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Post Postpartum Fitness and Pelvic Floor Dysfunction

Maureen Mason, DPT, Function Smart PT

Many women are shocked to discover that they have a different body post partum , not only in appearance, but in power, stamina and performance. Although some women bounce back to full function, many have to adjust, and reduce their activities to reduce problems such as bladder leaks, pelvic pain, and other troubles. Our health care system does not prepare women for post partum pelvic floor dysfunction (PFD), yet women’s health advocates are passionate about getting the message out there, Function Smart Pelvic Health team included! Here is a list of unexpected PFD that can occur around the perinatal window, and heads up, recur or become troublesome again around menopause:

Bladder hesitancy, urgency, frequency, pain, and leakage.

Bowel leakage, constipation, straining, pain.

Pelvic pressure, heaviness, aching, bulging, pelvic organ prolapse

Structurally, there may also be birth related over stretch injury to the myofascial structures, at the abdomen:diastasis rectus abdominus, the spine and pelvic joints :low back pain, pelvic girdle pain. Add in all the hormone changes and ta da!The body is in need of support, rest, recharge, and re booting.Medical guidelines concur with a gradual build up of exercise demands, to reach goals.Short home exercise programs can expand to longer sessions, and a return to fitness requires support for childcare for moms as well.As you read this do not despair, we promote health, resiliency, and return to function.Your body is an amazingly adaptable creation that needs your brain to recognize PFD problems and come up with a plan for care, and your own health and wellness, in addition to care demands for your growing family.

The key exercises women need post partum are to work the core, to restore and train foundations, but what is it?Technically the core is an interrelated group of deep muscles, the pelvic floor muscles (PFM), low back muscles (Multifidus), and the deepest abdominal corset, the Transverse Abdominus (TRA). Exercising for gradually increased lengths of time, in varied postures, will rebuild the core so you can get off the floor and spring into action beyond your home, if that is your goal. Consider that new moms have tasks of frequent lifting 7# plus infant, that will quickly ramp up to an 18# plus toddler, so moms have to be fit for child care and all its varied demands as well; lifting, pushing, pulling, and carrying.

PFM, Multifidus and TRA all ideally “turn on” and adjust to the workload for painfree function. Advanced post partum fitness exercises include rotation, agility and sport specific training, with core, upper and lower extremities.Strengthening post- partum can produce rapid results but in most cases it takes months to rebuild the core, especially for community and recreational activities, so pace yourself!

Here is a view of the 3 layers of the pelvic muscles, viewed from below, from the back.At the top area the pelvic muscles connect with the hip, for mobility and stability and painfree function if working optimally.The white bands down the center are deep ligaments (sacrotuberous) that connect the hamstrings and gluteals into the pelvic floor and up into the spine, so everything is “connected” from lower body into the pelvis and on up.If you have symptoms of PFD conservative care such as pelvic physical therapy may be part of your health care team for optimizing function and return to fitness; feel free to call for a Q n A re Physical Therapy.

Buurman M B R, Lagro-Janssen A L M, Womens perception of post -partum pelvic floor dysfunction and their health seeking behavior; a qualitative interview study, Scan J Caring Sci; 2013,27;406-413

Lipshuetz M, Cohen S M, Liebergall-Wischnitzer M, Zbedat K, Hochner-Celnikier D, et al, Degree of bother from pelvic floor dysfunction in women one year after first delivery, Eur J Obstet Gynecol Reprod Biol 2015; 191:90-94

Zourladani A, Zafrakas M, Chatzigiannis B, Papasozomenou P, et al, The effect of physical exercise on postpartum fitness, hormone and lipid levels: a randomized controlled trial in primiparous, lactating women, Arch Gynecol and Obstet 2015; 291, 3

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