Online Consultation

Iqra Mazhar

Understand the role of insulin in postpartum health with Meri Sehat. Get expert insights for a smooth transition into motherhood.

Insulin And Postpartum

Madeeha Syed

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

Your Body After Giving Birth

Overview

Post-pregnancy or postpartum is a crucial period. It&rsquo;s also known as the fourth trimester. This is when your body is <a href="https://merisehat.pk/disease/chronic-fatigue-syndrome">recovering from the fatigue</a> of pregnancy.

During pregnancy, the body goes through a lot of changes to accommodate your baby. The body eventually goes back to normal, but this can take a while.&nbsp;

Continue reading to find out more about some common changes that take place in your body, after you give birth. 
&nbsp;

Post-pregnancy or postpartum

During pregnancy, hair growth gets better and the texture of hair gets thicker. This is all thanks to the hormones that are active during that phase. However, post-delivery, this phase settles down and enters into a resting phase for about one to five months. Normal hair growth pattern usually returns six to 15 months after delivery. 
&nbsp;

Shoe surprise is pretty common after pregnancy. It is not just the midsection that gets affected. After a baby is born, your shoe size changes permanently. That is because during pregnancy women gain an average of 25-35 pounds which puts extra pressure on the feet. This pressure flattens out the arch in your feet which is the reason for extra inches in your feet. 
&nbsp;

Belly bulge is common after pregnancy. A lot of women expect that the belly will return to its normal size after birth. The upper portion of the uterus is at the level of your navel. Post-pregnancy belly returns to its normal size in about six to eight weeks. A good diet and exercise are the key to toning down your belly. Workouts focused on the core can show quick results. 
&nbsp;

A common expectation of most women is that the breast size will go up after giving birth and breastfeeding. Once you stop breastfeeding, however, the size goes back to what it was. In fact, in some cases, it goes a cup down. The main reason for the size to increase is that fat tissue in the breast is replaced by functional tissue. Once a woman stops breastfeeding, functional tissue depletes as it is no longer needed. 
&nbsp;

The first six months of the post-partum period are the recovery period. No matter how easy or smooth your pregnancy is, your body has gone through a lot of stress and trauma. It needs time to recuperate. Remember that every mom goes through a different experience and symptoms; hence, the recovery rate also changes.

Most of the symptoms, like sore nipples, backache, pain in the thigh area, etc., continue for more than a week. Other symptoms, like leaky breasts, can linger on for months.

In vaginal delivery, recovery timelines vary depending upon the kind of delivery. The soreness and perennial pain go away in three weeks. However, in the case of vaginal tear or episiotomy (incision made on the vagina to ease the delivery process), recovery can take up to six weeks.

If you have been delivered through c-section, it will take around three to four days in the hospital to recover. In about four to six weeks you can recover completely. 
&nbsp;

For the first 24 hours after birth, ice your perineum region. Sit in warm baths for 20 minutes to ease pain and avoid long periods of standing or sitting.

Ease pain and aches by taking hot showers and massages.

Do your Kegel exercises, to strengthen your pelvic muscles.

Keep up with your doctor appointments. It will help you stay on track. Your doctor can also notify you about your emotional well-being and help you with your new journey.

Ask your doctor regarding your workout plan. They can guide you about how and when can you exercise. It is a good idea to start by walking into your house and then gradually into the neighbourhood. Walking helps in recovery by improving blood circulation and toning muscles. 
&nbsp;

Bottom Line

Your diet after pregnancy shouldn&rsquo;t be very different from what you eat during pregnancy. Avoid processed foods. Focus on eating whole grains, high fibre foods, Omega-3 fatty acid-rich food, nuts, and fish.&nbsp;

<ul>
	<li>Lean Meat: Milk, cheese, and yogurt are all crucial components of a breastfeeding mother&#39;s diet. Your infant receives calcium from breastmilk for the formation of bones. Consume foods high in calcium to replenish the calcium your body has lost. Include three cups of dairy in your diet each day.</li>
	<li>Pulses: These are a good source of protein and fibre. You can cook them with different seasonings to make them tasty and easy to eat. Pulses also prevent fat from accumulating in the body.</li>
	<li>Vegetables:&nbsp;These are low-calorie healthy food. They are rich in antioxidants and aid in losing weight. Spinach and broccoli are good sources of Vitamin A which is healthy for you and your baby.</li>
</ul>

Once the baby is born, you can resume most of the food you avoided during pregnancy. Include nutrient-rich foods like legumes, proteins, fibre, citrus fruits, and vegetables. Don&rsquo;t forget to keep yourself hydrated. You may consult a dietician and your doctor in designing your diet plan.

Namwer Rao

What Happens To Your Body After Giving Birth

Giving birth is a life-changing experience. You&rsquo;ve just brought a new baby into this world, which is an incredible, miraculous feat in itself, but it also means that your body has been through quite an ordeal. You may have experienced some pain during labor and delivery, or perhaps you&rsquo;re still recovering from an episiotomy or C-section incision. No matter what kind of birth experience you had, it&rsquo;s important to take good care of yourself now so that you can heal properly. In this article, we&rsquo;ll talk about what happens to your body after giving birth and how best to care for yourself during the recovery process. 
&nbsp;

Post baby body

After giving birth, your uterus will become smaller and return to the shape it had before you became pregnant. This process can take up to six weeks, but it can happen faster if you have a cesarean section or if you have your baby naturally (vaginally). 
&nbsp;

You&rsquo;ll lose weight and muscle mass which can cause you to look different than you did before your pregnancy.

Your breasts will lose some of their volume as breast tissue shrinks. Your uterus will shrink back down to its pre-pregnant size as well.

You&rsquo;ll also notice that your stomach is flatter and less rounded than it was before delivering your baby. Your hair will likely grow back first, followed by another six months or so until any other changes are noticeable. 
&nbsp;

You may have cramping and pain. This can be uncomfortable, but it&rsquo;s a normal part of healing after delivery.

You may have a fever. This usually starts about 48 hours after birth and will go away on its own within a week or so as your body heals. It can also happen if you are breastfeeding and the baby has thrush (an infection of yeast in their mouth). If your temperature goes above 100 degrees Fahrenheit (37 degrees Celsius), <a href="https://merisehat.pk/doctor-now" target="_blank">call your doctor</a> right away!

A fever could mean that you had an infection during pregnancy or while giving birth (puerperal sepsis) and need antibiotics right away; this is highly unlikely unless you have symptoms such as chills, shaking/shivering, nausea/vomiting with diarrhea, and headaches. 
&nbsp;

This is normal and it will pass. Your body is dealing with a lot of changes, including lower blood pressure and blood sugar levels. 
&nbsp;

When you&rsquo;re ready to start exercising again, it&rsquo;s important that you consult your physician first. Many women think they can immediately resume their normal exercise routine after giving birth, but this isn&rsquo;t always the case. You need a postpartum check-up with your doctor before jumping into any rigorous workouts.

The good news is that most doctors will want to see you after just one week of rest and recovery (or sooner if there are complications). They&rsquo;ll assess how much weight you&rsquo;ve lost since giving birth, as well as take note of any pain or discomfort in your pelvic area and abdomen. If everything looks good, then they&rsquo;ll likely give the go-ahead for some light exercise like walking on flat surfaces with support from family members or friends until things feel better &mdash; and then maybe even invite some gentle stretching movements back into play! But don&rsquo;t worry too much if these tips aren&rsquo;t enough; talk with your physician about what activities would be safe for someone recovering from childbirth before getting started yourself! 
&nbsp;

The stitches will feel uncomfortable when you go to the bathroom. You can take painkillers to relieve the discomfort, but if that doesn&rsquo;t help, talk to your doctor about stronger medications.

You may also feel some discomfort from gas and bloating, which happens because of all the food your body has been absorbing in preparation for breastfeeding. In order to minimise these side effects, it&rsquo;s important not to eat anything for a few hours before feeding your baby&mdash;and make sure that whatever you do eat is high in fibre and low on fat. 
&nbsp;

Postpartum bleeding (lochia) may last for several weeks after delivery. Lochia is the normal discharge that comes from the vagina after giving birth, and it contains blood, mucus and tissue from the lining of your uterus. The amount of blood varies greatly among women, but most new mothers can expect to see some sort of discharge for six weeks or so after giving birth.

