Postpartum Scar Management: Cesarean and Perineal Scars

Postpartum Scar Management: Cesarean and Perineal Scars

/in /by

Part IV of a guest blog series for Lokahi Acupuncture by Dr. Janet Yu. Read part I here, part II here, and part III here.

The third category of common postpartum ailments I see in my clinic pertains to scar management.

When patients are postpartum, their scar tissue should be able to move freely, without pain, discomfort, or itchiness. Scar management varies on type of scar, of course, so I’ll describe more in detail below.

Cesarean Scars

With cesarean scars, restrictions can lead to impairments in scar mobility, posture, fertility, pressure tolerance, pelvic pain, low back pain, and leakage.

Silicone sheets:

Patients can manage their cesarean scars by using silicon sheets to improve scar color, flatten their scar, and improve mobility. Patients should only begin using silicone sheets when their incision is healed and they no longer have any stitches or scabs.

Desensitization:

Patients can use soft to harsher materials to rub across the incision to desensitize the surgical area in an effort to get the area used to having something touch it. Start on the outside of the skin, around the incision area – as opposed to directly on top of the scar – as early as 2-4 weeks postpartum.

Scar massage:

After the incision has fully healed – with no redness or red spots anywhere – patients can move the scar in all different directions without pain.

Cesarean: In time, patients should be able to lift the scar and move it up and down, side-to-side, and twist the scar skin.

Cesarean Scar Massage

Perineal Scars

Restrictions associated with perineal scars can lead to painful sex, urinary or fecal incontinence, prolapse, and postnatal depression. As many as 25% of perineal scars will get infected, unfortunately.

Scar massage:

A majority of perineal scars are in the grade 1 or 2 category, with only a small number of people having grades 3 or 4. Patients can perform self-scar massages by using clean hands and gently sweeping their thumb across their scar. It may be uncomfortable initially, but it shouldn’t be painful.

Perineal Scar Massage

Ice pack: Patients can also apply ice packs to their perineal area to help minimize swelling and decrease pain. Ice is most often used for the immediate acute pain, though some patients also use heat.

Sitz bath: Patients can use a sitz bath 2-3 times a day when they are newly postpartum to help soften tissues, but typically this option is not available to most postpartum parents due to newborn constraints.

Local anesthetic: Using a local anesthetic such as Epifoam or lidocaine gels or creams can help decrease the pain temporarily.

Use a cushion when sitting: Sitting on a cushion can help decrease the pressure to the perineum when it feels particularly raw and tender postpartum.

When to see a pelvic floor physical therapist

So often parents with newborns feel like their own health challenges become secondary, and they assume that their experiences postpartum, like urinary leakage, constipation, or painful perineal or Cesarean scars, are “normal” because they know so many postpartum parents who have the same.

I started Optimize Pelvic Health in part because I want the world to know that just because something is “common” does not mean that it is “normal.” Many pelvic floor dysfunctions are rectifiable by pelvic floor physical therapy; you don’t have to live in pain or discomfort.

Consider seeing a pelvic floor physical therapist if you’ve experienced any urinary or fecal leakage, organ prolapse, or pelvic/back/hip pain that has lasted longer than six weeks. If you’re having difficulties or pain managing your cesarean or perineal scar, you may also be a good candidate for pelvic floor physical therapy.

Pelvic floor dysfunction can feel like an “invisible” injury and oftentimes is uncomfortable and stigmatized to talk about, making it hard for patients to get the care they need.  I would love to partner with you and help restore your health so that you can fully and comfortably enjoy life with your family.

Written by Dr. Janet Yiu, PT, DPT, OCS, FAFS

Lokahi Acupuncture
408.279.9001
Follow us on Instagram
Make an Appointment

Postpartum Bowel Challenges: Constipation

Postpartum Bowel Challenges: Constipation

/in /by

Part III of a guest blog series for Lokahi Acupuncture by Dr. Janet Yu. Read part I here and part II here.

Postpartum bowel challenges: constipation

Nobody likes to be constipated (obviously), and I’ll be frank: that first postpartum bowel movement can be downright scary because tissues feel raw and incisions are healing. The thought of pushing out a hard stool when everything feels so tender is anxiety-inducing.

