Hemorrhoids, Fissures and Tears, OH MY!

February 9, 2016 in Childbirth, Pelvic Floor, Post Partum, Pregnancy

Hemorrhoids, Fissures and Tears, OH MY!

Let’s talk about something! It’s not a pleasant subject. It’s the nasty little triad of issues one might face after having a vaginal birth.  I’m talking about the after effects and trauma that can happen to your bottom. It’s rarely discussed before a birth and I believe there is a reason for that.   The physical injury to the pelvic floor area from a vaginal birth can cause significant damage that leads to some rather unpleasant, uncomfortable and down right painful issues some women have to face.   I’m talking about hemorrhoids, fissures and tears that occur in the perineum during, for hemorrhoids, and after birth for all three. There are some things you need to know to help you deal with these uncomfortable issues if you find you have developed these.

HEMORRHOIDS

Let’s start with hemorrhoids!

Hemorrhoids are a swelling and inflammation of veins in or around the anus and lower part of the rectum. They can be painful and itchy. Hemorrhoids are very common in pregnancy as the increased weight from carrying the baby causes greater pressures on the pelvic floor. Also prenatal vitamins and hormones cause a slowing down of your colon and swelling of your veins, two factors contributing to constipation that can lead to hemorrhoids.

So to avoid hemorrhoids you’ll want to avoid constipation and the bearing down that usually goes along with it.

The first step is to avoid being constipated.

Diet has a huge implication on constipation. (Please consult a nutritionist for greater help with your diet) By eating more fiber rich foods you can help keep things moving in your colon. Raw veggies are a great way to increase fiber or adding flax seeds to your foods can help too. Be careful in adding too much fiber at first if things aren’t moving well especially if you aren’t doing this next thing.

That is, drinking enough water. Increasing your water intake, especially when you are breastfeeding, will bring more water to help keep things flowing through your colon. Moving your body will also do the same.

The next step it to use good toileting habits. When you sit on the toilet, you want to make sure you keep your back straight and lean forward. Avoid sitting slumped on the toilet. It can help to have your knees higher than your hips. There is the squotty potty chair you can purchase to help with this or you can use two yoga blocks, toilet paper rolls or a big fat can of tomatoes and put your feet upon.

To relax your pelvic floor you can try making different sounds to see which sound bulges your pelvic floor downward more easily. Take a deep breath and say “Grrr!” or “Shhhh” and see which one lengthens your pelvic floor. Use that sound during your next bowel movement to help move things down and out so your pelvic floor stays relaxed!

Once a hemorrhoid is in place you need to decrease any excess pressure on this tissue in order for it to heal. With all the bearing down that happens in birth the rectal tissues need to learn to come back up in and inside again. That can only happen when you avoid bearing down during a bowel movement after your birth. It’s important to allow your stool to pass on it’s own without you having to force it out. Any forcefulness will only exacerbate your hemorrhoids.

Also when dealing with hemorrhoids after birth, I find you also have to address the soft tissue in your vaginal and anal openings.   We’ll cover how to do this later in this article.

Around the anal opening is a sphincter muscle. It’s very common for this muscle to have small “knots” in it from the birth, especially if you tore. These knots don’t allow the muscles to expand evenly to allow your stool to come out. When a hemorrhoid is present, most likely there is a restriction or “knot” in these tissues that can prevent the hemorrhoid from healing. They can also lead to an even greater problem and that is a fissure!

FISSURES

A fissure is a open tear inside the rectal tissues.   Fissures have to be one of THE most painful conditions to recover from after birth.   The problem with this condition is the tear has a hard time healing because it gets reopened every time you have a bowel movement.   It makes having a bowel movement EXTREMELY painful! Some women, who have a fissure, report having chills, breaking out into a sweat and even their whole body shaking after having a bowel movement. The pain afterwards can last for hours. When dealing with a fissure for any length of time the anticipation of a bowel movement can bring fear and greater tightness to the pelvic floor area, which creates a vicious cycle that is hard to break. It’s no fun at all!

There is one thing that has helped my clients when dealing with a fissure and that is to massage their perineum and anal sphincter prior to a bowel movement. Usually there is increased tension in the anal sphincter that is on the opposite side of where the fissure lies. When you release this knot prior to a bowel movement it can lessen the pressures placed on the fissure and allow it to heal a little bit easier.   Stay tuned to learn how to massage your anal sphincter area.

