10 simple steps to care for your postpartum body.
Understanding your core and your pelvic floor.
8 min readFoto credit: Instagram that.wandering.life Many of us hear about the pelvic floor for the first time in an antenatal class when we are preparing for the birth of our babies. And, if we are lucky, we find about Diastasis Recti the moment we step on a Postnatal Pilates or similar postnatal class. Pelvic floor health is something we should all look after from a young age but not many of us know how to do it. In this article, personal trainer Paulina Szymanska helps us understand the postpartum body and shares 10 simple habits and exercises to protect both, your ‘core’ and your pelvic floor for a lifetime.
In this article, I would like to do two things. Firstly, shed some light on the pelvic floor, what is it and why is it so important. Secondly, I will provide you with a list of everyday habits which are crucial for your pelvic floor and core recovery and lifetime protection.
A workout can take between 20 to 60 min a day, but what matters most, is what we are doing with our bodies for the remaining 23 hours of the day.
Before I get started I want to say, this article cannot take the place of professional support, and if you have any issues with your pelvic health, it’s crucial that you consult with a Women's Health Physiotherapist to get proper treatment.
Now, let’s get started....
Pelvic Floor. What is it and what is it for?
I would like you to picture a hammock hanging from hooks between two trees, and three fruits of different weights and sizes chilling on it. The hammock represents your pelvic floor muscles which, like a fabric, have their resistance and bounciness. The same applies to ligaments – the hooks holding our hammock. Our yummy fruits represent the organs sitting on the pelvic floor, relying on its support and strength. These organs are the bladder, the uterus and the rectum. If one of our fruits happens to grow 500 times bigger, as our uterus does during pregnancy, our hammock would start to struggle, especially if the hammock wasn’t particularly strong beforehand.
While pelvic floor disorders might be common after pregnancy and childbirth, they are not normal. If you experience incontinence, leaking, reduced sexual arousal or pain during intercouse, a Women’s health physiotherapist will be able to check your pelvic floor and provide the best treatment plan.
Moving to the “core”
Think about your “core'“ like a cylinder filled with compressed gas. Like the geometric figure, your core has: a ceiling (Diaphragm), a front wall (Abdominal Wall Muscles & Connective Tissue), side walls (Obliques - Internal and External), a back wall (Lumbar/Thoracic Muscles & Connective Tissues) and a floor (Pelvic Floor Muscles).
If one of these ‘walls’ is weak, it becomes more exposed to the pressure and the tension. And if that happens over a long period (think about 9 months of pregnancy!), we can find our cylinder failing, having cracks.
Imagining cracks in your cylinder’s walls is a good way to understand a common problem for many women who have been pregnant called Diastasis Recti: the separation of the rectus abdominis muscles. Diastasis Recti is not really a “gap” issue, but a functional problem. You might have some separation, but if the strength of surrounding structures and tension is restored, it might not cause any symptoms. In the same way, pelvic floor issues do not always require strengthening of the pelvic floor because sometimes, the problem lies in having too much tension and what is needed is relaxation of the muscles.
Diastasis Recti. Image credit: www.mamawell.orgNow think about the compressed gas inside of the cylinder pushing on the walls with great force, this phenomenon takes place in the human body and we refer to it as intra-abdominal pressure. Intra-abdominal pressure is always there but varies depending on what you’re doing with your entire body; coughing, laughing, pooping, breathing, birthing, moving, lifting heavy objects, are all things that can change the amount of pressure in your abdomen. These strain your linea alba from inside all along with babies or excessive intra-abdominal fat.
Let’s talk about breathing
Breathing is an indispensable part of pelvic floor health and health in general. Look carefully at the image below to see how the movements of the Diaphragm are coordinated with the pelvic floor and the inhale/exhale processes.
During the inhalation, the Diaphragm descends, the pelvic floor relaxes, the rib cage expands and the abdominal wall relaxes and expands.
During the exhalation, the Diaphragm ascends, the pelvic floor tenses, the rib cage contracts, the abdominal wall tenses, and the lumbar and thoracic muscles and other soft tissues contract/tension to provide support.