If you experience heavy bleeding more than two weeks after giving birth, contact your doctor immediately. 
&nbsp;

To avoid infection, you&rsquo;ll want to:

<ul>
	<li>Take a shower or bath</li>
	<li>Change your pads frequently, especially if they&rsquo;re not waterproof</li>
	<li>Wash and dry yourself well in the genital area after using the bathroom. If you have stitches, use medicine that has been prescribed by your doctor for cleansing stitches 
	&nbsp;</li>
</ul>

Eat healthy food that is high in protein and low in fat (a few small meals throughout the day), such as peas, beans, and fish (not red meat). Avoid junk foods like chips or chocolate bars; they won&rsquo;t give you much nutritional value.&nbsp;

Get plenty of rest so your body can repair itself from all those intense contractions during labor; don&rsquo;t worry about taking naps &mdash; it&rsquo;s okay to sleep whenever it&rsquo;s easy for you. If you feel tired during the day, try lying down on a couch instead of sitting up straight at a desk or table. 
&nbsp;

We hope you feel more prepared for what is to come. It can be overwhelming, but the best thing to remember is that your body knows what it&rsquo;s doing and will get back to normal soon enough. If you have any concerns about your health or recovery, don&rsquo;t hesitate to talk with your doctor!

Umna Salah

Humza Khizer

Baby Blues (Postpartum Depression): Is There A New Treatment?

The entire process of pregnancy is very rewarding, but what happens after you have delivered the baby? Your body that has gone through so many constant changes over the 9 months, reverses them all to get you back to normal. This process often leads to postpartum <a href="https://www.merisehat.pk/disease/depression">depression</a>.

About 11% of women in the United States suffer from postpartum depression (PPD).<a href="#accordion">[4]</a>&nbsp;PPD affects not just the life of the mother but also the infant. If left untreated, it can get worse and affect your spouse or other people close to you. So far, the treatment used for PPD has been very generic; similar to that of major depressive episode (MDE) consisting of conventional antidepressants like SSRIs, benzodiazepines, and tricyclic antidepressants. FDA has recently approved the first-ever drug targeted toward treating postpartum depression. 
&nbsp;

Understanding The Latest Treatment For Postpartum Depression

Postpartum depression is best explained as a worsened form of postpartum blues or baby blues. Baby blues are experienced a few days after delivery. Some new moms, however, experience a much more severe case of baby blues that can be classified as postpartum depression and it can go on for over a year.<a href="#accordion">[8]</a>&nbsp;PPD is characterized by:

<ul>
	<li>Feeling depressed and low</li>
	<li>Sleeping too little or too much</li>
	<li>Feeling tired all the time</li>
	<li>Doubting yourself as a mother</li>
	<li>Thinking that you do not want the baby</li>
	<li>Excessive crying</li>
	<li>Loss of appetite</li>
	<li>Anxiety and panic attacks&nbsp;</li>
	<li>Thoughts of harming yourself or the baby</li>
	<li>Unable to think clearly or make the right decisions</li>
	<li>Increased anger and irritability</li>
	<li>Overall reduced interest in everything</li>
</ul>

If you or anyone that you know are facing any of these symptoms, immediately contact your physician and get yourself screened through the Edinburg Postnatal Depression Scale (EPDS). It is one of the most common and quickest screening tools with high accuracy and allows your physician to assess the situation better through the score.&nbsp; 
&nbsp;

A lot of factors contribute to postpartum depression.The biggest factor that is not only responsible for PPD but also for the baby blues is the drastic change in hormones. During pregnancy, your estrogen and progesterone levels are very high. As soon as the baby is delivered, these levels are dropped drastically.

Since estrogen is directly linked to increasing serotonin levels in our brain&nbsp;and progesterone is known for stimulating dopamine release, the decrease in the production of these hormones coupled with some underlying mental issues or previous history of depression or anxiety becomes the most common and the biggest cause of PPD.<a href="#accordion">[2][3][7]</a> 
&nbsp;

While screening of postpartum depression can be done by several tools that are used for Major Depressive Episodes (MDE), the most universally acceptable tool targeted especially for PPD is Edinburgh Postnatal Depression Scale or EDPS. EDPS is a 10-item questionnaire with a response score of 0 to 3. If the total score is over 12, then there is a need for further in-depth assessment of the situation and severity of the condition.&nbsp;

PPD is best diagnosed by your medical practitioner through regular visits. Your doctor asks a series of questions every few days to assess your mental health and well-being. Another way to differentiate PPD from baby blues is to ensure that the patient has at least 3-5 of the symptoms that make up PPD. The generalized diagnostic criteria used for PPD are similar to the one used for Major Depressive Episode (MDE). Immediate attention is recommended to avoid any worsening of the symptoms and from transitioning of PPD to postpartum psychosis. 
&nbsp;

So far, the treatment of postpartum depression is similar to that of conventional major depressive disorder. Special attention is paid to the excretion of the drug and the concentration of the drug removed from the body through breast milk.

The following antidepressants are commonly used to treat postpartum depression due to their low levels of excretion in breast milk, making it safe for use if you are a breastfeeding mother:

<ul>
</ul>

<ul>
	<li>Fluoxetine</li>
	<li>Paroxetine</li>
	<li>Sertraline</li>
	<li>Bupropion</li>
	<li>Amitriptyline</li>
	<li>Doxepin</li>
	<li>Desipramine</li>
	<li>Tranylcypromine</li>
	<li>Trimipramine</li>
	<li>Desipramine</li>
	<li>Paroxetine</li>
	<li>Escitalopram</li>
</ul>

These antidepressants come with some common side effects that include nausea, vomiting, dizziness, sexual issues, diarrhea, blurry vision, weight gain, increased perspiration, etc.<a href="#accordion">[6]</a> 
&nbsp;

Brexanolone (under the brand name of Zulresso) got approved by the FDA as the first drug targeted toward PPD. Brexanolone is approved with a Risk Evaluation and Mitigation Strategy (REMS) which means that it is currently a controlled medicine available through a restricted distribution channel to carefully assess the conditions of the patients throughout the treatment. The program is currently known as Zulresso REMS Program.<a href="#accordion">[5]</a>&nbsp;Currently, to get Brexanolone administered to you for treating your PPD, you are required to enroll in the Zulresso REMS program.&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Mechanism Of Action</h5>
	</li>
</ul>

Brexanolone is a synthetic form of allopregnanolone. Allopregnanolone is a neurosteroid. Neuroactive steroids are a group of substances that change a receptor&rsquo;s response to a stimulus by binding to them.<a href="#accordion">[4]</a>&nbsp;Allopregnanolone is best understood as a metabolite of progesterone, which is a GABA-A receptor agonist. This means that progesterone is responsible for increasing GABA functions.

The exact mechanism of the drug and of allopregnanolone is still unknown. Their enhancement of the functions of GABA (Gamma-aminobutyric acid) means that it will inhibit neuronal excitability by blocking messages that are sent to our nervous system with the help of certain stimuli. This not only aids in dealing with depressive triggers but also helps with anxiety.<a href="#accordion">[1]</a> 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Dosage And Administration</h5>
	</li>
</ul>

Zulresso is administered intravenously. The dosage is determined by your doctor based on your weight and other factors. The drug is administered over a period of 2.5 days or 60 hours and requires constant monitoring due to the risk of unconsciousness.<a href="#accordion">[5]</a> 
&nbsp;

<ul dir="ltr">
	<li>
	<h5 dir="ltr">Adverse Effects</h5>
	</li>
</ul>

Since the drug is relatively new, there are a limited number of side effects reported so far. They include:

<ul>
	<li>Dry mouth</li>
	<li>Dizziness</li>
	<li>Flushed skin</li>
	<li>Losing consciousness</li>
</ul>

<h5 dir="ltr">Important!</h5>

FDA has advised to stop the treatment of Zulresso if more serious side effects occur that may include the worsening of PPD and suicidal thoughts especially in women under the age of 25. 
&nbsp;

Current research suggests that brexanolone may interact with other CNS depressants like opioids and benzodiazepines and increase the severity of the adverse effects with regard to sedation. Alcohol consumption is also not advised due to similar reasons.

