Q&A: Your Body After Baby

Monday, March 09, 2015 4:13 PM comments (0)

babyMany women know what to expect during pregnancy but do you know what changes could be in store for your body after your bundle of joy has arrived? Whether you’re wondering how long to wait before engaging in exercise or sex again, or if pelvic prolapse surgery might be right for you, find the answers here.

Roger Goldberg, MD, Director of the Division of Urogynecology at NorthShore and author of “Ever Since I Had My Baby,” answers “Body After Baby” questions.  

Is moderate pain, like a pulling sensation, normal in a c-section incision site after the incision itself has healed? 
Certainly any abdominal incision—including cesarean—can cause certain symptoms that are slow to fully resolve. This can include pulling or even sharp pain on occasion. The likelihood of any serious issue with the symptoms you describe are small, and symptoms like these typically linger for awhile and then fade on their own. Certainly if this or any symptom continues or gets worse, happens frequently, or disrupts your quality of life, have your surgeon re-check the area. 

Are there things a woman can do prior to or during labor to minimize tearing and nerve damage, and improve and/or speed recovery?

There are. Here are some strategies:

  1. Tone your pelvic floor with Kegel exercises before labor
  2. Perineal massage might help in some cases
  3. Discuss a labor and delivery strategy with your doctor including considering "passive" labor, where you delay pushing until the baby descends
  4. Try to minimize the use of forceps and vacuum extractor delivery, but remember that these are needed in some cases
  5. If you have a very large baby, a very small pelvis or other risk factors, an elective cesarean is worth discussing. I realize that this can be a “hot button issue” so have an open dialogue with your physician well in advance

After childbirth, there is the option of pelvic floor physical therapy. We work closely with our physical therapists here at NorthShore, and they're a great resource for rehabilitating muscles and tissues that have undergone change due to pregnancy and childbirth

How long after pregnancy and labor should you wait to exercise? 
There's not a great deal of science to "prove" the right answer to this question. Assuming you are feeling well, walking and general aerobic activity can usually be resumed around four weeks for your overall health and well being. However, I would be concerned about heavy weightlifting, excessive squatting and high-impact activities at a time when pelvic tissues are still recuperating. The pelvic tissues in terms of strength and tone look very different at one month postpartum compared to three months postpartum. As a doctor and surgeon who deals regularly with women that have prolapse symptoms, I would recommend to err on the side of caution by waiting three months postpartum for high-impact activities. Always check with your obstetrician to be sure. 

Is pain during sex normal after childbirth? How long could pain last? What remedies are there? 
The perineum (tissues between the vagina and rectum) can be very tender after childbirth. Some patients require more time, some require less, for pain to resolve. Studies have shown that roughly 25% of women will still have some sexual complaint at six months after “normal” vaginal birth. The good news is that many of these resolve spontaneously with time and patience.

If the area is extremely tender, check with your physician because in rare cases, a quick surgical revision may be required; however, for most, pain subsides with time, patience, lubrication and perhaps some estrogen cream.

When should you be concerned about pain after childbirth?
I want to emphasize that pain is not normal if it doesn't slowly but surely resolve on its own. If you're getting better and the pain is disappearing, there isn’t a problem; however, if you're experiencing worsening or persistent pain in the pelvic area, consider seeing a urogynecologist for a basic evaluation. 

Is it normal to leak urine when coughing or sneezing? 
This is called stress incontinence, and it's reported to some degree by up to 50% of post-childbearing women by age 40.  While it is common, it’s not normal and not something you must simply accept. Fortunately, stress incontinence is amazingly treatable. 

Treatment options:

  1. Kegel exercises, sometimes with the help of a nurse or physical therapist to ensure you are performing them correctly.
  2. A pessary is a device similar to a diaphragm that is designed to reduce symptoms when inserted.
  3. The “sling” procedure is a huge breakthrough. It's a 15-minute, outpatient procedure that eliminates stress incontinence in over 90% of cases. 

When would you recommend surgery for pelvic prolapse? How long is the recovery after surgery?

This is a personal decision for every woman. It’s important to note that there is rarely a medical reason to rush the decision. Minimally invasive surgical options are available, so some women opt for surgery rather than trying non-surgical methods. 

