Pelvic floor exercises post pregnancy

Your post-pregnancy body - NHS

Having a baby changes your body. Here’s some advice to help you feel comfortable with your body.

Physical problems after pregnancy

There may be physical problems after having a baby.

They can be related to pregnancy or birth, or the things you do while caring for young children, such as lifting and bending.

For some problems, you can do a lot to help yourself. For example, if you have a leaky bladder (incontinence) or a heavy feeling between your vagina and anus, you may need to strengthen the muscles around your bladder by doing pelvic floor exercises.

Also, if you have back pain, you may need to learn how to look after your back and do some exercises to strengthen it.

If a physical problem is bothering you, ask a GP or health visitor for help at any time. They can advise you and the GP can refer you to a specialist if necessary.

Your postnatal check

Your postnatal check at around 6 to 8 weeks after the birth of your baby is a good time to talk to the GP about any physical or mental health problems you've had since the birth.

Find out more about what happens at your postnatal check.

Separated stomach muscles

It's common for the 2 muscles that run down the middle of your stomach to separate during pregnancy. This is called diastasis recti, or divarication.

The amount of separation can vary. It happens because your growing womb (uterus) pushes the muscles apart, making them longer and weaker.

The separation between your stomach muscles will usually go back to normal by the time your baby is 8 weeks old.

After you have had your baby, you can check the size of the separation with this simple technique:

Lie on your back with your legs bent and your feet flat on the floor.
Raise your shoulders off the floor slightly and look down at your tummy.
Using the tips of your fingers, feel between the edges of the muscles, above and below your belly button. See how many fingers you can fit into the gap between your muscles.

Do this regularly to check that the gap is gradually getting smaller.

If the gap is still obvious 8 weeks after the birth, contact the GP as you may be at risk of back problems. The GP can refer you to a physiotherapist, who will give you some specific exercises to do.

Regular pelvic floor and deep stomach muscle exercises can help to reduce the size of the separation between your stomach muscles. It's also important to stand up tall and be aware of your posture.

Pelvic floor muscle exercises

Pelvic floor muscle exercises strengthen the muscles around your bladder, vagina and bottom. This can help to stop incontinence, improve prolapse and make sex better too.

You can do these exercises lying down, sitting or standing. With practice, they can be done anywhere and at any time:

Squeeze and draw in your bottom as if you're holding in wind.
Squeeze around your vagina and bladder (urethra) as if you're stopping the flow of urine or squeezing during intercourse.
Long squeezes – hold for as long as you can, but no longer than 10 seconds, then relax.
Short squeezes – quickly squeeze the muscles and then let them go immediately. Do this until your muscles get tired.

Aim to build up to 10 repeats of each exercise, at least 3 times a day.

It's important to keep breathing normally while you do these exercises. Make sure you don't pull in your stomach when you squeeze.

Sitting on the toilet can be a good reminder to do your exercises. Just make sure you do them after you've finished.

Visit the Chartered Society of Physiotherapists website for more tips to strengthen your pelvic floor.

Stomach exercise

This exercise can help you tone your stomach muscles:

Lie on your side with your knees slightly bent.
Let your tummy relax and breathe in gently.
As you breathe out, gently draw in the lower part of your stomach like a corset, narrowing your waistline.
Squeeze your pelvic floor muscles at the same time.
Hold for a count of 10, breathing normally, then gently release.

Repeat up to 10 times.

Ways to ease back pain

These practical tips may help to relieve an aching back:

while feeding your baby, sit with your back well supported and straight. Put a small pillow or cushion behind your waist to support your lower back. Make sure your feet can reach the floor
kneel or squat (do not bend your back) to do tasks that are near the floor, such as picking up toys or bathing your baby
change a nappy on a raised surface. You could kneel on the floor next to a sofa or bed. Never leave your baby unattended on a raised surface, in case they fall off
keep your back straight and bend your knees when lifting
Keep your back straight when you push your pram or buggy. Or, carry your baby in a well-fitting sling

The 10 Best Pelvic Floor Exercises to Do Postpartum

Pregnancy + Postpartum

Jun 14, 2022Dr. Celeste Compton, PT, DPT3 MIN

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Nine months of pregnancy and birthing a baby can do a number on your body and, more specifically, on your pelvic floor. You may find yourself running to the bathroom, leaking when you sneeze or cough, having pain with sex, or feeling as if your insides are falling out when you run — which can all be signs of pelvic floor dysfunction. Welcome to the 4th trimester :)

It's important to know that you don't have to "just deal" with these symptoms. There are things you can do to retrain and rebuild your pelvic floor so these issues don't become a permanent fixture in your life. Working with a pelvic floor physical therapist will help you determine exactly what's going on, and ensure that you heal your postpartum body efficiently and effectively.

There's no one-size-fits-all solution to pelvic floor dysfunction, but the 10 exercises below are typically safe and effective for waking up the pelvic floor after childbirth and rebuilding your connection with this core muscle group.

