Postnatal Check with a Women's Health Physio
So why should I bother booking a postnatal check with a Women’s Health Physiotherapist? Surely my GP review is enough?
It is totally understandable that in those early months after baby arrives, when sleep deprivation is hitting its peak and simply just making it through the day is an achievement, the last thing you would want to do is have your bits examined again. Especially when you have been checked by the public health nurse (PHN) and the GP already.
1. Pelvic Floor Muscle Assessment
These muscles form a sling at the bottom of the pelvis. They are responsible for keeping the bladder and bowel from leaking, holding up the pelvic organs, supporting the lower back and pelvis, and maintaining optimal sexual function. Pretty important muscles and not ones you want to neglect!
In order to check these muscles, your physiotherapist will assess your pelvic floor muscles either vaginally or by using a real-time ultrasound (if she/he has access to one). The ultrasound is placed on the lower tummy and shows the physiotherapist how well the pelvic floor can lift and relax. Plus, you can see this on the screen too, which is great for feedback and learning.
Bladder or bowel incontinence
A feeling of vaginal heaviness
Any pain in the vaginal area
2. Abdominal Muscle Assessment
Your tummy muscles will be checked to see if they have returned to normal after delivery or if a gap/diastasis remains. It is normal for women to have some degree of stretching in the midline tissue and movement of the “six pack muscles” during pregnancy and if this was assessed immediately after delivery, we would expect the muscles to still be sitting apart from each other and be quite weak in the midline.
- Sit ups
- Heavy lifting
- Chronic coughing and sneezing
- Straining to open your bowels
But research has shown that natural healing only occurs in the first 8 weeks postpartum and if the tissue in the midline isn’t back to being thick and strong by that stage, you will need to do specific exercises to rectify it. Your physiotherapist can put an individualised program in place for you, at your check if it is applicable to you.
3. Musculoskeletal Assessment
Your physiotherapist will ask you about any current or past pain or injury to any joints or muscles.
- Pelvic girdle pain (pain in the pubic bone or buttock region)
- Coccyx (tailbone) pain
- Back pain
- Wrist pain
Early diagnosis and management of these issues is essential to stop them becoming chronic problems. Posture will also be addressed and education and retraining will be provided.
4. Bladder and Bowel Function Screening
- How much you’re drinking
- How often you’re opening your bladder and bowels
- Whether you feel an urgent need to get to the toilet
- Whether you have a history of pain with intercourse
- Whether you experience any urinary or faecal leakage
- And a whole lot more questions!
While these may be embarrassing issues to discuss, it is so important that someone asks these questions and delves into whether there are any early signs of dysfunction. Prevention is better than cure, and your physiotherapist can pick up anything at this point that isn’t quite right and help put a plan in place to optimise things before it becomes a bigger issue.
5. Return To Exercise Plan and Goal Setting
Everyone has different goals regarding return to exercise and activity after having a baby. But, whatever your goals are, it is important to discuss them with your women’s pelvic health physiotherapist and together you can work out how achievable they are, and what steps are required to safely achieve those goals.
Of course, as physiotherapists we want everyone to achieve their activity goals but sometimes we need to bring you back to basics and rebuild from the foundations up depending on how your pregnancy and birth went. This allows you to phase up your activities at a safe pace and avoid further issues setting in down the track or causing trouble in a subsequent pregnancy. This assessment will test where you’re at with your core strength and your ability to transfer load effectively when you do abdominal muscle exercises, high impact exercises, weights, running etc – whatever it is that you individually want to achieve.
In this way, a postnatal check is a very individualised assessment and it encompasses the whole body. Women should never assume that one woman’s muscle activation, hormonal changes, and birth trauma are the same as the next and although there are many common issues that affect women in the short and long term after childbirth – incontinence, vaginal prolapse, back pain etc – there are things that can be put in place to help to prevent and treat these issues. You don’t need wait for problems to occur or to worsen, you can be proactive by seeing a specialist Women’s Pelvic Health Physiotherapist in the early months after delivery.
Making an appointment is easy, simply search for a private physiotherapy practice that has someone who specializes in this area (you don’t need a referral) or ask your GP to refer you to see a specialist physiotherapist in the public system.
Suzanne Carney is a clinical specialist in women’s and men’s pelvic health physiotherapy. She holds a masters level qualification in this area from Curtin University in Perth, Australia where she lived for seven years. She has been a physiotherapist for more than 10 years and has recently set up Anatomy Physiotherapy in Claremorris, Co. Mayo which is a specialised practice for women's, men's and pelvic health. Suzanne also works part-time in Mayo University Hospital as senior pelvic health physiotherapist. To get in touch with her email firstname.lastname@example.org or call 083 034 3277.
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