Postpartum bowel issues are my second most-common postpartum malady I see my patients experiencing when they come in to address their pelvic floor dysfunction.

Tips to rectify postpartum constipation

About 50-60% of postpartum mothers experience constipation, so unfortunately, this is also a common postpartum malady. Do everything in your power to make those first postpartum bowel movements as painless – literally and figuratively – as possible.

Make stools soft:

You don’t have to be newly postpartum to know that having easier-to-pass stool can make a huge difference in how you feel. Fortunately, making stool softer can be as straightforward as drinking fluids like water and consuming fiber-rich nutritious food, such as oatmeal, soups, and vegetables.

Some providers also advise their postpartum patients to continue to take magnesium and stool softeners on a daily basis as well. Having a daily bowel movement that is strain-free, and one in which you feel completely “empty” afterward and not like any stool is stuck, that you can’t push out, is the goal for most patients postpartum.

Use a foot-supportive device like a squatty potty to give your bowels an anatomical advantage:

Sitting at a toilet to pass stool – without supporting our feet – is actually not advantageous to our bowels, due to the angle at which our legs become situated relative to the toilet seat. In fact, it becomes more challenging for our rectum to pass stool when we are sitting at the toilet with our feet on the floor.

Instead, supporting your feet when you’re trying to have a bowel movement by using products like squatty potties or footstools can help better support your legs and open your rectum in a way that simply having your feet on the floor does not, as it allows for your pelvic floor muscles to relax.

Additionally, after having a cesarean section, a shorter stool is helpful to lessen pressure on the abdomen.

Puborectalis Function - Postpartum bowel challenges: constipation

ILU Abdominal massage daily for 5-10 minutes

This intervention works best when done daily for 5-10 minutes, and doing so can help you maintain bowel regularity even when you’re not taking stool softeners or magnesium. Start on the right side of your abdomen and sweep up for the “I,” and then for the “L,” start on your lower right side as before and sweet up and across. For the “U,” again start from the right, and sweep up, across, and down your midsection.

These letters trace our bowels’ movement in our bodies. Research has shown that it doesn’t really matter if you rub your stomach, move it all around, or do a skin-lift or skin-pinching technique; it can all help with bowel movements by decreasing the pressure in your abdomen to have a bowel movement.

If you had a Cesarean: Consider using a pillow to support your abdomen while you’re sitting on the toilet. Brace with the pillow while you’re having a bowel movement to lessen the pressure on your abdomen and thus, on your scar.

If you had a perineal tear: Take a piece of tissue and press it up against the scar, then support it with 1-2 fingers and have your bowel movement. This technique can provide a type of support or splint during a bowel movement.

ILU - Postpartum bowel challenges: constipation

When to see a pelvic floor physical therapist

So often parents with newborns feel like their own health challenges become secondary, and they assume that their experiences postpartum, like urinary leakage, constipation, or painful perineal or Cesarean scars, are “normal” because they know so many postpartum parents who have the same.

I started Optimize Pelvic Health in part because I want the world to know that just because something is “common” does not mean that it is “normal.” Many pelvic floor dysfunctions are rectifiable by pelvic floor physical therapy; you don’t have to live in pain or discomfort.

Consider seeing a pelvic floor physical therapist if you’ve experienced any urinary or fecal leakage, organ prolapse, or pelvic/back/hip pain that has lasted longer than six weeks. If you’re having difficulties or pain managing your cesarean or perineal scar, you may also be a good candidate for pelvic floor physical therapy.

Pelvic floor dysfunction can feel like an “invisible” injury and oftentimes is uncomfortable and stigmatized to talk about, making it hard for patients to get the care they need. I would love to partner with you and help restore your health so that you can fully and comfortably enjoy life with your family.

Written by Dr. Janet Yiu, PT, DPT, OCS, FAFS

Lokahi Acupuncture
408.279.9001
Follow us on Instagram
Make an Appointment

Postpartum Bladder Challenges: Urinary Incontinence

Postpartum Bladder Challenges: Urinary Incontinence

/in /by

Part II of a guest blog series for Lokahi Acupuncture by Dr. Janet Yu. Read part I here.

Postpartum bladder challenges: urinary incontinence (UI) & a pelvic muscle primer

The most common postpartum bladder challenge I see in my clinic each day is urinary incontinence, which refers to when a person accidentally leaks urine. Many patients leak urine when performing everyday activities like jumping, sneezing, and coughing.

