What You Need To Know About Pelvic Health

As women, we live in this one body, yet, we still have a difficult time bringing awareness to the pelvic floor muscles and learning how to contract and relax these muscles. This is a topic that surprisingly, not a lot of women are well educated on. I love addressing the pelvic floor muscles, their roles in our health and how they can change with pregnancy and birth.  

The pelvic floor muscles offer many functions to our bodies: they are supportive to our organs, they help pump/ circulate fluid in as we breathe in and out, they aide in sexual function, they control opening and closing of our openings and stabilize our SI joint, pelvis, hip joints and lumbosacral joints. The muscles run from the front of the pelvis at the pubic bone, to the sits bones and attach to the SI/ tailbone area.  When functioning properly, the pelvic floor muscles should fire prior to movement of lifting children, laundry, jogging, grabbing a glass of water etc. So it is important to continue to focus on your pelvic floor muscles through all phases of life.

Your "core" is made up of your diaphragm, pelvic floor muscles, transversus abdominus and your mulitidus muscles in your low back.  So, as you can see, doing abdominal exercises for your "6-pack" muscles, will not target the true core. 

With life, we generally create habits.  Even within our bodies, we tend to do things the same way most of the time.  For example, we tend to carry our children or purse on the same side of our body.  This can create compensations to certain tissues and joints, especially during pregnancy and postpartum.  For instance, during pregnancy we may stand with our bum tucked under, our abdominals stretched and tightness in our backs to hold us up with our growing belly/ uterus.  After birth, our bodies stay in a similar posture, with weakened tissue and we start moving throughout the day making new compensations with carrying an infant or a toddler.   Seeing a pelvic floor physical therapist can help you fire and re-train your core the proper way to improve your core support during pregnancy and postpartum. 

One day, I hope it becomes a natural thing for a women to be seen at least once during her pregnancy and then get an automatic referral to a pelvic floor physical therapist postpartum to check on how the pelvic floor is functioning prior to beginning an exercise routine.  I believe many women would benefit on a prenatal visit with a pelvic floor physical therapist, to figure out how to make their pelvic floor muscles function properly and then what posture and body mechanics would be beneficial to avoid to promote a healthy pelvic floor.  Then postpartum, addressing women's pelvic floor strength, endurance, coordination and any areas related to pelvic floor dysfunction, diastasis recti or scarring from cesarean birth or perineal tearing.  I think so many women are doing too much too soon instead of giving their bodies enough time to heal postpartum prior to jumping back on the exercise train.  Remember, it took your body 9 months to grow that baby (ies), so give it grace with healing.  You will be glad your took your time and were smart with your healing and exercise, instead of rushing back into things.  

What Happens During a Cesarean Birth?

This is an area that as women, even those of us who have HAD a cesarean birth,  we know little about.  Cesarean births can be planned or unplanned.  Planned are scheduled ahead of time and unplanned can happen after pushing for long periods, or when needing to deliver baby quickly, like in my first delivery.  There are lots of different reasons for an unplanned cesarean.  

During the cesarean delivery, the doctor makes an incision into your skin, through your fat cells, connective tissue and into the abdominal cavity.

The abdominal muscles are spread apart and the bladder is moved so the doctor can get to the uterus.  An incision is made into the uterus and the baby is guided out.  After the placenta is removed, then the uterus is stitched up, the bladder is put back, the connective tissue and abdominals, and then the skin is stitched up.  A lot of layers of sutures within the tissues so scar tissue develops as you heal.

Please note, your abdominal muscles are not cut through during a cesarean birth, but your connective tissue is.  This is important to understand why we need recovery programs after birth, not just “sit ups” and running as soon as we feel like it.  

Running Postpartum

Your 4th Trimester is your recovery phase.  A time to restore your strength and endurance.  Think of your postpartum recovery more like a marathon vs a sprint.  If it were a sprint, you would see your OB at your 6th week check up and get released to resume exercise AND you would head home to go for a jog.  If this sounds like you, you will likely increase your risk for pelvic floor dysfunction (leaking urine, pelvic organ prolapse, low back pain, hip pain, pelvic pain...I could go on and on and on...). 

Retraining your pelvic floor and core muscles how to work for you is very important and should take time to get them back functioning properly.  I mean, the pelvic floor and abdominal muscles have been stretched for 9+ months and forgot how to work properly.   It is our job, as smart moms, to make sure they are functioning before running/ jumping with 10-12 times our body weight thru those muscles.  That's a lot of stress on those muscles.  Think about your life down the road with your pelvic floor, abdominal muscles and your organs...you want them working in the correct way when you are in your 60s, 70s and so on, right?!  I do!