I perform 95% of surgeries without any abdominal incision, the majority of cases take less than an hour and many involve no hysterectomy. This has translated into a quick recovery for most, but, we always need to acknowledge that recovery can be slower than expected for some. In my current practice, nearly all patients go home the next day, use pain medication for only a short of number of days. 

My overall advice is that if you're considering surgery, the most important factor is that your surgeon has a lot of experience with the technique being performed. Part of the reason we believe our patient outcomes are so strong here at NorthShore is that we're committed to being the experts in these areas. 

Have questions about recovery following childbirth or advice to offer other new moms? Join our new online community The Parent 'Hood to start a conversation. 

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Heart Disease: Women vs. Men

Tuesday, February 17, 2015 1:58 PM comments (0)

man vs woman heart healthHeart disease is the leading cause of death in the United States for both men and women. Each year, approximately 600,000 people will die of heart disease, nearly half of them women. And yet many still believe that heart disease is a man’s disease. It’s not.

There are some possible differences, however, between men and women when it comes to heart disease. Brian Shortal, MD, Cardiologist at NorthShore, discusses these differences and the heart disease risk factors that are the same for everyone:

Age. Men are considered at cardiovascular risk starting at 40. Women, on the other hand, are considered at cardiac risk starting at 50. That does not mean that women under the age of 50 have no risk for heart disease, so any symptoms should not be disregarded.  The incidence of heart disease between men and women equalizes around 65, and studies then show that women actually begin to surpass heart disease events in comparison to men. 

Symptoms. Typically, men exhibit more classic cardiac symptoms, including pain across the chest that radiates down the arms, back and jaw, and shortness of breath. Women might display more atypical symptoms like nausea, vomiting, dizziness and syncope (fainting/temporary loss of consciousness). In fact, the most common symptom in women over 80 is not chest pain but shortness of breath. 

Risk Factors. The risk factors are the same for both men and women. The major risk factors for coronary artery disease are hypertension, high cholesterol, diabetes, smoking, family history of heart disease, obesity and a sedentary lifestyle. If you think you might be at risk, see your physician for more information. 

Do you know your risk for heart disease?

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Cervical Cancer: Prevention and Early Detection

Wednesday, January 28, 2015 3:24 PM comments (0)

cervical cancerThough highly preventable and treatable if caught in its early stages, cervical cancer remains the second leading cause of cancer death in women worldwide. The most significant risk factor for cervical cancer is the sexually transmitted virus, human papillomavirus, or HPV.

There are over 100 different types of HPV that are broken down into two categories: low-risk HPVs, which rarely cause cancer but can cause genital warts, and high-risk HPVs, which may cause  cancer.  HPV types 16 and 18 are responsible for upwards of 70 percent of all cervical cancers. 

Kerry Swenson, MD, PhD , OBGYN at NorthShore, stresses the importance of measures and tests that can prevent or identify cervical cancer in its early and most treatable stages: 

HPV vaccine. More than 80 percent of women will be exposed to at least one strain of HPV in their lifetime.  Thankfully, there is a vaccine that can protect against the four most common strains of HPV. The vaccine only works to prevent infection and is not effective if an infection is already present, which is why it is recommended that these vaccines are administered to girls and women between the ages of 9 and 26, and boys and men between the ages of 9 and 21.  It is best to complete the HPV series before any sexual activity takes place with a potential  exposure  to the HPV virus.   By protecting against HPV, the risk of developing cervical cancer is significantly reduced.  HPV vaccines do not provide protection against all cancer-causing HPV infections so regular screening is still important.

Pap and HPV testing. Regular screening with a Pap smear may identify cervical cancer or cellular changes of the cervix that can lead to cervical cancer. Women should begin Pap tests at age 21 and every three years until age 30.  At age 30, cotesting with a Pap smear and high-risk HPV test should be performed every five years, unless otherwise directed by your physician.  

Well-rounded health. A healthy diet, maintaining a healthy weight, exercise and quitting smoking all contribute to lowering one’s risk for cervical cancer as well as many other types of cancer. 

January is Cervical Cancer Awareness Month. Remember to raise awareness about cervical cancer prevention among the important women in your life this month and year-round. 

