When to exercise
First few days after birth
For normal vaginal births, you can start very gentle pelvic floor exercises in the first few days after birth.
If you had a caesarean section, wait until your catheter (tube in your bladder after surgery) has been removed before you begin pelvic floor exercises. Remember, a caesarean section is a major surgery and you shouldn’t lift anything heavier than your baby up until 6 weeks after birth.
SAFE EXERCISES
Exercises to engage your core (deep abdominal muscles and pelvic floor)
1. Lie down on your back with your knees bent.
2. Gently draw in the lower abdominal muscles as if hugging the baby when pregnant. Hold for up to 10 seconds. Keep breathing during the exercise.
3. While lying on your back, flatten your lower back against the bed and release. Do these pelvic tilts five times x 5.
4. While lying on your back, engage lower tummy muscles by gently turning and twisting your knees side to side. Do this five times.
EXERCISES TO AVOID
· Sit-up type movements
· High impact activities
· Weight lifting activities
6-8 weeks after birth
- Wait until after your 6-8 week check-up before returning to light, gentle exercise.
· Avoid abdominal crunches and curl-ups, if your tummy muscles have separated. Visit a women’s health physiotherapist before starting or re-starting exercise, if you have muscle separation.
· If you experience any pain, heaviness, dragging or incontinence while doing these low impact exercises, contact your women’s health physiotherapist or physician.
LOW IMPACT EXERCISE
· Long walks
· Low impact aerobics,
· Gentle stretching
· Tai chi
· Stationary bike
· Swimming (when you have had 7 days in a row without vaginal bleeding).
3 months after BIRTH
· If you have had a caesarean section, and you are considering going back to the gym or exercise class stop exercising if you feel any discomfort, pain or a pulling sensation on your scar, and try again in a couple of weeks.
· Do not return to high impact sports, such as running, before 3 months postpartum or if you have any symptoms of pelvic floor dysfunction.
Moderate impact exercises
· Postnatal Pilates
· Yoga
· Cycling
· Power walking
· Zumba
· Ballroom dancing
High impact exercises
· Running
· Circuit training
· Rope skipping
6 months after birth
· While you can return to high impact sports from 3 months postpartum, (provided you do not have any symptoms of pelvic floor dysfunction) remember that up to 4-6 months postpartum the hormone relaxin may still be present in your body, which increases your risk of injury.
· Use proper posture and technique while exercising and think about your safety if you enjoy activities where falls or impacts can occur.
· Hiking
· Rock climbing
· Mountain biking
· High intensity sports, such as weight training, martial arts, rugby.
How to find your pelvic floor muscles
A quick reminder about how to find your pelvic floor muscles. Think about the three openings in the pelvic floor, the back passage, the vagina in the middle and the small bladder opening at the front called the urethra.
Begin by lifting and squeezing around the back passage as if you are stopping wind, then bring this feeling forwards around the vagina as if you are tightening around a tampon, and forward again as if you are stopping the flow of urine.
Ways of doing a pelvic floor squeeze
There are two ways of doing a pelvic floor squeeze, either a slow or a fast squeeze.
Slow squeeze
The slow squeezes build up strength and endurance by working the muscle hard. To do this, you must keep the squeezing and lifting going throughout the squeeze up to a count of 10 seconds.
Don’t just squeeze once and hold it and hope that it will get to 10 seconds as you may not feel that you have let the squeeze go. Instead, keep squeezing until the muscle is tired and then release completely for a few seconds and repeat.
Remember to keep your muscles and face relaxed while doing pelvic floor exercises, no one should be able to tell from looking at you that you are doing pelvic exercises.
Fast squeeze
The fast squeezes help to get the muscle reacting quickly. You need the muscle to squeeze quickly to prevent a leak when you cough or sneeze without much warning. For the fast squeezes, squeeze as hard as you can, followed by an immediate release and let the muscle relax.
Where to do the exercises
For this coached task, we suggest you sit upright on a firm chair and with your lower back supported. Or you can try leaning forwards with a straight back and your knees apart with your elbows resting on your knees.
In this forward lean position, your pelvic floor will be in contact with the chair so that you may have more sensation and you can think about lifting the pelvic floor up from the seat of the chair.
Keep your buttocks relaxed and breathe throughout the task. If you find it easy to complete the task in sitting, then you can progress to standing. However, if you find it difficult to do them in sitting, try the coached task again lying.
Breathing is important
To train the muscles effectively, it is important that you are able to breathe throughout your exercises and not pull up your muscles by holding your breath and sucking in your tummy. No one should know you are doing these exercises by looking at you, so don’t squeeze your face or tighten your buttocks. Make sure that you finish your exercise programme each time, so that you are challenging your pelvic floor muscles to change its strength and co-ordination, but remember to release completely between squeezes.
Challenging yourself
You can increase your programme of exercises by changing your position from lying to sitting and up to standing. Finally, you can include the pelvic floor squeeze while doing other tasks such as coughing, lifting or with exercising. This is when you will really begin to see the benefit of doing your exercises.
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