THE IMBALANCED PELVIC FLOOR AND SCAR TISSUE FOR EPISIOTOMY OR TEARS
Women often come to me in my clinic with pelvic floor dysfunction after having had a traumatic vaginal delivery, often with tearing or an episiotomy. The women I see have frequently already seen a specialist about this and been prescribed kegel exercises, yet the problem is not improving. This leads to feelings of being very disheartened and not knowing where to turn.
The main symptoms I come across in relation to this are pain and discomfort and decreased function. Pain might be from direct pressure on scar tissue with intercourse or perhaps with bowel movements or more indirect pressure with movement. Often associated with this is a sensation of heaviness. Decreased function may entail reduced ability to hold urine with coughing, sneezing, jumping and running, also known as stress incontinence. Occasionally, with more severe tearing, you might be experiencing some fecal incontinence. Or a sense of general weakness with just everyday activities such as holding your baby.
Standard practice for women who experience these problems is to prescribe them exercises to strengthen the pelvic floor i.e. a kegel type exercise. Sometimes this can be just on its own or sometimes with a pelvic floor trainer, which measures the contractions. While the strengthening of the pelvic floor is a part of the rehabilitation process, it is usually not the piece to start with. And why is that?
So lets connect with your pelvic floor for a minute and imagine what it might have been through. Maybe it’s been cut and stitched (that will always be on the posterior right side of your pelvic floor and what is medically known as an episiotomy). Maybe it’s torn and you’ve had to have stitches. Just now, in this moment, stop and connect with that part of your body. What do you feel there? What can you sense? Is this the first time you’ve actually stopped and tried to sense in to that part of your body?
CONNECT
After trauma to the pelvic floor, we often experience a disconnect. When something overwhelming happens, then it is the body’s natural response to create this disconnect. While initially this can help us survive, it does not help us to thrive. And if we can’t properly connect to and feel an area of our body, then we are not going to have optimal control of the muscles, as we will be lacking what’s called ‘proprioceptive feedback’. So step 1 is always connect. We can do this through mindful practice, visualising that area of the body, bringing your breath to that area and through gentle touch. I do all of this in my pelvic floor practice, which combines osteopathy with Holistic Pelvic Care™. If you can’t find a practitioner to work with you on this, then doing some of your own mindful practice will help and I often recommend my clients to read the book ‘Wild Feminine’ by Tami Lynn Kent, the creator of Holistic Pelvic Care™. In that book she has a practice on self massage of the pelvic floor. If you have had a difficult delivery, then reconnecting to this part of your body can (and usually does) bring up emotions.
While you do not want to overwhelm your nervous system, it is also a healthy healing response to allow the release of emotions. I have created a practice which allows you to once again connect in a healing way to this part of your body. The key with this is to bring love and light to that part of yourself. So you could imagine yourself surrounded, filled and protected with white light and you invite that light into those parts, whilst at the same time connecting to your grounding cord, which you can visualise flowing from your perineum down into the centre of the earth.
BALANCE
So now that you are connected again with this part of your body, the next key step is to balance the pelvic floor. Invariably I find that the pelvic floor is not contracting evenly. The pelvic floor muscles connect the left and right sides of our bodies and the front and back. When contracted, you get a squeeze and a lift. To get a good squeeze and lift, you need the whole complex of muscles to contract in a balanced way. If part of that system is not working well, then we can lose our inherent strength in that area. In my experience, balance is absolutely key to strength, yet it is mostly overlooked. If you’ve had a cut or a tear, there is a good chance that the muscles around that cut or tear are not engaging as well as the undamaged muscles – it’s obvious when you think about it. Now if you start on a program of strengthening without first connecting and balancing, you are not likely to change that underlying pattern of imbalance. Instead, you will potentially get an even greater imbalance, where some areas get tighter with high tone and other areas stay disconnected with low tone. This can sometimes lead to more discomfort or irritation around scar tissue areas. With strengthening programs (which haven’t first addressed balance) you might initially get some improvements but this then plateaus and symptoms can even get worse over time. Just being told to do more and more squeezes is not the answer long term – balance is.
So how do you balance the pelvic floor? Again this is work I do in my practice but there are also some self care practices you can do. The key is to first notice if you have an imbalance. You can check this by squeezing your finger in your vagina first centrally to notice what the contraction is like. Then move your finger to the left, right, front and back and compare how you can engage and control and hold the contraction in each of these four quadrants. Its common for instance following an episiotomy that the left side will contract better than the right side. How well you were stitched, how much trauma you experienced during your delivery and how well your stitches healed, will all be contributing factors. If there was trauma and ongoing issues with the healing of your stitches, I would definitely recommend some hands-on release work with an experienced practitioner.
If you find an imbalance, then notice if it is in relation to any tearing or episiotomy. Can you feel any scarring under your finger or any tender areas? It really helps to do gentle fascial release work on the area of scar tissue to help it to heal as optimally as possible. I often find that gentle, healing release work improves balance and instantly improves the pelvic floor squeeze and lift, which feels easier to engage. If you are trying to do this work by yourself, then think of very very gently massaging and stretching of that area, whilst bringing your breath and visualising light into the area. The gentler you can do this, the better. The brain to pelvic floor connection becomes stronger and the muscles’ range of movement increases, such that the muscles can both relax and contract more efficiently.
STRENGTHEN
Now is the time to go onto the strengthening. There’s lots of information out there about strengthening – I like to give exercises that allow one to connect through the levels, from the superficial muscles all the way to the deep muscles. You can also think about isolating the different sphincters of the pelvis (the urethra, the vagina and the rectum). It can be useful to use one of the biofeedback devices, which measure your contraction like for instance the Elvie trainer. Weighted balls like the Lelo Luna Beads can also be useful, as you can use them to incrementally build up strength. This is also the time to think about the connection with the core muscles and the breath.
So remember the 3 key steps – Connect, Balance and Strengthen
I hope you find this guide useful. Please subscribe to my newsletter using the ‘Keep up to date’ form below, if you would like to get more news on women’s health, future blogs, workshops and programs. I do plan at some point to organise a workshop on this area, so will keep you posted via my newsletter.
Rebecca x