 

TEARING IN YOUR PERINEUM

The third issue that is closely related to hemorrhoids and fissures is tearing in your perineum. Unfortunately tearing from birth is very common for women. Scar tissue forms to help heal a tear. Scar tissue is not as flexible as normal tissue and restricts the tissue mobility in the area. This can inhibit a stools flow out the anal sphincter and contribute to the development and prevent the healing of hemorrhoids and fissures. Mobilizing this scar tissue can help soften the tissues and allow easier flow with less pressures, helping both issues heal.

 

Caring for your Perineum After Birth

So what’s a new mama to do to help her perineum after birth?

Massage this area!

What do you do?  It’s simple!

Take your thumb pad and place it just inside your vaginal opening. Your knuckle should stay on the outside. Place your index finger on your anal sphincter. Start on one side as far as you can go and pinch the two fingers together and see if it feels soft and mushy or hard and resistant to compression. You want your tissues to be soft and supple. Work your way along toward the opposite side and see where the tissues are resistant to compression.   Where there is resistance you can apply pressure by gently compressing the area between your fingers while breathing into the area at the same time. Hold this pressure until you feel the tissues soften and release.

Scar tissue can create thickening and resistance to mobility.   Compression and pressure can help release this but sometimes scar tissue needs more. If you find scar tissue that is not releasing to pressure there can be an emotion stuck in there. Honoring that feeling and releasing whatever emotion is there is needed before it can let go. To read more about how scar tissue and emotions are connected check out this blog post.

Pinching between the anal opening and the vagina works on the upper half of the anal sphincter. For the lower part take your index finger and apply pressure around the sphincter from 3 to 9:00 if you think of it as a clock face. Check to see if you feel any spot more resistant than the others. If you do gently apply pressure with your finger in a downward motion and just hold it until you feel the spot release.

Massaging this area before every bowel movement can allow the tissues to expand more easily for your stool. This can help keep some of the excess pressure off your fissure area and potentially help it heal. Decreasing any resistant or thickened tissues helps to normalize the tissues so your stool flows through more easily.

There’s so much more to all of this that if you don’t find relief from doing the above, please go see a women’s health physical therapist or a holistic pelvic care specialist to get some help. You can find a practitioner near you by checking out these websites:   MoveForwardPT.com or WildFeminine.com

 

 

Breathing Difficulties After Baby?

August 29, 2013 in Abdominals, Post Partum

Diaphragm and Organ Restrictions after Childbirth Leads to Breathing Difficulties

Ever wonder what happens to all your abdominal organs when the baby grows so big in your belly?   Did you have problems taking a deep breath during your pregnancy?  What about afterwards?

It’s very common for woman to experience mid back pains after delivery or have difficulty taking a deep breath.   As your baby takes up space in your belly, your stomach, liver and small intestines all get jammed upwards and laterally. See photo below.  It also compresses your diaphragm upward into your chest and your ribcage widens out to the sides.  Sometimes things have a hard time getting back to their original places after birth.  This is really true if your baby found it fun to use your stomach or liver as its punching bag!pregnant belly w_ organs

Working with so many post partum woman I’ve seen time and time again where one organ, more commonly the liver, gets jammed upwards and remains this way for months to even years after birth.  I also find the thoracic spine and diaphragm to be restricted in mobility after having a baby.

If you find it difficult to take a deep breath after delivery or you have pain in the bra line area you may have some restricted organs or diaphragm in your midsection.

Jane came to see me after delivering twins two years ago.  She complained of not being able to take a deep breath since delivery.  One of the babies laid sideways across her upper belly near her ribs during her pregnancy.  I found her liver and stomach to be jammed up into her chest and her diaphragm and mid thoracic spine restricted in the middle.  With just one session her organs and her diaphragm released and were back in their normal place, and the mobility of her thoracic spine was freed.   She told me she was surprised she wasn’t hyperventilating because she had been taking so many deep breaths since our session together.

