Pelvic Floor

Home / Posts tagged "Pelvic Floor"
What exercises can I do at home after having a baby?

What exercises can I do at home after having a baby?

The experience of bringing a new baby home is exciting and wonderful. But this period can also be terrifying for a new mother, and at times, isolating. It’s a word we have been hearing so much of lately, but for other reasons – “Stay at home. Self-isolate. Social distance”. The concept of this is hard for anyone, more so for a new mother. As new mothers, we rely on getting out of the house and being social with our family, close friends and mother’s groups for support. We rely on access to our medical and allied health professionals so that we can look after ourselves and in doing so, care for the new baby we have brought into this world. Even though Covid restrictions are now easing,  it can still be challenging to leave the house with a new baby in those first weeks or months, for reasons other than the essentials. Looking after yourself and getting into some regular exercise might be low on your list of priorities.

 

Exercising from home

While the recent Covid crisis has been challenging, especially for new mums, this crisis has produced a tremendous surge in online exercises and exercise programs. We are lucky to have technology and the online platform to access exercise programs from home, however new mothers wanting to start exercising need to be cautious in selecting exercises. Some exercises place extra load on the abdominal muscles or pelvic floor which new mums need to avoid soon after having a baby, as these can have adverse results. Getting professional guidance before embarking on an online exercise program is vital.

At PhysioTec, we have two Women’s Health physiotherapists, Megan Power and Irene Li, who can assist you through this uncertain time. If you can’t make it to the clinic in person, we are able to provide an online ‘Telehealth’ video consultation. We will take a thorough history inclusive of your pregnancy and birth experience. We will also look at your posture and a variety of movements. From this we will give evidence-based advice and, if appropriate, recommend a personalised exercise program you can do safely at home.

We can address any of the following during a consultation:

  • Pelvic floor muscle and function
  • Abdominal separation
  • Safe exercise options/exercises to avoid
  • Pelvic pain

We also offer an App for your exercise program and this includes video, audio and text description. It also allows in-app messaging to stay in touch with your physiotherapist.

 

The Importance of the Pelvic Floor Muscles

Like any other muscle in our body, the pelvic floor muscles may be weak, too active, a source of pain and can also be different side to side. These muscles, along with connective tissue, support the pelvic organs. In women, these are the bladder, uterus and bowel. The pelvic floor is important for prevention and management of prolapse, management of urinary incontinence and also for its role in sexual function. Following childbirth, the pelvic floor needs time to recover and then we can start to gradually build up strength and coordination of these muscles again.

The main recommendation of the most current guidelines state that pelvic floor muscle training is associated with a reduction in prenatal and postnatal urinary incontinence (Mottola MF, et al., 2018). These exercises can be performed daily HOWEVER, it is crucial that women seek instruction from a knowledgeable health professional  to ensure proper technique in order to obtain the best outcomes/benefits from performing these exercises. This is especially the case for women who have never trained these muscles.

 

What about running?

In March 2019, three highly experienced physiotherapists – Tom Goom, Gráinne Donnelly & Emma Brockwell combined their areas of expertise to release a paper on returning to running after childbirth and the guidelines for this population. The main findings were that women in the post-natal period benefit from an individualised assessment and guided pelvic floor rehabilitation in order to prevent and manage pelvic organ prolapse (Hagen, S et al., 2014), manage urinary continence (Bø, 2003) (Dumoulin, C et al., 2018) (Price, N et al., 2010) and improve sexual function.

 

Based on expert opinion, the following suggestions were made:

  • Return to running is NOT recommended at all prior to 3 months post-childbirth OR beyond this time point if any symptoms of pelvic floor dysfunction are identified before or after attempting a return to running
  • Pelvic health, load management and strength testing should be assessed in order to establish if a patient is ready to return to running in the post-natal period
  • Additional factors that should be considered in the postnatal evaluation are weight, fitness, breathing, psychological wellbeing/status, abdominal separation, breast support and feeding, running with a buggy and relative energy deficiency in sport (RED-S)

 

How can a Physiotherapist help me?

At PhysioTec, our physiotherapists who specialise in Women’s Health can address your postnatal concerns and advise you on the safest exercises, individually tailored to your symptoms and current capacity. If you are wishing to return to a level of activity similar to pre pregnancy, your physiotherapist is able to guide you on load and intensity and how to graduate safely back to full activity. We are passionate about what we do and our continuity of care. We are here (in person at Tarragindi or online via TeleHealth) to help and provide you with the best advice and support!

Book Online or call us on 3342 4284 to speak to us today!

 

References

Bø, K. (2003). Is there still a place for physiotherapy in the treatment of female incontinence? EAU , 145-153.

Dumoulin, C et al. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews(10).

Hagen, S et al. (2014). Individualised pelvic floor muscle training in women with pelvic organ prolapse: a multicenter randomised controlled trial. 282(9919), 796-806.

Mottola MF, et al. (2018). 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine, 52, 1339-1346.

Price, N et al. (2010). Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas, 67(4), 309-315.

