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Women need to rebuild from the inside out after having a baby. All too often as women and mothers we neglect our own health and wellbeing. I experienced pelvic floor issues after the birth of my kids that I regretfully ignored! I thought this topic would be of interest to you so I invited women’s health physiotherapist Taryn Watson from FitRight Physio to write a guest blog post about the importance of a postnatal core muscle assessment.
6 Week Health Check
It’s common practice to go and see a health professional at approximately six weeks after giving birth, usually an obstetrician, a midwife or a GP. The purpose of this consult is generally to ensure you’re medically well, and to get the ‘all clear’ for return to normal activity – whether that be lifting toddlers, driving, sex, sport or all of the above!
It is time that the word got out there – being medically well at 6 weeks postnatal is great, but this check up does not necessarily mean that your body is ready for the vigour of loaded exercise like kettle bells and burpees.
Women’s Health Physio Check Up
It is very important to have a check up with a Women’s Health & Continence (WH&C) Physiotherapist after having a baby. Ideally at 6 weeks postnatal, when you have your medical check up. If this time is too hectic, then it can be later. Just make sure it is before you get back into higher level physical exercise, or before you get pregnant again. As your physiotherapist in hospital (if you’re lucky enough to have access to one) should tell you, physical activity in the first 6 weeks or so should be limited to pelvic floor exercises, gentle stretches and functional strengthening exercises. You can gradually return to 30-60 minutes of low impact cardio exercise like walking too. This is outlined further in my educational video series, Postnatal Rehab – The First Six Weeks. Click here for more information.
At a postnatal WH&C Physiotherapist appointment, a physiotherapist will go through a number of questions about your:
- pregnancy and birth,
- medical history,
- bladder and bowel function,
- muscle and joint function,
- exercise history and
- exercise goals
Pelvic Floor Muscle Assessment
The physiotherapist will then assess your pelvic floor muscles, which is important even if you have had a caesarean section delivery. You may be thinking – aren’t internal examinations over and done with now that the baby is born?! But it doesn’t necessarily have to be done via a vaginal examination.
A screening test can be done with an ultrasound of your lower tummy to show the physiotherapist how well you can elevate and relax those muscles. The patient, can see this on the screen too, which is great for feedback and learning. A vaginal examination however, is the gold standard and a lot more information can be gained such as pelvic floor muscle strength, tone and the presence of pain or a vaginal prolapse. This more thorough examination is even more highly recommended if you have any symptoms of pelvic floor dysfunction, such as bladder or bowel incontinence, a feeling of vaginal heaviness, or any pain in the vaginal area.
Rectus Abdominis Diastasis
Your abdominal muscles will also be assessed for Rectus Abdominis Diastasis (RAD). To determine whether or not your ‘six pack muscles’ and the connective tissue in the mid line have returned to normal after pregnancy. This stretching apart of the two belly muscles is completely normal if you carry a baby to full term. But did you know that natural healing only occurs in the first 8 weeks? If the tissue in the midline isn’t back to being thick and strong by that stage, you will need to do specific exercises to rectify it.
An assessment will be made as to whether you can activate your deeper ‘core’ abdominal muscles, and your gluteal muscles. These muscles together with your pelvic floor help to support your lower back and pelvis. You posture will be assessed, as will any specific joint or muscle dysfunction.
Then a plan of attack will be put in place as to the best way to achieve your exercise goals. In this way, it is a very individual approach to postnatal exercise. There is no ‘recipe’ to achieve a certain level of activity at a certain number of months postnatal. I can’t tell you how many times I hear ‘but I waited until 3 months before I did sit ups, so I should have been fine!’ We can never assume that one woman’s muscle activation, hormonal changes, and birth trauma are the same as the next woman’s. We’re all individual!
A Gradual Return to Exercise
Think of return to exercise like building a house. If you don’t first build strong foundations, you will always have issues building your house on top of it. Therefore, spend the first weeks or months preparing your ‘foundations’ or your ‘core’. This is what a Women’s Health Physiotherapist specialises in. My educational videos ‘Post-Natal Rehab – The First 6 Weeks’ has recommendations for how to rehabilitate in these early weeks. When your joints, muscles and pelvic organ support have been assessed, you can work together to plan a graduated return to higher intensity and loaded exercise. Ideally the physiotherapist would liaise with your personal trainer or coach to formulate this plan.
The plan may be anywhere between 6 weeks and 12 months + after childbirth. It all depends on how you present at the initial assessment and how quickly you progress. Even when you graduate to higher level exercise it is still so important for all women to incorporate pelvic floor and deep abdominal exercises into their routines. Pelvic floor and deep abdominal exercises keep your foundations strong!
Don’t Leave it Too Long
“There is nothing that makes me sadder than when a woman comes to see me months or years after giving birth. These women have put up with pelvic floor related issues for a long time and waited for them to get worse before seeking help.”
More often than not they’re suffering with worsening urinary incontinence, back pain, or vaginal prolapse symptoms. When I ask them about their return to exercise, in retrospect they went too hard, too soon, without ever getting the right information. It happens more often than you would think! Don’t be one of these women! Please get your postnatal assessment done with a Women’s Health Physiotherapist FIRST, and build on strong foundations.
About Taryn Watson
Taryn is a Women’s Health & Continence physiotherapist with a passion for providing pelvic floor friendly exercise options in the community.
In 2013 Taryn completed her Masters in Continence & Women’s Health Physiotherapy at Curtin University. Her master’s research project was on the incidence of stress incontinence (the leakage of urine with exertion) in women who attend gyms to exercise. The results of this study were that a staggering 50% of the women surveyed reported that they suffered from this incontinence. These results lead to Taryn starting FitRight Physio.
Through FitRight, Taryn is providing the community with a variety of fitness classes. Women are referred to FitRight classes. This provides reassurance that they won’t be doing any exercise that could be detrimental to their pelvic floor health.
Taryn is passionate about assisting women through the childbearing years and treating women and men with pelvic floor dysfunction.