Author: Kara Schuft, PT, DPT: Doctor of Physical Therapy, Business owner, and Blog Contributor. Specializing in chronic pain, pelvic health and peripartum care. Passionate about health literacy and conversation around our changing bodies throughout the lifespan. Learn more about Kara here.
Hello! Welcome to my four-part postpartum discussion on the post-baby-body. I recently just had my second child so it’s feeling really fresh in my mind! It seemed like good timing to chat about what can happen to our bodies after childbirth (so many things!) and how physical therapy can make a difference. I have worked with many pregnant and postpartum clients over the years. Remember, that every person and their experience is different. This is meant as a conversational starting point to think about some of the ways your body has changed, and how to help if you are experiencing pain or functional difficulties after childbirth. This is a mix of my own personal experience as well as of those of the many women I have had the pleasure of working with as a physical therapist. Come join me as we jump right in and talk about pelvic floor weakness after having a baby.
What just happened?
You had a baby! Whether it’s your first, second, or one along the line of many, congratulations! I can legitimately tell you now that it gets easier. That first month is so hard. Every. Time. It’s not just the emotions and sleep deprivation, it’s also that your body doesn’t just “bounce back” to what it used to be. If you are anything like me, all of a sudden you have skin and muscles and even bones that have “rearranged” themselves. One of the topics I want to talk about is how much weaker you are after delivery, especially through the core. Whether your baby came via c-section or vaginal delivery, the weakness happens to all of us, particularly through the pelvic floor and our abdominal muscles. One of the biggest challenges with the loss of pelvic floor strength is dealing with urinary incontinence. Having some difficulty with incontinence after having a baby is normal. However, you don't have to CONTINUE to deal with incontinence months or years later. This can get better. incontinence does not have to be your "normal."
What muscles are you even talking about?
Pelvic floor weakness affects us all after having a baby. But what exactly IS the pelvic floor, you ask? The pelvic floor is a phrase describing a group of muscles at the very base of the pelvis. You can think of it as a hammock or sling of muscles right between our legs. Let me try my hand at a little drawing...
The pelvic floor very important for support, sexual function, and sphincter control in both women and men.
SUPPORT: The pelvic floor supports our pelvic organs which include the bladder, vagina, and rectum.
SEXUAL FUNCTION: In women, it maintains the erection of the clitoris and it is the rapid contraction of the pelvic floor that you feel during an orgasm.
SPHINCTER CONTROL: This refers to circular muscles in the pelvic floor that surround the openings for the bladder (urethra), vagina, and rectum (anus.) These muscles are small but they are extremely important because when they contract they can close the openings so that you do not let any urine or feces through. When you go to the bathroom, the pelvic floor relaxes and the sphincters open to allow waste to pass.
When you deliver vaginally the baby has to pass through these muscles of the pelvic floor. This causes the muscles to become more stretched and therefore, weaker. However, pelvic floor weakness can also occur from the “heaviness” of the baby and extra tissue on the pelvic floor muscles that comes with pregnancy. You can still experience pelvic floor weakness after having a baby, even if you do not deliver vaginally. Having a baby is like an Olympic event for our pelvic floor - every time.
Why am I leaking?
Ok, so stay with me. Muscles need to be at an optimal length to really do their jobs right. When muscles have been stretched out they simply don’t have the mechanics to get a really good muscular contraction anymore. This is what happens after having a baby. When the muscles of the pelvic floor that act as a sphincter can’t work as well anymore it means that the pelvic floor doesn’t do as good of a job closing the openings of the bladder, vagina, rectum, or all three. This can lead to leaking after delivery. When the pressure from our body is greater than the pressure the pelvic floor can contract against, we leak. Classically, this happens if we are sneeze, cough, laugh, blow our noses, or participate in sports like running. This is commonly known as stress incontinence and the main topic for this piece.