During the clinical trials, patients who were taking antidepressants also showed a more severe case of sedation as compared to the ones who did not or were a part of the placebo studies. 
&nbsp;

Conclusion

Considering the rapid onset of action with brexanolone especially when compared to the long-term treatments offered by conventional antidepressants, it is believed that brexanolone can take over the go-to therapy for PPD. However, a much more convenient way of administration would be through oral pills instead of I/V. There are still many concerns left that can only be answered through long-term data in a lesser restricted environment as opposed to a clinical trial setting.&nbsp; 
&nbsp;

Key Points

<ul>
</ul>

<ul>
	<li>Current antidepressant therapies employed for PPD are based on&nbsp;long-term treatment.</li>
	<li>Brexanolone&rsquo;s onset of action is fast and has shown significant improvement in women of all ages suffering from PPD.</li>
	<li>Some women under the age of 25 were observed to experience severe side effects that even led to the worsening of their PPD.</li>
	<li>The drug is still under strict observation with the help of the REMS program.</li>
	<li>Administration coupled with the duration over which it has to be administered can make it difficult to commercialize as compared to drugs that are available in the form of oral pills.&nbsp;</li>
</ul>

[1] Allen B, Vespa PM. Antiseizure medications in critical care: An update. Curr Opin Crit Care. 2019;25(2):117-125

[2] ATP Science, 2021. HOW DOES PROGESTERONE CREATE A DOPAMINERGIC RESPONSE?. [Online] .

[3] Debra Fulghum Bruce, P., 2020. Postpartum Depression. [Online].

[4] Fala, L., 2019. Approved by the FDA Specifically for Postpartum Depression in Adults. [Online]

[5] Federal Drug Administration, 2019. FDA approves first treatment for post-partum depression. [Online]

[6] Fields, L., 2021. Which Antidepressants Treat Postpartum Depression?. [Online]

[7] Matthew Hoffman, M., 2021. Estrogen and Women's Emotions. [Online]

[8] Mayo Clinic, 2022. Postpartum depression. [Online]

Getting Back To Working Out After Giving Birth

The weeks after one&rsquo;s delivery can be as stressful as they are joyous. Newborn babies need constant attention and it&rsquo;s difficult to take out time to care for oneself. When the baby is down for a nap, it&rsquo;s our chance to get some sleep too or catch up on chores. Naturally, there&rsquo;s very little time or mental space for fitness and physical activity. Plus, there&rsquo;s the physical exhaustion that comes with long nights and breastfeeding. 
However, taking care of our bodies is essential to recovering quickly from pregnancy and childbirth. Taking time out for fitness enables us to better manage the stressors that come with a newborn baby, both physically and emotionally. This, in turn, ensures that we are able to enjoy the joys of new motherhood as well.

<div>&nbsp;</div>

time to recover body

As a new mother, it&rsquo;s important to ensure that you are consuming all of the nutrients that are essential to your health and recovery. If you are breastfeeding, it is even more important that you consume a nutritious diet.&nbsp;

Try to include a good amount of protein in your diet, as well as good fats and essential fatty acids. Eating a sufficient amount of carbs will give you the energy you need to keep up with your baby. Make sure to include fruits and nutrients in your diet as they are an important source of <a href="https://merisehat.pk/article/a-guide-to-essential-vitamins-and-micronutrients-and-should-you-be-taking-them">micronutrients and fibre</a>.&nbsp;

If you have a straightforward vaginal delivery, you can start with gentle movement in the form of short walks as soon as the day you deliver; however, you will have to wait till your epidural has been taken out. If you delivered via a caesarean or faced postpartum complications, you may have to wait a few extra days to give your body time to recover.&nbsp; 
&nbsp;

<h5>Moderate Walking</h5>

Easy to moderate walking is the best way to start moving after childbirth. You can start with just 20 minutes a day and gently build up to half an hour over the course of four to six weeks. Consider breaking up your walks into several walks a day to avoid tiring yourself out and being able to fit them in more easily into your newborn&rsquo;s routine. You could start with two 10-minute walks a day, build that up to two 12-minute walks after a few days and so on. Walking burns calories, while also strengthening muscles and joints, and improving blood circulation. 
&nbsp;

<h5>Postpartum Exercises</h5>

Incorporate gentle postpartum exercises and stretches into your routine in the first few weeks after a delivery. There is a lot of information online about safe postpartum exercises. You can look some up and aim to do them for five minutes a day. YouTube videos focused on postpartum exercises can also be easy to follow along, and if you&rsquo;d like the opportunity to get out of the house, a postpartum exercise or yoga class might just be the thing for you. As with walking, start with just a few minutes a day and slowly build up as your body adjusts.

Your pelvic floor and core tend to be particularly weak after childbirth. Before you move onto high-impact exercises, it is important to build some strength in these parts of the body. You can start doing gentle pelvic exercises, like kegels and pelvic tilts in the first week after your delivery. Aim to do them for about five minutes at a time, up to three times a day. Again, there&rsquo;s no need to do long sessions and tire yourself out. Fitting in smaller movement sessions throughout the day will ensure that you are able to be consistent and don&rsquo;t end up pushing yourself too much.

About a month after childbirth, you can start exercising core exercises into your routine. Again, this also depends on what kind of delivery you&rsquo;ve had and whether you faced any complications during or after. Once again, incorporate a few minutes of core work into your daily movement sessions and break it up into two to three sessions a day.&nbsp; 
&nbsp;

<h5>As A Rule Of Thumb</h5>

You should wait at least six weeks after childbirth to get into high-impact exercises. It&rsquo;s important to prepare your body in the preceding weeks and to also take it slow when you do start with higher impact movement. Make sure to consult your doctor and get their okay beforehand. Even at this stage, start slowly and listen to your body. There&rsquo;s no need to push forward from the get go. What&rsquo;s important is that you maintain consistency and build up in a manner that is doable for you. 
&nbsp;

It&rsquo;s easy to forget to take care of ourselves in the first few months after childbirth. But we need to remember that we need as much love and care as our newborn babies do. Being kind to yourself and patient with your body is especially important after a delivery. Remember, the healthier you feel, the better you&rsquo;ll be able to enjoy the time you get with your newborn!

Ayesha Binte Rashid

Back Pain And Sleep Problems - What’s The Connection?

Introduction

Back pain and <a href="https://merisehat.pk/article/are-you-sleeping-on-your-sleep-cycle">sleep</a> problems can be a vicious cycle. However, there are ways to alleviate both issues and promote better overall health.

&nbsp;

Understanding the link between Back Pain and Sleep Issues

Back pain and sleep problems are two of the most common health issues that affect millions of people worldwide.

In particular, low back pain, which is considered a primary cause of disability worldwide, is a widespread condition and it affects individuals of all ages<a href="#accordion">[3]</a>. Based on the 2015 Global Burden of Disease Study, the global prevalence of activity-limiting low back pain was 7.3%, which means approximately 540 million individuals were affected at any given time<a href="#accordion">[3]</a>.

Low back pain is more likely to occur in individuals who have certain lifestyle habits, such as engaging in physically demanding occupations, smoking, and having low levels of physical activity.

Back pain and sleep issues are often interconnected, with one affecting the other. When a person suffers from back pain, it can be challenging to get a good night&#39;s sleep. The lack of sleep can then exacerbate the pain, leading to a vicious cycle of pain and sleeplessness. Lack of sleep can also affect mood and energy levels, making it harder to cope with pain. 
&nbsp;

<h5>Understanding Back Pain</h5>

Back pain is a common problem that can be caused by a variety of factors, including injury, poor posture, and aging. The pain can range from mild discomfort to severe. Moreover, it can be localized or radiating to other areas of the body.

Some common symptoms of back pain include stiffness, muscle spasms, and difficulty moving or standing.

A study conducted on 9,611 participants using cross-sectional methodology has shown that inadequate sleep duration and poor sleep quality are linked to low back pain<a href="#accordion">[1]</a>. 
&nbsp;

<h5>Understanding Sleep Problems</h5>

Sleep problems can be caused by a variety of factors, including stress, anxiety, depression, and physical pain.

