Get your pelvic floor ready to run after having a baby

Getting back to running after having a baby can seem daunting. There are lots of considerations to think about, but one thing that does sometimes get overlooked is our pelvic floor. This guest blog by pelvic floor expert Louise Field, who created the Adore Your Pelvic Floor programme, is the final article in a three-part series. The blogs will give you the lowdown on everything you need to know about your pelvic floor and running. You can read the first part, which asks ‘Is it okay to accidentally pee during exercise’, here: Essential pelvic floor advice for female runners. The second part looks at running during pregnancy itself, which can be found here: Can I exercise or run during pregnancy? So read on to find out how to get your pelvic floor running ready.

Note: While this blog is aimed at getting postnatal women back to running, this information can be applied to women post-surgery and of any age, at any stage of life, looking to get back to running – or dancing, lifting or whatever activity floats your boat!

Run, jump and leap – get ready to run after having a baby

Postnatally, in the UK and Ireland, women usually get a cursory ‘six-week check’. The assumption is that this includes clearance for activity and exercise. However, this doesn’t necessarily mean you can go back to your HIIT class and half-marathons straight away!

Having said this, you shouldn’t remain completely limited or not consider your pelvic floor prior to your checkup. Within this six-week period, you can work on developing an awareness of the pelvic floor with basic pelvic floor exercises and diaphragmatic breathing.

Start to incorporate gentle exercise, such as walking short distances, gradually building up the duration of the walks as your body allows.

Women are often so focused on getting their ‘pre-baby body’ back, they overlook their pelvic floor muscles and the fact the body needs some TLC and rehabilitation once the baby has arrived.

Research shows that after a vaginal delivery, the pelvic floor can take between 6 and 12 months to get back to full tensile strength. So, racing to a postnatal Bootcamp and doing loaded burpees as soon as you’ve had your ‘6-week check’ could put you at high risk of a pelvic floor injury.

If you think having a C-Section means your pelvic floor hasn’t been affected by your pregnancy – think again. Your pelvic floor has still been supporting your baby for nine months, as well as dealing with changes to your breathing mechanics and posture. Not to mention the increasing presence of hormones in your body. The abdominal wall will also take a least a year to heal.

Therefore, consideration to healing and rehab is vital to ensure returning to full health, function and fitness.

Baby has arrived – what next?

Our first recommendation after your six-week check is to get an MOT or a postnatal checkup with a Woman’s Pelvic Health Physiotherapist. I wish there was a protocol every woman can follow to return to pre-pregnancy level of fitness by the time baby is three months old, but I can’t.

First, your body has just spent nine months growing, supporting and nourishing a new human being. This process has changed your body, and that’s a beautiful and an awe-inspiring thing. But most women don’t bounce back immediately. The body needs time to repair from the delivery (C-section or vaginal). Hormones need to get back to an even keel again. This doesn’t happen overnight, so give yourself a break and learn to listen to your body.

Unfortunately, until recently, there has been little or no advice given about rehabilitating the pelvic floor back to running postnatally. Primarily I think this is because there is a severe lack of research in this area. Subsequently, much of the advice given is supposition, sometimes incorrect and often confusing or contradictory. Women can be led to believe that any kind of impact exercise is actually dangerous, or conversely, incontinence is fine – ‘Just wear pads’, forever!

I often hear women say they’ve been told to stick to swimming or Pilates. Nothing wrong with swimming or Pilates, but these are not, and should not be, your only options.

It is important to get a referral to a pelvic health physiotherapist if any of the following signs and symptoms are experienced prior to, or after attempting, returning to exercise (as referenced in the Returning To Running Postnatal Guidance):

Heaviness/dragging in the pelvic area (can be associated with prolapse)
Leaking urine or inability to control bowel movements
Pendular abdomen or noticeable gap along the midline of your abdominal wall. This may indicate Diastasis Rectus Abdominis (DRA)
Pelvic or lower back pain
Ongoing or increased blood loss beyond eight weeks postnatal, which is not linked to your monthly cycle

Other things to consider

Caesarian section or perineal scarring

A note on perineal scaring from a tear or episiotomy. Any area of tight or scarred tissue in the perineum can affect pelvic floor function, so once this has healed don’t forget it. A Women’s Pelvic Health Physio is an expert in this field, and can assess and treat scarring.

Using a good vaginal moisturiser can also help. Sylk or YesYesYes Vaginal Moisturiser can be used to massage the area. This can go a long way to speeding up the recovery of this tissue, breaking down adhesions and encouraging this tissue to become elastic and healthy again.

