Common Body Symptoms That Can Be Felt After Giving Birth

Anal incontinence can include:

• leakage of stool
• diarrhoea
• constipation
• bloating
• excess wind

It is less common than urinary incontinence but evidence shows there is approximately up to 25% wind incontinence and 20% stool incontinence in women who have given birth.  There is some evidence showing this issue to highly associated when a Grade III or IV perineal tear has happened during the birth (this grade means that the tear has extended into the ring of muscle that closes your anus called the Anal Sphincter or all the way through it.  Which explains why issues with the back end can happen after this type of tear.

Anal incontinence can have a huge impact on a person’s mental & emotional wellbeing. There is often a lot of shame or embarrassment associated with it and often people are reluctant to share their problems even with healthcare providers. It is important to know that there are many different treatment options & a lot can be done to improve or cure it!  If the anal incontinence has not resolved a few months after birth then seek out a Women’s Health physiotherapist who can assess and treat your individual issues.

This is the most effective treatment for Anal Continence and helps provide Long Term Relief.  The Anus passes through the pelvic floor and correct pelvic floor strengthening can help the control around the Anus helping to reduce the symptoms of Anal incontinence.  It is important that it is done correctly.   The ‘Pelvic Floor and Core Program’ in the HUB will help teach you how to do this and provides easy to follow workouts you can do at home.

Wearing pads or Incontinence specific underwear can help prevent embarrassment in the short term from leakage but as said its best to work on curing the underlying reason for the problem with Pelvic Floor strengthening work so you do not have to resort to this strategy long term.  There are several sellers of more flattering Incontinence underwear now.  Some examples are

• Tena

Ensuring sufficient fibre & fluid intake and adhering to the advice in our ‘Constipation’ section will help to not irritate the haemorrhoids.

After giving birth you may find controlling urine, wind or faeces very difficult. This will depend on a number of factors, some of which are generally agreed upon and some of which there is argument over. These factors include:

Your pelvic floor has had to do a lot of work supporting your internal organs as your baby grew and got heavier. By the end of pregnancy the pelvic floor is under a lot of pressure. If you gave birth vaginally or attempted to give birth vaginally and have had any trauma to the pelvic floor it is injured.  This injury to a muscle group can respond the same as any other, you will get pain and may get some muscle inhibition (limiting the working of a muscle). When you limit the capacity of the pelvic floor you can get leakage of urine and/or faeces and/or wind. Over time this should naturally improve. Over the course of the first week you should gain back some of the control and by your 6 week check up, you should have regained most of the control back.  However there are many women who do not and while incontinence is common it is not normal & there are many things that can be done to help.

We strongly advise all women to get check by a pelvic physiotherapist at around 6-8 weeks postpartum to assess the individual and determine what is the best course of action for them. However as this is not possible in all parts of the world we are going to give some general advice and suggestions however this will not be the direct course of action for everyone.

A very common type of incontinence experienced after birth is Stress Incontinence.  This is when leakage occurs due to pressure on the bladder. This pressure can come from an increase in  the abdomen itself, for example during a cough or laugh or sneeze.  It can also come from physical exertions like running, jumping, skipping; lifting a heavy object or having sex.

Then there is Urge Incontinence where you have the urge or feeling that you need to empty your bladder but you cannot get to the toilet fast enough.

There is also Mixed Incontinence where you have a mix of Stress Incontinence symptoms and Urge Incontinence symptoms.

This is where you keep a diary of things such as all fluids in & out as well as all episodes and amount of leakage; time of day & level of urgency. This helps to set a base line and starts you on a program to slowly increase interval time and frequency as well as urge issues.

Strengthening the pelvic floor muscles has been shown to help significantly when done correctly. See the video above.  Try to imagine trying to stop yourself passing wind and closing your anal hole.  Then relax. Try this 3-5 times and do several times a day.

Stimulation of the sacral (implanted in an outpatient setting) or tibial nerves can help some with pelvic floor activation.   These nerves nerves help stimulate bladder control and electrodes similar to that of the TENS are used to stimulate them.

Constipation has a huge impact on urinary incontinence.  See our section on how to deal with constipation to see different measures that can be taken to help this issue.

Alcohol and cigarette smoking have been shown to be a bladder irritant and increase the chance of Urge Incontinence acting a little like Diuretics.  Urge Incontinence is when you have the urge or feeling that you need to empty your bladder but you cannot get to the toilet fast enough.

