Benefits of Compression Wear for Pregnancy, Postpartum and Prolapse

Medical grade compression can make a huge difference to pregnancy and postpartum ailments and discomforts. Pregnancy in particular creates an environment of venous insufficiency, as pregnancy hormones relax blood vessel walls to allow for additional blood volume needed to support the growing fetus. When the vessels are not able to sufficiently support normal blood flow return, reflux  occurs into superficial vessels which can cause pain, swelling and visible varicosities. Additionally the added, necessary weight of pregnancy creates additional venous pressure, as does the weight of the uterus on abdominopelvic blood vessels. Compression stockings and limb support garments work by compressing the superficial veins and lymph vessels, which creates a ‘pump effect,’ and in this way help to reduce swelling and vessel distension. 

Studies (5) have also shown that compression stockings improve lower extremity symptoms associated with venous insufficiency during pregnancy, and that pregnant patients report a superior quality of life with their use.

Compression is measured in millimetres of mercury (mmHg).

Medical grade compression is graduated in nature and provides slightly more pressure further away from the heart facilitating movement of fluid (blood and lymph) towards the heart/ core.

Classification:

We use the British pressure classes for compression - there are many across the globe, though Australia doesn’t yet have it’s own compression classification system.

Mild 14-17mmHg- (Lenny Rose Pregnancy Garments)

II Moderate 18-24 mmHg (Lenny Rose Postpartum Garments)

Are compression garments safe in pregnancy?

We have conducted extensive literature reviews on the appropriateness of medical grade compression and grading / levels across pregnancy and postpartum, and whilst there are no formal scientific consensus, there are standard levels that are recommended globally by leading institutions and the medical profession,  with the greatest consensus being 10-20mmHg being appropriate and therapeutic for pregnancy, and 15-25mmHg for postpartum recovery. For lower leg only garments, higher grades of medical grade support may also be useful for lower leg oedema and vascular insufficiency.

Compression garments have been shown to be effective for treating a wide range of pregnancy and postpartum conditions, and you may benefit from pregnancy compression stockings, pregnancy compression leggings or shorts, depending on your symptoms including

• Varicose veins (leg and vulvar)
• Swelling and oedema
• Lumbar and pelvic pain
• Pubic Symphysis pain
• Sacroiliac pain

If you have any specific medical conditions, or are unsure about appropriateness of use for your own or referring a client, please check with your medical team.

Are compression garments effective for relieving pregnancy related back and pelvic pain?

Are you on the fence about whether compression products are appropriate for you, or for your clients? Our physiotherapist designed compression and support products are backed by science, with a host of benefits available through wearing our medical grade compression and pelvic floor support products.  A recent systematic review (2) of the effect of maternity support garments (MSGs) showed strong evidence for maternity support garments’ effectiveness in “pain alleviation, improvement of balance, and improvement of functionality and mobility in pregnancy women.”

The review (2) also concluded ‘that wearing MSGs during pregnancy could have beneficial effects when worn by pregnant women such as pain reduction (LBP, PGP, posterior pelvic, pubic symphyseal, and pain in the SIJ), improvement of functionality and mobility, and reduction of risk of fall during pregnancy.”

• Carr C.A (2) purports maternity support garments to provide improvement in symptoms via “low back support (lumbosacral area), stabilizes the pelvis, and elevates some of the weight of the uterus from the symphysis pubis by supporting the lower abdomen.”

• Flack, Hay-Smith  (3) suggested that improved proprioception may be influencing the behaviour of participants as having an external apparatus (belt) will make pregnant women aware of the activities undertaken by the body and will help women to modify behaviour to reduce pain.

• Bertuit, Van Lint (4) suggested that the use of pelvic belts may produce two different effects on pregnant women: a proprioceptive effect that improves body perception and movement awareness of the wearer and a second effect in which the garment acts as a modulating system to block pain influx conveyed at the spinal level. The study also suggested that belts could have a biomechanical effect to relieve and stabilise the SIJ

Lenny Rose Active maternity and postpartum compression products are currently being studied in partnership with Swinburne University to add to the body of research on product effectiveness and mechanisms of improving symptoms such as pelvic pain, back pain, abdominal separation and pelvic floor support related symptoms. To learn how you can refer your (Melbourne-based) pregnant and postpartum clients to the study, please email us on contactlra@lennyroseactive.com.au

You can read the literature review here (or scroll down for a full list of references).