If you think you may have pelvic floor dysfunction, let your primary care provider know and ask if physical therapy is right for you. You deserve to feel good in your body during postpartum and in every stage of life!

Lay on the ground in a comfortable position. Place your hands on your ribs or belly.
Inhale, and fill your belly with air as it expands outward into your hands.
Tip: Think about expanding your ribs out to the sides as you inhale.
Exhale and relax your belly back towards your spine, releasing the air through your mouth.

NOTE: Start by taking normal breaths to see where your breath moves. Check in with your chest, ribcage, and abdomen, take notice if any region lacks motion or does all of the moving. This breathing pattern should redirect your breath towards your abdomen in the direction of the pelvic floor.

Lie on your back with both legs straight.
Bring one knee in towards your chest, holding onto your shin with both hands.
Tip: Keep your shoulders relaxed and away from your ears.
Hold the position and breathe.

NOTE: If you have had hip surgery or replacements, consult your orthopedic specialist prior to performing this exercise for post-op precautions.

Lay down onto your back with your knees bent and feet flat on the ground.
Cross one leg over your opposite knee, placing the outside of your ankle just above the knee.
For a deeper stretch, interlace your fingers behind the thigh of your stabilizing leg, and pull your thigh in towards you, lifting the foot off the ground.
Tip: Keep your shoulders relaxed and away from your ears for the duration of the stretch.
Hold the position and breathe.

NOTE: You should feel this in your outer hip, this should not be painful. If felt in the knee or ankle, discontinue this stretch. You can also attempt this while seated.

Lie on your back, and hug both knees into your chest.
Separate your knees outward towards your sides, and reach with your hands to hold the outer edges of your feet.
Use your hands to guide your feet open to your sides, with your knees angled down towards your armpits.
Hold this position and breathe deeply. Think about relaxing all the muscles around your pelvis and pelvic floor.
Tip: Relax your shoulders away from your ears.

NOTE: Discontinue if you feel pinching in your anterior hip or groin or numbness and tingling in your legs.

Start in a standing position facing a wall or with your hands on the back of a chair for support.
Step one foot back behind you with your toes pointed slightly outward and heel on the ground.
Drive your hips forward as you bend your other knee towards the wall. Keep your back straight and shoulders relaxed.
Tip: It's ok for the back knee to bend a little and for your heel to come up off the floor if needed.
Hold this position and breathe.

NOTE: If you have had hip surgery or replacements, consult your orthopedic specialist prior to performing this exercise for post-op precautions.

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Stand in front of a table with your legs slightly wider than hip-distance apart. Lean forward and place your hands or forearms on a table or the back of a chair for balance. Shift your weight back into your heels and lock your knees.
Keeping your knees locked, lean your hips to the side opposite the leg you want to stretch and hold.

NOTE: You may feel this at your inner thigh and the back of your opposite leg for a mild hamstring stretch.

Inhale as you relax your belly, letting it fill with air.
Exhale, and draw your belly button in toward your spine as you squat down, letting your knees rotate outward and away from your center. Your heels may lift slightly off the ground.
Tip: For added stability, place a yoga block under your glutes, or hold onto a stable surface with one hand.
Hold the squat and breathe as you focus on relaxing the muscles in your pelvic floor and the surrounding areas.

NOTE: Try to relax your pelvic floor in this pose, if you feel you need to engage muscles to balance, make modifications so you are able to more fully relax.

Grab a few large pillows. Start on your hands and knees with your hands under your shoulders and knees under your hips. Separate your knees so they are slightly wider than hip-distance apart. Place the pillows stacked between your hands and knees.
Sit back onto your heels, and lean your upper body forward to rest fully onto the pillows in front of you.
Tip: You are now in a child's pose with your upper body supported by the pillows.
Hold this position and breathe, feeling your belly rise on your inhale, then relax inward toward your spine on your exhale.

NOTE: You can also try this without pillows for a deeper stretch to the back. If you have had hip surgery or replacements, consult your orthopedic specialist prior to performing this exercise for post-op precautions.

Laying on your back in a comfortable position.
Inhale, and fill your belly with air- feeling it rise as you keep your pelvic floor relaxed.
Exhale, and draw the belly back towards your spine as you contract and lift your pelvic floor muscles performing a kegel.

NOTE: Begin this exercise slowly to build awareness and coordination of your contraction and relaxation. Eventually, this exercise may be used to build strength and endurance in your pelvic floor, depending on your individual goals and needs.

Start lying comfortably on your back.
Inhale deeply, allowing air to fill your low belly and all the way down into your pelvic floor. Allow your pelvic floor to relax and lengthen down, away from your trunk
On exhale, allow your pelvic floor to return to its resting/neutral position.

NOTE: You can also do this with other exercises like DEEP SQUAT STRETCH or CHILD'S POSE

Dr. Celeste Compton, PT, DPT

Celestine Compton, PT, DPT is a doctor of physical therapy at Origin with a board-certified specialization in women's and pelvic health. She continues to expand her knowledge and capabilities within the field of women’s health PT to provide her patients and community with the best care, advocate for her profession on local and national levels, and support the advancement of women’s health through contributions to research, public awareness, and education. As part of the Origin team, she hopes to do her part to raise the standard of care that all women receive at every stage of life and to improve patient access to quality care so that no individual, regardless of location, race, identity, education, sexuality, or economic status is left behind.

