I was asked by someone this week about rehabbing the pelvic floor post birth, in preparation for getting back to running. I was so pleased that she was aware of the importance of taking her time – things keep popping up in my timeline about postnatal classes where people are running with buggies, skipping and even doing jumping jacks! All of this can have a deleterious effect on the pelvic floor and continuing to overstress a weakened pelvic floor can lead to prolapse.
However taking your time, making a few lifestyle changes and building up core strength can mean that even if you’re currently experiencing pelvic floor dysfunction (any leaking, back pain, heaviness in the pelvis) you may be able to get back to your previous exercise routine.
I prolapsed after my first child and was given very little advice about it other than being told I would probably need a hysterectomy when I go through menopause. Because of this experience I have spent my time learning more and applying it to my own life as well as in my work with others.
First thing I implemented was no impact.
As someone who wasn’t a runner, this wasn’t a big change. But I did have to stop jumping around in my aerobics classes and also give my trampette a wide berth…! I can now run for the bus without worrying and I played rounders in the summer where I was sprinting for quite a while with no effect. So I could probably run now if I wanted to but I’m still choosing to stay low impact most of the time.
Second thing was no crunches
The downward pressure created by crunches/sit-ups will push on the pelvic floor. Full planks and press-ups and exercises with both legs lifted also creates a lot of pressure and so I avoided them. However there are alternatives – for example in press-ups performing them on an incline, plus incorporating crunchless core exercises – so there is no reason to stop exercising, just make a few changes. Bear in mind that sitting straight up in bed is also a crunch (and how many times do you do that a night?) – I roll over to get out of bed instead.
It’s not all about what you shouldn’t do though. There are things that I needed to start doing:
particularly the with respect to the pelvis. Try tucking your tailbone under and bringing your hips towards your ribs. Lift the pelvic floor now. Then take your hips away from your ribs, allowing your lower back to arch more, then lift the pelvic floor. Then bring yourself to a neutral pelvis where your level through the front and the back of the pelvis (think of it like a bowl) – the pelvic floor lift should feel easier in this position. Pelvic floor works best when we are in alignment, with the head, shoulders, rib cage, pelvis and heels all stacked up in line
both looking at how you breathe during exercise and from day to day. During exercises you need to breathe out on the effort and lift pelvic floor at the same time. This also applies when you are lifting a weight – baby, shopping etc. – and also when you go from seated to standing (The knack – as you go from sit to stand but vice versa too). The other aspect of breathing is to stop breath holding and sucking your stomach in. When you breathe in your stomach should actually swell not suck in. I see so many people who’s stomachs stay still when breathing and instead their shoulders lift. Try lying on your back with your knees bent, feet flat on the floor. Put one hand on your chest and one hand on your stomach. As you breathe in you should feel your chest move first then your stomach. Your stomach lowers as you breathe out and then your chest.
All these changes I’ve made have meant that my prolapse has improved and I’m hoping to avoid that hysterectomy! I know that there’s still work to do and I’m currently learning more about another part of the puzzle:
stress can affect the pelvic floor, there’s also some evidence that lower limb injuries and back injuries will impact the pelvic floor too, even years after healing or the pain has stopped. There may also be scar tissue from episiotomies or tears. I’ve just learnt some trigger point release for that – sitting on one of the spiky balls! It’s uncomfortable but definitely has an effect – I will let you know how that goes! And it’s also helped to introduce deep breathing, mindfulness and relaxation practices into my daily life.
So when looking at rehabbing the pelvic floor, it’s not just about a list of exercises to do – we need to think of the body as a whole and the pelvis at the centre of that, and looking at improving in all these areas