Ask questions​

Many postpartum women do not know all of the details after birthing their baby.  Some have told me they were not aware they had stitches down below until the 6-week check-up when the doctor wanted to make sure they were healing well!  The check-up at 6 weeks can be quick so arrive with questions. It is helpful to know about any tearing, episiotomies, tools used during the birth, etc.  These factors are all great to bear in mind as you return to exercise and daily functioning.

Another question to ask-- “Is there a pelvic health PT that you would recommend?”  They may know someone in the area or have worked with them prior.  However, do not become discouraged if they don’t have a name to offer.  A Google search for “women’s health PT” or “pelvic PT” should show professionals in the area.  Compare websites and reviews to see if the PT would be a good fit for you and your goals!​


​Pelvic Health Physical Therapy

Once you have been cleared by the doctor for “usual exercise” and intercourse, I highly suggest visiting a pelvic health or women’s health PT.  They will be able to further answer any questions about symptoms you may experience immediately postpartum and later.

A pelvic PT is specialized on evaluation and treatment of the pelvic floor musculature.  They can perform internal evaluations to test the strength and endurance of your pelvic floor, check for prolapse, address any soft tissue issues, etc.

For the evaluation, the therapist will use a gloved finger to palpate muscles internally. While a great deal of information can be gathered from an internal evaluation, it is not necessary for visiting a pelvic PT.   The therapist can then prescribe exercises to help relieve the symptoms and provide hands-on work to hips, back, sacrum and other involved areas. Your PT should be a huge help in getting you back to fitness postpartum!  Other areas they can treat and improve are bowel/bladder issues, painful sex, and pelvic pain.


Focus on healing and strength rather than weight loss

Social media and advertising may be all about “getting your body back” and fixing “mummy tummy,” but that is not the focus when you are postpartum.  The first step in returning to fitness is addressing foundational strength and continuing to heal from the pregnancy and birth.  Your body will go through so many changes in the months following your pregnancy and the timeline is different for every single woman.

Steer clear of programs that say at week 8 you do blank. It should all be self-paced and based on symptoms, your birth story, and prior activity level.  Do you need help starting out?  This was the number one question I received from women in the clinic.  “What can I do?  Where do I start?” So I developed programming to recover and rebuild your core after having a baby. Check out the THRIVE: Rebuild Bundle programming HERE.

Midline stabilization is heralded as the foundation of safe and successful weightlifting.  But have we been ignoring a part of the “core”?  The pelvic floor is a topic that tends to be avoided.  Most people do not casually discuss urinary frequency over coffee or admit to their coach that they pee every time they perform double-unders.  Men- if you think this one is just for the women, stick around! 
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I only realized the prevalence of leakage after CrossFit HQ posted a video following regionals.  All of these women were saying “It’s ok, I pee during workouts too.  It’s normal!” Please do not confuse normal and common.  Urinary incontinence may be common in certain populations, especially of heavy lifters, but it is absolutely not normal. 

The pelvic floor includes a group of muscles that attach from your coccyx (tail bone) and sacrum to your pelvic ring. 
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​When you take a breath in, the diaphragm descends.  This requires the pelvic floor muscles to descend and lengthen. When you exhale the diaphragm rises and the pelvic floor rises and tightens. 

In fit individuals, (notice I said individuals and not just women), a common pelvic floor problem is overactive muscles. Very strong back or abdominal muscles can cause increased inward pressure.  It’s been shown that when your deep abdominals contract, so does your pelvic floor. 

Imagine squeezing the can from both sides with the pressure maintained. The bottom and top will have to withstand more pressure and bulge. If your abdominals are always squeezing in then your pelvic floor is always pushing up to withstand the pressure.  It’s overworked!  The diaphragm is pretty darn good at its job.  If it does not work, we have a bigger issue on our hands. 

So often, when something’s ‘gotta give’- it’s the pelvic floor.  When all of these muscles work in concert, your canister and the force it can produce is maximized. Thus, your workout improves.

A conversation about breathing techniques regarding the glottis and diaphragm is essential to training the entire core. Here I am simply touching on one contribution but remember it does not work alone. 
Keep in mind, PFD can also manifest in ways such as pelvic pain, painful intercourse, low back pain, urinary frequency or even the dreaded butt wink. It is not just urinary incontinence. 

 “ Pelvic floor pain is only caused by pregnancy, right?” 

Wrong.  There has been no correlation shown between PFD and post-partum women.  Sure, some moms experience issues but again, it is not normal for any population.  Weakness and/or tightness of the pelvic floor can be caused by poor postural habits, extended periods of sitting, over training of the abdominals and pregnancy.  Excluding pregnancy of course, men are susceptible to all of the other risk factors.  
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“Ok, so I pee on myself at the gym and it’s not normal.  What do I do to stop it?” 

• Minimize extended periods of sitting.  Standing is definitely superior to sitting but if you can, squat.  Hanging out in the bottom of your squat while you type an email can effectively lengthen the pelvic floor muscles. 
• Check your posture. Slumped sitting will lead to a laundry list of issues from head to toe, inside and out.  But specifically, avoid slumped or “sacral sitting” with your pelvis tucked under and your lumbar curve reversed. This causes the pelvic floor muscles to maintain an abnormal length for extended periods.  
• Train naked.  Ok, not no-clothes naked but no-gear naked.  Take off the wrist wraps, knee sleeves, weight belt, K-tape, etc.  Make training about you and your barbell.  Minimizing the amount of external support will expose your weak areas and teach your body to naturally stabilize. So you can’t PR your clean without your gear?  Keep training at that safe, lower weight where your body can appropriately respond and adapt. You’ll thank me later. 
• If you have continual issues or have specific questions, contact your local pelvic floor physical therapist.  They can help identify dysfunction and provide specific, individualized treatments. 

                                          
 Thanks for reading!

     Dr. Jackie, PT, DPT, CSCS



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References:
Sapsford, Ruth R, Hodges, Paul W. Contraction of the Pelvic Floor Muscles during Abdominal Maneuvers. Physical Medicine and Rehabilitation, 2001, Vol.82(8), pp.1081-1088. 
Healthyplace.com 
​Presentation at CSM 2016 by Mary Massery: referencing Massery 2005 & 2006.