When a person experiences back pain, falling asleep and staying asleep can be difficult. Certain sleep disorders like sleep apnea can also cause back pain due to abnormal sleeping positions. 
&nbsp;

Fortunately, several strategies can improve both back pain and sleep problems. Here are some tips: 
&nbsp;

<ol>
	<li>
	<h5>Exercise</h5>
	</li>
</ol>

Regular exercise, especially low-impact activities, like walking, swimming, or yoga, can help strengthen the muscles supporting the spine and improve overall fitness. This can help reduce back pain and improve sleep quality. 
&nbsp;

<ol start="2">
	<li>
	<h5>Improve The Sleep Environment</h5>
	</li>
</ol>

Make sure the mattress, pillows, and bedding are comfortable and supportive. Keep the bedroom dark, quiet, and cool, and limit screen exposure before bedtime. Here are some additional tips for better sleep patterns with back aches. 
&nbsp;

Choosing The Right Mattress And Pillow

<ul>
	<li>Use a supportive mattress</li>
	<li>Use a cervical or ergonomic pillow to support and align the neck and spine 
	&nbsp;</li>
</ul>

Sleep Position

<ul>
	<li>Avoid sleeping on the stomach</li>
	<li>Place a pillow between the knees when sleeping on the side</li>
	<li>Use a pillow to support the spine when sleeping on the back 
	&nbsp;</li>
</ul>

Practice Good Sleep Hygiene

<ul>
	<li>Develop a consistent sleep routine, i.e., going to bed and waking up at approximately the same time every day.</li>
	<li>Avoid caffeine and nicotine in the hours leading up to bedtime</li>
	<li>Avoid large meals close to bedtime 
	&nbsp;</li>
</ul>

<ol start="3">
	<li>
	<h5>Try Relaxation Techniques</h5>
	</li>
</ol>

Meditation, deep breathing, or progressive muscle relaxation can help reduce stress and promote relaxation, which can help improve sleep quality and reduce back pain. 
&nbsp;

<ol start="4">
	<li>
	<h5>Consider Physical Therapy</h5>
	</li>
</ol>

A physical therapist can help develop an exercise program tailored to the individual needs of the person to help reduce pain and improve flexibility. 
&nbsp;

<ol start="5">
	<li>
	<h5>Consider Alternative Therapies</h5>
	</li>
</ol>

Acupuncture, chiropractic care, or massage therapy may also help reduce back pain and improve sleep quality. However, it&rsquo;s important to consult a healthcare professional before trying any alternative therapies. 
&nbsp;

<ol start="6">
	<li>
	<h5>Manage Stress</h5>
	</li>
</ol>

Stress can exacerbate back pain and disrupt sleep, so find ways to manage stress. This includes scheduling a specific time of the day to worry about everything going on in life.

Another technique is to form a habit of journaling. Writing down worries, especially anything that triggers anxiety before sleep, helps them get out in the open so that it can be addressed.

Moreover, a to-do list for the following day can help instill a sense of achievement as well as deal with all the worries before bedtime. 
&nbsp;

Back pain and sleep problems are two of the most common health issues that affect people worldwide. These issues are often interconnected, with one affecting the other. Practicing good sleep hygiene, using proper sleeping positions, engaging in regular exercise, stretching before bed, and seeking professional help can improve both back pain and sleep problems. Remember, caring for the body is essential for a healthy and fulfilling life. 
&nbsp;

Key Takeaways

<ul>
	<li>Back pain can make it difficult to get comfortable in bed, leading to sleep problems.</li>
	<li>Poor sleep can worsen back pain by causing muscle tension and reducing the body&#39;s ability to heal and repair itself.</li>
	<li>Common causes of back pain and sleep problems include poor sleeping posture, an uncomfortable mattress, a sedentary lifestyle, stress, and medical conditions.</li>
	<li>To improve sleep and reduce back pain, it&#39;s important to prioritize healthy sleep habits and address any underlying issues.</li>
</ul>

[1] Murase K, Tabara Y, Ito H, et al. Knee Pain and Low Back Pain Additively Disturb Sleep in the General Population: A Cross-Sectional Analysis of the Nagahama Study. PLoS One. 2015;10(10):e0140058. Published 2015 Oct 7. doi:10.1371/journal.pone.0140058.

[2] Vos T, Allen C, Arora M, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the global burden of disease study 2015. The Lancet. 2016;388(10053):1545-1602. doi:10.1016/s0140-6736(16)31678-6.

[3] Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. The Lancet. 2018;391(10137):2356-2367. doi:10.1016/s0140-6736(18)30480-x.

Neelam Asad

Medilink Consultant clinic

ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Menopause And Breast Cancer

According to research, in all of Asia, Pakistan has the highest rate of <a href="https://merisehat.pk/disease/side-effects-of-breast-cancer-treatment">breast cancer</a>, with 1 in 9 women at risk of getting diagnosed with breast cancer<a href="#accordion">[7]</a>&nbsp;<a href="#accordion">[6]</a>. This is usually because of the myths associated with the condition. Delayed screening means the cancer is diagnosed when it has advanced and there is little chance of survival.

Understanding the link between Menopause and Breast cancer

Age is one of the major risk factors for developing breast cancer. The likelihood of being diagnosed with a malignant tumor in the breast is greatest between the ages of 45 and 55. Unless an individual has previously undergone chemotherapy, surgeries such as hysterectomy or oophorectomy, or possesses a genetic predisposition to experience early menopause, this is when a natural decline in hormone levels occurs.

The decreased production of estrogen and progesterone leads to irregular menstrual periods before they eventually cease. During this phase, one may experience hot flashes, sexual difficulties, insomnia, memory problems, osteoporosis, and anxiety.

However, menopause itself is not our concern here. Menopause itself is not related to a higher risk of getting cancer. It&rsquo;s the fact that 1 out of 8 cases of breast cancer occur during their lifetime, mostly in women over 50, that&rsquo;s worrisome<a href="#accordion">[8]</a>. This is why the age factor is important &ndash; a girl who starts menstruating before 12 and/or experiences menopause after 55 will have an increased number of ovulations and, thereby, increased exposure to hormones like estrogen.

And then there&rsquo;s the issue of medications or treatments like hormone replacement therapy one may be taking to manage the menopausal symptoms, which increases the risk of breast cancer. 
&nbsp;

While menopause is a risk factor for breast cancer, interestingly, breast cancer can also induce menopause. Treatments like chemotherapy, ovarian suppression (through surgery, hormone therapy, or radiotherapy), and hormone therapy (e.g., anastrozole, exemestane, letrozole, and tamoxifen) cause menopausal symptoms<a href="#accordion">[9]</a>.&nbsp; While each woman reacts differently to therapy, premature menopause due to breast cancer may be permanent (rather than temporary) if they&rsquo;re closer to the natural age of experiencing it. 
&nbsp;

Menopausal signs that are frequently experienced include:

<ul>
	<li>Joint pain</li>
	<li>Night sweats</li>
	<li>Anxiety and irritation</li>
	<li>Mood change</li>
	<li>Heart palpitations</li>
	<li>Change in libido</li>
	<li>Hot flushes</li>
	<li>Changes to hair and skin</li>
	<li>Weight gain, especially around our waist</li>
	<li>Difficulty sleeping</li>
	<li>Memory issues</li>
	<li>Vaginal dryness 
	&nbsp;</li>
</ul>

The onset of these symptoms can be gradual or sudden. It is worth mentioning that not all individuals experience all the listed symptoms, and the severity of symptoms can vary among individuals. 
&nbsp;

The estrogen-driven breast cancers, also known as estrogen-receptor-positive cancers, are a more common occurrence than aggressive cancers. They tend to develop gradually and have a lower mortality rate. In other words, they require less aggressive therapy and have a better outlook and reduced chance of recurrence.

According to studies, if you&rsquo;re overweight or obese post-menopause, you have a 20-60% greater risk of developing breast cancer than those who are lean<a href="#accordion">[10]</a>. This extra fat is the main source of estrogen at that time. It also produces proteins that increase inflammation throughout the body, which causes breast cancer to recur. 
&nbsp;

<h5 style="text-align:justify">Medications</h5>

There are two distinct kinds of drugs, and they both function differently. Aromatase inhibitors (AIs) reduce or halt the body&#39;s production of estrogen, which causes the tumors to die. Tamoxifen prevents estrogen from acting on breast cancer cells.

Both tamoxifen and an aromatase inhibitor can be used to treat postmenopausal individuals with estrogen-positive breast cancer. However, aromatase inhibitors are generally more effective and do not increase the risk of blood clots or uterine cancer<a href="#accordion">[10]</a>. 
&nbsp;

Exercising, a balanced diet, quitting smoking (including avoiding passive smoking) and drinking alcohol, and relieving stress can help breast cancer patients deal with the symptoms. 
&nbsp;

Menopause can be a risk factor for breast cancer and vice versa. However, you can overcome both issues with a balanced diet, a healthy lifestyle, proper checkups, and the right therapy.

[1]Sohail S, Alam SN. Breast cancer in Pakistan-awareness and early detection.

[2] Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. International journal of cancer. 2010 Dec 15;127(12):2893-917

[3] Clemons M, Simmons C. Identifying menopause in breast cancer patients: considerations and implications. Breast cancer research and treatment. 2007 Aug;104:115-20.

