Will I ever have a bladder of steel again?
Last week I talked about diastasis recti and this week it's time for the closely connected pelvic floor; these are the two most common postnatal topics I get asked about. From, do I have to do Kegels every day to, will I ever be able to do high-impact exercise without risking a leak? I don't have all the answers and I often refer my clients to a women's pelvic health physio if I think something is not quite right or outside of my scope of practice. But let's dive into some facts:
1. Your pelvic floor muscles run like a hammock from your front to your back passage and support all your pelvic organs. 70% of the pelvic floor muscles are slow-twitch and the other 30% are fast-twitch. The slow-twitch ones hold up the pelvic organs whereas the fast-twitch ones kick in when we cough, sneeze or jump over a puddle. In the mums that I see, it's often the latter that need some attention.
2. Whether you had a vaginal or C-section delivery, your pelvic floor muscles would have got weaker during pregnancy due to the constant and increasing weight on them. If an instrument such as forceps or ventouse was used during a vaginal birth, the muscles would have been stretched and weakened further.
3. Please do your Kegels. Yes, they are boring but this is the best way to strengthen your pelvic floor after birth. If you don't do them, you may not be able to return to high-impact exercise and you may have further problems in the years to come. The standard recommendation is 3 times daily. Ideally you would have started them while pregnant but it's never too late to start: Work up to 10 quick reps and 10 holds of up to 10 seconds each.
4. When we start pelvic floor exercises, it's helpful to isolate them. Once we've learnt this, we should connect them to the breath as that is the body's natural way of working: as you inhale the pelvic floor muscles relax and as you exhale they contract. Finally, we combine them with exercises.
5. A pelvic floor contraction only needs a 20-30% effort, like pulling a tissue out of a tissue box. Focus on both your front passage (stopping yourself from having a wee) and the back passage (stopping yourself from passing wind).
6. What other muscles should I be strengthening? Nearby muscle groups including your deep abdominals (transversus), glutes and adductors (inner thigh muscles) all need to be strong for optimal pelvic floor strength. Your can help your transversus fire by pulling your abs towards your spine on an exhale.
7. What is a hypertonic pelvic floor? This is when the pelvic floor muscles are hyperactive and don't release fully on the inhale. If this is you, focus on the relaxation part of a Kegel as opposed to the contraction. If the muscles don't fully release, they can't fully contract. A women's health physio can do an internal examination to determine whether this is you.
8. Do I have prolapse? Prolapse means that your pelvic organs have started descending and are no longer supported by your pelvic floor. There are different types and grades of prolapse (a women's pelvic health physio will be able to diagnose this). It can be felt as a heavy, dragging sensation, however I also know women who weren't aware that they had it.
9. Returning to high-impact exercise. At Buggyfit, we recommend you strengthen your core, especially your pelvic floor, by doing low-impact exercise with resistance bands and light weights until you are circa 5 months postpartum. This is also because you still have relatively high levels of the hormone relaxin in your body (it remains until your period returns) which makes your joints less supported. However, the guidelines surrounding this are constantly changing and some suggest women can return to high-impact activity at 3-4 months postpartum. At the end of the day, our bodies are highly individual so listen to your body and work with a qualified professional to progress your body at the right pace for you.
10. If you can afford it, I highly recommend seeing a private women's health physio at 6-8 weeks post-birth who can do a full postnatal check-up and determine the state of your pelvic floor. I've mentioned before that locally Jade Rodham at Chiswick Physio and The Mummy MOT at the One Body Clinic are both good options. There are also other excellent options further afield/online.
Knowledge is power so don't be frustrated if you get a leak - let's work together to figure out what is going on. If you are stressed, you may be holding tension in your pelvic floor so also be aware that its recovery is not only physical but emotional as well.