Sleep and diet

This is such a tough one. You show me a new mum who gets enough sleep and isn’t eating on the hoof! If this is you, a great, but often-ignored, piece of advice is to nap when the baby naps. And yes the housework can wait – your health is more important than the laundry pile. Do your best to eat as well as you can, and not just suck down the remains of the jar of baby food and hoover up leftover Farley’s Rusks – we’ve all done it. But your energy levels are so important. When you’re fatigued your core is fatigued, and your pelvic floor won’t function as well.

Breath

Believe it or not, the way you breathe has a direct effect on the pelvic floor. The pelvic floor and diaphragm should work together with the pelvic floor group ,releasing as you inhale and engaging as you exhale. If you’ve reversed the mechanics of your breath, breathing will encourage pelvic floor dysfunction. So every breath you take will either be working to support your pelvic floor or against it. We breathe approximately 20,000 times a day, so make sure all those reps are supporting your pelvic floor.

Posture and alignment

A kyphotic (hunched shoulders) or lordotic (increased lumbar curve) posture affects the efficiency of our breath. Foot alignment can affect our ankles, shins, knees, the pelvis and lower back. This, in turn, can affect the muscle tension surrounding these areas, such as the pelvis and pelvic floor. Even tightness in the hips can affect the pelvic floor, as the internal and external rotators of the hips create the back and sidewalls of the pelvic floor.

Tips to get ready to run after having a baby

So, you’ve had your six-week check, your pelvic MOT and been doing your pelvic floor exercises. You’re feeling good and you’re ready to pull your trainers on and start pounding the streets. But where do you start?

Whatever your pre-childbirth level of fitness was, you need to build up the intensity, duration load and the impact of your training slowly. This should be at your own pace, taking into account how you’re feeling physically and emotionally on a day-to-day basis.

The following is a list of movements you should be able to perform before returning to running without causing pain, leaking, heaviness, dragging or bulging in either the perineum or in the midline of the abdominal wall. Building up to these exercises can be a useful framework for your rehabilitation programme.

This is the latest evidence research taken from Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population by Tom Goom, Emma Brockwell, and Grainne Donnelly. While this has been created as an evidence-based resource to help assess readiness to get back to running or impact exercise, it also makes a great basis for training, as it clearly details the skills and movements you need to be able to do well before you start running.

Walking 30 minutes
Balance on one leg for 10 seconds each side
Single leg squat x 10 each side
Jog on the spot for one minute
Forward bounds x 10
Hop in place x 10 each side
Single leg running man x 10 each side (standing on a slightly bent leg and taking the other leg and opposite arm away from each other)

If you’re not a runner, the process of getting back to your activity or sport is the same. Start with movements that mimic the movements you need, but without the load and impact. Then gradually increase the intensity of the movements until you’re able to perform the sport you love.

What to practise at home

Based on this evidence, here is what you can be working towards at home to get you ready to run after having a baby.

Squatting and hip hinging.
Balancing on one leg, building up to 10 seconds on both side.
Single leg squat, building up to 10 each side.
Jogging on the spot. Start with running through your feet without lifting the feet, and gradually increase the height your feet are lifting up to until you are jogging for a minute.
Bounding forward. Start with smaller steps and increase the size of the step. Then increase the energy until you’re bounding and able to land without any symptoms. I would also add the same movement of bounding, but side to side. Start with stepping side to side and, again, gradually increase the size of the steps and the dynamism and bounce in the steps. I’ve added this as some women have difficulty side-stepping.
Hopping on the spot. Again, you can start with standing on one leg and just rising on to your toes and lowering ,and gradually build up to 10 repetitions. Then work to increase the impact as you move towards a full ‘hop’ movement.
And, finally, single leg running man is a great full-body stability exercise that demands your core, pelvic floor coordinating well with the rest of your body. Stand on your right leg and reach your right arm forward and your left leg backwards. You can begin by maintaining contact with the floor and keep the range of motion small, then gradually increase the range of motion. Alternate sides and build up to 10 repetitions.

If you’re unsure how to perform these movements well or whether you have good form, find a coach or trainer who has the relevant training and experience to work with you on these movements.

