It is common practice to seek physiotherapy advice following orthopaedic surgery, yet it is not so common to seek physiotherapy input following pregnancy and birth. Here we discuss why we think it is beneficial for women to have a routine post-natal body check and when this should be conducted.
How is the pelvic floor affected during pregnancy?
During pregnancy hormones can lead to a lengthening of the ligaments, muscles and fascia placing extra stress on the normal functioning of the pelvic floor. The pelvic floor consists of both deep and superficial muscles to upwardly support the pelvic organs which include the uterus, bladder and bowel, including facia and ligaments connecting organs to the pelvic walls.
How can your pelvic floor be damaged during birth?
During a vaginal birth, the pelvic floor lengthens and in some cases the muscles and ligaments can be thinned, torn or pulled off the bone. Vascular and nerve damage due to the pressure of the baby can contribute to reduced pelvic floor activation, resulting in urinary and faecal incontinence. Other factors including advancing age, smoking, BMI, strenuous physical exercise, pelvic floor trauma including forceps birth, increased head circumference, long pushing phase, 3rd or 4th degree tears and episiotomy have also been linked to pelvic floor muscle dysfunction. A vaginal birth can also increase the risk of pelvic organ prolapse which is the descent of one or more of the pelvic organs.
What exercises can I do after birth and when can I start?
We strongly advise all women to consult with a women’s health physiotherapist post-natal for a personalised ‘return to exercise’ program, however as a general rule the following can be used a guide.
Day 1: pelvic floor and lower abdominal exercises. The ‘squeeze and lift’ is only as good as your relaxation, so thinking of the ‘let go’ as much as the ‘close lift’ will help women to really make good progress with their pelvic floor strengthening.
Weeks 1-6: doing a pre-contraction of your pelvic floor prior activities of increased abdominal pressure – cough, sneeze, sit to stand, or lifting can help to give support to your organs and retrain the reflex.
After 6 weeks: remember that all women have different body types, different births and have different levels of fitness leading into the pregnancy. Returning to exercise at the right intensity is individual. Start with low impact exercise such as Pilates, yoga, stationary bike, cross trainer, and swimming (after your 6-week check) and build gradually from there.
After 3 months: guided and graduated return to gym/team/individual sports/running activities. These should ideally be under the guidance of a physiotherapist.
When should you see a Women’s Health Physio after birth?
It’s advisable all women see a women’s health physiotherapist at around 6 weeks post birth, regardless of delivery (vaginal or c-section). An assessment will determine pelvic floor muscle function, stomach muscle activation, a check of any Rectus Abdominal Diastasis (stomach muscle separation) and overall body biomechanics to prescribe an appropriate exercise program to avoid injury. Incorrect type and technique of exercise can actually lead to pelvic floor dysfunction or general injury.
Please call us if you have any further questions or would like to book a post-natal check up.