[4] Biglia N, Bounous VE, Sgro LG, D'Alonzo M, Pecchio S, Nappi RE. Genitourinary syndrome of menopause in breast cancer survivors: are we facing new and safe hopes?. Clinical Breast Cancer. 2015 Dec 1;15(6):413-20.

[5] De Villiers TJ, Pines A, Panay N, Gambacciani M, Archer DF, Baber RJ, Davis SR, Gompel AA, Henderson VW, Langer R, Lobo RA. Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric. 2013 Jun 1;16(3):316-37.

[6] Academic.oup.com.

[7] Khan NH, Duan SF, Wu DD, Ji XY. Better Reporting and Awareness Campaigns Needed for Breast Cancer in Pakistani Women. Cancer Manag Res. 2021;13:2125-2129. Published 2021 Mar 2. doi:10.2147/CMAR.S270671

[8] NHS choices.

[9] Menopausal symptoms and breast cancer. Breast Cancer Now.

[10] Stepko B, En español , español E, 03 O. Dealing with breast cancer after menopause. AARP

Syeda Qurat-ul-Ain

Importance Of Insulin In Diabetic Care

Nearly 463 million people in the world are diagnosed with <a href="https://merisehat.pk/disease/diabetes-a-complete-overview">diabetes</a>, out of which nearly 150-200 million people need insulin therapy for their health<a href="#accordion">[1]</a>.

If you have type 1 diabetes, you&rsquo;ll have to inject insulin on a regular basis to use glucose from meals and, basically, to survive. This is because your pancreas is no longer making any insulin or producing an insufficient amount of the hormone.

If you have type 2 diabetes, your body may be producing insulin, but due to the fact that you&rsquo;re overweight or inactive, it may not be utilizing the hormone properly. This is called insulin resistance. You may need insulin shots to help your body control high blood glucose levels or hyperglycemia.

About 5-10% of pregnant women develop gestational diabetes<a href="#accordion">[4]</a>&nbsp;If you have gestational diabetes, you may need to inject insulin as well to manage your blood glucose levels until the baby is born. 
&nbsp;

Understanding the importance of Insulin

Understanding the role of insulin therapy as part of diabetes treatment becomes a whole lot easier when you understand how the hormone typically works and what happens when you get diabetes. 
&nbsp;

<ul>
	<li>
	<h5>Regulating Blood Sugar Levels</h5>
	</li>
</ul>

When you eat or drink, your body breaks down the carbs into glucose, which is the primary source of energy for your body. This glucose enters the bloodstream, signaling the pancreas to release insulin. Insulin helps the blood sugar to enter the cells where it can be used as an energy source.

It also helps the blood sugar to be stored in the liver as glycogen for later use; in case of low insulin levels between meals, the liver releases this stored sugar, ensuring the blood sugar levels are within a narrow range. 
&nbsp;

As a result, the blood sugar levels in the bloodstream decrease and, accordingly, the insulin levels decrease, too.

The problem arises when there&rsquo;s a lot of blood sugar in the bloodstream. The pancreas either has difficulty keeping up with the rising blood sugar levels or the cells stop responding to all the insulin, which is why you need therapy. 
&nbsp;

<ul>
	<li>
	<h5>Preventing Diabetic Complications</h5>
	</li>
</ul>

Untreated high blood glucose can lead to various complications. This includes nerve damage, blindness, foot ulcers, kidney damage, heart disease, and stroke. There is lots of insulin in the bloodstream, too, instructing the liver and muscles to take up the excess blood sugar; when their capacity is full, the extra blood sugar is sent to fat cells and is stored as body fat, resulting in weight gain and increasing the risk of type 2 diabetes. Insulin therapy is crucial to managing blood sugar levels to reduce the risk of developing these life-threatening complications and also to maintain overall better health. 
&nbsp;

<ul>
	<li>
	<h5>Correcting Insulin Deficiency</h5>
	</li>
</ul>

Your body&rsquo;s immune system may mistakenly destroy the insulin-producing cells in the pancreas if you have type 1 diabetes. This leads to a complete deficiency of insulin. Some individuals with type 2 diabetes struggle when they don&rsquo;t have enough insulin or when other treatment options (e.g., oral medications) are not effective in controlling blood sugar. Insulin treatment supplements or replaces natural insulin with the aim to achieve normal blood glucose levels. 
&nbsp;

<ul>
	<li>
	<h5>Meal Scheduling</h5>
	</li>
</ul>

A lot of factors, including lifestyle and weight, influence your insulin therapy. Planning meals helps because you can then determine your insulin regimen (insulin pump therapy or multiple injections every day) according to the amount of carbohydrates you consume in a meal. It gives you the liberty to enjoy a varied diet along with better glycemic control. 
&nbsp;

<h5>Other Functions Of Insulin</h5>

Insulin is also involved in<a href="#accordion">[2]</a>:

<ul>
	<li>Modification of enzyme activity and the subsequent reactions in the body</li>
	<li>Management of the synthesis of lipids</li>
	<li>Uptake of potassium and amino acids by cells and regulate DNA replication and synthesis of proteins</li>
	<li>Management of the breakdown of lipids and proteins because of changes in fat cells</li>
	<li>Regulation of the excretion of sodium and fluid volume of urine</li>
	<li>Building muscle post-injury or sickness</li>
	<li>Enhance the memory 
	&nbsp;</li>
</ul>

Important!

<ul>
	<li>Starting insulin therapy can be frightening. Consult your doctor to know more about the type of insulin you need. Make sure you know how, when, and where to inject insulin, and also how to rotate your injection sites.</li>
	<li>Always keep a proper record of your insulin dose and your blood glucose levels.</li>
	<li>Insulin should be stored correctly for usage. Extreme (hot and cold) temperatures damage insulin.</li>
	<li>Proper disposal of syringes, lancets, pen needles, and cannulas is important.</li>
	<li>Inform a doctor if you need help adjusting your insulin doses. This change may be due to changes in diet, increased or decreased exercise, illness, medication, weight loss or weight gain, etc.</li>
	<li>Contact a doctor if you have any problems taking insulin or if you notice any side effects. 
	&nbsp;</li>
</ul>

Insulin is an important hormone that controls how tissues and cells absorb energy. Insulin shots are effective in counteracting the effects of insulin resistance or deficiency. While people with type 1 diabetes have to inject insulin for the rest of their lives, the majority of people with type 2 diabetes may not need it<a href="#accordion">[3]</a>. Regular blood sugar monitoring and close communication with healthcare providers are essential for optimizing insulin therapy and achieving optimal diabetes management. 
&nbsp;

[1] Buse JB, Davies MJ, Frier BM, Philis-Tsimikas A. 100 Years on: The impact of the discovery of insulin on clinical outcomes. BMJ Open Diabetes Research &amp; Care

[2] Smith Y. Insulin’s role in the human body. News.

[3] An overview of insulin. Medical News Today.

[4] Department of Health &amp; Human Services. Diabetes and insulin. Better Health Channel.

Shermeen Zuberi

The Impact Of Stress On Weight Gain/Loss And Mental Health

In today&#39;s fast-paced and demanding world, <a href="https://merisehat.pk/disease/stress">stress </a>has become an inevitable part of our lives. Whether it&#39;s due to work pressure, relationship issues, financial concerns, or any other life challenge, stress affects us all at some point. Not only does stress take a toll on our mental well-being, but it can also have a profound impact on our physical health, particularly when it comes to weight gain or loss. 
&nbsp;

&quot;I always tell my clients to have fun when working out with me,&quot; says 33-year-old Ahsan Shah, a fitness trainer and consultant based out of Karachi with over 15 years of experience in managing fitness and weight loss with clients in both Karachi and Dubai. &quot;If they&#39;re not having fun and are stressed out, it will impact not only their motivation but also their cortisol levels,&quot; he says. &quot;This affects everything: whether they will be consistent in pursuing a healthy exercise and diet regimen and most importantly, how their body will respond to it.&quot;&nbsp;

&nbsp;

Weight gain and Stress

<h5>Weight Gain And Stress</h5>

Stress can significantly contribute to weight gain for various reasons. One of the main factors is the hormonal response triggered by stress. When we are under stress, our body releases cortisol, often referred to as the &quot;stress hormone.&quot; Cortisol plays a crucial role in regulating metabolism, blood sugar levels, and energy balance. However, prolonged or chronic stress can lead to consistently elevated cortisol levels, which can disrupt these processes.

