Common Post-Partum Pain Part 1 of 4

As a pelvic health PT, part of my bread and butter knowledge base is pregnancy and post-partum…..everything.

I was asked by Dr. Kevin Carnivale, MD, a board certifed OBGYN to speak on his podcast Kvara. His podcast (and app to follow) is all about the fourth trimester. What is the fourth trimester? Ill make another post and go into detail, but the gist is, its the 3 month period immediately post partum when mom essentially get abandoned by the healthcare system. His goal (and mine!) is to provide access to quality, accurate information to women at once of the most vulnerable times in their lives. Boo, We got you. So, check out his podcast (featuring me! and other amazing experts) for all the things you never knew you needed to know. And, keep reading here for the info covered in the podcast + links + some extra content I couldn’t fit into 30 minutes. haha!

Here we go:

1) Perineal Pain

• Causes: vaginal tears sustained during birth or hemorrhoids

*Tears*

Tears are graded on a scale of 1-4.

• Grade 1 is just the skin, these dont usually cause much issue and dont often require any medical intervention.

• Grade 2 is skin and the first muscle layer. These often require a couple stitches, it will depend on location and your healthcare providers opinion.

• Grade 3 involve the skin, muscle and internal anal sphincter (there are nuances to this, but we are going over the basics for the purpose of this post)

• Grade 4 is what patients ofetn refer to as “hole to hole.” This is a complete tear of skin, muscle internal and external anal sphincter. Grade 3 and grade 4 require sticthes, often surgical repair. This is somtimes done in the operating room after delivery.

• There are things you can do to reduce the severity of tearing and liklihood of tearing (that will be another post to come) This post covers what you can do ocne you have sustained a tear and hwo to help it heal and manage the pain as optimally as possible.

*Hemorrhoids*

• Internal or external. Usually, external are more painful immediately post partum.

  • External are the ones you can see or feel around the anus when you wash in the shower

What Can I Do about it?

• Walk. Get up off your tear. Movement helps with tissue remodeling (scar formation), keeps the scar mobile while it heals so it doesnt get scarred down to tightly, improve blood flow and lymph drainage in the area. After you push out a human the vagina and pelvic floor muscles are swollen. Boo, you just performed a real-life miracle. Your body is built for this and it kicks in to start healing. Healing includes swelling (which is normal) If you can get up and get pressure off the tear as much as possible, you will help it heal better, faster and with less pain.

  • How often should I walk?

    • Great question! 2-5 minutes every couple hours. Minimum is 3 times a day. Im not asking for marathons. DO NOT OVER DO IT. You have proven you are superwoman already. Listen to your body and do what you tolerate. An extra lap around the kitchen table to give some extra time to off load is a fantastic start!

  • I hear you, but “It friggin hurts and I cant”

    • I hear you. Life hack time: Lay down.

      • No Joke. Off loading includes laying down. On you back, on your side, reclining in a chair rather than sitting up right. There you go, successful! If getting you and moving just isn’t in the cards today, that’s ok. Just change positions and try again tomorrow. You’re doing great momma.

• Sit on a cushion. That boppy someone got for baby? Yeah, its also for you. Sit on it to help off load the pressure on the tear. You can also use a neck pillow, jacket or towel. Roll it up like a “U” shape and sit on that to change in pressure.

• Manage Constipation

  • (This goes for hemerroid management too.) Firm stools suuucccckkkkkk when you have a healing tear or angry hemerroid. You have some options: stool softeners, miralax, fiber and mangeisum.

    • Many of my patients choose to be as hollistic as possible. So, they opt for Mangeisum. I have another post on constipation management (coming!) but here is the basics.

      • Mangeisum Oxide taken at night. Start with 400 mg. Your stool should be the size a shape of a ripe banana. NOt piecey, firm or lumpy.

      • Water (half your boyd weight in ounces minimum, especially if your breastfeeding

      • squatty potty (yes, there is a proper position to poop in)

      • Fiber: 25 grams. Go get some Bran Buds cereal. It looks like rabbit food and tastes slightly better. haha! IDGAF how you get it in you. Oatmeal, with milk. yogurt, eat it raw. Boo, just. get. it. down.

• Peribottle. Those bidets that were all rage during the COVID toilet paper shortage? This will be you rbest friend. If you never jumped on that bandwagon, get a peribottle. Rather than using toilet paper to wipe, use the water to rinse.

  • Pro-tip: 1) warm it to body temperature 2) put it in a thermos near the toilet and fill the bottle when you need it. Less extra steps. I mean, I am also all for asking spouses/ partners to go warm it up for you. After all, you grew and pushed out a human for them. Its the least they can do.

• Witch-hazel: You can get tucks pads or even make padcicles.

  • How to make a padcicle (click here)

  • Witch-hazel is great because it helps give a cooling and pain releif feeling.

  • Frozen peas are a good option too because they will contour to where you want the cooling. Don’t use for longer than 20 mins at a time as too much cold will delay or negatively impact healing.

Next part is for my c-section mommas!