The Fourth Trimester :: There is Help

We are thankful to our partners at UAB Women's Services for providing valuable information for this post.

The Fourth Trimester

I remember the first time I heard the term “fourth trimester”: the 12 weeks following childbirth. I was right in the middle of it myself, and thought, “Yes! That’s a brilliant term to describe what’s going on with my body!” I had insomnia, insatiable thirst, nausea, and don’t even get me started on the CRAZY night sweats. Our bedroom smelled like a college football locker room after a hot September game. The sweat smell would literally knock me over every time I entered our bedroom! (TMI? Sorry. Just keeping it real for all you new moms out there!)

The Fourth Trimester -- there is help available for pelvic floor issues, including urinary incontinence, vaginal dryness, and more.

You’re Not Alone

Just like with pregnancy, every woman has differing experiences and symptoms postpartum. While some of the changes women experience during the fourth trimester are common, including pelvic pressure, urgency to urinate, and constipation, these symptoms should not be ignored.  

Studies have reported an association between pelvic floor disorders and childbirth, particularly in cases of vaginal delivery. Women who give birth vaginally have twice the risk of stress urinary incontinence, or the loss of urine due to activities such as coughing or running, compared to women who deliver by cesarean section (finally a “win” for c-sections, am I right, Ladies?!).

Changes in Postpartum Care

Changing health policies and initiatives reflect the urgent need for improved postpartum treatment and care. The American College of Obstetricians and Gynecologists now recommends consideration of postpartum care as an ongoing process (compared to a single postpartum six-week visit), and a more comprehensive postpartum evaluation up to 12 weeks post-delivery. For example, at my six-week postpartum check-up three years ago, I just happened to find out that I had diastasis recti. That information was not volunteered to me; I had to ask about it. Had it gone untreated, I could have easily developed more significant issues down the road. This is yet another example of the need for improved postpartum treatment and education.

Moms Need Self-Care, Too

“Women should not ignore changes in vaginal, bladder and bowel symptoms they have during the fourth trimester,” said Holly E. Richter, Ph.D., M.D., professor in the Department of Obstetrics and Gynecology and urogynecologist at the University of Alabama at Birmingham. “Once a baby is born, many new mothers focus solely on their baby’s needs, but may neglect their own care and body changes. There is help for these symptoms during this fourth trimester.”

According to Richter, fourth trimester symptoms that postpartum women need to pay particular attention to include:

  • Urinary leakage, or incontinence: This may include a strong urge to urinate that cannot be controlled or urinary leakage when laughing or coughing. Your doctor can teach you pelvic muscle exercises to help alleviate these problems.
  • Constipation: The muscles that control your bowels can often be affected by childbirth. Watch for infrequent bowel movements and irregularity. (Hello Colace . . . a new mom’s best friend!) Relaxation techniques, certain exercises, or dietary changes can get you back on track.
  • Bowel leakage: Damage to the anal sphincter muscles or damage to other pelvic muscles/nerves can reduce bowel control, resulting in bowel leakage. Exercises, biofeedback therapy, dietary changes, medications, and surgery are options to discuss.
  • Vaginal dryness: There is less estrogen available after birth for several reasons, including breastfeeding.
  • Pelvic pressure or backache: You may feel pressure in your vagina, pelvis or lower back, which could be signs of the pelvic organ support weakening.

If you notice any of these symptoms, call your OBGYN to discuss treatment or other options for symptom management.

“A woman’s OBGYN is her advocate and can help her identify areas that aren’t normal as her body heals and provide treatment options for her,” Richter said. “If specialized care is needed, communication to those providers is facilitated and supported.”

Not the New Normal

Richter encourages women to not let these issues become their new normal after childbirth, even if it may feel uncomfortable talking about such personal subject matters. “Although pelvic floor disorders after birth can negatively affect your quality of life, they can be successfully treated,” she said.

It’s Time for YOU!

UAB Urogynecology and Pelvic Reconstructive Surgery offers the full spectrum of care for pelvic floor dysfunction, including urinary and fecal incontinence, and is the only NAFC Center of Excellence in the southeastern United States.

Even if you’re well out of the fourth trimester, but you’re still experiencing issues, give them a call to discuss your options and take charge of your health and well-being. You’ve nourished and sustained life, now it’s time to take care of the body that’s constantly taking care of everyone else!