Returning to Exercise After Pregnancy

After giving birth, most women are keen to lose weight and get their tummy back.  Regaining your pelvic floor muscle strength prior to returning to exercise is essential to provide support to your low back and pelvic area, as well as supporting your pelvic organs.

Many women believe that returning to sport or high impact activity helps to strengthen their pelvic floor.  Unfortunately, participating in exercise or sport too early can lead to further strain on your pelvic floor, and may result in pelvic organ prolapse or musculoskeletal injury.

Pelvic Floor: what is it?

First of all, it is important you understand that your pelvic floor is more than just muscle.  Your pelvic floor is made up of muscle, fascia and fibrous tissue.  It is like a sling or hammock that goes from your tailbone to your pubic bone and supports the organs above, such as the uterus, bladder, and rectum.

What is a prolapse? 

A prolapse is when one or more of the pelvic organs descend out of place into, or through the vagina.  The pelvic organs are usually maintained in place by ligaments, connective tissue, and the pelvic floor.  If one of these systems isn’t working well or fails, a prolapse can occur.  

What happens during pregnancy to my pelvic floor?

After giving birth, most women are keen to lose weight and get their tummy back.  Regaining your pelvic floor muscle strength prior to returning to exercise is essential to provide support to your low back and pelvic area, as well as supporting your pelvic organs.

Many women believe that returning to sport or high impact activity helps to strengthen their pelvic floor.  Unfortunately, participating in exercise or sport too early can lead to further strain on your pelvic floor, and may result in pelvic organ prolapse or musculoskeletal injury.

Pelvic Floor: what is it?

First of all, it is important you understand that your pelvic floor is more than just muscle.  Your pelvic floor is made up of muscle, fascia and fibrous tissue.  It is like a sling or hammock that goes from your tailbone to your pubic bone and supports the organs above, such as the uterus, bladder, and rectum.

What is a prolapse? 

A prolapse is when one or more of the pelvic organs descend out of place into, or through the vagina.  The pelvic organs are usually maintained in place by ligaments, connective tissue, and the pelvic floor.  If one of these systems isn’t working well or fails, a prolapse can occur.  

What happens during pregnancy to my pelvic floor?

Due to being bipedal, or standing upright, the weight of your pregnancy is carried by your pelvic floor.  Over the 9 months of pregnancy the pelvic floor endures extra stress.  As your baby grows, more weight, and therefore more stress, is applied to your pelvic floor.  After pregnancy and giving birth, your pelvic floor muscles can be stretched.  If your pelvic floor muscles are stretched they cannot work as efficiently, and more tension is applied to the connective tissue and supporting ligaments.  Without the extra lift from the pelvic floor muscles the supporting ligaments and connective tissue will stretch over time, which can lead to prolapse.  This may occur soon after birth or years later. Every women experiences some degree of stretch related weakness, even those who have had a caesarean section.  By strengthening your pelvic floor muscles there will be no ongoing increased tension on the supportive connective tissue which support your organs, and therefore less risk of developing a prolapse in the future. 

What does this have to do with returning to sport and exercise?

If you return to running or high impact activity before your pelvic floor muscles have been strengthened, the load on the connective tissue and supporting ligaments increases.  Imagine adding jumping, running, or bouncing to a pelvic floor that is still stretched and has minimal support from the pelvic floor muscles below.  This will add extra load to the already stretched connective tissue and supportive ligaments and could further stretch them, possibly leading to further damage and increases the risk of having a prolapse.

You may feel fine on the outside, but are unable to know what is occurring on the inside.  Which is why some women may not notice a prolapse occurring until they return to exercise, unaware of the risk they take.

Returning to Exercise:

Starting pelvic floor muscle exercises early after delivery decreases your risk for further injury.  A general guideline is to:

·         try 10 pelvic floor muscle squeezes each time you breastfeed your baby

·         each contraction should be held for X seconds (X= how old your baby is in weeks).

·         also remember to use your pelvic floor during functional increases in intra-abdominal pressure  (cough, sneeze, lifting etc).

It is important to realize that no matter how fit you are on the outside, you need to protect your pelvic floor.  If you return to exercise before you have recovered your pelvic floor muscle function and strength, you can cause problems to develop either now or later in life.  This could include prolapse, urine leakage or back pain.

Exercising has many benefits but it is important to consider what type of exercise you do initially, and how quickly you go back to higher impact exercise, sport and running. Gentle exercise (such as walking) can be started as soon as you are comfortable after giving birth.  Before commencing any form of exercise include a good warm up, begin slowly and build intensity gradually.  Consider lower impact activity, such as swimming or water running (after your bleeding stops and any wounds have healed), both can be done without increased pressure on your pelvic floor or low back.  Other low impact activities to consider include: walking, cycling, and low impact aerobic or post natal exercise classes.

For the first 6-8 weeks following delivery most women are fine to follow the same guidelines as for exercising during pregnancy.  You can return to your previous activity levels gradually after 16 weeks, provided your pelvic floor muscles are back to normal.  If you are pregnant or are thinking of getting pregnant, it is a good idea to get assessed to test and record your ‘normal’ pelvic floor strength so you have values to aim for after the birth.

You should consider seeing a women’s health physiotherapist if:

·         you feel any vaginal heaviness or bulging sensation

·         experience urine leakage

·         have pelvic, pubic or back pain during or after exercise

·         had complications during pregnancy or labor

·         had an assisted delivery

·         you want to be assessed

·         you want to discuss specific concerns

You may have to return to exercise more gradually if you:

·         didn’t exercise regularly before or during pregnancy

·         had an assisted birth

·         experienced complications during labor

·         had a caesarean

·         are having problems with urinary leakage

 Other Considerations:

Often women can be tired in the first months after having a baby.  The period of time from birth to 6 weeks was historically regarded as the time it takes the body to reverse the changes of pregnancy.  However, it is now known that pregnancy changes last much longer.  Musculoskeletal changes persist for a minimum of three months before returning to normal, although many believe that these changes may persist for up to a year.  

When returning to exercise it is important to remember that this is your time to recuperate from pregnancy and delivery.  You will likely be suffering from interrupted sleep, and extra demands of motherhood.  If you are feeling fatigued don’t push yourself, this will increase your chance of injury.  It is important to listen to your body and how you are feeling.  Be aware of any pain or discomfort and slow down.  Taking care of yourself now by letting any discomfort subside instead of pushing through it may prevent long term damage.

You may find that you don’t have the time or desire to exercise during the first few weeks or months.  During this time you can still be strengthening your abdominal and pelvic floor muscles in preparation for when you do feel ready to return to exercise.  Walking is a good way to get some exercise which allows you to get out of the house, and you can take your baby with you.