As a Women’s Health Physio I often get questions from new Mum’s about when it is safe to start pelvic floor exercises after giving birth. Here are a few tips on how to correctly perform pelvic floor exercises in the acute postpartum stage.
Whether you have had a vaginal birth or a caesarean, it is very important to begin your pelvic floor exercises as soon as comfortably possible after giving birth (or after your doctor has given you the all clear). Most women find this the hardest period to find time to do exercises as they are recovering from the birth and have a new addition to their life which needs 24 hour care. The good thing about pelvic floor exercises is that they do not require any equipment and can be performed anywhere, at any time and in any position (sitting, lying or standing). Even if you have had a traumatic birth with tearing to the pelvic floor muscles or an episiotomy was performed (which is cutting of skin and pelvic floor muscles), it is good to start using the torn/injured muscles as soon as possible as the gentle muscle contractions will help reduce swelling and bring the torn muscle fibres back in the correct alignment to heal. If you are still bleeding, please wait until this has stopped before you start your pelvic floor exercises, unless you have been cleared from the Doctor to begin a strength program.
The best way to bring yourself back into gentle pelvic floor exercises is to aim to contract 10 times and hold for the number of seconds corresponding to the age of the baby in weeks. For example in the first week you should be aiming to hold 10 times for 1 sec. When the baby is 2 weeks old, increase the pelvic floor contraction to a 2 second hold and so on. Once you can comfortably complete 1 set of 10 contractions without pain, you can increase to 2 x 10 contractions. Once the acute swelling and pain settles, and any stitches have come out and any wounds have healed you can start to increase the size of the contraction. In the first couple of weeks you should just aim for a gentle contraction (less than 50 % of your maximum). After this, and as pain allows you can start to build towards a maximum contraction to strengthen the muscles.
When you are turning on your pelvic floor muscles, try and relax all your other muscles including your abdominals, buttocks and shoulders. Focus first on your back passage and see if you can lift the muscles and squeeze inwards (as if you were trying to hold in wind).
DO NOT squeeze your buttock muscles, focus instead on the deeper muscles around the anal canal. After you have mastered this you need to try and bring the contraction towards the front passage as if you are trying to stop the flow of urine (think of the muscles you turn on when you are desperate to go to the loo to pass urine).
Try not to suck your belly button in or brace your abdominal muscles as this will actually put more strain down on the pelvic floor and can counteract the good of the exercises you are trying to perform.
When to seek help:
· If you cannot feel your muscles contract or relax
· If you notice you are getting worsening symptoms such as incontinence or if you are bleeding more after doing exercises
· If you have deep pelvic pain
· If you see no change in pelvic/bowel control after 3 weeks of daily exercises
· If you feel a downward pressure on your pelvic floor when you are trying to "lift" the muscles
· If you have any external bulging through your pelvic region
· If you feel the exercises are too easy but you are still getting bladder/ bowel leakage
· If you are managing with the 2 sets of 10 well but are keen to return to running and impact exercise or weights. (In this instance you need to ensure your pelvic floor muscles are significantly stronger to withstand the extra load through these muscles with weight lifting or repetitive jarring actions like you will experience when running).
Although this is the hardest time to remember to do your exercises, you will thank yourself later if you do the exercises required now! To ensure you remember, try to complete 2 pelvic floor contractions each time you are feeding the baby, try setting reminders on your mobile phone or put a “post it” beside your bed to remind yourself.
If you are not sure whether you are using the muscles correctly, or would like a specific exercise program to strengthen your pelvic floor, please book in to see Sophie our Women’s Health Physio. Just let the girls on the front desk know it is for a ‘Women’s Health’ assessment or alternatively please leave your details with the girls on the front desk, and Sophie is more than happy to call back to discuss any problems or answer any questions if you would like more information.
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