As far as postpartum maladies go, urinary incontinence is the most common. At three months postpartum, 33% of patients have urinary leakage; of those, 92% will continue to have UI at one year postpartum. Many people incorrectly believe that UI occurs when the pelvic floor muscles are weak. However, UI can occur when the pelvic floor muscles are tight.

Don’t know what your pelvic floor muscles are?

Most people don’t either until they experience dysfunction. The pelvic floor muscles encompass the muscles and connective tissues that support organs in your pelvis, such as your bladder, bowel (large intestine), and reproductive organs. Think of your pelvic floor like a sling; your muscles hold these organs in place while simultaneously supporting your bodily functions like peeing, pooping, and sex. If something isn’t working as it should – if it’s overly tight or weak, for example – you experience pelvic floor dysfunction.

Tips to rectify urinary incontinence

Many pelvic floor patients initially think they will leak urine for the rest of their lives after giving birth, but fortunately, that’s not true! Patients can rectify urinary incontinence through pelvic floor physical therapy, such as learning how to perform the knack, diaphragmatic breathing, and breath holding. I’ll walk you through these three options below.

The Knack:

The knack is a reflex that patients may need to retrain when they’re postpartum. It refers to when you lift your pelvic floor before you sneeze or cough. It’s a quick and simple technique that provides a strong and well-timed contraction of the pelvic floor muscles. When done correctly, the knack can help you prevent urinary incontinence episodes. As patients practice this over time, it will become a reflex again.

Diaphragmatic breathing:

The diaphragm and the pelvic floor mirror each other. Every time you inhale air, the diaphragm moves down, as does your pelvic floor. Similarly, when you exhale, the diaphragm moves up, as does your pelvic floor.

Here’s an easy-to-remember tip: when you’re doing a diaphragmatic breath, take a nice, long exhalation breath. When we pair a small inhale through the nose with a long exhale through the mouth, we can help restore our diaphragmatic breathing, which in turn can help to activate and relax the pelvic floor.

Breathing Properly

Eliminating the pressure in your abdomen by breathing out. Avoid holding your breath or squeezing your muscles as you lift your baby or stand up. Relax your abs and glutes to help you avoid putting pressure on your bladder and pelvic floor. Focus on exhaling as you lift your child and transition from sitting to standing.

When to see a pelvic floor physical therapist

So often parents with newborns feel like their own health challenges become secondary, and they assume that their experiences postpartum, like urinary leakage, constipation, or painful perineal or Cesarean scars, are “normal” because they know so many postpartum parents who have the same.

I started Optimize Pelvic Health in part because I want the world to know that just because something is “common” does not mean that it is “normal.” Many pelvic floor dysfunctions are rectifiable by pelvic floor physical therapy; you don’t have to live in pain or discomfort.

Consider seeing a pelvic floor physical therapist if you’ve experienced any urinary incontinence, fecal leakage, organ prolapse, or pelvic/back/hip pain that has lasted longer than six weeks. If you’re having difficulties or pain managing your cesarean or perineal scar, you may also be a good candidate for pelvic floor physical therapy.

Pelvic floor dysfunction can feel like an “invisible” injury and oftentimes is uncomfortable and stigmatized to talk about, making it hard for patients to get the care they need. I would love to partner with you and help restore your health so that you can fully and comfortably enjoy life with your family.

Written by Dr. Janet Yiu, PT, DPT, OCS, FAFS

Lokahi Acupuncture
408.279.9001
Follow us on Instagram
Make an Appointment

What is the “Fourth Trimester” and Why Should I Think About It?

What is the “Fourth Trimester” and Why You Should Think About It

/in /by

A guest blog series for Lokahi Acupuncture by Dr. Janet Yu.

The Fourth Trimester

For many parents, the so-called “fourth trimester” – that early postpartum period, usually considered the first 3 or 4 or months after giving birth – can be filled with joy and wonder as they marvel at their child. What’s talked about less often is how many parents feel burdened by anxiety, uncertainty, and even shame when it comes to talking about – and getting help for – their postpartum bodily challenges.

