Let’s first get a bit geeky and look at the anatomy of your body, bear with me ok?!
Your pelvis consists of 3 bones and 3 joints, one at the front and two at the back. The bones form a protective basin for your bladder, womb and bowel. The joints of the pelvis and spine are supported by ligaments and muscle.
So then you find out your pregnant, and those lovely hormones start kicking in. Regardless of the frequent trips to the loo and the bursts into tears, these hormone changes during pregnancy soften these ligaments and the joints become less stable. As your baby grows there is a change in your centre of gravity and posture. It’s these combined changes that can lead to low back pain and/or pelvic girdle pain.
What are our choices?
Well, of course it’s a bit too late to go back on the baby front but you can do things to help reduce the strain and discomfort you may be experiencing.
Here’s my top tips:
- Sit correctly, and when possible sit rather than stand when performing daily activities such as ironing
- Ensure your work surface is at the correct height
- Use correct technique for lifting and avoid heavy loads
- Find a comfortable sleeping position -try using a pillow between your knees and ensure you get in and out of bed keeping your knees together and rolling onto your side.
- Gentle exercise during pregnancy is good for you and your developing baby. Work within your own limits. You must listen to your body and stop if you feel unwell.
- Drink plenty of water to avoid dehydration
Fast forward 9 months and baby’s here- congratulations! The ante natal classes have stopped, the midwife has gone and you’re struggling with sleepless nights, working out what the baby cries mean and trying to work out how to drink a cup of coffee without it going cold. But what about your body? I’m not talking baby weight here but your insides, the bits you can’t see and probably after having baby, can’t feel either! You’ve just carried a baby for 9 months, then delivered it. It’s an amazing thing our bodies are designed to do isn’t it?!
Time to get anatomy geeky again….
What is the pelvic floor?
The pelvic floor are a sling of muscles that lie at the base of your pelvis between your pubic bone and coccyx and can be likened to the shape of a hammock. Strong pelvic floor muscles help you to control the bladder and bowel. The increasing weight of your baby during pregnancy, followed by delivery, may weaken your pelvic floor muscles. This may cause you to leak urine when you exert yourself, especially after delivery. We all know those stories of laughing or coughing, or running for the bus and feeling that little accident. It happens, but we can prevent it by exercising your pelvic floor every day, both during pregnancy and after baby is born.
What is the ‘core’?
The core consists of this pelvic floor, along with the diaphragm, transversus abdominis muscles and deep spinal muscles. They work together to form an ‘internal cylinder of support’ for your spine.
Exercises like Pilates can help you get re-acquainted with your core muscles again and get them working properly.
So you’ve had baby, now what?
In the early post natal period you need to be gentle and kind to yourself. Good habits here can serve you well. So remember to:
• Give yourself time to rest, recover and bond with your baby
• Take care moving in and out of bed, especially if you have had a caesarean section
• Sit well back in the chair for feeding. A pillow or folded towel behind your back will support you and may prevent backache. Supporting your arm on the armrest or on a pillow will prevent tension building up in the neck and shoulders from holding the baby for long periods of time. Alternatively a pillow on your lap will bring the baby up to the level of the breast for easier feeding
• When changing the baby it is easier for your back if the surface is at waist height, it will prevent bending and will be easier to lift the baby from this height.
• Avoid bending forward and straining the back when bathing the baby by kneeling by the side of the bath.
• You may experience leakage of urine if you cough or sneeze as a result of vaginal delivery weakening the pelvic floor muscles, this should resolve by your 6 week check up. If it continues you may need to seek professional help from a women’s health physiotherapist.
• Avoid constipation to prevent straining against your pelvic floor muscles and prevent piles or haemorrhoids worsening. Ensure you eat a varied diet and drink plenty of fluids.
• Start your pelvic floor exercises as soon as you are able (see below for info)
• Low impact exercises such as walking are recommended.
How do we switch on the pelvic floor?
Breathing with the correct technique enables you to switch on your pelvic floor. It’s important to learn to breathe deep and wide to the bottom of your rib cage. This allows your diaphragm to work correctly and therefore your pelvic floor.
- As you breathe out gently lift the area between your pubic bone and coccyx, the hammock. As you do this you should feel a small amount of tension in your lower abdomen as discussed above.
- Although you may feel a gentle tensioning around your back passage, you must not tighten your buttock muscles.
- Try and ‘close your openings’ first then imagine an escalator lifting from your bottom to your belly button.
- Similarly, you must let your upper tummy muscles completely relax, do not pull in your upper abdomen.
- Hold for 5 seconds then relax and let go. Repeat several times
As you get stronger you should build up the hold time up to ten seconds, and repeat ten times, several times a day
Returning to Exercise
The first 5 months following the birth of your baby is considered the ‘post natal period’.
• During this time it is best to refrain from any high impact exercise. This is to give your body and pelvic floor time to recover from child birth.
• If you are breast feeding you should take extra care in returning to any high impact exercise as the hormones produced during pregnancy may still be circulating in your system.
• There are always exceptions to the rules and if you’ve been running throughout your pregnancy and your pelvic floor is in extremely good condition then you may be able to return sooner.
• Never exercise at a level that your pelvic floor cannot cope with. If you start leaking when you are doing activities then stop immediately. This may not just be high impact activities but may also be lifting or abdominal exercises.
• All exercise should be done with a good posture as this enhances the pelvic floor contraction.
Look out for Rectus Diastasis
Rectus Diastasis is the separation of the Rectus Abdominis muscles due to excessive pressure during pregnancy. There are 4 layers to the abdominals and these are the most superficial. There are also Transversus Abdominis, Internal and External Obliques. When the tummy stretches, so does the connective tissue between the Rectus Abdominis muscles- this is normal. The muscles should recover and the gap lessen within the first 6 weeks post natally however some women do take longer to recover. Exercises that will help your diastasis to recover are ‘core stability’ exercises for your Transversus Abdominis that you do in the post natal Pilates classes.
Exercises that should be avoided are crunches, sit-ups, twists combined with crunches or anything that ‘jack-knifes’ the body, by pivoting at the hip & placing strain on the abdominals such as straight leg lifts.
Having a baby is a special time, but it’s also very demanding. Don’t forget to take time for yourself as well as looking after baby, whether your little ‘un is still in the bump, just arrived as baby or the months beyond.
Enjoy your mummy time!
Chartered Physiotherapist and Acupuncture Practitioner