How to Take Care of Your “Down There” After Having a Baby
By: Brook Orvis, PT, DPT, WCS, PRPC, CLT
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Have you heard all of the hype recently surrounding the pelvic floor with pregnancy and delivery and wonder, “What the heck is that?”
The pelvic floor is a group of muscles at the base of your pelvis that serve the following functions:
Sphincteric control which prevents leaking of urine, stool, and gas. On the flip side, they need to lengthen and release so you can empty your bladder and bowels completely.
Support helping to keep your pelvic organs like your bladder, bowels, uterus, and urethra positioned where they’re supposed to be.
Sexual function including being able to have an orgasm and pelvic penetration during sex and intimacy pain-free.
Stabilize the body acting as a direct extension of our “core muscles” helping to give support to our low back, abdomen, pelvis, and hips.
Circulate the blood and lymphatic fluid in the pelvis back up to the heart.
As a Duke Women’s Health Residency Trained and Board-Certified Women’s Health (WCS) and Pelvic Floor (PRPC) Physical Therapist, I work with everyone with a pelvic floor, including people that are pregnant and have had children. If my many years of experience working with this patient population, and having gone through pregnancy and delivery myself, has taught me anything, it’s that we don’t do enough to help prepare our clients for how to take care of their bodies (and specifically their pelvic floor!) once their baby arrives.
Here are five practical tips to take care of yourself after having a baby:
1. Your body mechanics while taking care of your baby are everything!
However you are feeding your baby, make sure you are bringing your baby to your chest or bottle instead of the other way around. Use a supportive pillow underneath your baby, like a Boppy or My Brest Friend, to bring them level with your chest to more easily feed without bending forward. Make sure you have good back support using a pillow behind your lower back, lean back against a supportive surface like a chair, and position your feet so they can rest completely on the floor or on a step stool. Habitually bending forward multiple times throughout the day to feed your baby could eventually lead to upper and lower back pain. And guess what back pain is linked to within research? Pelvic floor muscle dysfunction.
2. Scar tissue mobilization regardless of how you delivered your baby.
It usually takes 6 weeks for scar tissue to fully heal over, but that doesn’t mean you can’t work on the tissue surrounding your scar before the 6 week mark!
For cesarean deliveries:
Imagine your scar is broken into four sections. Working at both sides of your scar (above and below) start by gently using the pads of your fingers and gently stretch the tissue in all directions (up, down, left, right) and hold for 30-60 seconds before releasing and continuing at the next section. You can also gently do small circles working on either side of your scar and moving gently side to side and up and down for 30-60 seconds each direction. To progress further you can start to gradually sink the pads of your fingertips deeper and deeper into your tissue surrounding the scar (once working at the surface of the skin becomes more comfortable) and repeat the same types of stretches and scar mobilization techniques mentioned above. Another trick that I recommend to clients is using silicone strips (like Scar Away) over their incision once it has fully healed, typically around 2-4 weeks post-delivery. This will help to improve the appearance of your scar.
For vaginal/pelvic opening deliveries:
Similar to cesarean scar tissue, you can gently work on both sides of your scar (left and right) using the pads of your fingers and gently stretch the tissue in all directions (up, down, left, right) and hold for 30-60 seconds before releasing. You can also start to gradually sink the pads of your fingertips deeper and deeper into your tissue once working at the surface of the skin becomes more comfortable.
3. Lubricant during sexual activity is a must!
I know that sex and intimacy can be a loaded topic once baby arrives on the scene. Once you hit the six week mark and have been given the “all clear” by your OB/Gyn to return to sexual activity, it can sometimes feel scary thinking about returning to sex or solo activities post-baby. Usually estrogen levels are low in the postpartum period and if you are chestfeeding they will continue to be at a lower level until you finish up. We know that estrogen is incredibly important in our body’s ability to produce self-lubrication, and any form of dryness when paired with intimacy can cause pain, burning, and reflexive pelvic floor muscle contraction resulting in further discomfort. I always recommend to clients to use a water-based lubricant (some of my favorites are Slippery Stuff and Sliquid H2O), an oil-based lubricant (like Coconut Oil), or a lubricant that is paraben- and glycerin-free. Be generous with the amount of lubrication that you use both on yourself and your partner or whatever object you are using. There is no such thing as too much lubricant!
4. Check in with your pelvic floor and abdominal muscles.
This is something I usually spend a lot of time going over with clients during pregnancy and postpartum because our muscles are at a mechanical disadvantage with being lengthened from pregnancy and delivery. This can cause weakness and lead to different types of symptoms like low back pain, pelvic and hip pain, leaking of urine/poop/gas, and diastasis recti (separation of the six pack muscles in the abdomen or belly).
Practice contracting your pelvic floor muscles alone. Pretend as though you have a straw inserted in the vaginal/pelvic opening and you are using the muscles at the vaginal opening to suck fluid up and in through the straw. The trick with doing a pelvic floor muscle contraction aka “Kegel” is that no one else should know you are squeezing your muscles but you! If that’s the case and you can breathe and carry on a conversation like normal, you are likely doing them correctly. As long as your contractions are pain-free, practice doing them in any and all positions and activities throughout the day (laying down, sitting, standing, exercising). You want to make sure that you incorporate longer contractions where you squeeze the pelvic floor and hold up to 10 seconds and quicker contractions where you squeeze for a few seconds at a time before releasing.
Practice activating your deeper “core” muscles alone. Pretend as though you are trying to put on a pair of pre-pregnancy pants or you are blowing out birthday candles by gently bringing your belly button to your spine. You should feel the muscles at the inside of your hip bones gently activate, which is the deepest layer of your core or abdominal muscles and works together with your pelvic floor. You can incorporate this deeper core activation throughout the day such as when bending over to lift heavy objects (like your baby!), carrying different objects, or getting in and out of bed or out of a chair.
Finally, put the two together! Using the activation of these two muscle groups together can be incredibly helpful if you’re struggling with leaking of urine, poop, or gas with activities that increase the pressure in your abdomen such as coughing or sneezing. Simply do the abdominal and pelvic floor muscle contraction before the activity where you have the leaking, maintain the contraction during the activity, and then let it go immediately following.
5. See a pelvic floor therapist if you’re struggling.
You don’t have to wait until your six week postpartum checkup to seek additional help from a pelvic floor specialist and can start addressing any symptoms you may be struggling with as soon as you feel ready. All recommendations provided above are general recommendations and not a one-size fit all solution for everyone.
Websites that I frequently recommend to help find a skilled provider near you for specialized treatment interventions tailored to you and your symptoms are pelvicguru.com and pelvicrehab.com. Checking Dr. Google for local providers always works, too.
Just know that there are treatment options available to you if you are struggling…you don’t have to “just live with things” or accept your symptoms as “a normal part of having children.”
Last medically reviewed on December 5, 2023
Dr. Brook Orvis is a Board-Certified Women’s Health and Pelvic Floor Physical Therapist, Duke Residency-Trained in Women’s Health, and the owner of Flora Physical Therapy. As a momma to a spirited toddler, she understands the difficulty of being a parent while prioritizing self-care, including caring for your body and pelvic floor during pregnancy and post-delivery. She believes that pelvic floor therapy is for everyone and is passionate about providing accessible treatment options for birthing people so that they can take better care of themselves. She loves educating and empowering clients to take charge of their body and health and to not accept leaking of urine, prolapse, pelvic pain, pain during sex, and core weakness as a normal part of having a baby.
Want to chat more to see if working with Brook is a good fit for you? Schedule your free phone consultation today!