How to protect your
core and your pelvic floor.
In light of this information, I have for you a list of small everyday habits which can help you protect your “cylinder” for a lifetime!
1. When you lie down and when you lift yourself up from/to a horizontal position (floor, bed, sofa) always do it on your side. Avoid coming up forward like in the sit up. This is a tip for everyone, in every stage of life, but especially important during pregnancy and in the postpartum period to lessen the Diastasis Recti irritation.
2. Sneeze or cough to your elbow with a rotation of your torso.
If you suffer from leaking or incontinence you can also cross your legs and twist in the opposite direction. If you’ve had a c-section, take it easy with the rotation though, mind the stitches.
3. During urination sit straight, feet flat on the floor and let the urine flow naturally, do not push excessively. Also do not stop the flow, that’s an incorrect and dangerous way of doing Kegels.
4. When you pooh, try to put a short stool under your feet and lean forward. Like during urination, avoid excessive pushing as well as long sitting on the toilet, this can weaken the pelvic floor muscles. Drink lots of fluids to help avoid constipation and soften stools. Consult with a dietitian or physician about dietary changes and medications to avoid constipation.
5. When you need to lift something up do it on an exhale. When you pick up your kids, groceries, a suitcase, dumbbells from the floor or do anything in a squat position, take your breath out at the moment you are moving up. Avoid bearing down and holding your breath. Instead, contract the abdominals inwardly, breathe out, and contract the pelvic floor muscles (PFM) while you stand up.
6. Whether you are putting your child on the floor, lifting them up, or doing some work which is close to the ground like gardening, always go down on a reverse/forward lunge and work in a half-kneeling position rather than bent over with slouched back. If you had any tears or episiotomy wait until it heals before doing this movement.
7. When standing, particularly during pregnancy, try to practice a proper standing posture: shoulders back, pelvis in posterior tilt (think coccyx rolling underneath you), soft knees – not overextended but very slightly bent (active). Your centre of gravity should be in the middle, in between your feet. Keep reminding yourself about going back to this standing posture until you do it automatically.
8. Practice these positions to rest and relax your pelvic floor and lower back:
Get on your forearms and knees with your bum up. Nice and safe during pregnancy, but not recommended during your period.
Lying on your front with a pillow under your belly. During pregnancy only while it’s comfortable and not recommended during the second and third trimester.
Finally, I would like to add two exercises that are essential for any further training:
9. Side breathing. This exercise can be done either on a standing, sitting or lying position, it will help restore diaphragm breathing after birth and reduce flared ribs.
Place your hands on the sides of your ribcage. Slowly breath in through the nose towards the lower part of your ribs (feel your hands going to sides) then, slowly exhale through the mouth and keep bringing your ribs down and towards each other - ribcage dropped. Don’t rush your breath, keep it natural. You can start with a few reps and slowly build it up to 8-10 reps, done 2-3 times over the course of the day.
10. This exercise has two steps:
1. Pelvic Tilts. Lie down on your back, bend your knees, feet flat on the floor and relax for a minute. Now notice the small arch in your lower back (I took a picture doing it excessively to show you some movement). Breath in through your nose and during the exhale tilt your pelvis up, flattening the lower back and activating your core. Hold for two seconds and relax.
2. Glute bridge. The starting position and pelvic tilt are the same as described above. Then, once you’ve flattened the arch, raise your hips toward the ceiling, squeezing your glutes. It doesn’t have to be high, but should come from glutes. Start gently with one round of 8 reps. Once you feel comfortable and able to feel your glutes working (not your lower back), you can add more reps.
I really hope you will find these recommendations useful and find them something you can introduce onto your daily habits. Don’t give up if you forget to practice these postures some days, it takes time and consistency to build a habit. Remember, if you lift yourself up from your side only 10% of the time, it is already 10% more than before.
One is better than nothing. 😉
Image credit.
https://feelgoodfitness.org/
https://www.burrelleducation.com