by Dr. Taryn Kilty, DPT, OCS, Postpartum Certified Specialist. She has specialty in women’s health and postpartum pelvic health. She is a wife to a rancher from Wyoming, and a mother of two beautiful kiddos.
I thought after I had my kids I would just put myself back together again. Little did I know that my body wouldn’t just bounce back after I had my kids. I suffered from Diastasis Recti, back and knee pain, and pelvic floor dysfunction. This led me down the road to becoming a pelvic floor physical therapist. My mission is helping mothers thrive after having children instead of just surviving. Today I want to share 5 common questions I often hear regarding pelvic health.
What is the pelvic floor?
We talk about it a lot, yet many people lack a basic understanding of what it is. The pelvic floor is a group of muscles that run like a hammock from your pubic bone to the back of your pelvis and tailbone. They support the pelvic organs, aide incontinence (both pee and poop), and play a role in sexual function. Like any other muscle, the pelvic floor should be able to contract and also fully relax.
Does everyone just need to do more Kegels?
This age-old advice to just do more Kegels to make all symptoms go away sounds pretty magical. I wish it were this easy. In the case of an overactive pelvic floor, doing Kegels can actually make symptoms such as leaking, heaviness in the vagina, or pelvic pain worse. Similar to clenching your fist all day, would it make sense to clench your fist even harder over and over again? The answer is heck NO! An overactive pelvic floor can lead to things like incontinence, pain with sex, pelvic pain or even hip/back pain. Those women need to do the opposite–learn to relax those muscles before starting to strengthen them again.
The other reality is that studies have shown that up to 50% of women who believe they are performing a Kegel are not. They may be bearing down or it may be in-coordinated. It’s hard to tell without a proper assessment. Before “just doing Kegels,” consider seeking advice from a physical therapist who specializes in women’s health so you can figure out what is actually going on down yonder!
I am years postpartum, can you still help me?
The short answer is YES! I often tell my patients, “Once postpartum, always postpartum.”
Pregnancy and delivery will always be a part of your medical history and something to consider. Some women may have pelvic floor symptoms postpartum. Some may not have symptoms until peri-menopause or even menopause. Remember, just because the symptoms of incontinence, pelvic pain, or even back and hip pain are common, they are not normal. Pelvic floor physical therapists that can help you navigate these challenges, irregardless of your life stage.
Will my body ever be the same again?
In the world of “bouncing back” after having a baby, a lot of women I treat feel shame about their bodies. As much as we would like to love and accept our body, the reality is, many of us do care about what our bodies look like. When we like the way we look, we feel good about ourselves. Although your body may look a little different postpartum, remember that your body is not broken.
Our society has high ideals for the “perfect body.” When you see a woman three months postpartum with a six-pack, know that’s not the norm. Yes, genetics play a role, but she probably is on a pretty intense workout program and is eating a restrictive diet. For many of us, this isn’t healthy or sustainable. For me, I want to feel good about my body, so I do try and eat healthy foods and work out. I also love a good treat with my kids every once in a while! This probably means the six-pack is not in my future, and I am ok with that.
When is it safe to return to running and more intense exercise (HIIT, Crossfit, etc.)?
The six-week mark is often seen as the green light to return to all things, including high-intensity exercise. For some, this may be true. It is important, however, to build a strong foundation of strength, balance, and impact management before returning to these more intense exercises. Below I’ll share some things to monitor, and a quick assessment for returning to running or high-intensity exercise. If you maintain good mechanics during all these exercises without symptoms, you can start progressing to running (or other high-intensity exercises).
Sometimes it is best to start with intervals between a run/walk and increase your run time as you tolerate it. Many women I work with that do not have symptoms until later on in their run. A lot of times this is due to the endurance of the pelvic floor and other support muscles. This will take time working on building your strength and stamina.
Things to monitor:
- No coning/doming of the abdomen
- No breath holding
- Poor alignment: rounded shoulders flared ribs, butt tucked under, knee collapsing inward, etc.
- No pelvic floor symptoms: leaking (pee or poop), pressure or heaviness in the pelvic region, or pelvic pain.
Quick assessment for return to running (or high-intensity exercise):
- Double leg hop x 1 minute @ 160 beats per minute
- Plank on elbows for 1 minute (without doming/coning of the abdomen)
- Wall sit for 1 minute
- Single-leg squat, 10 times each side with good mechanics
- Single-leg balance, 30 seconds on each leg
- Single-leg calf raises 20 times on each side
Bonus: What can I do during pregnancy to improve postpartum pelvic health?
Postpartum is an unpredictable time, so be prepared for anything. Reported pregnancy-related risk factors for developing pelvic floor dysfunction are body mass index at term, weight gain, smoking during pregnancy, duration of the first and second stages of labor, spontaneous or operative delivery, perineal lacerations, weight of the newborn, mode of delivery (ex. episiotomy, forceps), and epidural analgesia. This list may give you a bit of anxiety because there are a lot of factors out of your control.
Don’t despair! There are a few things you can do during pregnancy:
- Exercise and/or stay active. Studies show that exercise during pregnancy can decrease maternal weight gain, decrease risk of gestational diabetes and gestational hypertension, decrease chance of having a C-section, reduce length of first and second stages of labor, and decrease risk of postpartum depression.
- Know your pelvic floor. Are you able to contract your pelvic floor and relax your pelvic floor? You may also consider doing some perineal massage. This involves pelvic floor muscle stretching by application of external pressure to muscle and connective tissue in the perineal region. You can perform this up to 4 weeks before childbirth to help the soft tissue in that region to withstand stretching during labor.
Taking action during pregnancy is fabulous, but if your laminated birth plan is thrown out the window during labor, don’t fear. You cannot control everything, and there is no shame in having a game day change of plan.
Reach out for help!
I love helping fellow moms navigate the muddy waters of postpartum pelvic health, no matter how many years postpartum. If you have questions, please reach out to me or find a local pelvic floor physical therapist that can help you. Remember, so many symptoms are common, but they shouldn’t be normal. You deserve to have normal function, and I believe that you can improve your symptoms with focused work.
Taryn Kilty is a doctor of physical therapy, wife to a rancher from Wyoming, and the mother of two wonderful kiddos with a secret desire to be Joanna Gaines. Her lifetime mission is to help mothers thrive after having children instead of just surviving.
After 5 years, two children, three orthopedic specialists, countless colleagues, and a handful of other healthcare professionals, she still wasn’t finding answers to her broken postpartum body. For her 30th birthday, she asked for what any normal 30-year-old gal would ask for: an online postpartum course for physical therapists. This was the course that changed her life and projection of my career.
This course was the starter fuel to her obsession for finding answers to all the pain points woman have after having a child. This course ramped up her nerdiness and has led her to become a certified postpartum physical therapist, applied prevention and health promotion therapist, and personal trainer. She will continue to obsess, research, and learn so that she can bring hope to as many mothers out there as she can. You can reach out to her at [email protected] or find her on Instagram and Facebook.