My name is Dr. Janet Yiu, and I’m a pelvic health physical therapist in northeast San Jose at Optimize Pelvic Health. As a pelvic floor physical therapist, I help patients with fertility, pregnancy, and postpartum concerns resolve their symptoms to lead an active lifestyle. In my clinic every day, I see pregnant and postpartum patients who are experiencing pelvic floor dysfunction like diastasis recti, pelvic pain, stress incontinence, prolapse, and more.

Optimize Pelvic Health

Postpartum care: common problems that are almost never discussed

After giving birth, patients immediately face an onslaught of information from their providers, including how to care for their baby, how to breastfeed, how to diaper, and so much more. It’s rare that providers walk their new parents through the most common postpartum problems, instead leaving them to “figure it out” on their own and assume that their experience, while common, is “normal.” “Common” and “normal” are not synonymous.

Through this series, I’ll explore the most common postpartum problems I see my pelvic patients experiencing in my clinic: bladder and bowel issues and scar management.

When to see a pelvic floor physical therapist?

So often parents with newborns feel like their own health challenges become secondary, and they assume that their experiences postpartum, like urinary leakage, constipation, or painful perineal or Cesarean scars, are “normal” because they know so many postpartum parents who have the same.

I started Optimize Pelvic Health in part because I want the world to know that just because something is “common” does not mean that it is “normal.” Many pelvic floor dysfunctions are rectifiable by pelvic floor physical therapy; you don’t have to live in pain or discomfort.

Consider seeing a pelvic floor physical therapist if you’ve experienced any urinary or fecal leakage, organ prolapse, or pelvic/back/hip pain that has lasted longer than six weeks. If you’re having difficulties or pain managing your cesarean or perineal scar, you may also be a good candidate for pelvic floor physical therapy.

Pelvic floor dysfunction can feel like an “invisible” injury and oftentimes is uncomfortable and stigmatized to talk about, making it hard for patients to get the care they need. I would love to partner with you and help restore your health so that you can fully and comfortably enjoy life with your family.

Written by Dr. Janet Yiu, PT, DPT, OCS, FAFS

Lokahi Acupuncture
408.279.9001
Follow us on Instagram
Make an Appointment

Benefits of Eating Congee Postpartum

Benefits of Eating Congee Postpartum

/in , /by

Congee is a type of rice porridge that has been a popular dish in Asian cultures for centuries.

It’s made by boiling white rice in liquid (usually chicken or vegetable stock) until it resembles a thick soup or stew. The result is a comforting and hearty meal that can be enjoyed as-is, or topped with cooked shredded meat, chopped green onions, diced carrots, and/or sliced mushrooms for extra flavor.

Congee is easy to make and healthy to eat – perfect for postpartum mothers looking for something comforting and nutritious.

Eating congee offers many beneficial health benefits for postpartum mothers.

It’s high in nutrients such as carbohydrates and proteins, which are important for lactation and providing energy during the healing period after childbirth.

Congee is also easy to digest, making it a great food choice for new moms who may be suffering from abdominal or stomach weakness.

Additionally, congee is comforting, warm and delicious – perfect for postpartum mamas who need a nourishing, hearty meal.

Here’s how to make the perfect basic congee:

Ingredients:

  • 1 cup of uncooked white rice
  • 4 cups of chicken or vegetable stock
  • Salt and pepper to taste
  • Any optional toppings you like (e.g., shredded cooked chicken, chopped green onions, diced carrots, or sliced mushrooms)

Instructions:

Rinse the uncooked white rice in a fine mesh strainer until the water runs clear. This will help to get rid of any extra starch from the rice so that it cooks evenly.

In a medium saucepan, bring the stock to a boil over medium heat. Once boiling, add in the rinsed rice and season with salt and pepper to taste. Reduce the heat to low and let simmer for 15 minutes covered, stirring occasionally. The rice should be completely cooked when ready — if not, cook an extra 5 minutes until done.

Serve warm topped with any optional toppings you’d like! Enjoy!

There are a few easy ways to make congee tastier.

You can add different ingredients like sauteed vegetables, tofu, or even cured meats to give your congee a flavor boost. For an extra kick of flavor, try adding herbs and spices such as cilantro, ginger, garlic, scallions and soy sauce. Alternatively, you can also add other condiments like chili oil or sesame oil for more depth of flavor. Adding fruits such as raisins or dates can make the congee sweeter and provide a unique twist on the traditional dish.

