Postpartum Pelvic Health Assessment Note

Pelvic Health

• 8 weeks postpartum assessment for mild stress urinary incontinence (SUI) and abdominal separation concerns.
• G1P1, mild asthma (salbutamol 100 mcg inhaled PRN), no previous pelvic floor dysfunction.
• Resolve urinary leakage during coughing/sneezing and safely return to recreational running by 6 months postpartum.

Obstetric History

• Spontaneous vaginal delivery at 40+3 weeks on 12/08/2023. 2nd-degree perineal tear, sutured under local anaesthetic. Birth weight 3.6 kg.
• Wound healed well with no infection; minor perineal scar tightness noted.

Current Symptoms

• Mild SUI with coughing, sneezing, and lifting heavy objects; no urgency or urge incontinence.
• Voids 6–7 times daily, nocturia x1 (coincides with night feeds).
• One simple UTI at 24 weeks gestation, treated with nitrofurantoin; none postpartum.
• Pale straw-coloured, non-offensive.
• Good flow, no hesitancy or straining.
• Occasional sensation of incomplete emptying if rushing; no post-micturition dribble.

Bowel Habits

• Opens bowels once every 1–2 days; Bristol Stool Chart Type 3–4.
• Nil abdominal pain.
• Normal calibre, no blood or mucus.
• Occasional mild bloating and straining if fluid intake drops; no faecal or flatal incontinence.
• Small, non-prolapsing perianal haemorrhoids post-delivery, currently asymptomatic.

Diet and Lifestyle

• Three balanced meals daily, though often rushed; relies on quick snacks during the day.
• Approximately 1.5–2 L water daily (exclusively breastfeeding).
• Nil currently.
• 2 cups of filter coffee in the morning, 1 cup of tea in the afternoon.

Sexual Health

• Not yet resumed penetrative intercourse.
• Reports apprehension regarding potential perineal scar pain.
• Mild anxiety surrounding body image and perineal integrity post-tear.

Mental Health

• Generally positive and stable; Edinburgh Postnatal Depression Scale (EPDS) score 5/30.
• Adjusting well, though fatigued from broken sleep.
• Supportive partner (currently back at work) and local family nearby.

Physical Activity

• Keen to resume 5 km parkruns and mat Pilates.
• Prefers low-cost or home-based routines while on statutory maternity pay.
• Daily 30-minute pram walks; no formal postnatal rehabilitation prior to today.

Examination Findings

• Mild thoracic kyphosis and anterior pelvic tilt in standing; protracted shoulders associated with feeding posture.
• 2.5 finger-width separation at umbilicus, 1.5 fingers above, 1 finger below; shallow depth with good linea alba tension generated on deep core activation.

Management Plan

1. Pelvic floor exercises and core strengthening

   • Initiate daily pelvic floor muscle training (PFMT) focusing on both slow endurance holds and fast twitch contractions, coordinated with exhalation.
   • Supine pelvic tilts, heel slides with transverse abdominis activation, and seated PFMT (10 x 6-second holds, 10 fast reps).
   • 3 sets daily, linking exercises to baby's feeding routine for habit formation.

2. Sexual health

   • Graded return to intimacy when ready; explore non-penetrative intimacy initially.
   • Use water-based or silicone-based vaginal lubricant (e.g., YES WB®) due to lactation-related oestrogen reduction; adopt female-superior or side-lying positions for control.
   • Daily perineal scar massage for 5 minutes using vitamin E oil or sweet almond oil to improve tissue elasticity and desensitise the area.

3. Lifestyle modifications

   • Increase soluble and insoluble fibre intake to prevent straining at stool; utilise a footstool (e.g., Squatty Potty) for optimal defecation mechanics.
   • Increase water intake to 2.5–3 L daily to account for breastfeeding demands and soften stools.
   • Incorporate oats, chia seeds, flaxseeds, and 5 portions of fruit/vegetables daily; swap afternoon tea to decaffeinated.

4. Exercise programme

   • Continue daily pram walking, gradually increasing pace on flat surfaces; follow NHS Fitness Studio postnatal Pilates videos at home.
   • Commended for maintaining daily walking routine; hold off on high-impact running until 12 weeks postpartum and completion of return-to-run load testing.
   • Signposted to local council-subsidised 'Mum and Baby' postnatal fitness classes starting next month.

5. Education

   • Discussed timeline for tissue healing, hormonal influences of relaxin/prolactin during breastfeeding, and natural resolution of diastasis recti.
   • Demonstrated "The Knack" (pre-contracting pelvic floor prior to coughing/sneezing/lifting) and ergonomic feeding postures using pillows for support.

6. Follow-up

   • Review in 4 weeks (early November 2023) for internal pelvic floor muscle assessment (patient opted to defer internal exam today) and exercise progression.
   • Pelvic Health Physiotherapy Department direct line: 0161 496 0321.

7. Referrals

   • None required at present; will refer to GP if urinary symptoms fail to improve with conservative management.

(Note: Patient consented to verbal assessment and abdominal palpation today; provided with written consent form and leaflet for vaginal examination at next visit).