Postpartum

BIRTH.

Due to the nature and physiological process of birth, there is always some degree of birth trauma, even during the most uncomplicated birth. Things like PUSHING, DURATION, STRETCHING, C-SECTION all affect the function and strength of the pelvic floor.  Birth is a physical marathon that results in tenderness, soreness, grazes, difficulty pooping, swelling, fatigue, blood loss, and dehydration and sometimes scar tissue development. Some women also suffer tearing to the perineum. These tears can be mild (1st degree) to severe (4th degree).

If your knee suffered the same trauma as your pelvic floor does (or abdominal wall for c-section) during birth, you’d be on crutches for weeks. . . . However as mothers we are expected to have a day or two rest and then go on as usual!?

After your baby is born, your abdominal wall and pelvic floor will immediately feel very different.  Don’t do anything vigorous for the first 8-12 weeks; however, you should  begin breathing, pelvic floor & core activations. Over the next nine to 12 months your  amazing body will be going through it’s healing processes. You can aid this by getting plenty of rest, hydration and nutrition and doing your rehab exercises, or you can hinder it by hitting the gym.  It can require lots of self discipline to stay away from gyms and bootcamps especially if you are keen to get back into exercising as soon as possible! But that is what I am here for! I can show you how, when and what to do to get back to your previous level of athleticism. (or get your body back).

Before your first session, make sure you visit a pelvic/ women’s health physiotherapist as soon as possible. For a list of WHP’s in Australia, click here.

WHAT IS THE PELVC FLOOR AND WHY IT MATTERS.

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The pelvic floor is made up of muscles, ligaments, connective tissue and nerves. The pelvic organs are suspended and held in place by all of these and all are subjected to stretching, weakening, lengthening and sometimes tearing as a result of pregnancy, childbirth and menopause. Exercises, repetitive coughing, straining on the toilet and obesity all cause intra abdominal pressure, which contributes to further strain on the pelvic floor  – leading to things such as pelvic organ prolapse and stress incontinence.  Pelvic floor problems are common during the first few years postpartum when the pelvic floor tissues are still healing, but are also expert at sneaking up on you over time, especially during menopause or when there is a sudden increase in intra abdominal pressures created by coughing or returning to exercising.

Pelvic Floor Functions:

  • Childbirth
  • Sexual Function
  • Pelvic Stability
  • Continence
  • Internal Organ Support

As far as pelvic floor issues go, prevention is key, and Knowledge is the KEY to Prevention!

Pelvic Floor Weakeners:

  • Pregnancy and childbirth
  • Sedentary lifestyle
  • Abdominal or gynaecological surgery
  • Heavy weight lifting
  • Excessive coughing, sneezing, vomiting
  • Poor exercise choices (too much abdominal work, no glute or pelvic floor integration, breath holding, running too soon)

Signs of Pelvic Floor Dysfunction: 

  • Incontinence (even just a tiny bit)
  • Back pain
  • Pelvic organ prolapse
  • Hernia
  • Painful Sex
  • UTI’s
  • Heavy or loose/wet sensation
  • Seeing or feeling a bulge in the vagina

Don’t ignore the signs! Visit a women’s health physiotherapist today.  Want to know more about how you can return to the gym without hurting your pelvic floor? Click here to view the Ultimate Core Restore Ebooks – or Book Postnatal screening and assessment with Ali here.

WHAT IS DIASTASIS RECTI (abdominal separation)?

Rectus abdominal separation (Diastasis Recti) is a completely essential part of pregnancy where the connective tissue linea alba between the two sides of the rectus abdominal muscles (RA) thin and stretch to accommodate the growing uterus. Post pregnancy, DR is the lingering unnatural distancing of the two sides of the RA muscles. Each woman is different, depending on the size & position of the baby, the number of babies, her age, her shape, and nutrition.

After delivery, there is usually a natural closing of inter-recti distance between Day 1 and 8 weeks after birth, after which time recovery plateaus. (this is where she needs to call on her breathing/TA/PF  exercises to encourage the gap to continue to close by stimulating the fascia).

Why does having DR matter and why do we need to check for it?

Having DR means that the function of the core is compromised because the widening and thinning of the linea alba disrupts the biomechanics of the abdominal system. The core is the central stability system, and DR affects abdominal muscle strength, lumbo-pelvic stability, posture & ligament support. Sometimes separation can return to “normal” in it’s own time, for others the gap can remain large for many years.

Many women who have had a baby will still have 1 finger separation many years afterwards. Closing the gap 100% is not always achievable, however A healed diastasis recti is not just about closing the gap but about being able to withstand intra-abdominal pressure and the transference of load and tension,  (A functional DR is one that does this)  as well as how the tissue feels. It is also about awareness and control.

WHAT DOES CORE RESTORE MEAN?

Retraining the inner core muscles to activate first without the outer core muscles helping out is what “Core Restore” means and what all postpartum programming should prioritise. When the inner core, (pelvic floor muscles and transverse abdominus), is weak, the outer core muscles (recti and obliques) kick in and try to take over.  This strategy is hazardous to the long-term health of the pelvic organs! You may not notice major changes within your core right now, (however most of us are aware that our mid section has changed dramatically after pregnancy) but what about when you have your next baby and pregnancy? What happens when we fail to rehab? What happens when the outer core muscles contract without inner core stabilisation?

= It causes a downward pressure on the organs and weaknesses in the fascia (think hernia).

This can cause or contribute to stress incontinence and pelvic organ prolapse, pelvic girdle pain, hernia and injuries to the lower back. With regards to prolapse, prevention is EVERYTHING.

The True Core is made up of four components;

  • The front – transverse abs & connective tissues
  • The back – multifidus & connective tissues
  • The bottom – Pelvic Floor & connective tissues
  • The top – Diaphragm

These are the innermost muscles of the trunk and they work together like gears in a machine. Gears are dynamic, they must move (and so must we)  and work together or the machine will fail. You may be familiar with terms such as “brace your core”, “belly-button to spine”, “imprint your spine”, however this is not how to activate the core. Bracing, sucking in the tummy and flattening the lower back only increases intra abdominal pressure and prevents the true core from working correctly (plus those that use these terms usually don’t include breath work, nor do they flatten and tone the abs!).  This is all explained in the Ultimate Core Restore Ebooks , Mama Athlete and the Prenatal Ebooks. This is also what we focus on in our Personal and Group Training!

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