The Postpartum Series Part 2: What’s Going on “Down there”?

Your little one has arrived! Just like you anticipated, you’re dealing with sleepless nights, a revolving door of family members coming to visit, and multiple clothing changes for both you and your baby. However, the one thing no one warned you about was what happens “down below”…

Most women don’t discuss their personal experiences of what happens to their vagina and surrounding area after they have a baby. In fact, many women are even embarrassed to bring it up to their doctor. It is very important, however, to know the difference between what is normal, abnormal and when to contact your doctor.

What is this discharge?

This discharge is called lochia (pronounced lowk-ee-uh). Lochia is the vaginal discharge you have after delivery, which can persist up to 8 weeks postpartum. This is a result of the shedding of the tissue lining the inside of the uterus. The first few days after delivery, lochia is similar to a heavy period, is red or reddish-brown and may require you to wear large overnight pads. After about 4 days, it progressively turns more pale, lighter and pinkish in color, and by approximately 2 weeks lochia is more white or yellow in color.

Lochia should never be foul smelling. If odor does become a problem, it may be indicative of an infection and should be mentioned to your doctor. In addition, if you begin bleeding so heavy that you are soaking a pad within an hour, you may need to contact your doctor or be evaluated at the closest emergency room. Heavy bleeding such as this may indicate postpartum hemorrhage. Postpartum hemorrhage usually occurs within 24 hours of delivery, but can also occur up to 12 weeks postpartum, which is referred to as late postpartum hemorrhage. Postpartum hemorrhage can also be continuous bleeding that lasts past 8 weeks postpartum and may indicate retained placenta, infection, or less commonly uterine or placental abnormalities. If this occurs, notify your doctor.

Why am I so constipated?

Constipation is common during pregnancy and can get worse postpartum. Constipation may result from taking narcotics for pain relief, slow return of bowel function after a cesarean section, or fear of defecating due to perineal pain. Constipation is best remedied with a high fiber diet, hydration, and stool softeners (these can be bought over-the-counter).

When can I have sex?

It is generally recommended that women wait at least two weeks postpartum before having sex and up to 6 weeks if there was a vaginal/perineal tear or episiotomy or a cesarean section. Be sure to discuss this with your doctor before leaving the hospital. However, many women refrain from having sex due to low sexual desire or a lack of interest. This low sexual desire is not uncommon as many postpartum women experience fatigue, time constraints, pain or vaginal dryness. Most issues with sexual dysfunction should resolve by 12 months. Any issues beyond this should be discussed with your physician.

It is important to keep in mind that ovulation may occur as early as 25 days after delivery in non-breastfeeding women. As a result, it is recommended that a form of birth control be used in the postpartum period.

Is it normal for IT to look like this?

You may have heard of terms such as vulva or perineum (pronounced para-nee-um). The vulva is the external genitalia, which includes the labia, opening of the vagina, and clitoris. The term perineum is the area between the opening of the vagina and the anus. Many deliveries result in swelling of the vulva and/or perineal tears. Vulvar edema, or swelling, can occur postpartum, especially if your labor was long or if you were pushing for a long time. The swelling can be managed with ice packs and pain can be treated with over-the-counter anti-inflammatory medication (NSAIDs). Within about a week after your delivery, the swelling usually subsides. If the swelling hardens or you experience worsening pain, contact your physician.

Perineal pain may occur with or without a perineal tear or episiotomy (an incision that your doctor makes at the time of delivery). Pain management for perineal pain is similar to that of vulvar edema and includes ice packs, NSAIDs and other comfort measures such as sitz baths. If your delivery did result in a perineal tear or episiotomy, it is important to cleanse the area from front to back after urinating and keep the area dry. It is possible for a tear or episiotomy to become infected. Signs of an infection include a foul discharge coming from the site, redness, worsening pain, fever or chills. Contact your physician if you experience any of these symptoms.

Why can’t I hold it?

After delivery, women may experience incontinence or involuntary leakage of urine or gas. These issues should improve over several weeks, however, it is not uncommon for incontinence to persist beyond the postpartum period. Persistent incontinence is more common with vaginal deliveries, older age at time of delivery, high body mass index, and the use of instruments to assist in delivery (i.e. forceps or vacuum) . Incontinence is also directly related to the number of vaginal deliveries a woman has had.

Incontinence is not always addressed by healthcare providers, so it is important to mention any concerns or questions you may have to your physician. This may result in your physician referring you to a urogynecologist who has had additional training in incontinence or pelvic organ prolapse in women.

The issues that occur “down below” are the least talked about, but the most confusing for postpartum women. Even women who have had previous deliveries will question what is normal and abnormal due to the fact that every pregnancy, delivery, and postpartum period is different. So if you experience any of the problems above make sure to contact your physician to discuss further. Also, keep in mind that it is not uncommon for these problems to occur before your scheduled postpartum visit and may require you to request an earlier appointment. Knowing how to distinguish between what is normal and abnormal is not only important to your health, but will also allow you to dedicate more attention to your little one.

Check out the Postpartum Series Part 1: Common Postpartum Conditions!