Uterine tenderness

What is abdominal tenderness?

Abdominal tenderness is an important finding on physical examination in a person who complains of
abdominal pain. A person with abdominal tenderness has abdominal pain when pressure is applied to the
abdomen (with the hand). Tenderness that is located in one area of the abdomen can provide an
important clue to the underlying cause. Many conditions cause abdominal pain, but few conditions also

cause abdominal tenderness.

What are the symptoms of abdominal tenderness?

Abdominal tenderness can range from mild to severe. Symptoms commonly associated with abdominal
tenderness include abdominal pain, abdominal swelling, nausea, vomiting, diarrhea, fever, anorexia, and
excessive sweating.

How does the doctor treat abdominal tenderness?

Treatment of abdominal tenderness depends on the underlying cause. Severe abdominal tenderness is
often treated with antibiotics and surgery.

Ice packs
You may notice some uncomfortable swelling and pain in this area due to the stretching required to
deliver your baby. To reduce swelling you can use ice packs. Be sure to wrap the ice pack with a
washcloth or other soft, absorbent material. Direct application of ice can damage tender tissue in this
area if prolonged. You can also take sitz baths. Your health care provider may have sent you home
with a special tub made for this. If not, you can simulate this bath by sitting in a tub with 2-3 inches
of warm water for about 15 minutes. If you notice a lot of pain while sitting in the bath, it may be
helpful to sit on a doughnut pillow or towels rolled into a doughnut shape.

http://www.healthsquare.com/mc/fgmc0279.htm

Perineal care
Care
You may need ice packs, or an ice sitz bath, to relieve the pain right after you give birth.

You may be given pain medicine ; and you also may get sprays or wipes that contain a
numbing agent to help ease the pain. In addition, your doctor may give you medicine to
help soften your stools so that it doesn't hurt as much when you go to the bathroom.
Keeping the area clean with a peri-bottle (a hand-held squirt bottle) can be soothing and
help prevent infection. You will also need to use peri-pads in your underwear to catch the
blood and discharge from the vagina.
WHAT YOU SHOULD DO
1. Keep a supply of the following items at home: peri-pads, peri-bottle, toilet paper or
cotton wipes, pain medicine such as acetaminophen, and other medicines your
doctor asks you to take. Let your doctor know if you have any problems or questions.
2. Check the amount and color of the discharge from your vagina. This shows how fast
you are healing.
1. For the first 2 to 3 days after you have had your baby, the blood will be a heavy
flow and dark red. Some women pass clots and blood for 3 to 5 days.
 2. From the 3rd to the 10th day, the discharge gradually becomes pink, and the flow
is lighter. After that, you will have a creamy or yellowish discharge for another 1
or 2 weeks.
3. Clean the perineal area each time you use the toilet or change your perineal pads.
Proceed as follows:
1. Use a hand-held squirt bottle (peri-bottle) filled with warm tap water.
2. While sitting on the toilet, rinse your perineum for at least 2 minutes. Aim the
water from front to back.
3. Pat the area dry with toilet paper or cotton wipes, again from front to back.
4. Put on a fresh perineal pad.
5. Stand up before flushing the toilet to avoid being sprayed with the water.
4. Sitz baths during the first week may help you feel better. Fill the bathtub with warm
water. Sit for 10 minutes twice a day. Put on a fresh perineal pad after the bath.

http://babyparenting.about.com/cs/postpartumissues/a/perinealcare.htm
5.

Topical medication
In medicine, a topical medication is applied to body surfaces such as the skin or mucous
membranes, for example the vagina, anus, throat, eyes and ears.
Some hydrophobic chemicals such as steroid hormones can be absorbed into the body after being
applied to the skin in the form of a cream, gel or lotion. Transdermal patches have become a
popular means of administering some drugs for birth control, hormone replacement therapy, and
prevention of motion sickness. Chloramphenicol is an example of an antibiotic that may be used
topically.
In dentistry, a topical medication may also mean one that is applied to the surface of teeth.
"Topical" is derived from the Ancient Greek topos (plural: topoi), "place" or "location".
http://en.wikipedia.org/wiki/Topical

Sitz bath
A sitz bath is a special bath used in the early postpartum period to help ease pain, promote healing
and give good hygiene to the perineal area. This is particularly helpful after an episiotomy or tearing
during birth. Though it also helps ease swelling in the perineum or a swollen labia.

