After a pregnancy, many women want to jump right back to getting into shape. Oftentimes they feel like they can pick up where they left off prior to pregnancy but many physiological changes occur with pregnancy as well as post-pregnancy. One of the most common complaints women have after pregnancy when they begin to work out is experiencing “leakage” with activity or unexpected urinary incontinence. It often happens with lifting something heavy, jumping, laughing, running, etc. This occurs because the muscles supporting the bladder have been tried and tested throughout your pregnancy. During pregnancy, the pelvic floor muscles can stretch/descend up to 2 inches due to the weight and growth of the baby. During delivery, the muscles can sometimes tear or stretch even more. If a C-section occurred, the cutting of the abdominal muscles weakens the entire chain of pelvic stabilizers. And to top that off, after pregnancy, especially if breast feeding, hormonal changes decrease the tone of the muscles and make ligaments and tendons more relaxed so they don’t function as ideally as they used to.
To counteract this, you must strengthen your pelvic floor after pregnancy (and before). It is VERY important to focus on the pelvic floor and not just your abdominals. If you focus too much on the abdominals, it will just continue to push down on the pelvic floor, rather than lifting it up. Three key pelvic floor exercises are:
Pelvic floor Contraction: Resting on you back or sitting supported in a chair, try to contract just your pelvic floor muscles. To do this, imagine trying to hold back your flow of urine, squeezing a tampon, or trying not to pass gas without contracting your abdominals or rear end muscles. You should feel a slight lifting up sensation in your pelvic region. Try to hold this contraction for 5 secs (oftentimes 3 seconds is as much as you can start with), and then relax for 10 seconds. Try to do 10 of these 2 x a day.
Bridges with inner thigh squeeze: Laying on your back with your knees bent up and feet on the floor, place a medium sized ball between your legs. Squeeze the ball gently between your legs, and then squeeze your pelvic floor as you lift your hips off the floor. Hold up for 3-5 secs and slowly lower back to the floor. Repeat 10 times.
3. Lateral Walking with resistance band and pelvic floor contraction: With a light to moderate resistance band around your ankles, squat ¼ of the way down and attempt to pull in your pelvic floor (not your abdominals). Staying in this position, slowly step side<>side the length of a hallway. Rest at the end and then recontract your pelvic floor and return. Repeat until the outside of your hips are fatigued.
These three exercises will help you start to regain your strength after pregnancy and help prevent any worsening urinary incontinence. If incontinence continues, be sure to see your Women’s Health Physical Therapist.
Mary Beth Ackerman, PT, CIMT
Mary Beth has been a physical therapist for 18 years and is co/owner of PhysioCare Physical Therapy. Mary Beth is a certified pre and post pregnancy exercise consultant with more than 15 years experience working in Women’s Health. She is also a certified integrated manual therapist.