Look Good Feel Good after pregnancy Physiotherapy advice and exercises for new mums
How to exercise after pregnancy with physiotherapy Bowel Tail Bone Uterus Bladder Pubic Bone Pelvic Floor Muscles Urethra Vagina Anus The Pelvic Floor Recovery of pelvic floor muscles to normal function following birth is vital. During pregnancy, hormones and the weight of the growing baby can cause considerable weakening of the pelvic floor. Even after a Caesarean birth, the pelvic floor needs to be strengthened. The pelvic floor is a sling of muscles that supports the contents of the pelvis, helps with bladder and bowel control, and is important in sexual function. One in three women who have had a baby will experience loss of bladder control (urinary incontinence). Incomplete recovery of the pelvic floor muscles can also result in loss of bowel/wind control, prolapse (poor pelvic organ support) and reduced sexual function.
Immediately after vaginal delivery R.I.C.E Rest in a horizontal position as much as possible, especially whilst in hospital. This relieves any pressure on the pelvic floor and perineum allowing it to recover more quickly. Aim for 2 hours a day for the first 2 weeks then 1 hour per day for the next 6 weeks (in addition to sleeping). Rest in any position you find comfortable back or side. Try feeding your baby in a side lying position. Ice is effective for reducing perineal pain and swelling. Apply externally for 15-20 minutes every 2-3 hours in the first 48-72 hours. Compression wear firm briefs, bike shorts, leggings, two pads for perineal support. Elevation if you have had a vaginal birth, try lying on your tummy with two pillows under your hips. You can also use pillows to reduce pressure on your breasts. PFExercise commence gentle pelvic floor exercises within 24-72 hours as pain allows. How to do your pelvic floor exercises after vaginal and caesarean birth Lift and squeeze your pelvic floor muscles upwards and forwards towards your public bone, tightening around the anus, vagina and urethra. Ensure your buttock, leg and upper tummy muscles are relaxed. Hold for 3 seconds or more as able to (build up to 10). Keep breathing. Rest for 3 seconds or equal to length of hold time. Repeat 8-12 times (this is one set). Do 4 sets per day. Position: Commence pelvic floor exercises lying on your back or side, and as this gets easier you may progress to sitting and then standing. The ability to contract your pelvic floor muscles varies between individuals, especially after having a baby. The amount of time you can hold for and the number of repetitions will vary depending on your muscle and nerve recovery after the birth.
HINTS: Do not do your pelvic floor exercises by stopping the flow of urine. Always tighten your pelvic floor muscles before you cough, sneeze or lift. Develop cues to help you remember to do your pelvic floor exercises ie when you are feeding your baby. Avoid constipation by drinking 2.5 litres of water/day, include fibre in your diet and gradually increase your general exercise. Avoid straining when using your bowels Support the perineum with toilet paper or a pad when opening your bowels. Correct positioning of yourself on the toilet will also help. Arrange to see a Women s Health Physiotherapist if you are experiencing any bladder or bowel symptoms such as incontinence or feel unsure of the correct technique of the pelvic floor muscle exercises. Abdominal Exercises Your abdominal muscles have stretched and weakened during your pregnancy as a natural result of your baby growing, as well as the hormones of pregnancy. This stretching may pre-dispose you to backache and injury. The deep abdominal muscles act as a natural corset to support your back, pelvis and abdominal organs. Activating these muscles will not only increase this support but will help to get you into shape! As a new mum you will be lifting, pushing and pulling everyday so good abdominal control is essential to meet these demands. The most important muscles to exercise in the tummy region after having a baby are the deep abdominal muscles (TrA). As you learn to control these muscles you will be preventing or reducing any back or pelvic pain. Deep abdominal exercises after vaginal and caesarean birth Sidelying Gently draw your pelvic floor and lower abdominal muscles upwards and forwards towards your pubic bone. Pull your lower abdominals into your spine. Ensure that you keep your upper abdominals relaxed thoughtout. Keep upper abdominals relaxed and lower back still. Hold for 5 seconds (build up to 10). Rest for 5 seconds (this is one set). Repeat this 5 times (build up to 10). Repeat twice per day. Tip: Maintain relaxed breathing throughout.