With biofeedback a probe is placed in the vagina to allow a visual feedback of the contraction/relaxation or tone of the pelvic floor muscles. This can help you better connect to your pelvic floor.  We strongly recommend having a Women’s Health physio consult to confirm if you are a good candidate for a Digital Biofeedback trainer and also the physio can teach you how to use correctly.  Popular brands for home Biofeedback are Elvie, Perifit and Elise.

These types of non digital trainers are often called Kegel Trainers.  They are to be inserted inside of you to give feedback to help pelvic floor contractions.

Being Overweight has been proven to be associated with pelvic floor disorders.  Research has shown that obesity is linked to a range of urine, bowel and sexual dysfunction.  Also Uterine prolapse is more common with Obese compared to non-Obese.   A 2015 study proved this and that urinary incontinence and sexual dysfunction all improved with weight loss.  If you are unsure if you are classifed as Overweight or Obese then you can work it out with this simple BMI calculator.

BMI For Adults Widget

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The ‘Belly Flattening Nutrition Guide’ and ‘How to Exercise Safely Guide’ give helpful easy to follow Nutritional Advice and Safe Cardio Exercise options to do.  These in combination will help you restore your BMI to within the Healthy range.

Your breasts go through a number of changes from pregnancy to birth to postpartum.  Below shows a pic of the normal breast anatomy and then the changes you can expect will be discussed.

When you are pregnant your body changes your breasts to start preparing them for feeding your baby. Some of these changes include:

• increase in breast size and tenderness
• changes in colour, size and sensation of nipples and areola
• bigger & more noticeable Montgomery glands (raised bumps on areola)

Usually after about the 16th week of pregnancy the breasts are able to start producing milk. This may result in colostrum (the nutrient dense first milk you produce) leaking from the nipples. It may be noticeable through clothing or merely just coat the nipple and areola.  Your breasts and nipples will grow in the last few weeks of pregnancy as the milk producing cells enlarge. This can lead to feelings of being overly full and uncomfortable.

As mentioned earlier the first milk you produce is colostrum which is nutrient and energy dense as a new born only has a very small stomach. Some women like to harvest the colostrum, freeze it and save it for after birth.  This should be discussed with your gynaecologist first and is generally done after the 37th week.

After giving birth your hormones drop rapidly and severely.  Your colostrum gets diluted with your mature milk that comes in generally around 2-4 hours after birth.  If you are breastfeeding or pumping there may be several problems that you may encounter on your journey. With all issues the key is to address your individual needs or problems so we always advise seeing a lactation consultant to help along your journey but here are some basic guidelines you can follow for the treatment of some of the more common conditions.

Nipple main is a common reason for stopping breastfeeding early.  Nipple pain or discomfort is very common in the first few days of breastfeeding however if it is persisting beyond that it needs to be reviewed.  There are many causes and the  nipple pain can be accompanied by trauma such as abrasions, fissures or cracks as well as bleeding and scabs.

As with all breast conditions it is important to determine the root cause of the issue. However there are some key strategies to implement:

• get help early!  The earlier the intervention the better the outcome
• the most important thing is to ensure the baby’s attachment is correct, when the attachment is correct the entire areola is in the mouth and your nipple will rest comfortably against the baby’s soft palate at the back of the mouth
• flattened, wedged, lipstick shaped or white nipples can be a sign of poor attachment where the nipple is being pinched & rubbed against the hard palate
• try different feeding positions to reduce pain
• feed with the unaffected side first (unless having any blockage or mastitis issues)
• wash your hands before handling breasts to minimise bacteria and change nipple pads (if you’re using them) with each feed (especially in warm humid countries)
• break the suction on the nipple instead of pulling baby straight off
• keep the baby feeding as long as they want – if you shorten the feeds to “rest” the nipples it does not help & may affect your supply
• wear a cotton bra to let the breast breathe or no bra if possible

If the nipples are already damaged or cracked the evidence is a bit more conflicting but some general advice to follow:

• washing and drying the nipples more frequently
• warm water compresses before feeding
• applying purified lanolin to the nipples (if irritation occurs stop use)
• if pain is persistent and or there is any discharge get checked to ensure there is no infection
• temporarily expressing until pain subsides with gradual reintroduction of breast feeding
• laser therapy to the nipple can be done by a Women’s Health physio and for some can give significant relief

A milk blister occurs when your nipple closes over a milk duct opening, becomes inflamed and milk fills up in the area behind it. They look like a small raised bump on your nipple and can be white or yellow.  They can look like a tiny line of toothpaste or small crystals.