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Birth Control: Options and Health Benefits

Tuesday, July 22, 2014 1:55 PM comments (0)

birth controlChoosing the right birth control method can be difficult; there are a variety of options available and nearly every type can affect different women in different ways. Ultimately the best method for each individual woman will be the one that doesn’t cause side effects that disrupt and impede normal daily activities and one she will use consistently. 

Diana Atashroo, MD, Obstetrics and Gynecology at NorthShore, discusses how birth control works, as well as birth control options and possible benefits beyond pregnancy prevention: 

Hormonal birth control, often referred to as “the pill,” contains estrogen and progestin. Birth control reduces the risk of pregnancy by inhibiting ovulation, or the time during a woman’s cycle when a mature egg leaves the ovaries. The pill also causes a thickening of the mucus of the cervix making it impenetrable to sperm and keeping the lining of the uterus thin.

Birth control options include:

Hormonal methods:

  1. A pill (typically a combination of estrogen and progestin, though progestin-only is also available.
  2. Skin patch changed weekly
  3. Injection given every three months
  4. Vaginal ring changed every month

Implanted devices (with and without hormones):

  1. Implant under the bicep for up to three years
  2. Intrauterine device (IUD) for between five to ten years

Health Benefits: 
The most common use of oral contraception is the prevention of pregnancy. While the daily contraception pill is the most popularly used and prescribed medication, the most effective method is the implanted devices. With appropriate use of these methods of contraception they are 99% effective. 

However, birth control is not prescribed or taken exclusively for the prevention of pregnancy. There are several benefits to hormonal birth control, and many women choose to take it for these reasons:

PMS symptom relief. Hormones have been shown to provide significant relief of many of the symptoms of premenstrual syndrome, including menstrual cramps, headaches, depression, heavy or irregular periods and hormonal acne.

Iron deficiency anemia. Women with heavy periods often experience iron deficiency anemia due to blood loss. Hormonal birth control can make heavy periods lighter.

Reduces risk for some cancers. Birth control has been shown to potentially reduce a woman’s risk of ovarian, endometrial and colon cancers.

Bone thinning. Some studies have shown that the use of birth control helps protect against bone thinning, which begins in most women after age 30.  

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"I Thought I Was Too Young." Patient Karin Rigg Suffered a Heart Attack at 44

Monday, July 15, 2013 11:42 AM comments (0)

karin rigg

“This is something that happens to 80-year-old men,” Karin Rigg thought as she was wheeled into NorthShore’s Evanston Hospital for an angioplasty. A busy mom of four young children, Karin Rigg suffered a heart attack at only 44—a year after giving birth to her youngest child.  She never thought she was at risk for a heart attack. Yet, heart disease is one of the leading causes of death in women 55 and younger. 

Successful efforts have been made to raise awareness that heart disease is a very real and very serious problem for women but more can still be done.  Studies show that only a little more than half of women would call an ambulance if they thought they were having a heart attack but more than 75 percent would call for a husband or partner.

Karin Rigg shares her experience as a young heart attack survivor and the changes she made to her life to improve her heart health. She also tells us why it is so important for women to start making their own health needs a priority. 

How do you protect your heart? Do you make your health a priority?

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Pelvic Health Conditions: Pelvic Organ Prolapse – Multiple Solutions

Monday, May 14, 2012 10:37 AM comments (0)

Pelvic ProlapseA common condition amongst both young and old women is pelvic organ prolapse. This condition happens when the uterus or vagina gets displaced and drops down.

While many women tend to ignore or live with this often disfiguring and uncomfortable condition, it can also lead to other problems including recurring bladder infections, difficulty emptying bowels and have a negative effect on sexual activity.

Dr. Tomezsko explains the various lines of treatments for prolapse:

  • Pelvic floor muscle rehab
  • Non-surgical procedure—done during an office visit—involving the vaginal placement of a supportive device.
  • Other minimally invasive vaginal or scarless procedures


According to Dr. Tomezsko, the majority of women can have great improvement with the rehab and non-surgical options.

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With all of the pelvic health conditions we have discussed this week, it is important for women to know that many conservative, non-invasive treatment plans exist for these common and chronic conditions.

Did you find the pelvic health information posted this week to be helpful? What other related topics might you be interested in learning more about?

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