The Effect of Maternity Support Garments on Alleviation of Pains and Discomforts during Pregnancy: A Systematic Review - PMC (nih.gov)

When should you start wearing compression garments in pregnancy?

Often compression garments are not worn until a pregnant woman experiences pelvic pain, back pain, swelling and discomfort, which is generally reserved for the latter part of pregnancy. However there are numerous benefits of wearing compression garments earlier in pregnancy. It may come as a surprise that there are huge vascular changes very early on in pregnancy, as hormonal levels rise to assist blood vessels to distend and allow for more blood volume, which is in full swing mid to late first trimester, around 8-10 weeks in pregnancy. This is a period where nausea and dizziness are also likely to be high, due to rising progesterone and other hormones of pregnancy.  This early hormonal peak causes the symptoms of nausea and vomiting of pregnancy, dizziness (due to significant vascular changes and a lagging blood volume), and can also mean that pelvic pain makes itself known early on. Early onset Pelvic Girdle Pain (PGP) can settle again with the right approach, but may return later in pregnancy due to hormonal fluctuations and mechanical changes associated with changes to centre of mass as your bump grows more up and out.   Essentially it is never to early to start wearing your compression and support garments, and there are benefits to wearing compression from first trimester onwards.

Can compression garments help reduce Nausea and Vomiting of Pregnancy (NVP) or morning sickness? 

Yes! A randomized crossover trial on the effect of compression stockings on nausea and vomiting in early pregnancy also showed that 50% of wearers had a notable reduction in nausea and vomiting, 67% felt they improved the sensation of ‘heavy legs’ and 80 % would recommend wearing them in the first trimester of pregnancy.  You can read more on the study here:

A randomized crossover trial on the effect of compression stockings on nausea and vomiting in early pregnancy - PMC (nih.gov)

Postpartum Compression and Supportwear

Are compression garments effective for postpartum recovery?

Studies have found reduces distress and pain scores for post ceasarean section recovery in women wearing compression garments versus standard care. (6) (7) “The use of dynamic elastomeric fabric orthoses may be considered during postnatal care as a non-pharmacological therapeutic intervention to manage pain resulting from common postpartum ailments.” (6) 

You only have to look to our reviews page to see that women feel more comfortable, confident and mobile when wearing a support garment in the early postpartum period, whether they wear compression for c section recovery or support for vaginal delivery and associated aftercare.

 What are the benefits of wearing compression after giving birth?

• The Effect of different kind of abdominal binders on intra abdominal pressure
• When can I start wearing compression after having a baby?
• Will compression products help my abdominal separation?
• Should I wear postpartum recovery shorts after C section?
• Will compression aggravate my C section scar?
• How often should I wear compression stocking after having a baby
• How do I claim my health insurance rebate on maternity compression garments?

Which is the best postpartum support product?

The best postpartum support product will depend on whether you have had a vaginal delivery or cesarean section, and if you  had a c section whether you laboured first or had an elective procedure (labouring will place some stretch on the pelvic floor and you may have more discomfort and swelling in the perineum and pelvic floor than if you had an elective cesarean section). An ideal product is medical grade, provides both abdominal and pelvic floor compression, does not increase the sensation of heaviness in your vagina, is comfortable and provides some absorbency for confidence and additional comfort. Our Recover Postpartum Support Shorts have all of these features, plus are listed on the TGA which means you are able to claim on private health insurance. Bonus!

What is pelvic organ prolapse?

Pelvic Organ Prolapse (POP) is a consequence of most vaginal births, to varying degree of symptoms. Many women have very mild POP with little to no symptoms, whilst 50% or more of postpartum women have ongoing symptoms associated with pelvic floor support - such as, bladder, uterine or bowel prolapse to varying degrees, with or without stress urinary incontinence or fecal incontinence.  

