I’d just had my 5th baby a few months ago and desperately wanted to get back into a regular workout routine. I didn’t feel like myself—not just because of the extra 30 pounds, but because I was used to being very active and hadn’t been since giving birth. Having my 4th and 5th only 15 months apart made it difficult to go…well…anywhere.
I finally got the “babies,” as I called them, all packed up and checked into the gym play room. I excitedly stepped into the aerobics room, ready to try my first High Fitness class. I’d heard it was the best thing since Zumba, and I LOVED Zumba, so this had to be pretty great.
About 10 minutes in, the adorable and incredibly fit instructor started a routine with some jumping jacks and tuck jumps. “No problem,” I thought, “I used to do these all the time!” WRONG. Every time my feet hit the floor, I peed a little. Pretty soon I was so wet that I knew I couldn’t pass it off as sweat anymore. I modified the rest of the class and ran out as fast as I could when it was over.
I’d felt pretty good about my pelvic floor after each baby—until now. That 5th one really did a number, and I needed to do something about it. But WHAT? Could I really undo the damage that all those babies had done to my body?
Whether you’ve had one baby or 5, chances are you’ve experienced some kind of pelvic floor weakness either during or after each pregnancy. The most important thing to know is that it’s totally NORMAL. The second most important thing to know is that it can be fixed, and for most women, doesn’t require any medical intervention.
Your Pelvic Floor
The pelvic floor is made up of muscles shaped in a figure 8 that extend from the pubic bone to the tail bone. They exist SOLELY to support your internal organs—specifically, your bladder and uterus. As the uterus grows during pregnancy, the increased weight can take its toll on your pelvic floor muscles. In addition, your body is releasing hormones that cause the muscles, ligaments, and joints to relax and loosen to prepare for birth.
It’s not surprising that most women experience a weakened pelvic floor after giving birth. However, the pelvic floor muscles—like any other muscle group in the body—are very resilient. The are designed to tolerate a bit of abuse. And like other muscle groups, they are able to be strengthened through a bit of exercise.
Postpartum Pelvic Floor Care
The most common mistake mothers make when returning to exercise after giving birth is doing too much too soon. It is very important that you not participate in heavy lifting or high-impact exercise until your pelvic floor is strong enough to support your organs once again. I made this mistake by attending a High Fitness class too soon after giving birth, before I had done anything to work on the strength of my pelvic floor.
Another common mistake postpartum mothers make is to start ab work too soon after giving birth. Even though your stomach likely looks like you’re still pregnant for weeks or even months after delivery, don’t be tempted to make it go away by doing lots of heavy ab work. Doing ab work with a weak pelvic floor is like squeezing a tube of toothpaste when the lid isn’t screwed on—it will just pop right off and let everything come out. (This is called prolapse, for those wondering, and is very serious but thankfully very uncommon.)
How to Strengthen the Pelvic Floor After Childbirth
The first few weeks
Starting the day you give birth, do at least three sets of Kegel exercises each day. In case you aren’t sure how to perform Kegels correctly, here’s a quick guide:
- Slowly draw in (not just tighten) the pelvic floor muscles as if you were trying to stop pee or gas
- Don’t forget to include ALL the pelvic floor muscles, even the ones around your anus
- Pause for 1-2 seconds
- Slowly relax the muscles
- Repeat 10-12 times in sets of 3
When you are no longer feeling pain in your abdomen, start with some simple floor exercises. Lie down on the floor, and use a yoga mat if you have hard floors. Bend your knees and place your feet and palms on the floor. Inhale and exhale. Feel your breath—focus on it. Start to become aware of your abdominal and pelvic floor muscles. Inhale and “draw in” the abdominal and pelvic floor muscles. Pause for 1-2 seconds, and then release. Repeat 10-12 times for 3 sets.
This exercise will help you reacquaint yourself with the core muscles in your body and start to engage them again. You should take it really slow and make sure you are engaging BOTH the abdominal and pelvic floor muscles together to avoid a risk of prolapse.
When you feel comfortable with this exercise, progress it by adding a leg lift. Inhale, and as you engage the abdominals and pelvic floor, lift one leg off the floor and bring it to a 90-degree angle. Exhale and slowly lower the leg back down to the starting position. Repeat on the other leg. Perform 10-12 reps for 3 sets. When you are ready, progress further by lifting both legs off of the floor.
Glute bridges are another great exercise to start around this time. Lie on your back as before, but this time, engage your core muscles as you lift your hips off the floor and try to make a straight line, or “bridge,” with your torso. Lower back to the floor and repeat 10-12 times for 3 sets.
Most women start to feel ready for exercise after about 4-6 weeks. However, if you’ve had a particularly difficult delivery or a c-section, it may take longer—and that’s OKAY. You don’t need to rush into exercise! Wait until your body is ready. Be patient with your body.
When you are ready to progress beyond Kegel exercises and the simple floor exercises, move to your hands and knees. I love bird dogs because they engage all the core muscles without putting extra pressure on the pelvic floor.
To perform bird dogs, come to the floor (using a mat for hard floors) on your hands and knees. Inhale. As you exhale, extend one arm and the opposite leg straight out, away from the torso. Pause for 1-2 seconds and return to neutral. Repeat with the opposite arm and leg.
To progress the exercise, extend the arm and leg and then move them outward toward opposite corners of the room. Think of making a diagonal line from the tips of your fingers to the tips of your toes on the opposite leg. Return the arm and leg to their straight line position, and then back to the floor. Repeat on the opposite side.
Another great exercise to begin about this time is a simple forearm plank. Place your forearms on the mat and push up onto your toes so that your body is suspended off of the floor. (If you need to modify, keep your knees on the floor.) Engage all of the core muscles, especially the pelvic floor. Hold at least 30 seconds, working to one minute.
To progress planks, here are some options:
- Hold the plank longer
- Switch to a high arm plank
- Lift one foot a few inches off of the floor, then lower and repeat with the other foot
- Pull one knee in toward your chest, then extend the leg back out and repeat with the other knee
- Perform plank walks—move the right arm and leg out a few inches, bring the left arm and leg in a few inches, etc.
- Grab some gliding discs and perform these progressions but with the feet gliding along the floor
Yoga is another great exercise to incorporate around this time. It strengthens the core without putting too much pressure on the pelvic floor, and the stretching helps increase blood flow and heal the weakened area.
Some other great exercises to begin around this time include body weight squats and light weight training in a seated position. You can use a bench if you have one, or even an exercise ball.
As soon as you can perform the exercises above without feeling any strain or pressure on the pelvic floor, you can start moving into light ab work (crunches, sit-ups, etc.) and low-impact cardio. Listen to your body—if you leak urine or feel any pain or pressure in your abdomen or pelvic floor, modify as needed. It may take several months before you can go “full out,” and that’s okay!
As a reminder, here is a quick reference guide for safe exercises to perform at each postpartum period. Remember—these are general guidelines and may not apply to your exact situation. Each pregnancy and each postpartum recovery will be different. Be sure to listen to your doctor and listen to your body as you slowly move back into your fitness routine. You’ll be glad you did!
|Postpartum Exercise Guide|
|1-3 Weeks||Kegels, “drawing in,” supine knee lifts, glute bridges|
|4-6 Weeks||Bird dogs, planks, yoga, squats, light weights in a seated position|
|6-12 Weeks||Light abdominals (crunches, sit-ups, etc.), low-impact cardio, light weight training|
|Beyond 12 Weeks||Slowly increase the intensity of cardio, slowly add weight as the pelvic floor becomes stronger|