For my friends and patients who love running, I advise waiting 4-6 months postpartum to begin running.  I really think closer to the 6 months would be best for our lovely pelvic floors.  4 months seems to be early when you think about life as a mom of 1, 2 or more children.  It is a challenge to train your muscles prior to that time consistently.  AND then we throw in breastfeeding (hormones), lack of sleep (increased cortisol-stress hormone-effects how our body heals and recovers) and then 6 months sounds a little early.  Especially with the hormones that are still heightened in our bodies.  If my patients are breastfeeding, we may push back running past 6 months, depending on how the body is functioning with movement and what the pelvic floor strength, endurance and tone is looking like.  

Before my patients are advised to begin running, they have completed certain pelvic floor/ core strengthening exercises and home exercise programs for a period of 8-12 weeks to set them up for good outcome when they go out for their run for the first time. 

Things to think about prior to going out for a run at 4-6 months postpartum:

1. Have you had an evaluation with a pelvic floor physical therapist to assess your pelvic floor function? core strength? function with posture and alignment?  You should!  All of us should postpartum!

2. If you pee your pants with coughing, sneezing, laughing, lifting, bending over etc you are not ready to run yet. 

3. Feeling of pressure or heaviness in the vagina? Worse after lifting? Or while on your cycle?  If you answered "yes", you are not ready to run yet. 

4. Do you have an abdominal separation in your midline that is weak (Diastasis Recti)?  If so, I would wait to go out and run. 

"So...what can I do instead?"

I love having patients find hills in their neighborhoods to walk up and down.  Prior to doing this, patients have been walking on a flat surface (for a long time) with no increased symptoms from above.   Patients are to practice proper alignment while walking to promote proper core recruitment.  I cue patients to rotate their upper body arm swing while ascending and descending hills. 

What You Eat MAY Affect Your Hormones

The talk of how crazy women can be has been going on for centuries.  Did you know a hysterectomy was thought to cure women of "hysteria"? Crazy right?!  The thought was women were going crazy (mood swings) because their uterus was searching for children.  So they must be cured if you remove it. 

I am thankful to be living in times of modern medicine.  We know so much more now days about what can affect our hormones.  There are lots of options out there, but I will be focusing this blog on more food related items. 

So how can our hormones get "imbalanced"?  The most common causes are: 

• excess stress
• lifestyle choices
• aging
• genetics
• lack of nutrients
• pregnancy, miscarriages and abortions 
• environmental exposure to toxins

We have quite a bit of control over the above, especially our genetics.  New studies have shown that we can turn on and off genes in our DNA with external factors (such as diet, sleep and stress). How cool is that?!  The DNA is still passed down to your children and grandchildren, but the choices you make today, can affect your great grandchildren.  Pretty amazing.  

So what choices can we make to make a positive change?

• Start adding dark, leafy greens: most nutrient dense food, yet lacking in a lot of people's diets
  • dark greens clean you blood, improve circulation and improve your immune system by restoring strength and reducing inflammation
  • Start by adding in a 1/2 cup of cooked (lightly sauteed or steamed is best) greens to your day.  Slowly work your way to 3-4 cups of raw and cooked greens
• Add more healthy fats (Fats! Handout)
  • Women's bodies are made up of about 60% fat.  That's almost 50% more than males and it is important for our fertility (that's hormones ladies!). 
  • When we eat a low fat diet, our bodies have a harder time digesting fat-soluble vitamins (Vitamins A, D, E and K) which play an important role in hormone regulation. 
  • Add more Omega 3s to support brain function (deficiencies have been linked to ADD, ADHD etc) 
  • Examples of my faves: coconut butter and avocados

How much fat do I need?  It depends.  Start by keeping a journal and see how you feel after eating good fats. I feel better when eating meals with more healthy fats and I find I am eating more fats now than ever before, somewhere between 30-50% of my daily food, especially while pregnant. Eating more healthy fats has been shown to help some women regulate their hormones to getting their periods/ cycles back on track (while reducing their carbs, not eliminating them).

• Chewing starts your digestion and most of us aren't chewing our food enough.
  • Chewing less makes it harder for food digestion to occur and can cause bloating, gas, abdominal pains, constipation/ diarrhea etc 
  • TRY chewing your bites 20-30 times and see if you notice a difference in how you feel!