• Other symptoms include:
• A feeling of pressure or fullness in the pelvic area
• A backache low in the back
• Painful intercourse
• A feeling that something is falling out of the vagina
• Urinary problems such as leaking of urine or a chronic urge to urinate
• Constipation
• Spotting or bleeding from the vagina

Pelvic Organ prolapse is graded based on 1) where the prolapse is occuring - prolapse of bladder into the front of the vaginal wall, bowel into the back of the vaginal wall, prolapse / descent of the uterus in the vaginal canal, and how severe the prolapse is:

It consists of four grades: grade 0 – no prolapse, grade 1–halfway to hymen, grade 2 – to hymen, grade 3 – halfway past hymen, grade 4 –maximum descent

The most commonly recognised grading system is the Pelvic Organ Prolapse Quantification system (POP–Q) (5). This refers to an objective, site–specific system for describing, quantifying, and staging pelvic support in women, and is approved by the International Continence Society (ICS), the American Urogynecologic Society (AUGS), and the Society of Gynecologic Surgeons for the description of female pelvic organ prolapse. It is the most common system used by gynecologists, physiotherapists and female pelvic health specialists.  Your women’s health practitioner will use this alongside other assessments and talk to you about your symptoms to gain a good understanding of your symptoms and form a diagnosis.

What is stress urinary incontinence?

Stress urinary incontinence (SUI) is a leakage of urine during moments of physical activity that increases abdominal pressure, such as coughing, sneezing, laughing, or exercise. There are over 6 different types of incontinence - so it is important to see your women’s health professional if you have symptoms of incontinence so you can be guided on the right treatment pathway. 

What causes stress urinary incontinence?

Stress urinary incontinence occurs when the muscles internally and or externally that control the bladder are unable to match the pressure placed upon them - which is increased in activities such as coughing, sneezing, laughing or impact activity. 

Is supportwear effective for symptoms of prolapse? And what options are there for conservative treatment of prolapse?

The first line of defence for lower levels of prolapse (grades 1-3) is often specific treatment and exercises with a trained women’s health physiotherapist or osteopath. These highly specialised experts can assess using the above grading system and help decide the most appropriate course of action - conservative treatment, surgical referral, or a combination of both. 

Pelvic floor exercise - or kegels - are known to have a benefit on symptoms of prolapse and incontinence, both during and after pregnancy, This paper found significant reduction in symptoms with a 12 week pelvic floor training program in pregnancy, and this study shows improvement in symptoms postpartum.

Getting the best results though, requires a multifaceted approach. We are HUGE fans of pelvic floor exercise, and you can find how-to- videos with Rosie, our Women’s physiotherapist over on our fitness platform - Rose Fit  - but we highly recommend seeing a women’s health physiotherapist during your pregnancy journey and for your early postpartum recovery, to ensure you are performing your exercises correctly and on the road to recovery.  A recent Japanese study (9) found that pelvic floor support underwear to improve symptoms of prolapse with just 2 weeks of wear, and with further improvement of symptoms when the support  wear is worn in combination with pelvic floor exercise. 

In essence: conservative treatment for prolapse includes:

• Working with a women’s health / pelvic health therapist for an assessment, treatment strategy and further referral if necessary
• Pelvic floor muscle  training - under their guidance, or using clinically validated at- home tools such as the JunoFem
• Pessaries - your therapist will guide you in selection, fit,  use and care if they are recommended as part of your treatment and symptom management
• Support Wear such as our Lenny Rose Recover Postpartum with patented FemmeCore™ pelvic floor support (9)
• Exercise and dietary modifications
• Improved toileting / bladder and bowel habits
• Psychological and emotional support is also important - we need to support all aspects of a woman’s journey as the changes our bodies go through during and after childbirth can be overwhelming

We like to use the analogy of our FemmeCore ™ Pelvic floor support system as like a personal assistant to the pelvic floor - making it easier for your pelvic floor to get on with its main tasks by taking on some of the load so your overall output is greater and with greater ease. Our muscles work best when they are in what’s called a “mid range” or optimal length-tension relationship. When our pelvic floor is stretched  by the growing weight of your baby, and up to 3.5 x resting length during childbirth (reference), when our organs have prolapsed to a more mild degree, when our posture is not optimal (pregnancy, after childbirth and breastfeeding all contribute to altered spinal and pelvic posture, which affects our pelvic floor function). So having some assistance to find and maintain the right posture can help regain pelvic floor control and may help to reduce some of the symptoms associated with prolapse.

