Fitness, MumHood, 18.05.2017

MumHood Post-Partum 101: Breaking Down Everything From Your Pelvic Floor to Diastasis Recti

It’s no secret carrying and delivering a baby has a significant impact on the mother’s body but these changes can also have a huge mental effect on anxiety levels, too – often because of the lack of clear information available which translate the changes into layman’s terms. We’ve enlisted Clare Pacey of Beyond Health’s Beyond The Bump post-natal specialist arm to break it down…

In France the Government provides all women with la rééducation périnéale – up to ten physical therapy sessions to restore the postnatal pelvic floor and retrain abdominal muscles following birth. While our NHS is undoubtedly a boon, post-natal care has a comparatively low profile and isn’t routinely available, meaning women must work with a specialist Women’s Health Physiotherapist for anything beyond the standard six-week postpartum check-up with the GP.

Signs You Might Need to See a Women’s Health Physiotherapist Post Birth
Your body undergoes many changes during pregnancy and continues to change postnatally – this is totally normal, but if you’re experiencing any of the common symptoms after having a baby it’s important to address them ASAP to avoid complications down the line.

Pelvic floor trauma, perineal tears and pudendal nerve injury (the nerve which supplies your bladder and pelvic floor) experienced during childbirth mean you may experience urinary or bowel urgency and/or incontinence, urinary frequency, incomplete emptying, pain on urination/defecation and pain or discomfort with sexual intercourse. In fact one third of women experience post-natal urinary incontinence (“Mørkved, K. Bø”, 1999) and 83% of women at 3 months and 64% at 6 months experience sexual problems (“Barrett et al”, 2000) such as pain on penetration, during intercourse or orgasm, vaginal dryness, vaginal tightness, vagina looseness or loss of sexual desire.

Why the Six Week Check Isn’t Enough to Clear You for Exercise
Another commonly experienced pregnancy complication is the separation of the abdominal muscles (Diastasis Recti*) – but what’s not so common is a detailed examination of the severity of the separation and how to fix it. A Women’s Health Physio can help monitor and advise during the healing process, including the appropriate type of exercises to begin your ‘comeback’. Doing the wrong type of exercise too early – or the right type too late – can be inefficient or, more seriously, can have long-term consequences for your health and happiness.

Many women who experience Diastasis Recti remain abnormally widened at eight weeks postpartum and without treatment this distance remains unchanged for a year (“Coldron et al 2008”, Liaw et al 2011). If your abdominal muscles remain weak, you are more likely to suffer from back pain and have an increased risk of a hernia. If you have abdominal separation and are unable to create tension within the linea alba (the connective tissue that attaches the right and left sides of the rectus abdominis) then the pressure within the abdomen when exercising incorrectly could also cause your tummy to bulge – worsening the issue. Even worse, your body might not be able to coordinate the pelvic floor muscles with physical movement and the pressure created by everyday activities like breathing, potentially causing or worsening an organ prolapse.

*How do I know if I have Diastasis Recti?
Diastasis Recti is the separation of the left and right sides of your rectus abdominis. This occurs due to the growth of the baby in the uterus pushing against the abdominal wall and pregnancy hormones that soften connective tissue. Separation often occurs in the third trimester of pregnancy when the abdominals are at their greatest stretch.

Most pregnant woman will have a small separation (i.e. one-to-two fingers’ width) after pregnancy. While it’s not usually a problem and should resolve naturally on its own within six weeks, if the gap at your midline is more than two fingers’ wide and has a visible bulge, you may have a diastasis of your rectus abdominis and need to see a Physiotherapist. Diastasis recti can be problematic after pregnancy when the abdominal wall is weak and it may make it harder for you to regain your tummy tone and return to your normal exercise routine.

About Beyond The Bump…
Beyond The Bump is Beyond Health’s post-natal specialist assessment that, for the very reasons explained above, we believe every woman should have following childbirth. A consultation with Clare and Beyond Health includes:

  • A review of your prior medical history and personal goals which could range from confidence in your pelvic floor, returning safely back to exercise, getting your pre-baby tummy back, returning to sex, running a marathon or getting ready for another baby!
  • The use of vaginal examination and/or real-time ultrasound and functional tests to investigate in detail the impact of pregnancy and labour on your abdominals, pelvic floor and pelvic stability muscles.

Depending on your results and goals:

  • Advice on specific treatment (manual therapy techniques, internal release to scar tissue or tight/overactive pelvic floor, acupuncture, relaxation and breathing techniques, advise on toileting and positional modifications, specific exercises and onward consultant referral). 
  • Formulation of a restoration programme to relieve symptoms and improve overall strength, stability, function, performance and confidence.
  • Following the assessment the Physiotherapist will provide you with a report of the findings of the day.

To learn more and book a consultation with Clare, visit Beyond-Health.co.uk.