Experiment with these ideas and find which combination of ingredients works best for you!

If you are not the cooking type, we have resources that can make life easier. There is a great local place that can dropship soups to eat for easy, nutritional meals. Consider eating Congee in the mornings to start healing your gut. This company makes ready-made packets that you put in a slow cooker. Once you get the hang of it, you can branch out on your own.

Schedule a 15 minute video consultation to learn more about how our team of acupuncturists can help.

Anna Rudel
San Jose Acupuncturist
408.279.9001
Follow us on Instagram
Make an Appointment

Postpartum Congee Recipe

Postpartum Chicken Congee Recipe

/in , /by

Postpartum nutrition is an extremely important part of the mother’s recovery and can be as nourishing and healing as it is delicious.

Qin Zhu, L. Ac. shared another traditional recipe that can be helpful for new mothers.

Why postpartum nutrition is so important:

  • It takes 9 months to grow a baby, after which the body is tired.
  • Labor is physically, mentally and emotionally exhausting. It is important to take the time to heal.
  • Decreased micronutrient stores can increase the risk of postpartum depression.
  • Breastfeeding can place high energetic and nutritional demands on the body.

How you nourish your body in the postpartum period is important, not just for your own health, but also in order to help your baby grow strong and healthy. A healthy postpartum eating plan should include fruits, vegetables, whole grains, protein and healthy fats.

4 secrets of healing postpartum food, according to East Asian Medicine

  1. Eat warm and digestible foods. Soups, congee and stews make great postpartum meals.
  2. Eat a nutrient-dense and anti-inflammatory diet. Think colorful produce, healthy proteins, fats, and certain grains. Try to include different colors in one meal, for example, green leafy vegetables, yellow bell peppers, carrots, red iron-rich protein and brown rice.
  3. Eat collagen-rich foods to support tissue repair. Collagen is a super nutrient for rebuilding tissues, collagen-rich food includes bone broth, skin-on chicken, skin-on sardines or Salmon. Don’t forget about adding some berries and aloe vera juice to your diet too. They help your body build collagens.
  4. Hydrate often. For breastfeeding mothers, 10 to 15 glasses of water a day are required to quench thirst and produce enough breast milk. Plus, the more fluids you consume, the faster your body can rebuild and regenerate.

Below is a traditional recipe for chicken congee.

This rice soup is ideal for new mothers because it includes ingredients that nourish and support the energy of the body. Try to drink this soup at least once a week for the 8 weeks following birth. It is easy to make a large batch and freeze individual portions.

Ingredients:

  • 1 cup rice (½ of brown rice and ½ of white rice)
  • 4 cups chicken bone broth
  • 4 cups water
  • 1 cup carrot or broccoli
  • 1 skin-on chicken breast
  • Sesame oil, to taste
  • Salt and pepper
  • Cilantro
  • Black sesame seeds, to taste

Method:

  1. Place rice, bone broth and water into a large pot. Cover and bring to a boil, then reduce to a simmer and continue to simmer, for 1-2 hours or until rice takes on a consistency of congee. Stir every now and then, adding a bit of extra water if the rice becomes dry.
  2. Cut carrots or broccoli into 1 inch pieces and throw into the congee and boil for another 20 to 30 mins or till the vegetables become soft.
  3. Preheat the oven to 350°F. Pat chicken breast dry, then season with a bit of salt and pepper and a splash of olive oil. Place in a roasting dish and bake for 30 minutes, until the internal temperature reaches 165°F and the juices run clear. When cool enough to handle, shred the chicken.
  4. Season the congee lightly with salt, pepper and sesame oil.
  5. Serve each bowl with a generous handful of shredded chicken, a few sprigs of cilantro
  6. Sprinkle the black sesame seeds on top for taste. Black sesame seeds nourish the reproductive system, build blood for postpartum recovery, and boost milk supply.

Chinese nutritional principles herbs can be very effective in the treatment of postpartum recovery.

If you would like to know more about how acupuncture and herbs can be helpful for you, give us a call for a free 15-min consultation!

Anna Rudel
San Jose Acupuncturist
408.279.9001
Follow us on Instagram
Make an Appointment