What It Is, What You Can Do, And How A
Physical Therapist Can Help!
article by Dr. Rhianna Wickett, Pt, Dpt, Cscs
Congratulations, Mama! Your body is doing of the most important jobs around – creating life!! This is such an exciting time of your life that also brings about many other changes to your body that you either may start to notice or have already been experiencing! As a Women’s Health Physical Therapist, I’ve helped many women through the changes during pregnancy, such as low back pain, hip pain, neck pain and more. There is one very important, less commonly discussed topic I’d love to discuss with ALL new moms – Your Pelvic Floor. This information is important for pregnant and new moms alike!
As your baby grows and adds pressure to your pelvic floor, you may begin to notice some of the symptoms of heaviness, incontinence, or pain. The great news? There ARE some things you can do while pregnant and postpartum to help this! These conditions do NOT need to interrupt your daily life and you are not alone. My goal is to change how men, women, and healthcare professionals think about the pelvic floor and Physical Therapy.
What is the pelvic floor?
The pelvic floor is a group of muscles wrapping underneath your bladder and rectum that work to hold all the organs up (including bladder and rectum), much like a hammock. These muscles control the passage of urine and bowels. If they become weak, you may experience stress incontinence, or “leaking”, especially if you laugh, sneeze, cough, or jump. This may increase later in pregnancy as your pelvic floor is under more pressure. The pelvic floor is just like all the other muscles in your body. The difference is that you can’t see these muscles work. If you engage your bicep, your elbow bends, but if you engage your pelvic floor, it may be challenging to know if you’re contracting properly. Weakness can begin in early pregnancy, but if left untreated, may continue many years after pregnancy for some women. You can strengthen your pelvic floor prior to and during pregnancy by performing specific exercises to accommodate for the growing weight of your baby. Some of these exercises are commonly known as “kegals”, but there are many other exercises you can practice, as many people commonly perform kegals incorrectly and can actually make their symptoms worse. The stronger you and your pelvic floor are prior to giving birth, the more quickly you are likely going to return to your normal activities without stress incontinence. The best form of strengthening is to start before you experience these symptoms!
Will these muscles just get better after I have my baby?
Not necessarily. Although some women are able to return right back to their normal activities, many women need to specifically focus on strengthening their pelvic floor. You should work to strengthen these muscles after each baby, otherwise you’re at an increased risk for continued symptoms of incontinence as you age. Menopause can also increase incontinence symptoms, so you will want to address this as early as you can!
What causes a weak pelvic floor?
Pregnancy and childbirth will cause your pelvic floor to work harder from added pressure throughout the pregnancy and stretching during childbirth. You may experience tears during childbirth that can further weaken the muscles. Because your pelvic floor is stretched from the pressure of baby late in the second and third trimester, it may become difficult to squeeze the muscles and sphincters controlling bowel and bladder. Constipation during pregnancy is also common and can put added stress on the pelvic floor, especially if you strain to have a bowel movement. You may also experience muscles of the pelvic floor that are too tight after childbirth. These can also contribute to incontinence, low back pain, pressure, and pelvic pain. A physical therapist can help you identify if your muscles are weak, tight, or both and get you on the path to healing!
Should I exercise if I am pregnant or recently gave birth?
Exercise is a key component to keeping you and your baby healthy. Research shows that benefits for children are observable related to body weight and composition, cardiovascular health, and nervous system development when mom exercises during pregnancy. However, the SAME exercise may not be appropriate for each person or for the same person the entire journey of pregnancy. If you are a healthy woman without complications during pregnancy, you can continue your exercise routine, modifying high intensity exercises. Depending on your pregnancy and birth experience, you may or may not be ready to begin physical activity following childbirth and you should have approval from your physician or physical therapist to begin an exercise program.
The American College of Obstetricians and Gynecologists makes the following recommendations:
- Physical activity in pregnancy has minimal risks and has been shown to benefit most women, although some modification to exercise routines may be necessary because of normal anatomic and physiologic changes and fetal requirements.
- Women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before, during, and after pregnancy.
- Obstetrician–gynecologists and other obstetric care providers should carefully evaluate women with medical or obstetric complications before making recommendations on physical activity participation during pregnancy. Although frequently prescribed, bed rest is only rarely indicated and, in most cases, allowing ambulation should be considered.
- Regular physical activity during pregnancy improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes in obese women, and enhances psychologic well-being.
What can I try starting today?
- Sit tall and squeeze your pelvic floor, as if you’re stopping the flow of urine. (Do not actually practice stopping the flow of urine, as this can cause incontinence problems.) If you are having trouble feeling the contraction of your pelvic floor, try it laying down, as this will be easier. Hold this squeeze 5-10 seconds and fully relax. Continue to breathe normally as you practice this. Repeat as many times as you can, about 8-10 times.
- Squats: simply go from sitting or squatting to standing in front of a chair (especially late in pregnancy), breathing out as you stand up. Squeeze your glutes tight as you stand tall.
- Walking is a great form of exercise that you can do even late into pregnancy.
Speak with a Specialized Fitness Professional or Physical Therapist to form the best program for you throughout your pregnancy and motherhood journey!
Why Your Pelvic Floor Needs Physical Therapy
Your symptoms should diminish in the first 6 weeks following childbirth. If they do not, a comprehensive evaluation by a Women’s Health Physical Therapist is key. We need to examine your goals, lifestyle, and find the muscle imbalances causing your symptoms. A physical therapist will help you learn how to feel the “right” muscles contracting, and safely strengthen these muscles with the correct exercise prescription and progression. Many times, patients present with incontinence, prolapse, or pain after trying to jump back (Pun intended!) into their normal routine or high intensity exercises without strengthening the proper muscles following childbirth. Your pelvic floor, breathing, and brain work very closely together. We need to help them communicate properly, efficiently, and at the right time throughout your movements.
Congratulations on your Journey of Motherhood! If you have questions about your pelvic floor or exercise throughout or following pregnancy, contact a Women’s Health Physical Therapist today!
If you have questions, would like to learn more, please visit www.ElevatePerformanceSD.com or email Rhianna@ElevatePerformanceSD.com.
Always contact your physician prior to beginning a new exercise program. This article is property of and copyrighted by Rhianna Wickett, PT, DPT, CSCS and Elevate Performance, LLC and may not be copied or distributed for sale without written permission of the author. ©2019 Elevate Performance, LLC.