Your pelvic floor questions answered!

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An interview with Nicole Bringer, DPT

Should new moms ignore all exercise until their 6-week postpartum follow-up appointment?

Kickboxing class? YES. Gentle core and pelvic floor exercises? NO. Let me explain. Women are often advised to avoid “exercise” until they are cleared by their provider at their 6-week follow-up appointment. The word “exercise” is a very broad term covering everything from breathing and meditation to climbing Mount Everest. As a general rule, most female bodies are not ready to return to lifting, running, or other more rigorous activities until they’ve had time to heal during the first 6 weeks of their postpartum recovery.

On the other hand, does something magical happen after 6 weeks of rest that suddenly allows a woman’s body to jump back into her Zumba routines? Probably not. The advice I give new moms is to start practicing belly breathing, deep abdominal activation, and pelvic floor strengthening starting week 1 after the birth of their babies. Being gentle, starting with low reps, and doing the exercises in very comfortable positions such as laying down is a great place to start. As the weeks pass, I advise moms to continue improving their brain-body connection, strength, and coordination. It’s important to practice exhaling as they draw in their deep abdominals and lift their pelvic floor. This is followed by an inhale that expands their bellies out and lengthens the pelvic floors towards their feet. I believe women need a strong foundation of core and pelvic floor muscles in order to progress effectively when cleared by their provider at the 6-week postpartum appointment. Even after this appointment, it is wise to progress SLOWLY back into the exercises they know and love. Women should never be afraid to modify exercises if their bodies aren’t ready.

Is it normal for sex to be painful after having a baby?

Pain with intercourse or dyspareunia after childbirth is common; however, not normal. If it’s been months or even years since a woman has had her baby and she is still experiencing pain with sex, the pain is probably not going to go away without treatment from a professional. A study from 2015 found that at 6 months postpartum 94% of women had started having intercourse again, but 43% of them were still experiencing pain! Scar tissue, muscle tightness, and birth trauma are a few common causes of pain with sex. If women are experiencing pain, they have several options. Consulting a Women’s Health or Pelvic Health Physical Therapist for an in-person or virtual consult to guide you through the recovery process is a great way to get help.

Online courses and free resources created by pelvic health experts are another options that offer step-by-step guidance for moms that is accessible within her home as she works through the healing process. McDonald, E. A., Gartland, D., Small, R., & Brown, S. J. (2015). Dyspareunia and childbirth: A prospective cohort study. British Journal of Obstetrics & Gynaecology, 122(5), 672-679.

Should moms do crunches if they have diastasis recti?

This is a question that lots of moms have. Physical Therapists and researchers are constantly asking this question too as we look for the best way to address diastasis recti. Diastasis recti is simply the separation of abdominal muscles. It is commonly found in women during and after pregnancy. This abdominal separation can often be repaired with education and exercise. Crunches are one way to strengthen your abdominal muscles, but in my opinion, it’s not the best way. When a woman’s goal is to strengthen her core and close the gap in her abdominal muscles, I always start with education on breathing and deep core activation. The deep core muscle is the transverse abdominis, and it acts as a corset that starts at your spine and wraps around to the middle of your stomach. You can activate this muscle by drawing your belly button towards your spine as you exhale. Once a woman knows where this muscle is and how to turn it on and off, she can strengthen her core with almost all exercises. It’s leg day and she’s doing squats, activate the core while squatting. She wants to improve her arm strength so she’s strong enough to lift her baby’s car seat, activate the core during arm exercises. Very few exercises are ever completely off-limits, but exercises that involve twisting and crunching are often reserved for later in a mom’s postpartum recovery.

How often are moms laying on the floor crunching anyways?

Not very often! I’d rather see moms strengthening their cores doing activities that they’re going to be doing all the time around the house and while caring for their children. Will my first postpartum poop be painful? It depends on the type of delivery you had and if there was any perineal trauma from tearing or an episiotomy. It’s likely that your first bowel movement will be uncomfortable at best and painful at worst.

Here are my tips to minimize pain with bowel movements after childbirth. 1) Avoid constipation by using stool softeners, taking supplements such as magnesium, consuming fiber in your diet, and drinking lots of water. 2) Position yourself on the toilet in a way that keeps the colon to anus path clear. Keep your knees above your hips, feet supported, and lean slightly forward all while avoiding slouched posture. Stools, squatty potties, and tipped over trash cans are fantastic tools for moms to use. 3) Avoid bearing down and tightening your pelvic floor muscles. Instead, open and relax your pelvic floor muscles by making an “ooh” sound and letting your belly bulge out. These 3 simple steps will make your bowel movements a breeze. Don’t rush. Avoid feeling stressed. Relax and breathe.

If the perineum tore, will the vagina ever be the same?

Most of a mom’s body will never be the same after having a baby, but different is NOT always bad. A mother’s body has sustained and delivered life. This is a remarkable phenomenon that changes women forever mentally and physically. After perineal tearing or incisions from episiotomies, women often notice changes to their vulva, vagina, and perineum. Two of the most common changes are pelvic floor weakness and pain. The great news for moms is that there are solutions to these problems; Pelvic Health Physical Therapists are licensed professionals that want to help. Typical treatment for pelvic floor weakness includes diaphragmatic breathing, improving coordination and strength of the pelvic floor muscles, and progressive loads placed on the pelvic floor. If pelvic floor weakness is not addressed, women may experience incontinence and/or prolapse, which is inconvenient, expensive, and an ABNORMAL part of being a mom. Pelvic pain can be related to overactive pelvic floor muscles, scar tissue, prolapse, and trigger points within the pelvic floor muscles.

Physical Therapists don’t want anyone to experience pain with sex or have the inability to comfortably care for their children while maintaining an active lifestyle. After finding the cause of pelvic pain, Physical Therapists teach relaxation, breathing, if necessary perform internal manual work to the pelvic floor muscles, and help women gradually get back to the activities they love and enjoy. WITHOUT treatment, it’s true, the “vagina” might never be the same, but with guidance, most women recover fully. Some might even say they like their post-baby vagina MORE and are absolutely able to enjoy mom-life to the fullest.

Dr. Nicole Bringer, DPT has been working in Physical Therapy for the past 10 years.  She has specialized training in Pelvic Health and Obstetrics through the American Physical Therapy Association. Her mission is to make postpartum recovery classes just as popular as birth courses! You can check out her Online Postpartum Recovery course at www.mamasandmisses.com . She’s the creator of the Mamas and Misses YouTube Channel and you can find her on Instagram @mamasandmisses_pt with a mission of advocating for all things pregnancy, labor and delivery, and postpartum recovery. Sign up for her monthly newsletters and free guides at www.mamasandmisses.com

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