Peripartum Evaluation and Assessment of the Pelvic Floor around Delivery (PEAPOD) Clinic

At Prentice Women’s Hospital, over 11,000 women each year give birth. The birth of a child can be a hectic and overwhelming time for new moms, and pelvic floor complications are not always addressed.

With this incredibly high delivery volume, Northwestern Medicine’s Division of Female Pelvic Medicine and Reconstructive Surgery faculty are in a unique position to offer comprehensive specialty care for women’s pelvic floor needs before, during, and after pregnancy.

Designed to help pregnant women and new moms receive specialized care sooner than a standard six-week postpartum appointment, Northwestern Medicine's PEAPOD clinic is a unique program in Chicago and its suburbs with its focus on the peripartum care of women who experience pelvic floor symptoms. Within this innovative, transdisciplinary care program for new mothers, the urogynecologists work cooperatively with obstetrician-gynecologists to provide comprehensive care plans for these women. 
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Specialists

The Northwestern Medicine Peripartum Evaluation and Assessment of the Pelvic Floor around Delivery (PEAPOD) Clinic consists of experts from various backgrounds to adequately address, evaluate and manage the needs of all of our pregnant and postpartum patients. We have developed a multi-faceted program to accomplish the best care possible for new mothers, and our team includes Female Pelvic Medicine and Reconstructive Surgery physicians, physical therapists, psychologists, and sex counselors.

When to Seek Care

Many women begin experiencing pelvic floor symptoms during their pregnancy. While some of these symptoms will resolve after delivery, many women have bothersome symptoms that can be addressed during pregnancy and should be discussed with a primary obstetrician-gynecologist.

Obstetrician-gynecologists may recommend that women consult with one of the urogynecologists in the Peripartum Evaluation and Assessment of the Pelvic Floor around Delivery (PEAPOD) Clinic during pregnancy or after delivery.

We recommend that women with severe obstetric lacerations or tears be seen within one week of delivery. Our multidisciplinary team comes together weekly to care for all pregnant or recently delivered women to accommodate that need. Often, we find that patients only require one visit to reassure them that they are healing correctly. However, if a patient has a more complicated recovery, she may be seen multiple times. Once a patient has recovered properly, she will resume care with her primary obstetrician-gynecologist.

One of the urogynecologists in the PEAPOD clinic may conduct additional tests of your pelvic floor and anal sphincter muscles, including: 

• Pelvic floor and endoanal ultrasound: Women who have sustained perineal tears during delivery often have muscle and sphincter damage that can be visualized using cutting-edge ultrasound technology. The pelvic floor and endoanal ultrasound is painless, quick, and is done right in the clinic. Using this imaging modality, we can assess ways to best promote pelvic floor recovery. 
  
  

• Anorectal manometry (ARM): ARM is used to assess the strength and integrity of the anal sphincter after a severe tear. This testing modality is also painless and is performed in the clinic. Some women may benefit from this testing to track the progress of proper healing of the anal sphincter.

Symptoms

Many women experience new, bothersome pelvic floor symptoms during their pregnancy or after their delivery. In fact, one in three women develop urinary incontinence during or after pregnancy. A more detailed list of the problems women can experience includes:

• A severe tear or laceration that affects the anal sphincter (otherwise known as a third- or fourth-degree tear)
• Infection or breakdown of a tear
• Anal incontinence or accidental bowel leakage (involuntary loss of gas and/or stool)
• Urinary incontinence
• Urinary urgency and frequency
• Urinary retention
• Pelvic pain
• Pain with intercourse
• Fistulas
• Sexual dysfunction​
  
  

There are many risk factors for development of pelvic floor disorders after childbirth. One of the most significant risk factors for developing anal incontinence after having a baby is a severe tear. These tears are known as third- or fourth-degree tears and damage the anal sphincter. At the time of delivery, the sphincter is repaired with stitches; however, close follow-up to ensure proper healing is necessary.

Risk factors for developing a severe obstetric anal sphincter laceration include the following:

• Use of forceps to help deliver the baby vaginally
• Long “pushing” phase of labor
• Episiotomy
• Large baby
• Delivery position of baby (“sunny side up”)
• Older maternal age

Treatments

Women who have suffered perineal trauma (or severe tears) after delivery typically can have their symptoms managed with a variety of surgical and non-surgical options.

Severe (third- and fourth-degree) tears are prone to complications including wound separation/breakdown and infection. In our PEAPOD clinic, we counsel patients and offer various treatments to decrease their risk of developing wound complications.

Perineal care

We always recommend good perineal care for new mothers, including daily sitz baths and proper drying techniques afterward. Wound healing is accelerated and infection can be prevented with good perineal care, with the addition of antibiotics if necessary.
 
Medical management of urinary and anal incontinence

In the immediate postpartum period, symptoms of urinary and anal incontinence are not uncommon in women who have suffered severe tears.

In PEAPOD, we offer immediate treatment of urinary incontinence with pessaries that are fit in the clinic. Similarly, patients can be fitted with vaginally placed bowel-control devices that they can easily remove and replace themselves to help with anal incontinence immediately after delivery. These interventions, while simple, can be life-changing during the early days after pelvic floor injury before complete recovery has occurred.

​Pelvic floor physical therapy

We recommend pelvic floor physical therapy for all women who have had a vaginal delivery, especially those that were complicated by a more severe tear. Pelvic floor physical therapy is instrumental in helping the anal sphincter and pelvic floor muscles regain their function after delivery.

Physical therapy is also helpful for a myriad of other issues that are common after childbirth such as pelvic pain, pain with intercourse, and pain due to vaginal scarring.
 
Surgical Correction of Wound Breakdown

If a vaginal tear does not heal properly, wound care (such as packing and dressing) and even surgery are sometimes necessary to ensure good healing and recovery. Our FPMRS specialists are trained extensively in the surgical management and revision of perineal wounds.
 
Surgery to correct the anal sphincter is known as an anal sphincteroplasty and this is often accompanied by a revision of the vaginal and perineal injury.
 
Sexual Counseling

Sexual dysfunction after a vaginal delivery is not rare. While some patients have pain with intercourse, many have anxiety and fear of intimacy, especially if they have sustained a severe tear. 

Support Groups
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In collaboration with the Department of Psychology, we have expanded our offering of counseling and group session work for women to share their stories and experiences of birth trauma, being new moms, and supporting one another in the postpartum period. 

To Request an Appointment

If you're suffering from a pelvic floor disorder, you don't have to live with the symptoms. To learn about treatment options, call 312.694.7337 to schedule an appointment with one of our urogynecologists. ​

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