You may have noticed that we like to talk about Pelvic Floor fitness and health. For good reason! Your pelvic floor is incredibly important. It supports you through your pregnancy and childbirth and after. We talked to Marianne Ryan about why we should take care of our Pelvic Floor post pregnancy and how we can start.
1. How can rehabilitating the pelvic floor help a woman in her daily life? What is the lived impact?
Pelvic floor muscles are important, and women should rehabilitate them after childbirth because they serve several functions:
a) The pelvic floor muscles act as a hammock to help support all the pelvic organs such as the uterus and rectum. Without this support women can develop pelvic organ prolapse, which is when the organs in your pelvis migrate downwards. This can lead to all sorts of problems and pain.
b) Pelvic floor muscles play an important role in continence. When the pelvic floor muscles are weak or in spasm it can cause a leaky bladder and constipation.
c) Pelvic floor muscles play an essential roll in sexual function and about 20% of women reported experiencing painful sex 18 months after giving birth.
d) Pelvic floor muscles are part of the core muscles system. I like to describe the core as a thin “balloon” of muscle fibers that wrap around your organs and act to hold or stabilize your midriff when you move around. The core muscle system is made up of 4 muscles: the inner fibers of the diaphragm on the top, the transverse abdominis which is the deepest abdominal muscle in the front, in the back the multifidus muscle system holds the spine together and the pelvic floor muscle form the bottom. If the pelvic floor muscles are not working optimally the entire core system is weakened and you are at risk of developing back and pelvic pain.
After childbirth the pelvic floor muscles are weakened and stretched out, and sometimes there are tears from pushing a baby out.
After childbirth the pelvic floor muscles are weakened and stretched out, and sometimes there are tears from pushing a baby out. To fully rehab these muscles, you need consider alignment and breathing techniques. Just doing Kegel exercises is a waste of time if you do not use the optimal alignment and breathing techniques.
During pregnancy women tend to lean their ribcage backwards to accommodate the growing baby inside the abdomen. Moms tend to continue this behavior after birth and need to change their alignment by stacking their rib cage over their pelvis. By doing so, the pelvic floor muscles will become stronger and are able to coordinate with the other core muscles to protect your body.
Give it a try – Alignment Correction:
Sit in your “normal sitting position” and try to contract your pelvic floor muscles by pretending you are stopping the flow of urine. Make a mental note of how the contraction feels. Then sit with your pelvis in neutral by rocking your pelvis forward and backwards and stop when you feel like you are midrange. You will know your pelvis is in the neutral position when your vagina is sitting on the seat. After you are in neutral, contact the pelvic floor muscles again. Did it feel stronger?
Give it a try – Breathing Correction:
Now try to exhale gently while you contract the pelvic floor muscles. Did the contraction feel even stronger?
If you answered yes to both of those questions you are now on the road to developing a stronger pelvic floor.
2. What do all moms need to know about pelvic health in their pregnancies?
During pregnancy women should try not to strain the pelvic floor muscles when passing a bowel movement or when lifting, pushing and exercising.
My basic advice is to stop holding your breath when exercising to prevent pushing down on the pelvic floor muscles.
Here are some tips pregnant and postpartum women can use to prevent straining their pelvic floor muscles:
Constipation: The hormones produced during pregnancy can cause constipation. When passing a bowel movement, pregnant women often strain. To protect the pelvic floor muscles, try to eat a diet that is rich in fiber and consider taking probiotics. Other things women can do is using a stool under their feet when on the toilet to make it easier to pass a BM and doing a self-constipation-massage prior to going to the toilet. (You can learn this massage technique in my book, Baby Bod).
Lifting or Pushing: When you lift or push something heavy EXHALE to reduce staring the pelvic floor and abdominal muscles. The amount you should exhale should match the effort need to perform a task. For example, when lifting your new born baby, exhale lightly. When lifting a heavy pot of water or a toddler, exhale more deeply.
Exercising: My basic advice is to stop holding your breath when exercising to prevent pushing down on the pelvic floor muscles. Try to choose exercise routines that encourage normal breathing patterns, not breath holding like lifting heavy weights.
3. How can they prevent pelvic complications post birth?
One of the best ways to prevent pelvic complications and pain post birth is by going to a women’s health physical therapist for an evaluation. This type of therapist will do a detailed orthopedic evaluation along with an exam of your pelvic floor muscles. Then your therapist will design an individualized treatment program to help you fully recover from childbirth.
Going for postpartum physical therapy is underutilized in the US. In other countries, such as France, women go to a physical therapist for rehab after every single birth to work on strengthening their pelvic floor and abdominal muscles. That is why I wrote my book, Baby Bod. Since the American health care system tends to ignore the medical needs of postpartum moms, I decided to create a program woman can follow on their own.
4. What if you haven’t focused on your pelvic health and it’s already 6 months + postpartum. Where can you start?
I like to tell women, “Once Postpartum, Always Postpartum”. It is never too late to recover from childbirth! As a matter of fact, most of the moms I treat in my physical therapy office in Manhattan, MRPT Physical Therapy, are at least 6 months postpartum. Some moms come into treatment years or even decades after giving birth. This is because many of the problems postpartum women develop after childbirth such as a diastasis recti (aka, Mommy Tummy), pelvic organ prolapse, a leaky bladder and pain can take years to show up as problems. It is ideal to go for treatment starting at 6 weeks postpartum, even earlier if you are in pain, but most women in NYC are too busy taking care of their baby and ignore their own needs. There is also a lack of awareness that all these problems can be avoided or at least addressed when they start treatment right after childbirth.
Some moms come into treatment years or even decades after giving birth. This is because many of the problems postpartum women develop after childbirth such as a diastasis recti (aka, Mommy Tummy), pelvic organ prolapse, a leaky bladder and pain can take years to show up as problems.
Marianne is determined to spread awareness that ALL MOMs need to rehabilitate their pelvic floor and should have pelvic physical therapy after each and every birth. That is why she did her Ted X talk, “What Your Momma Never Told You About Childbirth”. It might be “common” to have problems like a leaky bladder or pelvic / back pain after childbirth, but it is not normal to live with them!
Marianne is the founder and Clinical Director of Marianne Ryan Physical Therapy. She has achieved the highest level of advanced orthopedic manual therapy techniques. She is a thought leader in the field, known for her special knowledge in the areas of Prenatal and Postpartum physical therapy, TMJ and Headaches. A frequent lecturer and source for national media, her international best seller book Baby Bod – Turn Flab to Fab in 12 weeks Flat is available on Amazon.com. Read More
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