Increased cortisol levels can cause an increase in appetite, particularly for foods that are high in sugar, fat, and calories. This can lead to overeating and indulging in unhealthy food choices as a way to cope with stress. Additionally, cortisol can promote the accumulation of fat, especially around the abdominal area, which is associated with an increased risk of various health problems, including cardiovascular diseases and<a href="https://merisehat.pk/disease/diabetes-type-1-and-2"> type 2 diabetes</a>.

Furthermore, stress can disrupt sleep patterns. Lack of sleep or poor-quality sleep is linked to weight gain as it affects hunger-regulating hormones, such as leptin and ghrelin. When we don&#39;t get enough sleep, ghrelin levels increase, stimulating hunger, while leptin levels decrease, reducing feelings of fullness. This imbalance can lead to excessive calorie intake and weight gain over time. 
&nbsp;

<h5>Weight Loss And Stress</h5>

On the other hand, stress can also lead to weight loss in some individuals. During stressful periods, some people may experience a loss of appetite or have difficulty eating due to digestive disturbances. This can result in inadequate nutrition and unintentional weight loss. Moreover, stress can increase metabolic rate and energy expenditure, causing some individuals to burn more calories than they consume, leading to weight loss. 
&nbsp;

<h5>Mental Health And Stress</h5>

The impact of stress on mental health is widely recognized. Chronic stress can contribute to the development or exacerbation of mental health conditions such as anxiety and depression. These conditions can have a profound effect on a person&#39;s overall well-being and can further contribute to weight gain or loss.

Stress and mental health are closely intertwined. For some individuals, stress can trigger emotional eating or binge eating episodes as a coping mechanism to alleviate negative emotions. This can create a vicious cycle where stress leads to unhealthy eating habits, resulting in weight gain, and in turn, worsening mental health symptoms.

Conversely, stress can also lead to loss of appetite, decreased interest in food, or even disordered eating patterns. In severe cases, chronic stress can contribute to the development of eating disorders like anorexia nervosa or bulimia nervosa, which can have serious consequences on both physical and mental health. 
&nbsp;

<h5>Managing Stress And Promoting Well-being</h5>

To mitigate the negative effects of stress on weight and mental health, it is crucial to implement effective stress management strategies. Here are some recommendations: 
&nbsp;

<ul>
	<li>Regular Exercise: Engaging in physical activity can help reduce stress levels, promote weight management, and enhance overall well-being. Exercise releases endorphins, the body&#39;s natural mood elevators, which can counteract the negative impact of stress hormones. 
	&nbsp;</li>
	<li>Balanced Diet: Adopting a balanced diet rich in whole foods, fruits, vegetables, lean proteins, and healthy fats can support both physical and mental health. Avoid using food as a coping mechanism for stress and opt for healthier stress-relief strategies. 
	&nbsp;</li>
	<li>Adequate Sleep: Prioritize good sleep hygiene and aim for seven to eight hours of quality sleep each night. Establishing a consistent sleep routine can improve stress resilience, aid in weight management, and enhance mental clarity. 
	&nbsp;</li>
	<li>Stress Reduction Techniques: Explore stress reduction techniques such as meditation, deep breathing exercises, yoga, or mindfulness practices. These techniques can help calm the mind, reduce cortisol levels, and promote relaxation. 
	&nbsp;</li>
	<li>Seek Support: Don&#39;t hesitate to reach out for support from friends, family, or mental health professionals. Talking about your stressors and emotions can provide relief and help you develop healthier coping mechanisms. 
	&nbsp;</li>
</ul>

bottom Line

Stress can have a significant impact on both weight management and mental health. It is important to recognize the interplay between stress, weight gain/loss, and mental well-being. By implementing effective stress management strategies and seeking support when needed, individuals can better navigate the challenges of stress and promote their overall health and well-being.

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

Behind The Scenes Of Postpartum Care

Your body has endured the most rigorous and remarkable changes to do something extraordinary: give birth to another human being. For 9 months, you took the necessary precautions, went to the best doctors to receive top-notch medical care, and followed all maternity books to ensure your baby finds its new abode comfortable.&nbsp;

&nbsp;

9 months and a healthy baby later, you are enveloped with maternal joy. What worries you now is natal development. While your concern is justified, it is necessary to remember that you need rest as well. For 9 months you were completely selfless and now, for the 12 weeks following the delivery, you must direct your time and energy to recuperate, heal, and recover.&nbsp;

<div>&nbsp;</div>

Understanding The Importance of Postpartum Care

There may have been unprecedented or unanticipated events during delivery. The delivery might have been riddled with complications or it might have been traditionally simple. You might have undergone a cesarean birth (C-section) or the doctor might have suggested a vaginal delivery. Your labor might have lasted for a couple of hours or even a day. Regardless of what your delivery situation resembled, your body has had to deal with an outstanding and remarkable trauma, and consequently, it needs to compensate for it with the appropriate time to recover and heal.&nbsp;

&nbsp;

Your postpartum journey could be by the book or it could be unique. But, at the end of the day, your hormones will fluctuate, and so will your body. You will feel puzzled and bewildered, confused and alone. It&rsquo;s easy to be excited yet intimidated. All these emotions are justified and appropriate.&nbsp;

&nbsp;

Remember, you should never hesitate to <a href="https://merisehat.pk/doctor-now">reach out to a doctor</a> for a safe consultation and to update them on your situation. Finding refuge and comfort with friends and family is also encouraged.

<div>&nbsp;</div>

So, you assumed labor was difficult? Well, think again. Postpartum changes after vaginal delivery necessitate conversations with your OB/GYN before delivery, so that you can have a relatively well-organized recovery. Some changes that you can expect include the following:

&nbsp;

<h5>Vaginal Soreness</h5>

Vaginal tears during labor are medically known as perineal lacerations (episiotomy) or just tears. It can occur in either of the two circumstances: (a) the child&#39;s head is getting through the vaginal opening and is excessively huge for the vagina to dilate around; or (b) the head is a typical size, but the vagina is unable to fully extend. These sorts of tears are normal and are made between the vagina and the anus<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

Post-delivery, these tears heal at a gradual pace and, therefore, cause vaginal soreness and discomfort. To ease and cope with the pain, an individual could try different home remedies and medications, such as:

i) Placing an ice pack on the tear or sitting on a padded pillow.

ii) Use warm water while washing the area, to ensure the prevention of any infection of the wound. Cool water can also be used if an individual finds it to be more soothing.

iii) Investing in a witch hazel pad sanitary napkin, cool for a while before placing it on the tear, which is usually localized between the vaginal opening and anus (perineum)<a href="#accordion">[5]</a>.

iv) Consult the doctor for painkillers and laxatives to help you deal with painful stools or constipation.

&nbsp;

During the postpartum visit to the doctor, inform them of every symptom, as any slight development could be an indication of an infection. 
&nbsp;

<h5>Vaginal Discharge</h5>

Vaginal discharge postpartum is called Lochia and contains a mix of&nbsp; uterine tissue, blood and mucus. The discharge is dark colored and released in copious amounts&nbsp; for the first couple of days, and later it becomes paler and the amount of discharge reduces<a href="#accordion">[4]</a>.&nbsp;

&nbsp;

To be on the safe side,&nbsp; doctors advise against the use of tampons or vaginal douching until 4-6 weeks in the postpartum period. The involvement of such items&nbsp; in the early postpartum period increases the risk for uterine infection.&nbsp;

&nbsp;

If your vaginal discharge is putrid or pungent, refrain from using heavily scented vaginal cleansers and inform your doctor to avoid future complications. If you are experiencing heavy vaginal bleeding, such that the sanitary pad is soaked in a matter of hours then you must contact your primary care physician<a href="#accordion">[4]</a>. 
&nbsp;

<h5>Incontinence</h5>

Pregnancy and consequently labor has been associated with the stretching of the pelvic floor muscles, which bolster the uterus, bladder, and rectum<a href="#accordion">[4]</a>. This stretching can weaken the pelvic floor muscles leading to a possibility of incontinence or the lack of bladder control. For instance, urine might leak when you laugh, sneeze, or cough.&nbsp;

&nbsp;

While incontinence decreases after a few weeks, it is incredibly frustrating and embarrassing, especially in public. To avoid any unfortunate incidents, you could try wearing protective pads or diapers and exercising to tone the pelvic floor muscles. A specific set of exercises called Kegel (also known as pelvic floor muscle training) can be practiced thrice a day. Sit on a stable and flat surface and tighten the pelvic floor muscles as if you&rsquo;re stopping yourself from going to the toilet. Begin with tightening and quickly releasing the muscles. After some time, you can hold a contraction for at least 5 seconds. Try doing 8 squeezes for each set<a href="#accordion">[6]</a>. 
&nbsp;

<h5>Hemorrhoids</h5>

If you feel discomfort during bowel movements and there&#39;s swelling near your anus, then you might have a case of hemorrhoids. It is a swelling of veins in the rectum, which is usually caused during your pregnancy. If not, you might have gotten them from the excessive strain and forceful pushing at the time of your delivery. Hemorrhoids are extremely painful, and cause itching and bleeding after defecation<a href="#accordion">[2]</a>.

