instruments.
It takes a long time for nerves to heal and if the surrounding tissues have also been injured, posture is altered, pelvic congestion or there are imbalances in tissues causing tension or guarding squeezing the nerve it'll take even longer.
The nerves that run through the pelvis not only control the pelvic organs and tissues but also the legs!
Ever wonder why it's hard to lift your leg or why your foot is numb after birth?
Long term effects of a vaginal birth on pelvic health are:
These are influenced by:
- Scarring (tearing, episiotomy)
- Injury from vacuum, forceps
- Length of labor and pushing
- Ability to relax the pelvic floor during birth
- Awareness and health of the pelvis prior to pregnancy
- Nerve damage
- Any other pelvic injury during birth
The good news is all of these are treatable in some way, with care from a pelvic health PT!
The sooner you are able to speak up and seek care the better.
The more women who do speak up about it and find out that these effects are not normal results of childbirth the women who will be able to live a fuller life!!