Postnatal pelvic floor health and awareness.
Having a baby makes a woman three times more likely to leak urine than a woman who has not had one. In Australia alone, one in three women who have ever birthed will wet themselves. In the majority of cases, however, urinary incontinence as a result of pregnancy and childbirth is preventable and treatable.
It is very important that health professionals who provide care for women during pregnancy and the postnatal period reach out to women about pelvic floor health. The importance of a strong and healthy pelvic floor cannot be underestimated. The pelvic floor muscles are tightly slung between the tailbone (coccyx) and the pubic bone, and support the bowel, bladder, uterus and vagina. Childbirth can weaken these muscles and cause problems, such as incontinence, later in life.
This is one of the main reasons why we have developed both pregnancy and postnatal pelvic floor physiotherapy classes with our physiotherapist colleague as we are passionate about making a difference to this often overlooked component of maternity care.
Returning to sport or exercise after birth
There are many misconceptions about when women can resume their sporting activities or other exercises after their baby is born and there is so much social pressure on women to lose ‘the baby weight’ due expectations conveyed via social media and the celebrity culture that surrounds us. Participating in sport, running or other high-impact activities early after childbirth may actually reduce pelvic floor muscle strength and cause long-term bladder and bowel problems or even prolapse of the pelvic organs. New mums can minimise the risk of these developing by following some careful precautions.
Postnatal exercise guidelines
It is very important that new mums check with their doctor, midwife, physiotherapist or continence nurse before returning to sport or exercise after birth. Remember, that joints and ligaments will still be quite loose in the first few months after birth as they have been stretched to accommodate a growing baby. Here is a general guideline which can be used to plan a return to postnatal fitness:
0-3 weeks postnatal
- Postnatal abdominal muscle bracing
- Pelvic floor exercises
3-8 weeks postnatal
- It is recommended that new mums wait until their 6-week postnatal review before starting back at the gym or joining a group exercise program.
- Low impact aerobics or postnatal class
- Low intensity water aerobics and swimming (once bleeding has stopped)
- Gym program (maintain posture, light weights, no breath holding)
- Postnatal abdominal muscle bracing
- Pelvic floor exercises
8-12 weeks postnatal
- New mums can follow the guidelines for 3-8 weeks, gradually increasing their intensity and weights
- Progression with postnatal abdominal muscle bracing
12-16 weeks postnatal
- New mums should consider visiting a physiotherapist at this time for a postnatal abdominal muscle check and pelvic floor muscle testing before returning to high-impact exercise, running, sport or abdominal exercise programs.
After 16 weeks postnatal…
- As a general rule, new mums can return to previous activity levels provided their pelvic floor muscles have returned to normal and they are not experiencing any back pain, vaginal heaviness, or urine loss during or after exercise.
- Further advice from a health professional should be sought if these symptoms are present.
Other factors to consider
New mums may feel more tired in the first few months after having a baby due to interrupted sleep, the extra demands of motherhood and feeding. Fatigue and over exertion during exercise can increase the risk of injury. It is always important that women listen to their body and how they are feeling. If new mums are feeling their muscles are aching; their bleeding changes colour from pink to red or it increases in amount (especially if it starts again after it has stopped) then they need to be reviewed by their caregivers. Continuing to exercise if these warning signs are apparent and ‘pushing through the pain’ is likely to end up causing severe damage.
Pelvic floor exercises can help speed the recovery for women who experienced a Caesarean birth or had to have some perineal stitches after the baby was born. Again, guidance from caregivers will assist with what specific exercises might assist with this type of recovery.
Other points to think about…
New mums should always be guided by their caregivers but should also consider the following:
- Allow sufficient time to heal, particularly after a Caesarean birth.
- Seek assistance if they are having trouble performing particular exercises.
- Aim for slow, gradual weight loss.
- Wear a supportive bra.
- Avoid activities that place stress on an unstable pelvic floor and hip joints until strength and stability has improved.
- Gradually increase the length of exercise sessions.
- Drink plenty of water before, during and after exercise.
- Don’t push themselves to the limit and always listen to what their body is telling them.
Regular exercise after childbirth offers a range of health benefits. Exercise helps new mums return to their pre-pregnancy shape and gives them increased energy to cope with the demands of new motherhood. It is important that new mums gently exercise their pelvic floor and abdominal muscles every day but that they ensure that their abdominal muscles have healed before undertaking any vigorous tummy exercises, such as crunches. New mums need to also be reminded that it may take months for them to return to their pre-pregnancy shape and weight and they should not be discouraged by what they might consider slow progress.
Better Health Channel (2016) Postnatal exercises, Accessed 9/1/2016 via https://www.betterhealth.vic.gov.au/health/healthyliving/postnatal-exercise-sample-workout
Continence Foundation of Australia (2013), Pelvic floor awareness in pregnancy, childbirth and beyond, Accessed 9/1/2016 via http://www.continence.org.au/news.php/211/pelvic-floor-awareness-in-pregnancy-childbirth-and-beyond
Pelvic Floor First (2016) Returning to sport or exercise after birth, Accessed 9/1/2016 via http://www.pelvicfloorfirst.org.au/pages/returning-to-sport-or-exercise-after-the-birth.html