Let me be very clear here: Leaking after delivery, whether it be urine, passing gas, or even leaking feces is very common because of residual pelvic floor muscle weakness. Continuing to leak years later and hearing or believing that this is "something all women go through and deal with" is NOT NORMAL and should be addressed. This is not something that you just have to "live with" and that's why we need to talk about it.
What can be done about it?
Ok, so we are weak, we are leaking, you say this isn’t normal, but what are we supposed to do about it?
I know, it’s the last thing you want to do. It’s the last thing I want to do. I’m trying to feed this baby and get it to sleep - WHO HAS TIME FOR ANYTHING ELSE? I get it. It’s really hard to fit in exercise to the mix after having a baby. Not to mention the fact that I for sure didn’t FEEL like doing any exercise after having a baby. However, there are two exercises you can start right away, that take fairly little time, and that you can incorporate into your routine without any fancy equipment or leaving your bedroom. First is the pelvic floor muscle contraction, and second is the transverse abdominal muscle contraction.
A pelvic floor muscle contraction is often referred to as a Kegel because of Dr. Kegel who first described a movement like this back in the 1940’s. A pelvic floor muscle contraction is where you try to lift that hammock of muscles up away from the floor and towards your head. Don’t worry, they don’t actually move that far. In fact, my first reaction after having a baby was, “are they moving at all?” Rest assured, even if you can’t feel them moving, just thinking about the movement and trying to feel it (practicing the movement if you will) is enough to start those muscle fibers firing again. It is the same motion as if you are sitting on the toilet and you try to stop the flow of urine. That would be a contraction of the pelvic floor muscle.
At first, it’s often easier to do this lying down because you don’t have to work against gravity. This is an exercise that can be done immediately whether you deliver vaginally or by c-section. The one caveat is that if you get stitches in the pelvic floor, such as after tearing during delivery, it will not feel as comfortable to move that area as if you did not tear. However, it’s perfectly ok to do so. I encourage women to practice two different ways.
First try to hold the muscle up and in (as if you were closing all the openings of the pelvic floor) quickly for 1-2 seconds, then release. Try this 10 times. Second, try to hold the pelvic floor muscle up as long as you can. Start with 3 seconds and work up to 10, and try this one a few times. This works on the overall endurance of the pelvic floor.
A contraction of the transverse abdominal muscle also helps immediately strengthen our core. This is a muscle that goes across your tummy area and acts as our internal back brace. The way to engage this muscle is to slightly pull in as if you were drawing your belly button backwards towards your spine. Now, don’t go too far. You shouldn’t look like you are sucking in so tightly that you’re trying to get back into those non-maternity pants. This is a finesse movement. A subtle holding in. If you are feeling particularly inspired you can try to hold this muscle in WHILE you hold your pelvic floor up and in. Now that’s an exercise in coordination.
With this muscle, it is all about endurance. I encourage women to hold in starting with 10 seconds and working up to 2 minutes at one time. Again, sometimes it is easier to do it lying down. However, with both of these exercises, you can do them sitting, standing, lying down, or while on your side.
What else can be done about it?
I’m so glad you asked! Of course, I would highly recommend seeing a physical therapist. Here are some thoughts that would prompt you to make an appointment:
I read those exercise descriptions and I still can’t tell if I’m doing it right or not.
I have been working on doing a kegel and I just can’t stop leaking urine. It doesn’t seem to be helping.
Core, what core?
I got stronger and I no longer leak if I cough, sneeze, or laugh. But I’m trying to walk longer distances for exercise and my pelvic floor gets so tired I start to leak after 10 minutes.
I’m ready for harder exercises! What should I do?
When in doubt, see a Physical Therapist. One who specializes in pelvic floor will be very familiar with how to manage and correct incontinence and improve weakness after having a baby. In Oregon, many insurances allow for direct access where you can go straight to a physical therapist without seeing your doctor first. However, typically OBGYN’s, Midwives, and other providers are more than happy to refer you to a physical therapist when needed. Don’t delay, see one today!
Join me next week for The Postpartum Diaries Part 2: Second, why did nobody tell me about this?