Our Bodies, Our Lives
By Drs. Tristi Muir and Catherine Hansen
Bringing a new life into the world is truly a miracle. Yet in the aftermath of the birth and all the excitement surrounding bringing the baby home, many women find themselves noticing something not so miraculous — their body is not the same.
The uterus, vagina, pelvic muscles and nerves undergo tremendous change during pregnancy, delivery and postpartum.
The uterus shrinks back to approximately its pre-pregnancy size within six weeks. Bleeding can persist throughout this time, but resumption of an actual period is variable and often significantly delayed if a woman decides to breast-feed.
The hormones a woman’s body produces around the time of delivery empower the cervix and vagina with the tremendous capacity to expand and contract.
Frequently, though, the baby exceeds the body’s powers of expansion and tears the vaginal skin.
Minimal tears or abrasions will heal on their own (although they can sting with urination during the healing phase), while deeper cuts require stitches.
The increased blood supply of pregnancy improves the body’s ability to heal these tears, but infection and persistent pain can still occur.
Hormonal changes associated with breast-feeding can thin vaginal skin, making it much more sensitive and increasing pain with sex.
After a woman receives the green light to resume sexual activity, the use of vaginal lubrication is highly recommended to ease the friction on the healing tissue.
If two months have elapsed since the baby was born and there is still vaginal pain, a woman should return to her doctor for re-evaluation.
The muscles and nerves that support the pelvis can be damaged during birth. This type of damage may lead to leakage of urine or stool.
Women who experience urinary leakage with cough, sneeze, and exercise before or after delivery are not alone.
Approximately 1 in 3 women experience urinary incontinence after giving birth.
Fortunately, as the body continues healing, urinary incontinence resolves in half of these women within a year.
However, the risk of persistent urinary incontinence increases with each vaginal birth.
Damage to the anal sphincter has been reported in up to one third of women.
Approximately 10 percent of women will notice loss of control of gas. Incontinence of stool occurs much less frequently (two percent), but can be devastating to those affected.
Sometimes the vagina does not spring back to its old self very easily.
Sagging of the pelvic organs (prolapse) is 10 times more common in women who have had four or more vaginal deliveries compared to women who have not given birth.
Many women who come to us never knew that the support for the bladder, uterus or rectum could “drop,” leaving them with the sense of bulging in the vagina.
In addition to pain with sex related to tears or vaginal dryness, some women describe decreased sensation, change in ability to reach orgasm and incontinence during sex.
One of the best answers to all these problems: pelvic floor muscle exercises.
Kegel exercises can strengthen the muscles that support the bladder, urethra, anus, and uterus and help to cure incontinence, prevent further pelvic organ sagging and improve sex life.
It is a great idea to start a pelvic floor workout program before giving birth.
Women should ask their doctor to check their pelvic floor muscle strength and confirm that they are squeezing the correct muscles.
We recommend that all women perform pelvic floor muscle exercises throughout their lives.
The difference they can make in quality of life — from the childbearing years through menopause and beyond — cannot be overstated.
Our Bodies, Our Lives focuses on issues surrounding women's sexual, gynecological and emotional health. Drs. Tristi Muir and Catherine Hansen are gynecologists at the University of Texas Medical Branch. Learn more information at utmbhealth.com/pelvichealth.