Getting your organs back in their proper place and getting the thoracic spine moving again is helpful to regain that sense of having your body back after pregnancy.  Doing some abdominal contractions, pulling your belly button back to the spine til it can’t go anymore, while also focusing on bringing your lower ribcage together in front can help with the flaring ribs and to mobilize your diaphragm.   Initially, some woman report having mid back pains when doing these contractions but over time that pain goes away as things gain more mobility and find their way back to their normal position.  If your organs are really stuck upwards you may need some help from a practitioner who does visceral manipulation and or a chiropractor to help make an adjustment in your thoracic spine.

THERE IS HELP OUT THERE FOR YOU!

Just know that whatever ailment you may be experiencing in your body after birth, there is help for you.  Keep searching til you find the right practitioner who knows how to help you.  Many healthcare professionals don’t have experience working with the post partum body.  Keep searching til you find one who does.

It saddens me how many women are left to feel crazy, “it all must be up in your head” after childbirth when their body doesn’t feel the same anymore.  There is help and it can feel the same again.  Don’t give up!

 

 

Abdominal Hernia’s-Diastasis Recti in Post Partum Women

April 22, 2013 in Abdominals, Diastasis Recti, Post Partum, Pregnancy

Diastasis Recti- Abdominal Muscle Separation

Do you know what one of the most commonly untreated issues women face after delivering a baby?  It hardly ever gets diagnosed and if it does the medical community doesn’t think there is any solution other than surgery.

Diastasis Recti

I’m talking about Diastasis Recti.  This is the separation of the rectus abdominus muscle, which is the “six-pack” muscle in our abdomen.  The rectus abdominus muscle has two sets of muscle fibers that run up and down from the sternum, or chest plate, down to the pubic bone. They are connected by a connective tissue called the linea alba. These muscle bellies can become separated and the connective tissue between them stretched thin with pregnancy.   The muscle bellies get forced out to the side to make room for the expanding uterus.  Also, activities with a forward forceful movements as in coughing, sneezing, laughing, or doing sit ups incorrectly can create a diastasis or make an already existing one worse.

Abdominal Muscles

The abdominal muscles are one of the most important muscles in our body. They are responsible for all of the support and movements in our trunk and consist of three layers. The most superficial layer, the Rectus abdominus, otherwise known as the “Six-pack” muscle, helps us to bend forward or sit up from laying down. The middle layer includes the Internal and External Obliques which helps us to twist and the deepest and most important layer, the Transverse abdominus, helps to compress the abdomen in and is part of our core muscles to stabilze the spine and pelvis.

How do you know if you have Diastasis Recti?

The separation of the Recti muscles is called a Diastasis Recti. You will know if you have one if you are laying down on your back and you place your fingers pointing down toward your spine in your belly button. When you lift your head any fingers that fill the space between the two muscle fibers of the rectus abdminus let’s you know you have a separation.  One to two fingers separation is considered normal.  However you also need to check the depth of your connective tissue.  That linea alba needs to be very superficial.  If you sink down past your fingertip the connective tissue still needs to heal.

Also another key sign you have a

Doming of linea alba in Rectus abdominus with diastasis recti

Doming of linea alba in Rectus abdominus with diastasis recti

separation is when you lift your head do you have any doming in the midline of your abdomen?

There are certain things we do like getting in and out of bed, doing abdominal crunches, and playing golf and tennis that can make this separation worse and keep it from healing.

At Intuitive Hands PT we offer training and education to teach you a 4 step program to help you heal a Diastasis Recti and also to help you lose the “pooch” from pregnancy. By learning how to use your body and strengthen your transverse abdominus muscle correctly you can loose your “pooch” and bring the rectus abdominus muscle bellies back together again.

Anyone with a diastasis can be helped no matter how long your muscles have been separated.   If you are currently pregnant, reading this previous post on how to avoid developing onein the first place can help save you ton of effort in the post partum period.

Post Partum Care of Your Body

February 26, 2013 in Childbirth, Pelvic Floor, Pelvis, Post Partum

POST PARTUM CARE

Congratulations on the arrival of your baby!  Now that your baby’s here, now WHAT do you do with your body!?!?

Whether you had a caesarian section or a vaginal birth your body has just completed the most strenuous feat.  After the adrenaline and fatigue wear off you may be wondering what has happened to your body?  Things may not feel normal in your abdomen or your pelvis.    That is where Intuitive Hands Physical Therapy can help!