Do not pop as can lead to infection. Try the following to help remove a milk bleb or blister.

1. Try applying vinegar to the milk bleb with a cotton wall ball placing it against your nipple inside your bra.  The vinegar helps to dissolve calcium so can help relieve the blister
2. Try a warm wet compress before feeding for a few mins which will help loosen the skin so when the baby nurses the skin opens and releases the bleb 
3. Try a saline soak of 2 teaspoons of epson salts with 1 cup of water and dip a flannel in the mix and hold on the area for a few mins 
4. Try applying olive oil to the milk bleb with a cotton wall ball placing it against your nipple inside your bra between feeds which can help to loosen the skin and release the bleb.
5. Encourage breastfeeding as the baby will help apply pressure gently to the bleb helping it to release or have a go at gently manipulating or massaging the area around the bleb after a warm wet compress to help it release 
6. If it appears inflamed or infected try applying an antibiotic cream to the area in a tiny amount applying after feedings 
7. If none of the above succeed then you can see your Doctor who may be able to help by releasing it with a sterile instrument (do not try this at home yourself).  

Depending on the reason for the engorgement will determine the treatment. If you are struggling with recurrent engorgement & oversupply we strongly recommend seeing a lactation consultant to assess your individual needs. However there are some general guidelines you can follow:

• self massage of the boobs – see post video for some massage techniques to try
• frequent and effective feeding or pumping/expression at regular intervals (roughly 8-12 times/day)
• warming the breasts with hot flannels or hot packs before feeding to help getting the milk flowing
• cooling the breasts with frozen cabbage leaves or cool packs
• wear a good fitting nursing bra
• expressing a little milk to relieve discomfort
• there are certain over the counter pain medications that are safe to be taken during breastfeeding discuss with your doctor
• other treatments such as ultrasound & lymphatic massage for pain relief
• if symptoms do not improve or if you develop any fever or flu like symptoms then consult a doctor

The milk making glands in your breasts are segmented and bunched together somewhat like an orange.  Then narrow tubes carry the milk from the glands to the nipple, these are called ducts. When a blockage in the ducts occurs it can lead to a build up of milk behind the blockage.  Signs of a blocked milk duct include one or more of the following:

The overall health of the mother is unaffected but if the blockage is not treated quickly it can lead to mastitis.

An Abscess is a painful build up of pus in the breast caused by an infection.  They are more common than previously believed.  If the pain does not improve with any of the treatments then do not leave it without getting medical help.  Ideally we would advise seeing a breast doctor who will be used to dealing with these situations and know what to do.  They sometimes will prescribe antibiotics and or may even need to drain the area.  If you are unable to get an appointment with a Breast Doctor then do make sure you see your usual Doctor asap to get help.

While it is not always known what causes a milk duct to get blocked it is usually due to insufficient drainage of a duct.  This can be due to tight clothing around the breast (eg a tight poorly fitted nursing bra); long periods between breast feeding or the baby not attaching well. In the case of the difficult attachment seeking the help of a lactation consultant is really going to help. The key thing is to remove the blockage so here are some general guidelines you can follow:

• try getting your baby to feed more frequently on the affected side
• try different positions, if possible pointing the baby’s chin towards the lump
• avoid wearing tight clothes or bras
• certain anti-inflammatories ie ibuprofen
• cold compresses over the breast (try frozen peas wrapped in a towel) or purchase an icepack from the local pharmacy
• massage the affected area before and during feeding or pumping gently but firmly trying to work the lump towards the nipple
• temporarily expressing after feeding
• Women’s Health Physios can help with providing ultrasound therapy to the blocked duct combined with lymphatic drainage which often helps to break down the blockage and clear it out

Mastitis is where your breast becomes swollen, hot and painful and may be accompanied by infection. It occurs most frequently in the first 6 weeks postpartum but can occur at any point during lactation and sometimes in women who are not breastfeeding or men. Mastitis generally affects one breast at a time, you may have a swollen wedge-shaped lump or hard area in your breast usually accompanied by a fever (>38.5C/101.3F).  You may also present with flu like symptoms of aches, chills & fatigue.

Mastitis may result from blocked ducts and or engorgement. If left untreated it can lead to a breast abscess. Mastitis can worsen rapidly and needs careful & immediate treatment. If the mastitis is a result of blocked ducts or engorgement and is an ongoing issue we strongly encourage seeing a lactation consultant to determine what specific issues need to be addressed.