Can support garments improve stress urinary incontinence?

Recent studies out of Japan (10) have shown improved bladder neck position with the use of support wear for just 2 weeks, and with improvements that lasted beyond the wear period (beyond the 2 weeks). Bladder neck support and position has a significant impact on continence, with sufferers of stress urinary incontinence potentially ben

According to  Kobra Falah-Hassani’s recent literature review (11)  “Prevailing theory suggests a combination of disruption in the supportive connective tissues of the bladder and urethra, and weakening of the muscular structures of the pelvic floor, bladder neck and urethral sphincters all lead to reduced urethral closure pressure and lower ALPP, functionally resulting in SUI .” So it makes sense that a combination of supportwear and pelvic floor muscle training, not necessarily one or the other independently - is the best course of action for symptomatic relief and reversal for many sufferers of SUI. This study (12) demonstrated the importance of both endopelvic fascia support / compliance and bladder neck mobility for the continence mechanism - our bodies need good muscle function but also the connective tissue support that is lost with childbearing, childbirth and ageing. 

References

1. Rodriguez, C. The Effect of Maternity Support Garments on Alleviation of Pains and Discomforts during Pregnancy: A Systematic Review. Journal of Pregnancy. 2019: 2163790

2. Carr C. A. Use of a maternity support binder for relief of pregnancy-related back pain. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2003;32(4):495–502. doi: 10.1177/0884217503255196.

3. Flack N. A. M. S., Hay-Smith E. J. C., Stringer M. D., Gray A. R., Woodley S. J. Adherence tolerance and effectiveness of two different pelvic support belts as a treatment for pregnancy-related symphyseal pain - a pilot randomized trial. BMC Pregnancy and Childbirth. 2015;15(1):p. 36.

4. Bertuit J., Van Lint C. E., Rooze M., Feipel V. Pregnancy and pelvic girdle pain: Analysis of pelvic belt on pain. Journal of Clinical Nursing. 2018;27(1-2):e129–e137. doi: 10.1111/jocn.13888. 

5. Persu, C.,Chapple, CR.,** Canui, V, Gutue, S, Geavlete, P. Pelvic Organ Prolapse Quantification System (POP–Q) – a new era in pelvic prolapse staging. Journal of Medicine and Life. 2011 Feb 15; 4(1): 75–81.
6. Heller, J. Canner, J. Wei Lum, Y. Tsuchiya, K. Journal of Vascular Surgery, Venous-Lymphatic disorders. Compression Stockings During Pregnancy: Essential or Superfluous? A Pilot Study. 2016. DOI:https://doi.org/10.1016/j.jvsv.2015.10.038

7. Szkwara, J. Milne, N. Rathbone, E. A prospective quasi-experimental controlled study evaluating the use of dynamic elastomeric fabric orthoses to manage common postpartum ailments during postnatal care Womens Health (Lond). 2020; 16: 1745506520927196. Published online 2020 Jun 11. doi: 10.1177/1745506520927196 PMCID: PMC7290251PMID: 32525761

8. Gillier CM, Sparks JR, Kriner R, et al. A randomized controlled trial of abdominal binders for the management of postoperative pain and distress after caesarean delivery. Int J Gynaecol Obstet 2016; 133: 188–191
9. Taniguchi T1, Kobayashi Y1, Takaoka S1, Kobayashi H2, Mitsui T1, Yoshiyama M1,Takeda M1. University of Yamanashi. Pelvic Floor Supportive underwear enhances alleviating effect of pelvic floor muscle training on lower urinary tract symptoms in pelvic organ prolapse patients. ICS, 2016
10. Taniguchi T1, Kobayashi Y1, Takaoka S1, Kobayashi H2, Mitsui T1, Yoshiyama M1,Takeda M1. University of Yamanashi. (2018) Evaluation of a novel underwear which supports the pelvic floor in pelvic organ prolapse patients. 
11. Kobra Falah-Hassani, Reeves, J., Rahman, S., Hickling, D., Mclean, L. The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis. International Urogynaecology Journal. 2021; 32(3): 501–552.
12. Compliance of the bladder neck supporting structures: importance of activity pattern of levator ani muscle and content of elastic fibers of endopelvic fascia - PubMed (nih.gov)