So again...

• Take longer to chew your bites (20- 30 times)
• Add 1/2 cup of leafy greens to 1 meal a day, working up to each meal 
• Add good fats to one meal.  It might be avocado slices to your eggs in the morning or to a salad at lunch.  

Pelvic Organ Prolapse: 50% of Women Who Have Had Children May Have This

Pelvic Organ Prolapse (POP) is a diagnosis women can get postpartum and after childbirth.  Statistically, 50% of women are at risk for POP after pregnancy, but you can develop POP prior to pregnancy.  I ended up having a little pelvic organ prolapse during my "training for half marathon" days, which then worsened postpartum (with each of my pregnancies).  Know this though, having prolapse does not mean you have to stop exercising. I certainly have not and I am pregnant with my third! :)    

Picture from Google Images

Prolapse can tend to be a scary word, so let's go over what it is.  Pelvic Organ Prolapse (we will discuss female anatomy) is when the pelvic organs are pushing against weakened pelvic floor muscles that are not functioning to support the organs within the pelvis (bladder, uterus, rectum, urethra) and women can begin to feel pressure in vagina (sometimes women feel like an old tampon is coming out) from the organs starting to come down into the vagina.   

3 Most Common Types of POP:

Picture from Google Images

1: Cystocele: bladder prolapse.  Women may complain of feeling pressure in vaginal canal.  Sometimes the pressure is felt when the rectum is filling with stool and pushing in on cystocele.  Other times it is felt after lifting or carrying weight (same with all 3 types), such as babywearing.

2. Uterine: The uterus can lower post pregnancy and delivery.  Sometimes it is difficult to keep a tampon in due to a lower uterus or some women find intercourse uncomfortable because their partner may be hitting their cervix during deep penetration.  Do keep in mind, the uterus does move during our cycles (higher and lower) and this is why some women may feel this during their days 14-21 of their cycle (different for everyone). 

Picture from Google Images

3. Rectocele: Rectum prolapse:  Some women may complain of feeling a bulge in vagina when the rectum is full of stool.  Some women have to "splint" or insert their fingers vaginally to push back on the rectum to void during a bowel movement. 

Prolapses are measured by grades of 0-4.  "0" meaning no degree of prolapse and "4" meaning the prolapse is bulging outside of the vaginal opening.  Your doctor can give you your grade of pelvic organ prolapse in their office.  I like to look at my patients' prolapase in the clinic in a few different positions and let the patients see what they are feeling in their vaginal canal. Remember, 50% or more of women can have some kind of degree of POP after baby and some can be asymptomatic and manageable. Some POPs cause more issues so it's important to seek proper postpartum exercises and the help of a pelvic floor physical therapist to assess what exercises would benefit you and help you get back to certain exercises that interest you.  

With being early postpartum, and/ or if you are experiencing "feeling of pressure in your pelvis" or "pressure down there", it is important to avoid certain activities and exercises:

• Avoid standing for prolonged periods of time: this could be household work, baby wearing through the grocery store,  carrying toddler, lifting heavy weight (moving furniture) etc 
• Avoid wide leg squats and lifting from a deep squat, especially while holding your breath may increase your prolapse
• Avoid abdominal exercises: such as crunches, sit ups, planks and push ups (not saying avoid forever)
• Avoid running, jumping, HITT workouts, plyometrics and burpees etc ( I like to avoid these until 4-6 months postpartum AT LEAST to help the pelvic floor muscles heal properly after delivery). 

What you can do while exercising in early postpartum:

• Pay attention to what you are feeling in your vagina while exercising and afterwards.  Increased bulging and pressure are bad.  If you feel this, you may have increased your exercise time or intensity too soon. 
• Focus on your posture and alignment while exercising.  Remember to keep ribs stacked over pelvis.
• Watch your breathing with exercises.  EXHALE during exertion and avoid holding your breath with exercises.
• Focus on core and pelvic floor strengthening and retraining to get the muscles on the right tract to support you and your organs again
• Do exercises in different positions: lying on your back, back and hips elevated, sidelying, sitting, standing (avoid too much of this one due to gravity)

I like to suggest to new moms to seek the help and guidance of a pelvic floor physical therapist before getting back into running or plyometric exercises to avoid POP and other pelvic floor dysfunctions in the future (especially if they are having signs of pelvic floor dysfunction: urinary incontinence, pelvic pain, feeling of pressure, diastasis recti, low back pain, hip pain etc).   .