In the hospital you may be given a portable sitz bath. This sits over a normal sized toilet. You fill a bag
with warm water and sit on the sitz bath. The warm water then flows over your perineum allowing for
healing and cleansing. You can add medication or herbal preparations at will.

This can be done often through out the day and is a lot easier than getting into the bath tub. Should
you not have a portable sitz bath sent home with you, you can generally sit in tub filled 2-3 inches
with warm water for the same effect. Or you can order a portable sitz bath for your home.

http://pregnancy.about.com/od/postpartumrecover/qt/sitzbath.htm
Caring For Your Yourself: SELF - CARE
Perineal Care Activities and Healthy Exercise
Episiotomy Care Nutrition and Diet
Proper Perineal Care Vitamin Supplements
Proper Handwashing Weight Loss
Ways to Speed Healing
Ways to Relieve Discomfort Resuming Sexual Intercourse
Kegel Exercises
Birth Control and Family Planning
Physicial Changes and Healing
About Lochia Normal Baby Blues or Postpartum
How to Recognize Hemorrhage Depression?
Hemorrhoids What To Expect At Your Postpartum Check-up
Afterpains
Other Physical Changes The Importance of Getting As Much Rest As
You Can
Breast Care When To Call Your Doctor
For Bottle Feeding Moms
For Breast-Feeding Moms

Kegels
Kegel exercises are extremely important for strengthening the muscles of the pelvic floor. These muscles
will be swollen and tender after delivery and you will not feel like doing these exercises. You should do as
many as you can tolerate to gradually gain back tone of the muscles. The exercises can also help speed
up the healing process of an episiotomy.

• Tighten your urinary passage and vaginal muscles for three seconds, relax the muscles for three
seconds.
• Begin with 10 three-second squeezes twice to three times a day. Increase repetitions slowly.
• Work up to doing 50-100 Kegels a day.

Pelvic Tilt
This exercise will strengthen your abdominal and back muscles. Move gently.

• Lie on your back, knees bent, feet on floor.

• Exhale and tilt your pelvis upward.
• Tighten your abdominals and squeeze your
buttock muscles together.
• Gently flatten the small your back against
the floor.
• Hold for a count of five.
• Inhale as you release.
• Repeat 4 - 6 times.
 • DO NOT arch your back while performing
pelvic tilts.

Ankle Circles
This exercise will feel great, and enhances circulation in your legs and feet.

• Make 10-15 circles with your ankles in a clockwise

and counterclockwise direction.

• Repeat three to five times.

• You can do ankle circles while sitting or lying down.

Day 2-to-4
Repeat the Kegels, pelvic tilt and ankle circle exercises. Add the leg sliding exercise.
Leg Sliding

• Lie on your back with your knees bent.

• Do the pelvic tilt (do not arch).

• Inhale, then slowly slide one heel up the floor or bed,

exhale and slowly lower the leg.

• Keep your back flat at all times and only work within
the range that you can maintain a flat back.

• Repeat 5 times with each leg.

Day 5-to-7
Repeat the Kegels, pelvic tilt, ankle circle and leg sliding exercises.
Add the bridge and modified crunch.
Bridge
This exercise will strengthen abdominal and back muscles while providing mobility to your spine.
 • Lie on your back with knees bent, feet firmly on bed
hip width apart.

• Raise buttocks slowly off the ground and lift your hips
about 2-3 inches off the floor to form a straight line.

• Place your hands on your buttocks to feel the muscles

tighten.

• You should feel the weight primarily in the legs and

buttocks, not your lower back. If you feel in the lower
back, then lower your hips slightly.

• Repeat 3-5 times.

Modified Crunch
This exercise will strengthen your abdominal muscles.

• Lie on your back with knees bent. Arms

can be behind back, out in front, or
crossed on chest.

• Inhale, then exhale and raise head and

shoulders off the floor.

• Inhale, and slowly lower your body.

• Relax.

