Your Core Matters – why should you consider your pelvic floor when choosing postnatal exercise?

There is a lot of misinformation out there about what is safe for women to do in terms of postnatal exercise. A client recently told me that at her 6 week check her doctor told her it was now safe for her to start running. THIS MORTIFIES ME!! One of the reasons it can be confusing is because it really is different for everyone. Your experience of pregnancy, your birth experience, your body type, your collagen type, your posture, how many babies you have had, your exercise history and your diet will all impact on how you should be exercising and how well your pelvic floor will cope with your choices. However, even if your pelvic floor seems to be in tip top shape (and unless you have seen a Women’s Health Physio you won’t know for sure if it is or not!), there are long term implications in doing too much too soon that many women (and GPs!) aren’t aware of.

The pelvic floor experiences huge forces during labour and will undergo a huge stretch, possibly tear or even cut (episiotomy) during a vaginal delivery. When a woman has a c-section the impact on the connective tissue also means that postnatally the pelvic floor will be recovering and needs to learn to function again. In addition, it is coping with the normal load of supporting the organs and sphincter functions. All this after having carried a growing baby for around 40 weeks! It is not really surprising that around 25% of women have a level of pelvic floor dysfunction and this number rises with age – just because things seem to be OK immediately after your birth it doesn’t mean you don’t need to be be mindful of what your pelvic floor has been through!

The general guideline in the UK is that for a vaginal birth a women can return to exercise after 6 weeks and for Caesarean birth 8-12 weeks. But what kind of exercise is safe and appropriate?

Exercise should be approached gently – RCOG makes the following recommendations

‘If you have had an uncomplicated pregnancy and delivery, then you should be able to do mild recreational exercise such as walking and stretching immediately after birth. You should be advised to do pelvic floor exercises after the birth, as this reduces the risk of urinary and faecal incontinence.’

However, I would add the following:

Immediately after birth what women should ideally be doing is RESTING!! No matter what your birth experience your body has been through a lot and the best way to heal is to sleep (as much as baby and other children will allow) and eat good, nutritious food that will support your body in it’s recovery. While walking is certainly a great way to get moving again, I would say that at least the first couple of weeks should be spent relaxing as much as possible rather than feeling the need to “exercise”. If you feel like going for a walk then great but if you feel like resting (and are afforded that luxury!) then please do it!

Another important point is that pelvic floor issues can come from tightness/tension in the pelvic floor as well as weakness so the typical pelvic floor exercises (lift and squeeeeeze) that are often given out to postnatal women do not work for everyone. It is really useful to have an awareness of how the pelvic floor connects to the breath so that you can work with it’s natural rhythms and allow a fluidity of movement as well as strength within the muscle. It is often difficult to find the pelvic floor muscles as neighbouring, more global, stronger muscles like the buttocks may be faster at responding. This is especially true for postnatal women who may have lost sensation due to weakness or birth trauma.

How do I find my pelvic floor?

There is a vital relationship between our breathing and our pelvic floor. The pelvic diaphragm works in synergy with the thoracic diaphragm so we need to look at the overall postural alignment when restoring the functioning of this interplay.  When we inhale, both diaphragms contract and pull downwards, the ribcage expands and the abdominal wall expands and then we exhale both diaphragms recover their position to resting. Try lying on your back and just noticing the moment of the breath as you inhale and exhale. See if you can visualise the downward pull and release of the pelvic floor as you breathe in, then the gentle lift and contraction as you exhale. You may just be imagining this at first but if you start to think about it more it should start to make a bit more sense!

To get an effective contraction that works with the breath, it is helpful to imagine the elasticity of this system; rather than ‘working hard’ during the exhalation, exhale first, make time to allow for the natural recoil and recovery process before deepening the connection through a pelvic floor contraction. This helps the pelvic floor to work without tension and, hopefully, will mean that the contraction becomes more effective. On the inhale, the focus should be on release and letting go of the pelvic floor.

Different visualisations that work for some people are as follows:

• Drawing the sit bones, pubic bone and tailbone into the centre of your pubic triangle
• Pulling your front and back passage towards each other like you are trying to stop yourself from passing wind
• Imagine that your vagina and anus are an elephant’s trunk and think of trying to pick something up with them
• Imagine you are trying to suck up a piece of spaghetti into your bottom!

If you can choose one of these visualisations then start to coordinate it with the breath as outlined above, making sure that the release is just as important as the contraction, hopefully you will be doing an effective pelvic floor strengthener. Ideally, if you have pelvic floor issues, you should be doing this 3 times a day, every day.

Is this all I need to do to keep my pelvic floor strong?

In a word, NO! The basic contraction is just the tip of the iceberg and needs to be added to movement to make it truly effective and functional for your every day life. The pelvic floor muscles contribute to both postural and respiratory functions so it has to be viewed as part of a full body movement system rather than a muscle that can be strengthened with an isolating exercise  as described above. When you have learned to co-ordinate with your breath, movements like squats, lifts and lunges can be deeply strengthening for the pelvic floor and are useful for new mums too as they are functional and applicable to their daily movement patterns.

RCOG also says:

‘You should return to the exercise routine you maintained before pregnancy only when you feel ready to do so. You should not try any high impact activity (where both feet leave the ground at the same time such as jumping or jogging) too soon.’

Many women aren’t really sure what ‘too soon’ means. One major thing you need to be aware of is that leaking is not OK! It may be considered ‘normal’ because many women experience it but that doesn’t mean it is something that you need to live with. Do not assume that this is part and parcel of postnatal exercise – if you are leaking, you are overloading your pelvic floor and you need to up your pelvic floor exercise (this doesn’t just mean lift and squeeze) and adjust your running expectations.

The pounding motion of high impact exercise like running has a high impact on the pelvic floor and the action of the heel hitting the ground with each stride can stretch the pelvic floor and connective tissues that have already been weakened by pregnancy and birth. When the stride is repeated again and again, the impact forces the pelvic floor downwards and if the pelvic floor is already weak you are setting yourself up for pelvic floor problems at some point, even if your body isn’t showing you the warning signs now.

My advice would be to go and see a Women’s Health Physio like Erica Lewis at www.hertfordshirewomenshealth.co.uk to get your pelvic floor function checked before you think about returning to high impact exercise again. Begin your postnatal exercise with low impact work such as Pilates, swimming and walking. Move on to more difficult low impact movement (cycling, standing squats, lifting) when you are ready and don’t be in a hurry to ‘get your body back’. If and when you do start more high impact exercise again, begin with shorter sessions and take your time. The faster and longer you exercise for the more pressure you are going to exert onto your pelvic floor so build up to it so your body has time to adjust.