Pregnancy and childbirth result in profound physical & mental changes to woman. It is very important to understand the changes that occur in pelvic region. Inadequate or poor rehabilitation before returning to high impact exercise (i.e. HIIT or CrossFit), increases the risk of having ongoing pelvic floor dysfunction.
What is Pelvic Floor?
Pelvic floor (PF) is the band of muscles that run from tailbone behind to pubic bone in front. These muscles support your pelvic organs, which include your uterus, bladder and bowel. Think of your pelvic floor like a hammock on which these organs rest. PF muscles play a critical role in bladder & bowel continence, sexual function & giving birth.
Common signs & symptoms of pelvic floor dysfunction
- Urinary & Faecal Incontinence
- Heaviness/dragging in the pelvic area
- Pain with intercourse
- Obstructive defecation
- Abdominal separation
- Lumbopelvic pain
What changes happen to the pelvic region during and after pregnancy?
Pelvic floor muscles work harder than normal during pregnancy: they support the weight of the growing baby. They are also softened by the effects of pregnancy hormones. Whether giving birth vaginally or by caesarean, pelvic floor muscles are impacted. During birth pelvic floor muscles can stretch to additional 259% (total length=359%) of its resting length. During a caesarean, surgery through multiple muscle layers can lead to a slower recovery post-delivery and a weakened abdominal wall.
Current statistics
- Between 15-30% of first-time mums will experience urinary incontinence (Milsomet al.2014)
- 1 in 5 first time mums complain of faecal incontinence at 1 year post-natal (Johannessen et al. 2014)
- At 3-6 months postnatal up to 56% of new mothers demonstrate grade 2 or more pelvic organ prolapse (Bø et al. 2017).
Recovery time
Recovery time for the tissues is usually between 4-6 months (Shek et al.2010, Stær-Jensen et al. 2015) , beyond the traditional concept of full recovery by the 6-week postnatal check. Comparatively, with C-sections up to 93% of abdominal fascia strength is regained by 6-7months (Ceydeli et al.2005)
What should I do?
General Guideline for Exercises: Always check with your doctor, midwife or physiotherapist before returning to sport or exercise after giving birth. Give pregnancy and childbirth the same level of consideration for recovery that we do for ligament, tendon, nerve and muscle injuries around the body
- Weeks 0-2: Start doing pelvic floor exercises, basics abdominal exercises first day or two after birthGentle walks at your own pace for cardio fitness
- Week 2-4: Progress walking, pelvic floor & abdominal exercises & introduce squats, lunges & bridges at home
- Week 4-6: Low impact exercises & static cycling/ cross trainer
- Week 6-8: Add resistance to lower limbs & core, power walking & low impact exercise (start mums & bubs classes) *maintain posture, no breath holds & light weights
- Week 8-12: Introduce swimming, progress intensity & resistance with exercises
- After 16weeks: May return to previous activity levels, provided pelvic floor muscles have returned to normal and not experiencing any back pain, vaginal heaviness, or urine loss during or after exercise. Always consult Health Professional
How can Physio help?
Our role as a practitioner is to develop a plan to manage the conditions effectively. For example:
- Screen pelvic floor to rule out Pelvic organ prolapse, weakness or overactive muscles at 12-16weeks following birth
- Assess tummy separation (DRAM)
- Bladder dairy to rule out overactive bladder or low compliance bladder
- Treat constipation related to pelvic floor issues
- Design rehab programme to address
What do we offer at Back In Motion?
We offer Clinical Exercise classes specifically for both Mums-to-be & Mums which focuses on pelvic floor retraining, core stability and cardiovascular training; ultimately helping you get back into shape after your pregnancy whilst also getting to meet new mums!
Please call 5367 4130 for more details
Author:
Adeline Antony
Physiotherapist
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