• Repeat 5 times.
Aerobic Exercise After Delivery
Light aerobic activity, like flat ground walking, can usually be resumed about one week after delivery, or
as soon as you can tolerate it. Fatigue will also be a factor. Give yourself time to rest, recover, and get
used to your new routines with the baby before you do any more. A gradual increase in activity and return
to a more general exercise program can be started after your postpartum checkup, but be sure to
discuss your body's 'readiness' with your obstetrician before beginning.
http://www.storknet.com/ip/staying_well/active/after_deliv_exercise.html
Nutrition

Mother's Diet After Birth

Eating right after delivery isn't that complex. Just continue eating a good-quality diet just as you did during
pregnancy. If you are not breast-feeding, your nutrient and calorie needs are the same as they were
before you became pregnant. If you are breast-feeding, or if you are anemic or recovering from a
cesarean delivery, you require special nutritional management.
 Keep It Simple

Take a creative approach to nutrition, choosing foods that require little or no preparation. Quick, nutritious
foods include fresh fruit, raw vegetables, melted cheese on toast, cottage cheese, and yogurt with raisins,
sunflower seeds, nugget-type cereal, or low-fat granola. Broiled meats and fish are faster to prepare than
casseroles.

Let friends and family help you by providing nutritious meals during the early months after childbirth.
Meals you can freeze are especially helpful because you can pull them out of the freezer for use on those
occasional difficult days.

Nurture yourself by taking time to sit to eat your meals. Eating on the run or standing to eat makes you
feel you have not had a meal; this habit contributes to fatigue and may even contribute to overeating. It's
also not very good for your digestion. Place your baby in a swing or in an infant seat so your hands are
free. If your baby needs to be close to you, an infant backpack or sling is helpful. Or you may wait to eat
until your baby's quiet time or when she is asleep.

Constipation

Constipation is a common and unpleasant post-partum complaint. The following advice can help relieve it:

• Get some form of daily exercise, such as walking.

• Make sure you have adequate dietary fiber. Bran muffins, high-fiber cereals, and lots of fruits and
vegetables are good fiber choices. (Be sure to increase your fluid intake as you increase your fiber
intake.)

• Drink to fulfill your fluid needs. Two to three quarts of fluids a day is generally recommended-drink even
more if you breast-feed.

• Drink four ounces of prune juice on an empty stomach followed by several cups of hot water,
decaffeinated tea, or other hot beverage.

• Avoid the regular use of laxatives. If you use a laxative more often than every third or fourth day, you may
have problems moving your bowels without the use of the laxative.

• Try fiber-containing stool softeners such as Meta-mucil, Fiberall, and Fibercon. They can help relieve
constipation without the problems associated with laxative use.
Dealing With Fatigue

No foods actually relieve fatigue. A good-quality diet helps you to feel well but is not a substitute for rest
and sleep.

Most new mothers find themselves feeling tired from time to time. Getting adequate rest is important for
your recovery from birth, for making milk, and for enjoying your baby.

How do you get rest? Take time to rest every time your baby rests or sleeps instead of using the time to
clean house or wash clothes. During your rest times, take the phone off the hook so you are not
disturbed. Let your family and friends help you by doing laundry and other household chores. Avoid
caffeine to improve your rest and sleep.

Restoring Your Iron Reserves

 Egg yolks can be an excellent source
of iron, but you should limit your
intake to three to four a week.
Some women learn they are anemic after childbirth. This means they have fewer red blood cells than is
ideal to adequately supply their body with oxygen. Postpartum anemia may result from having been
anemic during pregnancy, from blood loss during childbirth, or from giving birth to more than one baby.

Your doctor evaluates your blood during the post-partum period. If laboratory tests confirm you are
anemic, treatment begins immediately. If blood loss was heavy during childbirth, you may have received a
blood transfusion. Otherwise, treatment aims at restoring iron levels through diet and supplements.

If your doctor prescribes an iron supplement, you need to help your body absorb it. To do this, eat a meal
that includes a food rich in vitamin C when you take your iron supplement. Excellent sources of vitamin C
include citrus fruits, tomatoes, baked potatoes, and steamed broccoli. It also helps to include a food that
contains iron.

