So your wondering how to optimise postnatal pelvic health and improve your recovery after birth? Perhaps you know you should be taking care of your pelvic floor and your core now that you’ve had a baby, but your not sure how to. Well, you have come to the right place. Here I will give you my top tips when it comes to postnatal recovery, and regaining your core and pelvic floor strength and condition in the postnatal period. So, if you want to know how to take care of your core and pelvic floor after baby, read on!
“In a short time (24-30hrs) the body has to adapt to rapid changes both to the anatomy of the abdominal wall and pelvic floor as well as intra abdominal pressure. Almost immediately most mums are expected to take on more loading as they manage caring for a newborn and breastfeeding with interrupted sleep. The strategies adopted in this CRITICAL early phase can shape a woman’s future musculoskeletal, urogynecological and sexual health. It is a critical time for posture and core training”
Dianee Lee Postnatal Physiotherapist & Expert in Postnatal Diastasis recovery.
It is for these exact reasons that women need to be educated and informed as to how to aid ‘safe’ and effective recovery of the core and pelvic floor after giving birth. Here are my tips to best care for your pelvic floor and core after giving birth.
See a Women’s Health Physio
Always, my number one tip regarding your pelvic health is to see a qualified Women’s Health Physiotherapist that conducts INTERNAL VAGINAL EXAMINATIONS! Even if you have a trusted gynaecologist I would urge you to seek the help of a Women’s Health Physiotherapist, because the assessment they conduct is completely different to that of your GP, midwife or gynaecologist.
A Women’s Health Physiotherapist will be able to give you valuable information regarding your pelvic floor health including:
- How ‘strong’ and co-ordinated the pelvic floor muscles are.
- If you are performing a pelvic floor contraction effectively (up to 50% of women will be bearing down whilst performing their PFM exercises – i.e doing exactly the opposite of what you are aiming to do)
- If there are any signs of pelvic organ prolapse.
- The best options for you to re-train your core and pelvic floor
The treatments offered by a Women’s Physiotherapist are extremely vast and varied. There is so much more to pelvic health than just doing pelvic floor exercises! ‘Kegals’ are just the tip of the iceberg when it comes to what Women’s Health Physiotherapists offer. Some examples of the treatment offered by Women’s Health Physiotherapists include (but are not limited to):
- Pelvic Floor muscle activation exercises
- Fitting of supportive pessaries to support the pelvic floor organs
- Postural correction and strategies to protect the pelvic floor and core during day to day movements
- Exercise prescription to improve core activation
- Teaching how to return to exercise safely after baby
- Treating musculoskeletal concerns that impact core function
- Rehabilitation of Rectus Diastasis or abdominal muscle separation
Improve your posture
Whilst baby is growing inside of us, we start to adapt different postures to make room for baby and compensate for shifts in our centre of gravity. Unfortunately, many women continue to carry these postural changes well after baby is born. These changes can lead to ‘instability’ within the ‘core’ which can ultimately lead to ongoing pelvic health concerns. Concerns such as incontinence, pelvic pain, low back pain, pelvic organ prolapse and persisting abdominal separation.
To practice improving your posture, try to:
- Stand with your weight spread evenly between the heels and balls of your feet.
- Ensure that your pelvis is in a ‘neutral alignment’. You can achieve a ‘neutral pelvic position’ by rocking the pelvis forwards and backwards. Find a position that is relatively in the middle i.e don’t allow the bottom to ‘stick out’, nor have the bottom overly ‘tucked under’.
- Make sure that your ribs are positioned over your pelvis – not behind the pelvis (as many women do after having baby).
- Ensure you rib position is ‘neutral’. You can achieve a ‘neutral’ rib position by aiming to keep your breasts pointing forward (assuming you have a well supportive bra on) If the breasts are pointing upwards to the roof, or downwards to the floor, you can assume that you have not achieved a ‘neutral alignment’
- Allow yourself the breathe into the belly and to the lower parts of your chest. If you have achieved a neutral alignment, then you should be able to breath into the belly and into the lower ribs as long as you are not ‘gripping’ the abdominal muscles.
Also, make sure that baby change tables/prams etc are positioned at a comfortable height. This will help you to maintain this important ‘neutral alignment’ in your early phases of recovery.
If you want to learn in more detail how to improve your posture and how to integrate strategies and techniques into your day to day living, you can find out during our Postnatal Yoga and Pelvic Health Workshops.