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Sex after childbirth: training intimate muscles

These muscles are often referred to as the intimate muscles. Well-developed pelvic floor muscles are the key to sexual pleasure: their volume and tone affect the degree of closure of the genital gap and, accordingly, the strength of arousal and orgasm. But very often after pregnancy and childbirth, these muscles weaken and lose their tone. Why is this happening?

NO MOTION

“Almost half of women leave the maternity hospital with weakness of the pelvic floor muscles (and even more if it is a repeated birth), says gynecologist Elena Silantyeva. - After all, the muscles of the pelvic floor, like all striated muscles, develop only in work, in active movement. But what kind of life do we lead? Most often - sedentary, which is why the muscles are inactive and atrophy. And during childbirth, when the birth canal is stretched, these flaccid muscles are more quickly stretched and injured. For this reason, a woman may experience a syndrome of "wide vagina" (vaginal relaxation). An infection easily penetrates into a wide open genital slit, thrush, colpitis or vaginitis may develop. And close contact of the vaginal mucosa with linen leads to its drying and partial atrophy. It is not surprising that the sensitivity of the mucosa as an erogenous zone is reduced. Moreover: during the love act, there is no tight fit of the partner's penis to the inner walls of the vagina. And as a result, not only the woman herself ceases to feel any pleasure during contact, but also the man (especially the elderly one): after all, the strength of his erection largely depends on the degree of fit.

HEALING ORGASM

Weak sensitivity of erogenous zones leads to another serious problem: a woman may experience a pronounced sexual desire, but cannot get an orgasm. And it's pretty bad for her reproductive system. After all, an orgasm not only gives pleasure and provides emotional release, but also supports women's health. “Orgasm causes an instant spasm of the smallest vessels of the arterial bed, blood renewal, an increase in the tone of the venous system,” explains Elena Silantyeva. - If discharge does not occur, then the outflow of venous blood slows down and congestion develops in the vessels of the small pelvis, which manifest themselves later in various painful sensations. And gynecologists treat these pains with antibiotics, which in turn destroy the microflora of the vagina, and a more serious infection enters the body. Actually, this is another reason to establish a harmonious sex life.

INTIMATE MUSCLES TRAINERS

What should a woman do if her pelvic floor muscles have weakened after childbirth and “wide vagina” syndrome has developed? Elena Silantieva offers several methods.

Physiotherapy. First of all, immediately after childbirth, in the first day or two, a woman needs restorative treatment using classical types of physiotherapy - a magnetic field, UHF and others that reduce inflammation and quickly heal damaged, stretched muscle tissue.
Physical exercise. As soon as the muscles have healed (not earlier than a month after the birth), you can gradually start working with them. But when exactly - only the doctor decides. Any physical activity that has no contraindications is welcome. But Pilates, yoga, and physiotherapy exercises, which were so popular in Soviet times, are especially useful - these complexes usually include exercises that at least indirectly involve the muscles of the pelvic floor.

biofeedback therapy. This is a hardware-computer complex, with the help of which women learn to do Kegel exercises, specially designed for training intimate muscles. Of course, these exercises can be done at home, but it is very important to master the correct technique under the supervision of a specialist, because women often confuse muscles and pump the wrong thing at all. If the muscles have not worked for many years, how can you know how these muscles feel, how to put them into work? For this, BOS-therapy is needed. What is its essence? An individual electrode is inserted into the vagina. And when the woman tenses and relaxes the corresponding muscles, the electrode receives an electrical impulse from them, and the data is displayed on the computer screen. If a woman does not relax her muscles well or by mistake uses the muscles of the anterior abdominal wall, the doctor, looking at the screen, coordinates her work, gradually changing and complicating the task. For 15-20 sessions, you can develop a stable skill in order to continue to practice at home on your own. As a result of such exercises, the volume, strength, endurance of intimate muscles, their ability to relax and stretch increases. There is nothing surprising and mysterious in this: just as a man in the gym, pumping up his biceps, increases their volume, so a woman can double - and this is easily confirmed by ultrasound diagnostics - the volume of her levators (those muscles that lie around the entrance to the vagina) . The genital gap closes and becomes tight, the sensitivity of the erogenous zones is restored.
Laser vulvo-vaginal rejuvenation and intimate cosmetology (plasma therapy and mesotherapy) are modern technologies that involve laser exposure or intradermal injections in the intimate area. They are designed to improve the quality of the mucosa of the external genital organs (and, if desired, change their aesthetic characteristics), improve their flora, and increase the sensitivity of erogenous zones.

Questionnaires conducted by physicians after the completion of these procedures show that women experience more vivid sensations during sex as a result, feel more satisfied at the moment of orgasm, and the orgasmic discharge itself occurs more often than before.

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