Is This Normal After Delivery?
There are changes that can occur effecting the strength and support of the pelvic floor following vaginal delivery. These changes are more common with larger birth weights, multiple deliveries, increased age and when there is a family history of urinary incontinence or prolapse. Many women experience a new onset of stress urinary incontinence (leakage of urine with coughing, sneezing, jumping on the trampoline, exercise and sometimes intercourse). Often women think this is a normal change after delivery. Symptoms typically improve for the first year after deliver. Kegel exercises or pelvic floor physical therapy can also aid in improving symptoms. If stress incontinence persists and becomes bothersome, while this may be common after delivery, it is often easily treated with a mid-urethral sling. Another common complaint or change after delivery is a sense of vaginal looseness. This is often notable during intercourse. One may also experience the feeling of air passing though the vagina. This happens from a relaxation of the pelvic floor and a relaxation of the vaginal opening itself. This can be repaired through perineorrhaphy or vaginal rejuvenation surgery. For vaginal rejuvenation, the muscle along the sides of the vagina, close to the vaginal opening are brought together with a series of sutures. If needed, excess vaginal mucosa is also removed. This results in vaginal tightening, resolving the symptoms associated with vaginal looseness. Patients are advised vaginal rest (no intercourse) while the site heals and the sutures dissolve. Often, when vaginal rejuvenation is desired, there is also some degree of pelvic organ prolapse. Pelvic organ prolapse is a relaxation or dropping of the bladder, uterus or rectum. The most common type of prolapse associated with vaginal looseness is of the rectum (this is called a rectocele). Symptoms of prolapse may include pelvic pressure, a vaginal bulge, difficulty emptying with urination or with bowel movements. When prolapse is also present, a formal prolapse repair may be recommended at the time of vaginal rejuvenation or mid-urethral sling surgery.
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