C-Section Recovery

Remember you have just had major surgery!  You need to be protective of your abdomen and not lift anything heavier than your baby.  It’s very important to watch the way you get up and down from laying, always remembering to roll over to your side first.  Your activities should be limited the first 6 weeks until you get the all clear from your MD that your incision is well healed.

SCAR MASSAGE

Once you get that clearance it is VERY IMPORTANT to massage your scar.   You want to move the scar up, down, side to side and rub it between your fingers.  There are many layers you want to work through so start off superficially and work till you can move the tissues deep down in the abdomen.   It may be very tender initially but do what you can to keep the scar tissue from adhering to other tissues.  It’s been my experience that 10-15 years down the road women come to me with frequency of urination.  They have scar tissue from their c-sections that is inhibiting the bladder from expanding.  A session or two of scar tissue release work gets them back to normal voiding frequencies.  You can avoid this by massaging your scar early on.

VAGINAL BIRTHS

The pelvis is amazing in its ability to open up to pass a baby through its canal.  Sometimes during labor the mechanics of the pelvis opening doesn’t work properly and you can experience a difficult delivery and have lots of back labor or pelvic pains.  If the delivery was traumatic in any way the pelvis can have a hard time going back into its normal position, thus creating pain for you.  At Intuitive Hands Physical Therapy we specialize in helping the pelvis find its natural home and help you get out of pain after delivery.

THE PELVIC FLOOR

It is quite common to experience a tear to the pelvic floor during childbirth.  Depending on the degree of tear, from 1st to 4th degree, you can develop scar tissue that can inhibit the pelvic floor.  Scar tissue is not as flexible as our normal tissue so intercourse can be somewhat painful the first couple of times after childbirth.   If intercourse continues to be painful please see a women’s health physical therapist to have them work on your pelvic floor and release any scar tissue that may be present.

Scar tissue can also inhibit the pelvic floor muscles from contracting as strongly as they could thus leaving you with weakness that could contribute to stress incontinence.   Just like our shoulders get knots in them, our pelvic floor does the same.  These knots can be caused by scar tissue and can prevent the muscles from contracting fully.  A session of soft tissue mobilization, using just a gloved finger can help work out those knots and free up the scar tissue so the muscles can work more normally.  You can really tell a difference in a “Kegel” contraction after your muscles have been fully released.

 

EVERY MOM SHOULD HAVE A BODYWORK SESSION AFTER CHILDBIRTH

Your body has just completed the most arduous task!  Think about what your body has been through in the last 10 months.  The baby grew so big, your belly was huge and what do you think happened to your organs?  The baby pushed them way up into your chest and somehow they find their way back down but in the meantime they can create some mid back pains as you try to care for your wee one.

Your pelvis can get out of whack from opening so wide to allow the baby through and could use help finding its place back home again.

If you had a c-section the doctors might have taken all your small and large intestines out and go through them all to make sure there’s no kink in them before sewing you back up.   I’ve had several women come to me complaining of things just not feeling quite right in the pelvis and abdomen after the surgery, and they were right.

One session can help you feel back to normal again.  We can check to make sure your organs are happy and in their rightful places, make sure your abdominal tissues can move freely, and check to make sure your pelvis and pelvic floor are working right and all the pieces are in their proper place.

So any aches and pains you may have post partum can be addressed in a treatment session with Lynn.

Contact her today for your post partum session for your ticket back to feeling normal in your body again!

 

Hi Lynn – I wanted to tell you that last night was the first night since my last pregnancy that I slept a solid 8 hours without having to get up to pee.  Unbelievable!  And all day I have felt so different too – I can’t really describe it.  It’s like what you said, I haven’t really thought about my bladder every 10 minutes like before because it wasn’t bothering me! Again, I thought I was bordering on a compulsive disorder with how much this issue defined my life.  

So I just want to say thank you, thank you, thank you from the bottom of my heart  – if I can write a testimonial for you or share my story please just let me know.  Now I know that no amount of kegels, core conditioning, etc. was going to help this problem go away – I am just so relieved that I found you and I avoided a costly surgery because of it. 

~A. S.

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