How do I know which exercises I can do after giving birth?
Basically – it depends on your body, genetics, how your birth was and what sort of birth you have. The fact is that we are all different. We have different levels of strength to begin with, our connective tissues are genetically different (some people have more rigid tissue and some more stretchy), and no pregnancy or birth is the same. Therefore, its about taking notice of HOW your body feels & respecting the changes and if you have ‘things’ going on – like incontinence, a heavy feeling in the vagina or a bulging tummy.
Why does it matter? Why is it an issue?
Following pregnancy, your body has been through many physiological changes. The vaginal canal or the abdominals will have all experienced some form of trauma to the tissues.
The body changes can lead to some suffering from low back or pelvic pain, urinary leakage, pelvic organ prolapses and Diastasis Recti. Therefore, completing exercise and strength training the wrong way or too soon can lead to several problems involving your abdominal muscles, back, and pelvic floor muscles.
What physical changes can occur during pregnancy?
Lower Back Pain:
During pregnancy, the abdominals and pelvic floor muscles are lengthened, which can weaken them. Also, the center of mass changes when the tummy is growing which makes us move differently and use our muscles differently (either too much, “overactive” or not enough, “weak”).
Lower back pain can make it difficult to do everyday tasks. It can be painful and hard to lift and hold your new baby and can be a barrier to exercising and strengthening after having a baby.
Following pregnancy, you may suffer from lower back pain or pelvic girdle pain (pain in the front of your pelvic bones or in the back of your pelvis at your SI joints). Pain is common during pregnancy with research stating that 45% of women experience this during pregnancy, 25% experience it after pregnancy and 5-8% have pain in this area that is persistent.(1)
Urinary Incontinence:
Urinary incontinence occurs when the pelvic floor muscles become weak or overworked/tight so urine is leaked. Leaking will also happen if the pressure exerted through the abdomen is too great for the pelvic muscles to hold the urine eg when people hold their breath with lifting (intra-abdominal pressure).
Urinary incontinence can lead to skin irritation or infections around the perineum. It can be embarrassing which leads to new mums avoiding going out or can lead to depression.
It can also prevent people from running or exercising. During the last trimester, about 45% of women who have only had one child reported urinary leakage, and 85% of women who had had more than one child had urinary incontinence during the last trimester of pregnancy.(2) Of those women, 44% continued to have urinary leakage 5 years later.(3) 92% of women who have urinary leakage at 12 weeks after giving birth will continue to have leakage 5 years later if they do not seek help for the issue.(4) (Please ask & I can direct you to the right Women’s health physios)
Pelvic Organ Prolapse:
Pelvic organ prolapse is when a pelvic organ such as your bladder, rectum, uterus, or intestines is pushed down into the vagina.
Up to 50% of women have pelvic organ prolapse after giving birth.(5) This can happen when muscles and supportive connective tissue in the pelvic region are weakened or overly stretched due to childbirth, poor lifting habits (holding your breath), or surgery.
People who have a prolapse usually feel discomfort, heaviness, pressure, or pain in the pelvic region. Prolapse can make daily activities, exercise, and sex difficult or uncomfortable.
Diastasis Recti Abdominis:
“Diastasis” means separation, and “Recti” refers to the outermost abdominal muscles: the Recti Abdominis. You have one rectus muscle on the right and one on the left. They are held together with connective tissue (this is your “six-pack”).
The connective tissue holding these two muscles together is called the “linea alba” meaning, white line. When you are pregnant that same connective tissue is called the “linea nigra,” meaning, black line. The color change is due to hormonal changes occurring with pregnancy. This tissue becomes very stretched during pregnancy as your tummy grows – it’s not your abs ‘splitting’ it is the connective tissue stretching.
Diastasis Recti can continue longer than 6 months and can lead to pelvic pain and pelvic floor muscle dysfunctions such as pain with sex, urinary or fecal incontinence, constipation, back pain, and poor posture. “Poor posture” can make someone still “look pregnant” and can lead to other limitations such as neck and midback pain. Most importantly, this lack of stability in the abdomen can impact trunk and core strength and mobility.(6)
To learn more please take a look at my Holistic Core Restore® Everywoman course which is designed to improve your core strength and pelvic floor, this popular programme covers nourishment, hydration and core strengthening exercises as well as the importance of rest and self care. It really is the best way to set you up for a lifetime of good pelvic health.
References
1) Wu, W. H., Meijer, O. G., Uegaki, K., Mens, J. M. A., Van Dieen, J. H., Wuisman, P. I. J. M., & Östgaard, H. C. (2004). Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. European Spine Journal, 13(7), 575-589.
2) Mørkved, S., Bø, K., Schei, B., & Salvesen, K. Å. (2003). Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial. Obstetrics & Gynecology, 101(2), 313-319.
3) Wilson, P. D., Herbison, P., Glazener, C., McGee, M., & MacArthur, C. (2002). Obstetric practice and urinary incontinence 5-7 years after delivery. Neurourology and Urodynamics, 21(4), 5-5.
4) Viktrup, L., & Lose, G. (2001). The risk of stress incontinence 5 years after first delivery. American Journal of Obstetrics & Gynecology, 185(1), 82-87.
5) Hagen, S., & Stark, D. (2011). Conservative prevention and management of pelvic organ prolapse in women. The Cochrane Library.
6) Lee, D. (2017). Diastasis Rectus Abdominis. Surrey: Diane Lee.
