Many 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.