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What’s up ‘down there’ after having a baby?

Woman's pelvis

What’s normal, ‘down there’ after having a baby? It’s a question on the minds of many new mothers. As an obstetrician and gynecologist, and new mother myself, I would love for women to be more familiar with what to expect after having a baby.

What exactly is the pelvic area?

The pelvic area is the lowest part of your abdomen, and includes organs like your bowel, bladder, uterus, ovaries and vagina. Your pelvic floor refers to the muscles, ligaments and tissues that stretch over the bones in the area and supports your pelvic organs. During pregnancy and birth, the muscles in your pelvic floor become stretched, from supporting your baby and during the hard work of labour. There are also hormones during pregnancy that loosen your tissues.

Here’s what you should expect after having a baby:

1) Good, or at least improving, bladder control: The fallout from a powerful sneeze or good belly laugh can be a little alarming for new mothers. Leaking urine this way is called stress incontinence, and is a common problem following birth when you sneeze, cough, exercise, run, jump and laugh. Leakage should steadily improve after birth, but for some women it remains persistent even a year after delivering your baby.

Another issue is urge incontinence, when it feels like you really have to go even though your bladder may be almost empty. You should notice improvement in urge symptoms in the first year following a vaginal delivery.

2) Resuming your sex life if you wish: You should be able to get back to a pain-free sex life after you stop bleeding. You may too exhausted from the demands of being a new mother, or may want to wait a little longer if you had a tear or episiotomy, and that’s absolutely okay. If you do try to have sex and you’re in a lot of pain, please speak with your doctor. A common complaint is vaginal dryness, which is common, especially if you’re breastfeeding or pumping milk. A lubricant can help. If sex is still painful, ask your doctor about an estrogen cream you apply inside your vagina.  (Sidebar: remember to use contraception when you resume having sex)

3)  Lessening pain in your pelvic area: It’s common for women to have discomfort during pregnancy, but it should steadily improve after birth. Some women may feel like something is going to fall out of their vagina. If this is the case, please speak with your doctor.

4) Easing back into physical activity: Most women get the ‘okay’ to resume their fitness routines from their obstetrician or midwife at their six-week postpartum appointment. Remember you were pregnant for nine months and your body is likely de-conditioned after pregnancy. Pace yourself with exercise. If you experience bulging near your bottom area, or experience urine leaking, please contact your doctor.

Kegels can help

You can help strengthen your pelvic floor by performing exercises called Kegels. These exercises contract and relax your pelvic floor muscles, which are the same muscles you would contract if you were on the toilet urinating and you want to stop the flow of urine. Just tighten your muscles, hold for a couple of seconds, then relax. Try to do around 15 to 20 contractions each time. Some women find it helpful to associate doing their Kegels with a certain activity (during the commercials of your favourite TV show, or during each stop the subway makes). Daily Kegels can help you regain control of your bladder after having a baby.  Before starting Kegels, however, an assessment by a physician or pelvic floor physiotherapist is necessary to see if these exercises are appropriate for you.

If you’re feeling uncertain about any changes in pelvic health after having a baby, I encourage you to speak with your family doctor, obstetrician/gynecologist, midwife, urogynecologist or pelvic floor physiotherapist.

About the author

Dr. Louise-Helene Gagnon

Dr. Louise-Helene Gagnon is a urogynecologist at Sunnybrook.