 

Pregnancy, pelvic pain & safely returning to running

Pregnancy, pelvic pain & safely returning to running

Pregnancy is an exciting and special time but it can also come with a lot of questions. Whilst Google gives us access to a wonderful world of information, it can lead to more questions and sometimes concerns. This article will discuss the effect of pregnancy on the mother in terms of pelvic pain and the pelvic floor and returning to running after pregnancy, backed up by evidence and research. It is important to remember that not any one pregnancy is exactly the same!

Pelvic Pain & Exercise during Pregnancy

Based on various studies, approximately 50% of women experience low back pain or pelvic girdle pain (pubic, buttock, tailbone, pelvic floor regions) during pregnancy and 25% continue to have this pain 12 months after delivery (Davenport MH, et. al., 2019).

A panel of experts looked at 32 studies, which included a total of 52,297 women without absolute or relative contraindications to exercise (Davenport MH, et. al., 2019). For the absolute and relative contraindications, please click here. From this, it was found that physical activity during pregnancy decreased the severity of low back, pelvic and lumbopelvic pain. (Davenport MH, et. al., 2019). This is both during the pregnancy and in the early postpartum period. The exercise components of these studies included yoga, aerobic exercise, general muscle strengthening and a combination of resistance and aerobic training (Davenport MH, et. al., 2019).

Another study by Owe et. Al (2016) looked at 39, 184 pregnant women who had not previously given birth. This study found that exercising up to five times weekly prior to pregnancy was protective against pelvic girdle pain and also those women who reported participating in high impact exercises prior to pregnancy had the lowest risk of pelvic girdle pain during pregnancy. (Owe KM, et. al, 2016).

The most current guidelines state that an accumulation of 150 minutes of moderate intensity exercise each week is recommended in order to achieve the health benefits and reduce risks of pregnancy complications (Mottola MF, et al., 2018).

Pregnancy & the Pelvic Floor

In relation to the pelvic floor, the main recommendation part of the most current guidelines state that pelvic floor muscle training is associated with a reduction in prenatal and postnatal urinary incontinence (Mottola MF, et al., 2018). These exercises can be performed daily HOWEVER, it is crucial that women seek instruction from a trained health professional (such as a women’s health physiotherapist) to ensure proper technique in order to obtain the best outcomes/benefits from performing these exercises. This is especially the case for women who have never trained these muscles.

Returning to Running after Pregnancy
More recently (March 2019), three highly experienced physiotherapists – Tom Goom, Gráinne Donnelly & Emma Brockwell combined their areas of expertise to release a paper on returning to running postnatal and the guidelines for this population. The main findings that were included in the paper were that women in the post-natal period benefit from an individualised assessment and guided pelvic floor rehabilitation in order to prevent and manage pelvic organ prolapse (bladder, bowel or uterus descending into the vagina) (Hagen, S et al., 2014), manage urinary continence (Bø, 2003) (Dumoulin, C et al., 2018) (Price, N et al., 2010) and improve sexual function.

Based on expert opinion only, the following suggestions were made:

• Return to running is NOT recommended at all prior to 3 months post-natal OR beyond this time point if any symptoms of pelvic floor dysfunction are identified before or after attempting return to running
• Pelvic health, load impact management and strength testing should be assessed in order to establish if a patient is ready to return to running in the post-natal period
• Additional factors that should be considered in the postnatal evaluation are weight, fitness, breathing, psychological wellbeing/status, abdominal separation, breast support and feeding, running with a buggy and relative energy deficiency in sport (RED-S)

How we can help you at Physiotec:

It is imperative to see your physiotherapist before commencing physical activity, especially if planning a pregnancy, already pregnant or in the post-natal period.

Here at Physiotec, your women’s health physiotherapist can:
1. assess your pelvic floor muscles to ensure you are using them correctly
2. assess and address other areas of concern such as low back pain or pelvic pain
3. advise you on the safest exercises during pregnancy as well as into the post-natal period
4. perform a physical assessment to determine whether you are ready to return to running or other exercise after pregnancy 
5. perform a running assessment to ensure that your technique places minimal loads on your pelvic floor and joints following pregnancy

You might also like to join one of our Pilates classes to stay strong or build strength and control before, during or after your pregnancy.

Bibliography

Bø, K. (2003). Is there still a place for physiotherapy in the treatment of female incontinence? EAU , 145-153.
Davenport MH, et. al. (2019). Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. British Journal of Sports Medicine, 53, 90-98.
Dumoulin, C., Cacciari, L. and Hay-Smith, EC. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews(10).
Hagen, S., Stark, D., Glazener, C., Dickson, S., Barry, S., Elders, A., Frawley, H, Galea, MP, Logan, J., McDonald, A., McPherson G., Moore KH, Norrie, J., Walker, A., Wilson, D. (2014). Individualised pelvic floor muscle training in women with pelvic organ prolapse: a multicenter randomised controlled trial. 282(9919), 796-806.
Mottola MF, et al. (2018). 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine, 52, 1339-1346.
Owe KM, et. al. (2016). Exercise level before pregnancy and engaging in high-impact sports reduce the risk of pelvic girdle pain: a population-based cohort study of 39 184 women. British Journal of Sports Medicine, 50, 817-822.
Price, N., Dawood, R. and Jackson SR. (2010). Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas, 67(4), 309-315.