&nbsp;

Here are a few things you can try to ease the pain:

i) Use a topical hemorrhoid cream that is easily accessible at pharmacies or any cream containing hydrocortisone.

ii) Opt for pads that are made of witch hazel to soothe the affected area.

iii) Go for a Sitz bath i.e. Soaking the hips and buttocks in warm water for around 10-15 minutes twice or thrice a day. Sitz baths help in reducing swelling.&nbsp; &nbsp;

iv) If you are avoiding defecation due to hemorrhoids and if the situation has been aggravated due to constipation after delivery, then it is suggested to consult a doctor for laxatives. Also, make sure you have a diet rich in fiber and you&rsquo;re staying hydrated. 
&nbsp;

<h5>Tender Breasts</h5>

It is common for breasts to fill up with milk after delivery for lactation. They become firm, tender, and sore; this is called breast engorgement<a href="#accordion">[2]</a>. It is suggested to alternate between breasts or even try alternating feeding positions during breastfeeding to minimize engorgement.&nbsp;

&nbsp;

If your breasts remain engorged for a prolonged period, then it would be difficult for the baby to latch on to the nipple. To help the baby while feeding, you might rely on hand compressions or a breast pump. Additionally, to relieve yourself of pain, you could try easily accessible pain killers, take long warm showers before breastfeeding, and place cold damp cloths on your breasts during feeding<a href="#accordion">[5]</a>. 
&nbsp;

<h5>Hair Loss And Skin Changes&nbsp;</h5>

Physical changes after delivery do not just involve weight gain or weight loss. As the body is producing an abundance of hormones, hair is also produced at a faster rate than it sheds, therefore you may experience substantial hair loss, too.&nbsp;

&nbsp;

And in addition to the permanent stretch marks that transition from red to silver as they start to fade, you might witness scaly, irritated skin. This would disappear as well, but for the time being, it&rsquo;s going to be more prone to acne.&nbsp;

&nbsp;

Consulting an endocrinologist and a dermatologist after delivery could help with the management of such symptoms. These are primarily due to the hormonal changes and thus could be accompanied by other side effects such as mood swings and excessive perspiration<a href="#accordion">[5]</a>.

&nbsp;

A postpartum visit to the doctor follows a personal objective. Your doctor would discuss your symptoms in detail, such as the inconsistent contractions or uncomfortable vaginal soreness and help you find solutions to relieve your pain. Furthermore, the discussion could also involve future birth spacing, contraception, and your emotional well-being.&nbsp;

&nbsp;

The doctor would also perform a physical examination. This includes&nbsp; a thorough examination of the abdomen, vagina, cervix, and uterus to ensure there is no physical scarring or post-delivery injuries.&nbsp;

&nbsp;

This is a terrific opportunity to discuss any worries you have, including continuing sexual activity and how you are adjusting back to routine with a child, while maintaining a healthy sleep cycle and nourishing your body with sufficient nutrients. 
&nbsp;

During a C section, most individuals are conscious and are only provided local anesthesia during their surgery. Afterwards, the patient is kept under observation at the hospital for a day or two to monitor vitals and gauge any abnormal behavior of the body. This might exclude the usual grogginess and nausea after surgery, which is easily managed through prescriptions.&nbsp;

&nbsp;

While most of the changes will be similar to vaginal birth, if you are delivering your baby via a C-section, please note there would be some additional circumstances which require different care. 
&nbsp;

<h5>Rest</h5>

A cesarean is an intense surgery that drains an individual. While normally an individual is admitted for only a couple of days after a cesarean, complications might persist for a couple of weeks. It is important to soak in as much rest (both physical and mental) as you can. This is quite difficult as the individual might have to care for a demanding newborn child or there could be numerous unexpected visitors to deal with. But it&rsquo;s important that you prioritize yourself.

&nbsp;

Organize and plan for effective postpartum care before delivery. This includes hiring help, constructing a workable timetable, and asking friends and family to pitch in. Moreover, you can be happy that everyone&rsquo;s coming to meet your new bundle of joy and, at the same, excuse yourself from gatherings for some alone time to recover faster<a href="#accordion">[3]</a>.

 
&nbsp;

<h5>Minimal Activity</h5>

While moving around could help with the prevention of blood clots, most doctors advise against participating in strenuous activities such as driving, competitive swimming, vigorous exercise, and handling heavy objects.&nbsp;

&nbsp;

Take things slowly and gradually. It would take 4-8 four to eight weeks after surgery before you have enough stamina to rejoin usual activities. Listen to your gut; your body will tire easily reminding you to take a break and just rest<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

<h5>Incision Care</h5>

The region where the incision was made, is naturally covered after surgery. Consult the doctor to know when it is safe to remove the bandage. Until then, keep the incision covered. Once you receive the green signal from the doctor, remove it and clean the region with saline water regularly to protect it from infection<a href="#accordion">[2]</a>. 
&nbsp;

Postpartum depression is a type of clinical depression experienced by women after delivery<a href="#accordion">[1]</a>. It is often trivialized and misconceived. A common blunder is how frequently it&rsquo;s used interchangeably with &lsquo;baby blues&rsquo; when it&rsquo;s so much more distressing and can also worsen.&nbsp;

&nbsp;

It is characterized by a prolonged and complicated mix of emotions, where the individual frequently feels severe anxiety, despair, dejection, fear of the unknown, and gut-wrenching guilt.&nbsp;

&nbsp;

If you experience such emotions and think about harming yourself or the child, then it is extremely important to inform relevant authorities for the necessary help.&nbsp;

&nbsp;

Moreover, if partners, friends, and family members observe concerning signs and symptoms then they must consult a therapist before anyone gets hurt<a href="#accordion">[1]</a>. 
&nbsp;

Your post-pregnancy or postpartum care will not be the same as an 8-hour long sleep after a tiring day at work. Complete recovery from pregnancy, labor, and any other complication can take several months. While numerous individuals begin to feel better and invigorated after 12 weeks, it might take more time to feel like your pre-pregnancy self.&nbsp;

&nbsp;

While your concerns are totally real, however, there&rsquo;s no need to rush the healing stage. Postpartum is not a race. Do not challenge or tire or exhaust yourself to reach a weight goal, or to go back to your corporate life. During this time, you might feel like your body has betrayed you. Do whatever it takes to not get disappointed with your progress. Look for ways you can reassure yourself that your body is recovering at its own pace.&nbsp; The smartest option for you is to rest, eat well, and enjoy some well-earned respite.

<div>&nbsp;</div>

<ul><li>Postpartum care refers to the period of recovery after delivery.&nbsp;</li><li>It involves physical and mental healing.</li><li>Changes and symptoms differ according to the type of delivery - vaginal or cesarean.&nbsp;</li><li>Individuals should rest, focus on their diet, and consult a doctor for better and personalized guidance.</li><li>Postpartum depression is a condition of prolonged grief and anxiousness after delivery. Individuals should reach out for professional help if they experience symptoms of Postpartum depression. </li></ul>

[1] Cleveland Clinic. (2022, February 9). Caring For Your Health After Delivery.

[2] Family Doctor. (2020, August 28). Recovering from Delivery (Postpartum Recovery).

[3] Heningsman, S. A. (2021, December 21). 6 Tips for a Fast C-Section Recovery. Healthline.

[4] Liberto, R. (2016, December 20). Recovery and Care After Delivery. Healthline.

[5] Mayo Clinic. (2022, March 25). Postpartum care: What to expect after a vaginal birth.

[6] NHS. (2020, March 20). Episiotomy and perineal tears.

Zarlish Kazmi

Does Postpartum Hypertension Go Away?

