Is weaning the best option when a mama has incontinence or prolapse?

Birth, it is a magical time where we finally meet the newest love of our life. Unfortunately, the birthing process sometimes leads to less than magical side effects like incontinence (leaking of urine when we laugh, cough, sneeze, jump or lift or a strong urge to go all.the.time) and maybe even pelvic pain or pelvic organ prolapse. For many moms that are breastfeeding they are given two options: 1) deal with it until you decide to stop breastfeeding or 2) wean your child. Since I’m feeling feisty today I’m going to put it bluntly, both of those options are steamy pile of BS. And since I like to back up my feistiness with research, here’s why you deserve better:

Relaxin and estrogen are not the enemy

Doesn’t increased relaxin and decreased estrogen weaken the tissues of the pelvic floor? Well, kind of. Prolactin, can block the production of estrogen. And it’s true, a decrease in estrogen can weaken the pelvic floor musculature but this is most commonly seen with the hormonal shifts of menopause, not postpartum. Relaxin has also been shown to decrease by three days postpartum so it is unlikely that relaxin is causing the pain or discomfort.

Many mamas who supplement also experience similar issues so emphasizing the hormonal effects of breastfeeding at the expense of looking at the bigger picture can lead to insufficient care for new moms. For a long time breastfeeding and hormones have been blamed but there is new information coming out about the importance of nutrition, methylation (liver support), the gut microbiome and even sleep quality as it relates to pelvic pain. All of this to say, it isn’t just breastfeeding but everything going on around you that can affect what’s going on down there.

Prolapse, incontinence and pelvic girdle pain are all signs of mechanical dysfunction

Often times mama who have prolapse or incontience also have hip and/or low back pain, diastasis recti and even pelvic pain. These are all signs of a mechanical problem. Mechanical problems are often best treated, well, mechanically. This is where a professional trained in pelvic floor rehabilitation and functional movement excels. A proper evaluation of the pelvic floor looks at you, the mama, as whole. If you aren’t sure what to expect, here’s a great article on what to expect at Your First Visit to See a Pelvic PT. The evaluation often includes your history, a movement exam (including how you are breathing, your posture, etc), specific tests to look for both stability and mobility, myofascial palpation (do you have tenderness in the abdomen, pelvis, buttocks or even the thighs), and the pelvic floor exam once you feel comfortable. This whole-body approach will help your provider determine the mechanical cause(s) of prolapse, pain, discomfort or incontinence in order to treat the entire system.

Breastfeeding and Pelvic Girdle Pain - Are they related?

There was longitudinal study out of Norway that followed over 10,000 women that showed breastfeeding has a small beneficial effect on pelvic pain and should be encouraged rather than discouraged.

The Catch: Lactational Atrophic Vaginitis

Atrophic vaginitis is dryness and inflammation of the vaginal tissues generally seen in post-menopausal women but can sometimes cause symptoms in lactating moms due to excessively low estrogen. Signs of lactational atrophic vaginitis include pain during sex, decreased sex drive, vaginal itching or dryness, frequent UTIs, irritation with clothes and an increased urge to urinate.

Although lactation atrophic vaginitis is caused by decreased estrogen, there are solutions that can help manage this discomfort! The management of atrophic vaginitis is different than the management of prolapse, pelvic pain or incontinence as it may include hormone replacement in the form of topical estrogen (see OB/midwife for appropriate recommendations), botanical therapies and self-help measures. Botanical therapies may include moderate amounts of phytoestrogens like soy, oats, sesame seeds, barley, apples, carrots, lentils and pomegranates. Self-help measures include using water-based lubricants to help moisturize the tissue or Vitamin E oil or hyaluronic acid suppositories.

There are many factors that influence postpartum recovery. It is important to figure out what influences you individually. For some moms, they need more emotional support or self care time, others benefit from attention to nutrition, improved sleep (yes, difficulty sleeping is closely related to pelvic pain) some are in pain from physical complications related to their birth and labor experience. If any provider undermines your confidence in feeding your child by stating breastfeeding is the only cause of your pain or discomfort, you are allowed to fire them. Each mama is different and it is important to enlist the appropriate support team to look at the whole picture. Along with you, that team may include a chiropractor or physical therapist trained in pelvic floor rehab, your OB or midwife, nutritionist or a functional medicine doctor. It’s important for the team to work together WITH YOU to determine the root cause of your incontinence, prolapse and/or pelvic pain.

I know you would probably love to be in control of your pelvic health and have a plan so I’m excited to offer a complimentary 15 Minute Healthy Mama Strategy Session or you can schedule an appointment today. I look forward to hearing from you and if you have questions, don’t be afraid to reach out and ask!

References:

1. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.13118?fbclid=IwAR0g9BcZRjxZjUA-rpXpWykvR_gWeDzF7-nNd78k7OA9_e4gp6ZF5UJNCa4

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307380/

3. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(86)92068-4/fulltext

4. https://www.ncbi.nlm.nih.gov/pubmed/12867914

*Disclaimer:

The information by Dr. Lauren Keller of Elemental Chiropractic, Inc. is provided for general information only and should in no way be considered as a substitute for medical advice or information about any particular condition. While every effort has been made to ensure that the information is accurate, Dr. Lauren Keller nor Elemental Chiropractic, Inc. make no warranties or representations as to its accuracy and accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. If you have any specific questions about any medical matter or think you may be suffering from any medical conditions, you should consult your doctor or other professional healthcare provider. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.