Other causes for mastitis include: damaged nipples; infrequent or missed feedings; poor attachment; rapid weaning; oversupply of milk; pressure on the breast (eg from a poor fitting bra as well as maternal stress, fatigue or illness. While the cause needs to be determined and addressed on an individual basis here are some evidence based guidelines to follow:

• Effective milk removal – either via increased frequency of feeding on the affected side or ensuring the latch is correct or using a pump
• pain can interfere with the let down reflex, if this is the case start feeding on the other side until the let down occurs and then switch
• Certain over the counter pain medications such as ibuprofen are deemed safe to take during breastfeeding but should be discussed with your doctor or pharmacist before commencing
• Position the baby with either the nose or chin pointing towards the blockage to try and help drain it
• Massaging during the feed to help get the milk flowing ensure to massage from the blocked area towards the nipple
• If feeding, once completed, try expressing or pumping any remaining milk out of the breast
• Lymphatic drainage towards the ducts can also help along with appropriate application of ultrasound therapy
• Resting as much as able
• If the symptoms are not improving in 12-24 hours or if you’re unwell then a course of antibiotics is advised

If symptoms are not improving then further tests may need to be done to determine what the cause is or to rule out other issues.

This is usually down to the position you are breastfeeding.  Your shoulders should not be protruding forwards and your head bending down.  Try to support yourself with cushions and pillows and position yourself as shown below. 

Once you have decided you wish to cease breastfeeding and your supply and routine are well established it is advised to slowly reduce the number of feeds/pumping sessions as stopping too quickly can lead to engorgement and or mastitis.  Your body will continue to produce milk as long as there is demand. So reducing length of feeds/pumping and dropping a session will help you wean. After you have stopped you may still leak for a while after if something triggers your let-down reflex.  If you are struggling have a chat to your doctor as there are some medications which may help to cease breast milk production.

Constipation can be a real pain in the backside! If you have struggled with constipation before or during pregnancy you are likely to struggle with it afterwards too.  However even if you’ve never struggled with constipation before it can occur after birth.  There are a vast number of different factors which contribute to constipation some of which include:

• hormonal changes,
• dehydration,
• insufficient fibre intake,
• pain medications,
• weakened or hypertonic (high tone) pelvic floor muscles,
• stress,
• lack of movement, and
• lack of sleep.

The first thing to realise is what is “normal”?  A normal bowel habit can range from 3/day to once every every 2-3 days. Everyone is different but to determine if you are constipated is firstly, do you struggle to pass a bowel movement and are you straining a lot? What are the stools that you pass like?

Ideally we are looking for Type 3 or 4 bowel movements. If your bowel movements are similar to the the Type 1 or 2 these are consistent with constipation. The type of stool accompanied with feelings of your bowel not being fully empty after passing a bowel movement, bloating and or pain in your intestines are also common symptoms of constipation.

Like with all people if you do not get enough fibre in your diet this can lead to increased constipation therefore increasing your fibre intake is crucial in fighting constipation.Fibre gives bulk and form to your stool as well as softening it.

How To Increase Fiber

Diet changes is the best option and Fibre rich foods are fruits, vegetables, whole grains and pulses. Fibre recommendations vary from country to country but when pregnant and struggling with constipation try and aim for above 25g of fibre a day. If appropriate sometimes a fibre supplement can be taken but discuss with your healthcare provider first.

It is important you keep your fluids up when increasing Fiber intake as increased fiber without enough hydration can do the reverse and worsen constipation.

Getting moving gets your guts going too! The colon responds to activity, the increased blood supply from exercise affects the whole body, the intestine included. As well as the cardiovascular increase that results in deeper breathing which uses the muscles around the intestines i.e. the abdominal muscles as well as the diaphragm which naturally helps to massage the intestines to help move bowel content along.

Walking is great one to start with.  There are other options listed in our ‘Safe Exercise Guide After Birth’ which can help get things moving.

Sufficient fluid intake is important to keep your stool soft and easy to pass. As mentioned previously fibre without fluid can actually increase constipation.  If you are breastfeeding you may be even more dehydrated than usual.  Try adding fruit to water to make it more enticing if you do not enjoy plain water. Or try sparkling water or fruit teas if trying to avoid caffeine. Drinks with caffeine can help some get their bowels moving but can be dehydrating so needs to be balanced out. Try having some prune juice as this does have a fibre content.

