Share Mayflowers - Postpartum

Expert Commentary with Dr. Hota of Boston Urogynecology Associates

Because Share MayFlowers is all about female pelvic and perinatal health, because pregnancy creates changes in the abdominal wall and the abdominal wall and pelvic floor work together in our bodies, because pregnancy always involves the female pelvis (even if not for childbirth, at least for support throughout pregnancy!) and because urogynecologists are experts in female pelvic medicine—we wanted to hear more about the role of urogynecology in perinatal health. We love these comments from Lekha Hota, MD, a urogynecologist with Boston Urogynecology Associates in Cambridge, MA.

“We see a variety of perinatal and postpartum problems that include symptoms of urinary urgency, frequency, nocturia, urge incontinence, stress incontinence, urinary retention, fecal incontinence, musculoskeletal pain, pain with sexual activity, vaginal pain and bladder pressure symptoms. We also see prolapse during pregnancy and afterwards.

We occasionally will see patients prior to pregnancy with concerns mainly about their existing prolapse symptoms. We will sometimes see patients during pregnancy for prolapse as well as urgency, frequency and incontinence.

A variety of treatment options are available. For women with prolapse we can start with non-surgical options such as a pessary, which is a small supportive device worn inside the vagina that is perfectly safe during pregnancy. If a woman is positive she is done childbearing, then we can certainly discuss various surgical options, which range from minimally-invasive laparoscopic procedures to abdominal or vaginal procedures.

When women present with voiding symptoms of urinary urgency, frequency, nocturia and urge incontinence, there are numerous conservative options including bladder retraining with fluid titration (following a schedule for type, amount, and time of fluid consumption), pelvic floor physical therapy, peripheral nerve stimulation, and medications. For women with stress incontinence, PT, pessary and surgery are all viable options. It is important to note that we typically reserve surgery for those that are done with childbearing.

When women experience postpartum urinary retention, teaching self-catheterization in combination with physical therapy is a good option. This is an uncommon occurrence and symptoms resolve with this treatment in the majority of women affected.

Symptoms of pain typically respond well to physical therapy. We can, however, add medications to help facilitate progress. Medication does not always have to be oral—it can be targeted locally if there are concerns about breastfeeding and impact on the infant.

Lately, I'm seeing a lot more women with urinary retention from over distention/over filling injuries after delivery. I also see a lot of postpartum women with urgency, frequency and incontinence and women with sexual dysfunction related to vaginal/vulvar pain.

I wish that providers would discuss/educate patients ahead of time about the changes that occur to their bodies as well as some of the pelvic floor dysfunction that can occur to help prepare them. I think better education about the body and changes that occur would be very helpful, including increased use of pictures and diagrams. This doesn't have to be done one-on-one, but could be done in a group setting as I know that doctors are getting busier all the time and don't always have the time to spend.

It would also be helpful if patients knew ahead of time that symptoms can be treated if there is a problem, so that the idea of developing a problem postpartum is less scary and daunting. Letting patients know that there are specialists who see these issues, not just physicians but also PTs who are able to help them in their recovery. By the time I see a patient they are often overwhelmed and tearful in addition to being sleep deprived and it would be great to avoid that as much as possible.

I hope that in the next few years there will be easily understandable information for patients—a tool that they can refer to and understand what changes are happening to their bodies during and afterward. It should be readily accessible, however; something provided to them at an early pre-natal visit with more information about what occurs, again, during the delivery and afterward. I think education is very key. Most women feel that the symptoms they experience are part of childbirth and while that is partially true, they don't realize that they do not have to live with it.

I would like to see the problems affecting female pelvic health are being identified earlier and women are helped to get into treatment quickly. Often, I hear that patients have been told that symptoms will get better on their own and to give it time or that it is normal, so otherwise beneficial care and counseling is delayed for months or years.

I'd like to see more research in the areas of proactive treatment, perhaps by looking at women that have PT soon after childbirth rather than waiting for a few years to begin identifying a problem and trying to treat it. It's harder to conduct this kind of research as you need to follow women for longer periods of time, but I think we may find that preventative and proactive care may actually cut down on dollars spent later in years."

If you or your organization is interested in donating to/funding this type of research, contact Jessica McKinney, PT Jessica@sharemayflowers.org.