Bringing a new life into the world is an incredible journey, but sometimes unexpected challenges can pop up, like postpartum hypertension.

In simple words, postpartum hypertension is high <a href="merisehat.pk/disease/blood-pressure">blood pressure</a> that shows up after you give birth. 
&nbsp;

Understanding postpartum hypertension

However, it doesn&#39;t stick around forever. It&#39;s like the body&#39;s way of saying, &quot;Hang on, I need a little more time to get back to normal.&quot;

The duration and severity of postpartum hypertension varies from woman to woman. Factors such as pre-existing health conditions and the presence of risk factors may influence the resolution of postpartum hypertension.

A recent study found that the condition was more commonly present in mothers who smoked, had delivered via C-section, were aged 35 and above, and were Black Americans.<a href="#accordion">[1]</a> 
&nbsp;

Other risk factors include:<a href="#accordion">[2]</a>

<ul>
	<li>Obesity</li>
	<li>Family or individual history of preeclampsia</li>
	<li>High blood pressure during pregnancy</li>
	<li>Multiple births</li>
	<li>Diabetes</li>
	<li>Autoimmune conditions 
	&nbsp;</li>
</ul>

High blood pressure usually peaks within 48 hours after delivery, which is when most women leave the hospital.

Call your doctor immediately if you have a reading of 140/90 mm Hg or higher or postpartum hypertension symptoms, such as changes in vision, shortness of breath, persisting and severe headache, abdominal pain, nausea or vomiting, and decreased urination.

Delayed treatment can lead to serious complications, including pulmonary edema, seizures, strokes, blood clots, and even death. 
&nbsp;

For a new mom, postpartum hypertension can be scary. Will it go away on its own? Will I need medications?

Postpartum hypertension treatment often revolves around a healthy lifestyle. Eating well, staying active, and catching those precious zzz&#39;s all contribute to your body&#39;s speedy recovery.

Regular check-ups with your healthcare provider ensure that any lingering high blood pressure is noticed and managed. Sometimes, they may prescribe blood pressure medicine, antiseizure medicine, and anticoagulant medications to treat it.

It could take several days to a few weeks for the blood pressure to return to a safe or manageable level. Remember, you&rsquo;ll also be recovering from childbirth itself during this time, too. So, you may experience physical and emotional changes, such as fatigue, tender breasts, cramping or vaginal discharge, and mood swings. 
&nbsp;

Your body has this remarkable ability to self-regulate and heal, ensuring that postpartum hypertension often resolves on its own. However, regular monitoring and doctor check-ups during this period can further help with a smooth transition back to pre-pregnancy blood pressure levels. 
&nbsp;

<ul>
	<li>Postpartum hypertension, or high blood pressure after giving birth, is a rare condition that affects some women during the weeks or months following delivery.</li>
	<li>Postpartum is a healing period for the body, and as it recovers from the stress of childbirth, blood pressure levels often return to normal.</li>
	<li>However, it&#39;s important to monitor postpartum hypertension through regular check-ups with a healthcare provider to ensure that it does not persist or lead to complications.</li>
	<li>Maintaining a healthy lifestyle, including a balanced diet, regular physical activity, and sufficient rest, helps blood pressure levels return to normal.</li>
	<li>In some cases, medical intervention, such as medication, may be required to manage postpartum hypertension.</li>
</ul>

[1] Sullivan K, Rauf D, Welch A, et al. New moms at risk of developing high blood pressure 6 weeks after childbirth, study finds. EverydayHealth.com. Accessed January 26, 2024.

[2] Postpartum preeclampsia: Causes, symptoms & treatment. Cleveland Clinic. Accessed January 26, 2024

The postpartum period refers to the time after you give birth. Your hormonal levels will be fluctuating as your body recovers from the physical and emotional toll of the pregnancy. You&rsquo;ll probably be overwhelmed by all sorts of emotions during this period.

Besides mood, these changes can affect your blood sugar regulation, particularly if you had <a href="https://merisehat.pk/disease/diabetes-gestational">gestational diabetes</a>. However, you can have postpartum diabetes even if you did not have gestational diabetes. 
&nbsp;

Around 2-10% of all pregnant women in the US have gestational diabetes<a href="#accordion">[1]</a>. The condition often shows up during the middle of pregnancy when the placenta produces hormones that prevent the body from efficiently using insulin. Consequently, glucose concentrates in the blood rather than being absorbed by the cells.

The best thing to do after the diagnosis of gestational diabetes is to look after yourself as much as possible. It&rsquo;s crucial to monitor blood glucose during labor and birth. While eating healthy and staying active during pregnancy can help control blood sugar levels, you may need to take insulin as well to control your blood sugar levels and avoid complications, like preeclampsia and birth defects, for you and your baby. 
&nbsp;

Insulin can be injected via pen or syringe and it&rsquo;s generally safe to use as prescribed by your doctor. Using too much insulin or skipping a meal, however, may cause hypoglycemia which can be dangerous for both you and your baby.

Note: If you have type 1 or type 2 diabetes, refer to a professional doctor before getting pregnant as uncontrolled gestational diabetes is not safe for your baby. Moreover, several diabetes tablets are not safe to be taken during pregnancy so your doctor can guide you regarding insulin injections<a href="#accordion">[2]</a>. 
&nbsp;

Understanding the importance of insulin in pregnancy

If you were diagnosed with gestational diabetes, it&rsquo;s important that you get tested for diabetes after delivery. Your doctor will order regular glucose checking for a few days after delivery, usually before breakfast and two hours after meals, to ensure your glucose levels are within the normal range. An oral glucose tolerance test is recommended 6-12 weeks after birth<a href="#accordion">[2]</a>. 
&nbsp;

If your blood glucose level is:

<ul>
	<li>Normal &ndash; Get checked every three years</li>
	<li>Pre-Diabetes &ndash; Get checked every year; talk to your doctor about minimizing your risk of diabetes</li>
	<li>Diabetes &ndash; Consult your doctor and set up a treatment plan 
	&nbsp;</li>
</ul>

The symptoms of gestational diabetes usually disappear in the postpartum period as blood sugar levels return to normal after labor and any medications, including insulin, will be stopped after your baby is born. But it&rsquo;s also possible that it progresses to type 2 diabetes. Around 50% of women with gestational diabetes develop type 2 diabetes<a href="#accordion">[1]</a>. 
&nbsp;

Getting checked helps because type 2 diabetes presents few symptoms during the early stages of the disease. With a timely diagnosis, you can prevent or delay the development of type 2 diabetes by continuing with your treatment, eating healthily, and avoiding a sedentary lifestyle.

Note: For future pregnancies, make sure to inform your healthcare team about your history of gestational diabetes. 
&nbsp;

According to the American Diabetes Association, breastfeeding can help you manage your diabetes<a href="#accordion">[3]</a>.

For the baby, breastfeeding for the first six months at least means a reduced risk of developing type 1 diabetes, obesity leading to type 2 diabetes, and other health issues like eczema and respiratory disease. For the mother, benefits include a lower risk of developing health conditions like breast and ovarian cancers and type 2 diabetes in addition to a quicker recovery after birth. 
&nbsp;

That said, is it safe to take insulin while breastfeeding your newborn? Yes, it is<a href="#accordion">[3]</a>. This is because insulin molecules are large enough to not pass through the breast milk to the baby.

However, the dose needs to be adjusted accordingly after the pregnancy and, again, during breastfeeding. Ideally, the blood sugar level while breastfeeding should be between 90 and 180 mg/dL.

These levels may drop during breastfeeding, a condition known as hypoglycemia, so you should eat before each session to keep the glucose levels stable. And check your blood glucose levels every time before and after nursing. 
&nbsp;

<ul>
	<li>Gestational diabetes goes away soon after birth in the majority of cases. This is because of a drop in pregnancy hormones and the insulin resistance associated with them.</li>
	<li>If you have had gestational diabetes or are at risk of postpartum diabetes, you should monitor your blood sugar regularly during the postpartum period.</li>
	<li>Breastfeeding may help reduce insulin and blood sugar levels after birth.</li>
	<li>If you started taking insulin during pregnancy, it may be stopped after childbirth. But, depending on your blood glucose levels, you may have to restart insulin again.</li>
	<li>If you were taking insulin before pregnancy, you will most probably continue to do so. However, the dosage and the type of insulin may be reviewed by your doctor.</li>
	<li>Lifestyle recommendations may further help prevent developing type 2 diabetes. 
	&nbsp;</li>
</ul>