Some studies have found that abdominal massage may help relieve constipation of a number of different reasons.  As well as decreasing pain and discomfort it has been shown to increase peristalsis, increase the frequency of bowel movements and decrease the time of the bowel movement spent in the colon. Try the following technique:

1. place your right hand on your abdomen above your right hip
2. massage up towards your rib cage and then across the abdomen under your rib cage to the left
3. then down to above the left hip
4. this square like motion is to be repeated 5-7 times.

Particularly useful to do this massage before wanting to try a bowel movement.

Squatty Potty Position

Simply just changing your position when doing a bowel movement can make a really big difference.   One muscle of your pelvic floor – the Puborectalis is an important muscle in your bowel function.  The muscle circles around the rectum like a tether and when it is pulled more tightly and stops the faeces from passing out.   However when wanting to have a bowel movement this muscle needs to be able to relax and lengthen so that the faeces can pass through the rectum easily.   Just try using a small stool to change your Anorectal angle will help this Puborectalis muscle relax and lengthen.

Don’t Put Off the Toilet Call

Many people will put off going to the toilet to pass stool, however after about 15 minutes your internal anal sphincter will come back on and lift up the stool back into the intestine. This will then further dehydrate the stool and make it harder to pass later on.

A major issue with constipation is the downward pressure exerted on the pelvic floor.  In the case of chronic constipation where someone strains for long periods and consistently they are at an increased risk of prolapse. The pelvic floor works with the breathing muscle the diaphragm.  When you take a deep breath in your pelvic floor is meant to descend and then when you breath out it raises again. When trying to pass out a bowel movement do not hold your breath and bear down.  Instead try and “breathe out the poop” by taking some slow and steady breaths or make a deep low humming sound.

There are natural laxatives such as Senna and Prune Juice.  Then more intense ones that are stimulants and stimulate bowel contractions.  It is best to discuss with your Medical Health Provider regarding use of medications as they do have a degree of dependency that can happen if taken regularly and can cause long term medical issues with your digestive system.

The tail bone known as the coccyx can be a common source of pain postpartum it is  known as Coccydynia. The coccyx is a small triangular shaped arrangement of bone at the end of the spine. It serves as a very important attachment point for the muscles of the pelvic floor.

Despite it being a small area it can be a very debilitating condition. It can be caused by the huge change in hormones experienced during and after pregnancy as the body softens ligaments and allows more movement around the joints to prepare for birth. Another common cause of coccydynia is trauma during childbirth, for example where the baby’s head passes over the tailbone and causes injury or in the case of an instrument assisted birth (especially with baby in a face up position) can result in a bruised or fractured tail bone.

Depending on the severity of pain or possible mechanism of injury your doctor could suggest some diagnostic tests such as x-rays or CT scans. However the most common method for diagnosis is a physical examination with thorough history taking. The examination includes an external palpation of the tailbone and if required an intra-rectal examination.

There are some over the counter anti-inflammatories that can be purchased or some more advanced anti-inflammatories on prescription from your Doctor.  If breastfeeding make sure they are safe to take.

If sitting is painful then you can try kneeling in the early stages as often the pain is not a problem in this position.

Or you can purchase a wedge seat which can offload the area taking pressure of the tailbone.  Ring shaped donut cushions are not recommended for long periods of sitting after birth as it can cause fluids to pool in your vulva (vagina lips). There are several makes of the wedge cushion. The make of the wedge cushion in the pic is Comfysure.

If there is pain on a bowel movement it is important to ensure constipation is not an issue worsening the problem and the pain. See our section on ‘Constipation’ for detailed strategies to help relieve constipation.

These simple positions can help with offloading the area and pain relief.

Water retention also known as postpartum oedema (swelling) is a very common issue to experience both during pregnancy and after giving birth.  It can often get worse in that first week after giving birth due to the increase in a hormone called progesterone.  Or if you have had IV fluids during a C-section.  While quite common it is rarely serious, however if you experience any of the below please seek medical help asap:

•  any difficulty breathing or shortness of breath 
•  headaches (usually severe)
•  swelling of face and or hands & feet 
•  swelling and or severe pain in one leg with warmth or redness
•  blurred or changes in vision

Even though this seems counter-intuitive it is important to keep hydrated to help flush out the fluids. Water, non-caffeinated teas, and isotonic drinks are simple ways to ensure this.  This is especially important if you are breast-feeding or pumping. 

Aim for 2 litres of water a day.