What We Think Women Need To Know During and After Pregnancy
What is our Pelvic Floor and what has it ever done for me?
The pelvic floor muscles from the base of our ‘core’. These muscles work with the stomach muscles, back muscles and the diaphragm to support the spine and control the pressure inside the abdomen.
The floor of the pelvis is made up of layers of muscle and other tissue. These layers stretch like a hammock from the pubic bone at the front to the coccyx (tailbone) at the back, and from one ischeal tuberosity (sitting bone) to the other (side to side). The pelvic floor muscles are normally firm and thick.
Your pelvic floor muscles help you to control your bladder and bowel and assist with sexual function. It is important to keep pelvic floor muscles strong. Many factors can weaken your pelvic floor muscles, including pregnancy, childbirth, surgery, ageing, excessive straining from constipation or chronic coughing, and being overweight.
General Advice During Pregnancy
As things grow and stretch it’s actually important to not overdo it with your pelvic floor and obliques. Too much tones in these areas is often a cause of SIJ pain, or pelvic pain. So learning to activate but also how to relax your pelvic floor is a key for a quicker and more comfortable birth, less risk of tears, and reduced risk or rectus diastasis.
See a pelvic floor specialist between 25 and 34 weeks into your pregnancy. This is for them to assess your pelvic floor control and allow time for you to improve this control before you give birth.
Keep strength in your glutes as well as you can during pregnancy. This means exercise the area but not necessarily walk around, bend over and do life with your bum cheeks clenched like some people are taught. This is another example of over-bracing. If you can’t breathe and move comfortably when bracing, you’re doing too much.
General Advice Post Pregnancy
Avoid inappropriate types or intensities of exercise too soon – 1 in 3 women experience a degree of prolapse returning to exercise. Time helps this process by allowing healing of key structures in your pelvic floor, but activation and strength are more important.
12 weeks minimum and certain testing is very beneficial to pass before you return to running and lifting if you want to do it safely. This isn’t to scare you but you will feel more supported and bounce back quicker if you do it right.
If you can’t breathe and keep form with your core and pelvic floor on, the exercise is too hard and you need to pace yourself. Win the argument with that voice in your head saying you need to push yourself and lose the pregnancy weight ASAP. You need to give yourself time to get the foundations right again, and ease back into exercise in a healthy way that minimises your risk of injury.
Don’t ignore even mild symptoms of incontinence! You deserve better and can have it.
The Dreaded Rectus Diastasis
Diastasis recti is caused by stretching of the abdominal wall during pregnancy and/or the forceful bearing down phase of labour. Diastasis occurs when the membrane joining the two Rectus Abdominis muscles splits apart or separates. It is a normal part of pregnancy. There are things you can do during pregnancy to reduce your likelihood of developing problematic abdominal separation during pregnancy,. Learning to use your pelvic floor and core in a healthy way following birth is incredibly important and yet another area where women’s health is often neglected.
How do I know if I’ve got it?
You should always have a doctor, physical therapist, or trained professional diagnose your diastasis recti, but you may be able to detect it yourself too.
To test for diastasis recti:
- Lay on your back with your feet flat on the floor and knees bent
- Curl your head up off the floor so your rectus or “six-pack” muscles are engaged, and feel along the indent down the centre of your stomach. That’s the linea alba, the tissue that stretches when you were pregnant
- Start at the belly button and feel just above and below in a vertical line. If your fingers can press down, you may have ab separation
A small gap is normal. It’s important to determine the width of the gap and push down gently to see if there is any tension or pushback, or if your fingers sink right down. You want to assess the width and, more importantly, the depth of the split. You can measure the width with your fingers: one-to-two finger widths is normal; three or more could be a sign of diastasis recti.
What do I do about it?
Treatment for this condition may include:
- Appropriate deep abdominal activation exercises. This encourages tightening, builds strength, and reduces intra-abdominal pressure being absorbed or going to the wrong places
- Period of binding the abdominal muscles together using tubigrip (abdominal elastic binder), support garments, or k-taping
- Modifying everyday activities to avoid abdominal strain (e.g. heavy lifting)
How do I incorporate this into life and training?
Effectively the goal is to learn how to do the braces effectively, then use them while still breathing, while doing functional movements, and especially while exercising. It’s important to get used to using these muscles again with simple tasks, and then gradually make them more difficult and more applicable to your life.
If you have any questions about the above information or would like to book a consultation to chat with one of our Physiotherapists, please get in touch!