Food sources of iron include lean red meats, organ meats, spinach, egg yolks (limit to three to four a
week), and cream of wheat. Avoid taking your iron supplement with any significant source of calcium
because calcium interferes with iron absorption. Calcium sources include milk, yogurt, cheese, and
antacids. Since low-fat dairy products are of significant nutritional importance, don't cut these out
altogether; include them in meals other than the ones that accompany your iron supplements.

Recovering From a Cesarean Delivery

Undergoing a cesarean section temporarily upsets the passage of food through the digestive tract,
resulting in gas production and constipation. Both of these early discomforts can be treated by walking,
which increases bowel activity and aids you in passing gas. Be sure to eat, too. There is a temptation not
to eat when you feel so bloated, but consumption of food helps restore normal bowel action, thereby
relieving constipation and gas.

If you are anemic after delivery, treating the anemia with the recommendations for restoring your iron
reserves helps speed your recovery from surgery.
Nutritional management after surgery includes increasing the vitamin C and protein in your diet. Vitamin C
contributes to wound healing, and protein helps your body repair itself.

While nutrition should be the most important concern, many new mothers are worried about losing the
weight they gained during their pregnancy. We'll look at realistic expectations for this goal in our next
section.

http://health.howstuffworks.com/postpartum-nutrition-guidelines-ga.htm

Bowel movements
You may find yourself avoiding bowel movements out of fear of hurting your perineum or aggravating
the pain of hemorrhoids or your episiotomy wound. To keep your stools soft and regular, eat foods
high in fiber, drink plenty of water and remain as physically active as possible. Ask your health care
provider about a stool softener or fiber laxative, if needed.

Another potential problem for new moms is the inability to control bowel movements (fecal
incontinence) — especially if you had an unusually long labor. Frequent Kegel exercises can help. If
you have persistent trouble controlling bowel movements, consult your health care provider.

Sore breasts and leaking milk

Several days after delivery, your breasts may become heavy, swollen and tender. This is known as
engorgement. The discomfort usually lasts less than three days. In the meantime, it helps to express
milk — preferably by feeding your baby. If your baby isn't able to nurse, use a breast pump to ease
engorgement. You may also want to apply warm or cold washcloths or ice packs to your breasts, or
take a warm bath or shower. Over-the-counter pain relievers such as acetaminophen (Tylenol, others)
or ibuprofen (Advil, Motrin, others) may help, too.

If you're not breast-feeding your baby, wear a firm, supportive bra. Compressing your breasts will help
stop milk production. In the meantime, don't pump your breasts or express the milk. This only tells
your breasts to produce more milk.

Leaky breasts are another common problem for new moms. You can't do anything to stop the leaking,
but nursing pads worn inside your bra can help keep your shirt dry. Avoid pads that are lined or
backed with plastic, which can irritate your nipples. Change pads after each feeding and whenever
they get wet. If nighttime leaking is a problem, place a towel under your breasts at night.

http://www.mayoclinic.com/health/postpartum-care/PR00142/NSECTIONGROUP=2

Bowel

Add more FIBER to your diet, and drink lots of fluids. Bulk-forming laxatives may also help relieve
constipation. Check to see if any medicine you are taking could be causing constipation.
Using over-the-counter hemorrhoidal creams or suppositories and soaking the area in warm water
may help relieve the pain and itching. If there's no improvement in 1 to 2 weeks, or if the bleeding
continues, see your doctor.
Nonprescription antifungal medications for yeast infections or antiparasitic medications for pinworms
are available. If you think an allergy is your problem, try using white, unscented toilet paper. See
your doctor if your symptoms don't improve.
See your doctor. Hemorrhoids are often treated with over-the-counter creams or suppositories.
Soaking in warm water may also help relieve any discomfort.
Avoid using laxatives. Instead, try adding more FIBER to your diet, and drink lots of fluids. Keep in
mind that it isn't necessary to have a bowel movement every day. A normal range is 3 times a day to
3 times a week.
http://www.mpmprimarycare.com/index.cfm?fuseaction=site.content&type=aafpsc
&destination=/online/famdocen/home/tools/symptom/532.membersite.html