Postpartum Pelvic Recovery: What is Normal?
“I just delivered a X pound Y ounce baby out of my vagina - now what?”
Regardless of the size of your newborn, your pelvic floor definitely experienced a significant life event when you delivered your baby! Of course, we expect that there will be soreness and discomfort in the immediate postpartum recovery period. You may even experience some pelvic pain during the first days of recovery. It is not uncommon to feel stinging/burning sensations of the perineum when you are urinating if you had an episiotomy or tear during the vaginal delivery, as the skin is healing you may experience rawness or other sensations at the perineum. There may be swelling or bruising of perineal tissue as well in those early days. The first bowel movements might be uncomfortable or difficult.
It can be helpful to use ice packs at the perineum to manage swelling or bruising. Many women also find “padsicles” to be helpful. What are padsicles?? Well, you can prep some of those prior to your delivery and have them ready when you return home! Using a menstrual pad, remove the pad from the packaging, but don’t remove the tabs from the adhesive backing. Pour or spray witch hazel (without alcohol!!!) onto the pad to completely cover it, avoid overly saturating it. Then, generously wipe aloe vera across the whole pad. Place the pad in the freezer to set, then wrap it in aluminum foil or place in a sealed bag and store in the freezer until you are ready to use! These will cool and soothe the perineum during the healing process for the first few weeks, as well as work to capture the normal vaginal bleeding (lochia) that will occur after delivery.
Speaking of bleeding, you can expect vaginal bleeding to continue for several weeks in the postpartum recovery. Initially the bleeding may be quite heavy, and bright red with some small blood clots present. That bleeding typically lasts 1-2 weeks and then it transitions to a pinkish, red/brown color and minimal blood clots for a few additional weeks. The final vaginal discharge then turns to a whitish/tan color. Things to monitor that would indicate “abnormal” bleeding would be things such as:
Passing large blood clots (larger than a golf ball)
Seeing a sudden increase in bright red blood after you’ve already moved into the pinkish/brown/whitish/tan stages
Having a very strong, foul, or fishy odor (can indicate infection)
Greenish color discharge
Experiencing a fever, body aches, chills
A peri-bottle can be a very helpful tool in the first week or two postpartum. You can use the peri-bottle to gently spray/rinse the perineum in the early postpartum days after urinating or having a bowel movement, and then gently patting the area dry rather than wiping in the early postpartum days while the tissue of the perineum is healing.
Having discomfort of the pelvic floor muscles, abdomen, and even muscles all around the body is common for the first week postpartum. Think about running a marathon or performing a high performance workout - you would expect muscle soreness from these activities. Delivering a baby will definitely give your body quite a workout! It is normal to experience muscle soreness and discomfort in the first 1-2 weeks postpartum. However, if you are still experiencing pain of the pelvic area after 2 weeks postpartum this is abnormal and you would benefit from reaching out to your local pelvic floor physical therapist to assess your symptoms. You do not need to wait 6 weeks before reaching out. If your pain is lasting longer than the first 2 weeks postpartum, don’t wait!
Other symptoms that are common in the postpartum period, but NOT NORMAL to experience after the initial 2 weeks of healing are:
Urinary urgency or leakage of urine
Difficulty fully emptying your bladder
Bowel urgency or bowel leakage
Pelvic heaviness or feeling of a bulge in the perineum
Pelvic pain
Constipation/difficulty having bowel movements
After 6 weeks of healing or more, pain during intercourse or with insertion of menstrual products into the vagina
If you are currently pregnant and are interested in learning more during a one-on-one session about prenatal, childbirth, or postpartum topics, you can reach out to SHIFT Physical Therapy to schedule your individual educational sessions. Or if you are postpartum and experiencing some of the abnormal symptoms discussed above, reach out to SHIFT Physical Therapy to get scheduled for pelvic floor physical therapy right away.
Written by: Renee Hancock, Pelvic Floor Physical Therapist