What to do out and about

You can also start building up to running outside the home, with these tips:

Ideally start with walking and build up to 30 minutes without any of the symptoms of pelvic floor dysfunction.
Once you’re able to walk well, then you can increase the duration of your walk or your pace, stride length or challenge your self with some gentle slopes.
Start to bring in a short burst of high-impact strides. Maybe 10 strides skipping or 10 bounds, gradually increasing the number of these bursts.
Once you’re confident and achieving this, maybe try a programme like Couch to 5K, which is a fantastic programme that’s designed to build people up from being completely sedentary to running. Even if you’ve been a runner in the past, you still need to build up your running at a steady pace and Couch to 5K is a great programme to do this. It’s also a great programme for those of you who’ve never run, but would love to take it up.
Remember, stress incontinence may only show on that last sprint or on the final leg of a race when you’re fatigued and digging deep to find that final push. This should still be addressed, and a well-trained coach can help you with this.

Hopefully this will give you a starting point to get back to exercising postnatally. You will probably find there’s a lot of tweaking and listening to your body. Take note of where you are in your cycle, how tired you are today, how well you’re eating and sleeping today. Lifting and lugging of toddlers, carrycots, weekly grocery shops and baby bags all add to effort upon the body.

We’re all individual

In my experience, some of the women I work with bounce back to impact exercise fairly rapidly once they’re pointed in the right direction. They manage to improve their posture and breathing mechanics to support good pelvic floor function. Others do take a little longer. This doesn’t mean you should give up… far from it.

Every woman is an individual, as are the factors that contribute to her incontinence or pelvic floor function. Resolving any issues is much like solving a puzzle. Look at the many factors, as previously mentioned, including lifestyle, chronic constipation, diet, daily activities, stress levels and posture, in addition to whether the individual’s pelvic floor is too weak or too tight.

Something you may not have considered is wearing clothing that can support your pelvic floor. EVB Sport produces support leggings and shorts, which help support your core and subsequently your pelvic floor. These were created by Yvonne Brady BA BAI Ceng. As an engineer and runner who experienced her own stress incontinence, Yvonne not only worked on creating running shorts and leggings that support the lower back, core and the pelvic floor muscles, she put the product through clinical trials at the Trinity College of Dublin, The Royal College of Surgeons and Dublin City University. These are receiving excellent reviews from runners who use them, as well as Specialist Women’s Pelvic Health Physios.

If you place an order, please use the coupon code Adore Your Pelvic Floor. The link is below, under ‘Useful resources’.

In summary

Yes, birthing is a natural process that billions of women experience. This doesn’t mean the body hasn’t undergone its own personal trauma. It’s an absolute necessity to exercise in order to rehabilitate your body to full fitness. To build a strong effective and functional core unit, including the pelvic floor, so it can work WITH the impact of our stride and the load associated with running. You should be looking to work towards the same general exercise recommendations as any other members of the population. These include efficient breathing mechanics, good flexibility, overall muscle balance, aerobic strength, balance and coordination. Add variety to your programme and balance your activities to keep you balanced

And remember: how you are feeling TODAY? This is such a hard concept for the real go-getters out there, especially if running is your ‘you’ time, your meditation or your sanity. Please consider when building up to running successfully if you’ve been up all night with your wee one and haven’t eaten properly, while also keeping up with the house. If you’re feeling run ragged and frayed emotionally and physically, be kind to yourself.

While you may really NEED the escape of a run, this may not be the day to up your distance or duration or even run at all. This may be the day to avoid impact altogether and take a long walk in the park instead.

Introducing Louise Field

Health and physical activity is my career and an extremely important aspect of my life. As a proud mother of five boys, I have a special interest in empowering women, in particular, helping women restore good pelvic floor function to enable them to get back to physical activity. After I personally suffered a significant pelvic floor injury, I was horrified to discover that this could not only rob me of the exercise I loved, but my career as well. When I looked for advice on how to rehabilitate my pelvic floor muscles and get back to full fitness, I found the available information was limited and often contradictory. One of the recommendations suggested to me was that I should stick to walking or swimming short distances for the rest of my life.

As a fit young mum who loves to move and teach exercise, this was NOT going to cut it! So I began my journey to educate myself and learn every thing I could about the pelvic floor and how to rehabilitate it. From talking to other women, using my own personal experiences and working closely with specialist women’s health physios, my passion and dream combined to share the evidence I learned along the way – the endorsed Adore Your Pelvic Floor Programme was born. I now offer seminars to organisations and fitness professionals and health care workers accredited training on how to provide women with the understanding and skills they need to keep their pelvic floors healthy for life, so they can pursue the activities and sports they love.