Physical problems caused by childbirth
A woman will notice significant changes to her body following the birth of a baby. Many of them will experience physical problems relating to the pelvic floor muscles, which are the group of muscles holding in place the pelvic organs (uterus, vagina, bowel and bladder). The function of the pelvic floor muscles is to support the bladder and bowel, enabling us to control our urination.
As we age, these muscles start to weaken. This is often made worse through childbirth, as the pelvic floor stretches to allow the baby to pass out of the body. As such, many women will experience problems after childbirth, due to weak pelvic floor muscles.
There are a number of problems specific to the pelvic floor muscles which can occur as a result of birth trauma:
- Distortion of the vagina or perineum (area between the vagina and anus)
- Heaviness or dragging sensation in the vagina
- Pain in the vagina or perineum that can also be associated with sexual intercourse
- Changes in appearance of the one or both of the labia (lips around the vagina)
- Incontinence of stools (faeces) or wind (flatus)
Is it normal to experience problems after childbirth?
It is very common for women to experience some birth trauma, physically affecting the pelvic floor and vagina. The vast majority of women recover completely and have no ongoing problems in the long-term, though we would always recommend that women continue to do their pelvic floor exercises to help to prevent problems later in life, such as incontinence or prolapse.
A small minority of women experience ongoing problems after childbirth including pain, scarring, or heaviness in the vagina, which may be uncomfortable. This can also affect sexual function and cause great distress, which should not be ignored.
Not all women require a surgical solution to their pelvic floor problem. Our care is tailored to your individual symptoms and expectations. We also take into account any plans for future children when deciding what treatment to recommend.
Vaginal scarring or tearing
Though the vagina is stretchy and is designed for accommodating the birth of a child, it is not uncommon for the perineum to stretch so far that it causes tearing, requiring the need for stitches.
Most women will experience some degree of tearing after vaginal childbirth, especially if it is their first time giving birth. Many of these will require stitching as result. The stitches usually dissolve after approximately 4-6 weeks, depending on the extent of the injury as well as the type of stitch used. The area will then continue to heal for several months after the delivery.
Normally, the vagina and perineum heal without any problems, but for a small minority of women, there can be scarring or distortion where the area has failed to heal correctly. This may cause no symptoms at all, but can sometimes produce pain, especially during sexual intercourse, or may lead to loss of confidence and sexual libido.
Often this can be managed with a “watch and wait” approach, or by using conservative measures such as vaginal dilators to break down any scar tissues. Alternatively, the vagina can be stretched if there has been any narrowing or shortening. If these methods fail, then the vagina and perineum can be refashioned.
Pelvic Organ Prolapse
It is quite common after childbirth to experience some feelings of heaviness in the vagina. This is caused by pelvic floor weakness and is usually temporary, taking up to a year after delivery to resolve.
If the pelvic floor has been severely damaged, then this feeling may persist. In some cases, the vagina or cervix may come very close to, or out of, the entrance to the vagina. This is referred to as pelvic organ prolapse and is caused by the weakening of the tissues which support the pelvic organs.
Symptoms of pelvic organ prolapse:
- The sensation of something coming down from inside, or out of, the vagina, which sometimes needs to be pushed back in
- Pain or discomfort during sexual intercourse
- Urinary incontinence
This condition does not pose a serious threat to health, but it can cause distress and discomfort. Most women do not require treatment, since the issue may not interfere with their normal day-to-day activities.
You should consult your GP or gynaecologist if you think you have any symptoms of prolapse, or if you have noticed a lump in or around the vagina. In mild cases, the health professional will usually recommend certain lifestyle changes, such as losing weight and practising your Kegels (pelvic floor exercises).
If severe, your doctor may suggest treatment, which involves the insertion of a medical device into the vagina to help hold the prolapsed organ in place.
Changes to the Appearance of the Labia
The labia minora are the flaps of skin which are found on either side of the opening of the vagina. After childbirth, the labia may be traumatised. As a result, one of the labia may appear scarred or reduced in size, when compared to the other. Labial enlargement can also occur after childbirth which may be present on one or both sides.
Enlargement of the labia may cause stress and discomfort. The increase in size may mean they are more likely to catch on clothing, make wearing certain types of underwear uncomfortable, make sex painful, or cause discomfort when sitting down. Additionally, the appearance of enlarged or damaged labia may affect a woman’s self-confidence or sexual libido, causing intimacy issues.
If the appearance or feeling of your labia is causing you problems, you might wish to consider labiaplasty, which is a surgery used to reduce the size of the labia minora. This can be done for several reasons, including the size and shape causing discomfort, or simply because a woman does not like its appearance. Many health professionals discourage labiaplasty for purely cosmetic reasons and as such, it is a major decision which one should consider very carefully.
Less frequently, childbirth can cause injury to the pelvic floor that is so severe that it may affect the muscles around the back passage or anus. This muscle complex, called the anal sphincter, is responsible for preventing loss of stool (faeces) or wind (flatus) from the back passage. If this is damaged then women can suffer from incontinence of faeces and flatus.
Most women will regain control of their bowels within a few months of childbirth, though for others it may continue for much longer. This is an extremely distressing symptom and generally requires review by a pelvic floor specialist.
In the majority of cases, the problem can be managed conservatively with pelvic floor exercises. These can help to strengthen the pelvic floor muscles and research has also shown that exercising these muscles may help or even prevent anal incontinence.
If Kegel exercises do not seem to help the problem, the next step may be to seek the help of a special pelvic rehabilitation physical therapist. This will include rehabilitation of the anal sphincter, carried out under the care of a specialist physiotherapist.
Since these non-invasive treatment options exist, it is uncommon for women with the condition to require a surgical solution.