HINTS: If you feel your pelvic floor muscles working with your TrA (deep abdominals) and vice versa that s fantastic! Gently draw in these muscles whenever changing position, bending or lifting. For example, picking up your baby/pram/washing basket. Arrange to see a Women s Health Physiotherapist if you wish to further improve your strength. General Advice Good Posture When standing, check your posture to ensure you stand tall. To do this, lift the top of your head up towards the ceiling, tuck your tummy in and drop your shoulders down. When sitting for long periods, including breastfeeding, place a pillow or rolled towel in the small of your back. Make sure your feet are supported. Exercise to help maintain good posture Uncurl your upper back Sit tall and stretch hands towards ceiling. Hold 5-10 seconds. Repeat 3-5 times. Bows and arrows exercise Sit down with your hands at shoulder height. Push your right hand forward and pull your left elbow back (as if you are pulling the string back on a bow). Let your body twist around as you do this. Relax. Repeat with you left hand forwards.
Taking care of yourself Rest Rest whenever possible by lying down. You need your pelvic floor to heal and being horizontal takes the pressure off it. Getting out of bed Your tummy muscles won t be strong enough for you to sit straight up. When rising from lying, bend knees, roll to one side and push up with hands as you lower your legs over the side of the bed. Straighten up slowly. It is not recommended to jack-knife forward. Good Bladder Habits Drink 8 cups of fluid per day. Limit caffeine and alcohol intake. Exercise your pelvic floor muscles 3 times daily. Go to the toilet to pass urine only when you need to. Constipation and Haemorrhoids Adequate fluid, fibre and exercise are vital for regular soft bowel motions. If breastfeeding, remember to drink extra water each day. Straining when using your bowel stretches and weakens your pelvic floor muscles and causes haemorrhoids. When on the toilet, lean forward and rest your forearms on your knees. Keep your back straight and have your knees slightly higher than your hips. Keep your lower abdominal muscles relaxed. Blocked Milk Ducts Daily rest is an important part of good breast care. Engorgement, blocked milk ducts or inflammatory conditions of the breast (including mastitis) may cause tenderness, redness or lumps in your breasts. Prompt treatment is essential. Arrange to see a Women s Health Physiotherapist if you develop symptoms.
Returning to Exercise and Sport Regular exercise increases your fitness and has a positive effect on mood and self-esteem. Appropriate exercise will help you recover from pregnancy and childbirth, and cope with the physical demands of motherhood as well as getting back into shape. The return to exercise should be gradual. Start with gentle walking and gradually increase your distance and pace. You can start swimming once cleared by your medical caregiver. A physiotherapist-lead postnatal exercise class, starting about 6 weeks (individual variations may apply) after the birth of your baby is recommended. These classes prepare you for more strenuous activities and provide professional advice for any physical problems. When returning to more specific sports, increase your activity gradually. Strenuous activities which involve running, jumping and fast or jolting movements should not be undertaken for at least 12-24 weeks after birth, as your body needs time to recover. These activities place too much stress on the pelvic floor muscles and abdominal muscles that have been stretched and weakened by pregnancy and birth. Ligaments and other soft tissues are also vulnerable to injury during this time. Breast tissue is also stretched during the first few weeks, and for many women, enlarged breasts make vigorous activity uncomfortable. Ensure that you are wearing a well-fitted sports bra during exercise. AVOID high impact activities (eg. running, high impact aerobics, and netball) or heavily resisted exercise for at least 12-24 weeks. You should wait longer if you notice any problems with the pelvic floor region, such as difficulty with bladder control. Always listen to your body and seek professional advice from your Women s Health Physiotherapist for more specific guidance.
Give you body the best of care. Consult your local Continence and Women s Health Physiotherapist. Australian Physiotherapy Association p: (+61 3) 9092 0888 or 1300 306 622 e: national.office@physiotherapy.asn.au www.physiotherapy.asn.au Level 1, 1175 Toorak Road, Camberwell, VIC 3124 Australia PO Box 437 Hawthorn BC, VIC 3122 Victoria