Abdomen and the pelvic floor, pain and connective tissue

I had worked with pregnant women for years before becoming pregnant myself, but No One could have prepared me for the changes I would experience in my abdomen and pelvic floor during pregnancy and postpartum. I learned all about the biomechanical aspects of pregnancy while going through it: the changed gait, the changed center of gravity, the effects of additional weight and ligament laxity on the feet, hips and lower back, and the increased rib pain as the baby grew and rearranged the abdominal organs, to name a few. And an unfair expectation was that as soon as the baby was delivered, all that tissue would go right back to where it was before the pregnancy… That really isn’t and wasn’t the case!

Abdominal adaptation in pregnancy
Abdominal adaptation in pregnancy

Both muscle and connective tissue (fascia) have muscle memory largely based on repetitive and biomechanical movements, and as you move in different ways over the nine months of pregnancy, that tissue adapts and molds into new patterns of movement to keep us mobile and the baby secure. The connective tissue is an intricate, tensile web of tissue that surrounds all of our muscle and fills all of the “space” in our body. The abdomen has a large amount of “space” to fill, and consequently has a large quantity of connective tissue surrounding the organs. When these organs move or there is some sort of trauma, the connective tissue has to adapt and change. And as you can guess, when there is a growing baby inside a growing uterus, and the surrounding organs have to shift to allow room for the baby, there is plenty of opportunity for the connective tissue to tighten, stretch, and adhere to itself or adjacent structures. Once the baby is born, the connective tissue again has to adapt to the sudden “empty space” in the abdomen as the uterus shrinks. This causes a change in the center of gravity with movement and the mother’s gait has to compensate, and again, so does the connective tissue – more pulling, stretching and adhering.

One of the more prominent areas for the connective tissue to bind and adhere is around the uterus and bladder due to the amount of strain placed on both organs during the pregnancy. There is usually more restriction in the left side of the pelvis and abdomen as well, because pregnant women are encouraged to sleep and lay on their left side, or to shift their weight to the left with sitting in order to keep the baby from compressing the vena cava, which can be compromising to both Mom and baby. Because of the close proximity to the pelvic floor muscles, they are often affected by tight connective tissue, in addition to the strain of pregnancy and the trauma of vaginal delivery. Abdominal connective tissue adhesions will often present as diffuse pain or discomfort in the abdomen with movement, or lower back pain. Why lower back pain? Connective tissue is a 3D web of tissue, as are the adhesions, and attaches to both the front and back parts of our abdominal cavity resulting in equal opportunities for pain in both the anterior abdomen and pelvis, lower back and lumbar spine, and posterior pelvis and sacrum.

Left side position in pregnancy
Left side position in pregnancy

If the delivery was Cesarean section, there are additional challenges that occur with connective tissue as the incision heals. Scar tissue is formed to create stability in an area of trauma, and is very dense for this reason. Scar tissue has a different organizational matrix than regular scar tissue, and it does not stretch in the way that regular connective tissue does. If left untreated, the scar tissue can bind and adhere to the connective tissue underneath and around, and can also eventually adhere to the uterus, ovaries, and bladder and impede movement and function of the pelvic floor muscles. Women with this condition may experience urinary or vaginal pain, sexual dysfunction, or back, pelvic or groin pain.

As a Neuromuscular Therapist, I always check the abdomen if clients come in with any of the above symptoms, and especially if they have been pregnant or have a history of abdominal surgery. Even laporascopic surgery will create scar tissue adhesions, albeit smaller in size than traditional open surgery. I also recommend that my pregnant clients schedule a postpartum session 3-4 weeks post-delivery to address all of these tissue changes, and to also decrease neck and back pain associated with caring for a newborn. Chances of pelvic adhesions and pelvic floor dysfunction are lessened if the surrounding tissue is appropriately treated in a timely manner. The longer the tissue stays in a tightened, adhered state, the longer it will take to treat and reduce symptoms.

If you are experiencing any pelvic floor pain or dysfunction, postpartum abdominal pain, or have had an abdominal surgery, I highly recommend that you consider investing in a few Neuromuscular Therapy sessions to treat the soft tissue. Your body will thank you!

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