Up to 15% of women sustain pelvic injuries during childbirth that do not heal, according to research published in the American Journal of Obstetrics and Gynecology.
Childbirth is arguably the most traumatic event the human body can undergo, and recovery from the pelvic injuries sustained can take 8 months or longer.
Kegel exercises, also known as pelvic floor training, are commonly prescribed and involve tightening and contracting the pelvic muscles, which is easy to do at any time.
They aim to strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum. However, in some cases they do not work.
Bladder problems and prolapse of organs can occur if the pelvic muscles are not functioning well enough to hold them in place; women often feel that something is not right but do not understand why. Physicians may not have an answer.
Pelvic muscle tears tracked
Janis Miller, associate professor at the University of Michigan School of Nursing, and a team of midwives, radiologists and obstetricians, studied a group of pregnant women at high risk for pelvic muscle tears. They used MRI scans to diagnose injury and track healing time.
Contrary to expectation, the scans showed that postpartum pelvic injuries were not primarily nerve-to-muscle related.
Instead, 25% of women showed fluid in the pubic bone marrow or sustained fractures similar to a sports-related stress fracture, and 66% showed excess fluid in the muscle, which indicates injury similar to a severe muscle strain; 41% sustained pelvic muscle tears, with the muscle detaching partially or fully from the pubic bone.
Kegel exercises cannot reattach pelvic muscles to the pubic bone; in fact, the researchers say that nothing can.
The team concludes that using MRI to diagnose childbirth injuries - a technique normally reserved for sports medicine - makes sense, because childbirth is as traumatic as many endurance sports.
"If an athlete sustained a similar injury in the field, she would be in an MRI machine in an instant. We have this thing where we tell women, 'Well, you are 6 weeks postpartum and now we do not need to see you; you will be fine.' But not all women feel fine after 6 weeks nor are ready to go back to work, and they are not crazy."
Most injuries, including all fractures, normally heal by the time the woman returns for her 8-month visit. However, the findings suggest a need to reconsider the current one-size-fits-all approach to treating postpartum injuries.
Miller emphasizes that the group was selected for high risk factors of muscle tear and is not representative of expectant mothers generally. Not every woman who gives birth needs an MRI, nor should women avoid Kegel exercises.
Her advice is to contact a specialist if recovery seems to be taking too long, if there are unusual symptoms of discomfort, or if the woman feels unable to continue with the Kegel exercises.
The research team now plans to follow the participants from this study through subsequent births to determine how the pelvic floor injuries impact childbirth and overall health and well-being.
Medical News Today recently reported on research suggesting that childbirth is riskier at the weekend.