Don’t ‘grip’ your core or pelvic floor
Often women have a sensation that ‘things are falling out’ after baby is born. Their reaction is to try and ‘lift and squeeze’ the pelvic floor and ‘grip’ the abdominal muscles in attempt to ‘hold everything in’.
‘Gripping’, ‘locking’, ‘bracing’, ‘switching on your core’….It doesn’t matter what you call it. What matters is that you don’t overdo it! Excessive contraction on the ‘core’ is not helpful. In fact, it can lead to all sorts of problems like:
- PFM fatigue – fatigued muscles will not contract effectively, and therefore not assist in protecting your pelvic organs as well.
- Pelvic Pain – imagine you were to grip your fist all day, by the end of the day it would feel pretty tired and sore. This same occurs for the Pelvic Floor. Often, when women experience this pelvic pain, they assume it’s because their pelvic floor is weak, so they continue to ‘grip’ and hold the pelvic floor. Doing so only reinforces the pain, and a viscous cycle is created. Understanding how to contract and relax the pelvic floor effectively during everyday movements is of upmost importance for good pelvic floor health.
- ‘Bearing down’ into the Pelvic floor. The group of muscles we call your ‘core’ essentially work in a ‘pressure system’. If you overdo it, and recruit more than what is required you wont allow the muscles to work as they are designed to. This could lead to intra abdominal pressure not being dispersed effectively, creating excessive pressure down onto the pelvic floor, even when you may feel as though you are engaging your core effectively.
In our ‘Postnatal Yoga & Pelvic Health Workshop Kate and I teach you specific breathing techniques, exercises and strategies that will help you to engage the core and pelvic floor effectively. To find out more about what we will teach during the workshop and what is included, you can visit our site.
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Improve your bowel health
If you are having concerns with constipation, it is likely that you will be pushing and ‘bearing down’ through the pelvic floor, which can further stretch and compromise the pelvic floor muscles, facial and ligaments. Avoid constipation by drinking plenty of water and eating a balanced diet with ample fruit and vegetables. Making sure you sit on the toilet ‘properly’ to avoid excessive pushing will also help. Have your back relatively straight, lean forward slightly, and have your feet supported. Make sure that your knees are higher than your hips, as this helps to ‘unkink’ the bowel and allow for the bowel motion to pass much easier. You can use a small foot stool to support your feet to ensure your knees are at an appropriate height.
Sort out those sniffles and sneezes
Coughing significantly increases our intra abdominal pressure, and is known to lead to incontinence and pelvic organ prolapse for many women. If you suffer from persistent coughing or sneezing, your pelvic floor will be suffering from extra load. Seek appropriate medical advice and management, and avoid triggers where possible. You might not want to take daily medication, but you could at least avoid having fresh flowers in the living room, even though they look so beautiful… Less coughing and sneezing will help to protect your pelvic floor.
Learning ‘the knack’ can also help tremendously. The ‘knack’ is basically a squeeze and lift of the pelvic floor muscles that is conducted in anticipation of a task – usually when the intra abdominal pressure is about to increase significantly. For example, lifting and squeezing the pelvic floor prior to a cough or sneeze.
You can use ‘the knack’ during the day for many activities of your daily living. It is very important though that you ‘match your tension to the task’. Avoid over activation of the pelvic floor muscles.
Don’t accept Pelvic Floor concerns
Has your GP, midwife or even your gynaecologist told that you your pelvic floor dysfunction is normal? Whilst many pelvic floor/core concerns like abdominal separation, pelvic organ prolapse and incontinence are common, they are not something that you need to live with. It is not fair for you to have to live with pain, fear and embarrassment!
Pelvic pain, incontinence, and prolapse are all common in the postnatal woman, but with the right intervention these issues are often reversible and very manageable.
If your health professional tells you that your signs and symptoms are “normal” and to ‘continue doing your pelvic floor exercises’, I strongly urge you to seek a second opinion! It has become so widely accepted that “a woman’s body will never be the same again after having babies” that these concerns get ‘fobbed off’. I agree, your body won’t be quite the same again. Nor will our bodies be the same as they were when we were in our teens, but that doesn’t mean we have to put up with it such problems. This takes me back to my first point, seek the advice of a Women’s Health Physiotherapist.
Take a gradual return to exercise, and get a trainer you can trust
Often women are told to “wait six weeks, and then you should be ready to return to exercise”. Unfortunately this is not always the case. Just as every pregnancy and birth is different, so is every womens postnatal recovery. I recommend a graduated return to exercise, using the guidance of a professional that will take into consideration your individual pelvic floor and core health.
