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You’ve had your baby and are dealing with many changes in your life. You anticipated some of these changes: lack of sleep, feeding schedules, and some pretty impressive diaper changes to name a few. However, some changes that you were not anticipating may be affecting every facet of your new life. Weak abdominal muscles, back pain and incontinence are just a few of the problems that many new moms face. Luckily, there is something you can do about it.
One of the primary reasons that women have back, hip or pelvic pain during the early post-partum period is due to weak abdominal muscles. During pregnancy, the abdominal muscles become stretched out and develop what’s called a “stretch weakness”. Essentially, the muscle fibers are not overlapping each other at an adequate level, and they are unable to work properly. In this case, the work that needs to be done is supporting your posture both at rest and with activities such as lifting or carrying your baby. There may also be a diastasis recti present, which is a separation in the “six pack” muscles. This separation leads to inadequate abdominal support and can usually be viewed as a bulge in the midline of your torso when you do a sit-up. Oftentimes, this separation can be corrected with specific exercises.
I’ve had many patients tell me “It’s normal because I’ve had a couple of kids … all my friends pee their pants when they cough or sneeze, too!” While this may be a common symptom it does not mean it is normal. Many times, incontinence results from overstretching of the pelvic floor muscles during delivery, resulting in weakness of these muscles. However, even women with c-sections can have incontinence after delivery, as the weight of the baby also stretches the pelvic floor. Weakness in the pelvic floor muscles can present as incontinence, prolapse, pain or any combination of these. There are alternatives to surgery or medication that you may not know about. It begins with Kegels, but goes way beyond that.
Kegels are voluntary contractions of your pelvic floor muscles (commonly referred to as your “PC muscles”). “PC” refers to pubococcygeus muscles, but there are more muscles in your pelvic floor that are involved than just this one. Many women do Kegels incorrectly (a study from the early 1990’s quotes 40%!) Rather than isolating the muscle, many women will use stronger muscles to compensate for the weaker pelvic floor, such as the adductors (inner thigh muscles), the gluteal muscles or by bulging out the abdominal muscles. When a Kegel is done correctly, it will not be noticeable to anyone looking at you, making it a “secret” exercise and something you can do anywhere, anytime. If a muscle is not exercised properly, it will not get stronger. When Kegels are done improperly, they will not help you at all, and may make your problem worse.
Whether it be the abdominal muscles or the PC muscles, unfortunately they don’t always bounce back during the postpartum period. While it is tempting to return to a rigorous exercise program, if there are problems present such as pain or incontinence, this type of exercise regimen may only make your symptoms worse. There are recommended exercise progressions, especially during the first 6-8 weeks after delivery. Beginning with short, quick Kegel contractions and later adding longer holds is a good place to start. (Click here for a sample Kegel plan.) (Click here for a sample Abdominal plan.)
Following up with a physical therapist who specializes in treating these problems will help you maximize your efforts to conservatively manage these problems. They can also instruct you in how to properly perform a Kegel and teach you advanced Kegels when you are ready using biofeedback, a non-invasive modality using a sensor and special equipment to show your Kegel performance on a computer screen in real-time. Kegels are a crucial exercise to maintain the strength of your pelvic floor muscles and should be done every day – through postpartum, through menopause and beyond.
If doing these exercise progressions provide you with some improvement of your symptoms, you are likely performing the exercise properly. Symptoms may take three to four months to improve during the early post-partum period, and sometimes longer if you are breastfeeding, due to hormonal influences. However, if your symptoms do not improve or they become worse, you may not be doing the exercises properly and evaluation by a physical therapist (once cleared by your physician) specializing in treating pelvic floor muscle disorders may be indicated. Remember the phrase “If you don’t use it, you lose it.” This is definitely an area you do not want to lose strength in!
Heather Jeffcoat, DPT is a licensed physical therapist with offices in Encino and Glendale, CA. She specializes in treating women with pelvic floor disorders and during pregnancy and postpartum. You can find out more on her website www.thepilatespt.com and reach her at firstname.lastname@example.org. She's also the proud mother of two little ones.
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Sample Kegel/PC muscle Exercise Progression|
*Performing the “Quick Flicks” will train your quick, reactive muscles (known as fast-twitch muscles). Performing “Long Holds” will train the postural and supporting component (known as slow-twitch muscles) that support your pelvic organs.
Sample Abdominal Exercise|
If doing these exercise progressions provide you with some improvement of your symptoms, you are likely performing the exercise properly.