During our ‘Pelvic Health and Postnatal Workshop’ I teach women the skills they need to help them return to exercise and help make activities of daily living ‘safe’ and more comfortable. During the workshop you will learn the ‘A B C D E technique’ for returning to exercise – a strategy designed to allow you to guide your own safe return to exercise. If you would like more details on the workshop, you can find out more here.
If you choose to participate in any form of personal training, group fitness, boot camps etc, please make sure you have a trainer that is adequately qualified, and one that you can trust. Just because an exercise group claims to be designed for antenatal and/or postnatal women, this does not mean the trainer has specific qualifications. Your trainer/coach should screen each client for any pregnancy/postnatal concerns, and should be able to modify each exercise accordingly. If your trainer has not asked specific questions regarding your pelvic floor, core and postnatal recovery, it is unlikely that they understand how to keep you and your pelvic floor ‘safe’ during exercise.
Part of trusting your personal trainer, coach or therapist also means giving them the best/most accurate detail you can regarding your pelvic health. You might not want to get into all the ‘nitty gritty’ details with them, but you do need to tell them what exercise/positions your Women’s Health Physiotherapist has encouraged you to avoid. After all, if they are unaware, they wont be able to guide you in the right direction. Not only will exercise be uncomfortable and possibly even painful, you could end up doing even more damage than good. Speaking openly about these issues will give you the most enjoyable and safe exercise experience. It will also help to break the ‘taboo’ nature of these subjects, which ultimately leads to better care for all women – YEAH!
In my clinic offer both 1:1 training, and group exercise classes that cater for women with pelvic floor dysfunction or postnatal recovery. To find out more, give me a call – I would love to speak with you.
Listen to your body, and know the ‘warning sings’
It is really important that you really LISTEN to your body. There are specific ‘warning sings’ that can indicate that you have pelvic health concerns. If you experience any of the following signs and symptoms, please seek the guidance of a Women’s Health Physio:
- Incontinence or leakage from the bladder or bowel
- Pelvic pain
- A heaviness or dragging sensation in the pelvis or vagina
- A ‘bulging’ sensation, or things feeling like ‘they will fall out’
- Low back pain or pubic pain
- Painful sex
- Difficulty emptying your bladder or bowel
These are all warning signs, and you need to LISTEN! Think of this as the same as when you lose your technique with an exercise at the gym. Your body is telling you that it is not quite strong enough to continue, and that injury could occur or has already happened. When it comes to pelvic health concerns, prevention is definitely better than treatment. Treating any concerns as soon as you experience them, or before they start will be of huge benefit. In saying that, if you have experienced these symptoms for some time, treatment is often still very effective. Our experienced staff offer gold standard assessment of the pelvic floor and can guide you in your postnatal recovery.
There will be some activities in your daily life that you can’t stop completely. For example, picking up children. However, modifying your exercise according to your pelvic health will help lessen the impact on your pelvic floor. Remember, just because you can’t do a particular exercise/activity right now, it doesn’t mean that you won’t be able to do it in the future. If you listen to your body, and gradually progress as your pelvic health allows, you will be far better off than if you ignore them altogether.
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Again, those tips for you
- See a Women’s Health Physiotherapist
- Improve your postnatal posture
- Don’t grip your core or pelvic floor
- Address your bowel health
- Learn ‘the knack’
- Don’t put up with pelvic floor concerns
- Take a graduated return to exercise, preferably guided by a qualified professional
- Know the warning sings
Unfortunately many women are unaware of potential pelvic health concerns postpartum, and don’t know how to recover after birth. The postnatal period is a critical time for women. The strategies adopted in this early phase can shape a womens musculoskeletal, urogynelogical, and sexual health. (Diane Lee – Postnatal Physiotherapist & Expert in postnatal reovery) This is exactly why Kate and I developed the ‘Postnatal Yoga and Pelvic Health Workshop’ so that women can get the right advice and implement appropriate strategies during their postnatal recovery.
Women often don’t seek the right postnatal recovery advice, either because they have not received appropriate education, or because they are too nervous to talk openly about their pelvic health concerns with their health professionals. If you want to help other women recover well after baby, and empower women to feel more in control of their postpartum recovery, please share this post. Normalising the conversation around pelvic health and improving postnatal education are important steps in helping to do so.