Postnatal exercises

Pelvic floor muscle exercise

The pelvic floor is a sling of muscles between your coccyx (tailbone) and your pubic bone. Its purpose is to maintain continence, support the pelvic organs and stabilise the pelvis.

It is important to strengthen your pelvic floor muscles by exercising them. This can help with any incontinence problems you may have already or reduce your chances of developing incontinence problems in the future. Keeping the pelvic floor muscles toned can also help to prevent bladder, womb or bowel prolapse later in life.

By starting the exercises soon after the birth you can help the muscles to recover quickly. It is safe to do these exercises even if you have had stitches. Exercising the muscles will help to lessen any discomfort or swelling. We recommend starting the exercises gently the day after you have given birth.

Some women find it difficult to feel these muscles working at this stage. If that is the case for you, try exercising each day after the birth to check when the feeling improves.

To contract the pelvic floor muscles, imagine you are trying to stop passing wind and at the same time trying to stop the flow of urine midstream. You should feel a sensation of ‘squeeze and lift’ as you close and draw up the back and front passages. Hold this for as many seconds as you can, up to a maximum of 10 seconds. At the end of the hold, there should be a definite feeling of ‘letting go’. It is recommended that you do 24 exercises a day. Try doing 4 or 5 holds every time you feed your baby. This will help you get into the routine of doing them. We recommend that you continue to exercise the muscles daily for the rest of your life.

Stomach exercises

Your stomach muscles will have been stretched as the baby was growing. It is common for this stretching to cause what is called divarication. A divarication is when the tissue joining the 2 halves of your stomach muscles widens. It is important to note that the muscles themselves or the tissue between the 2 halves of the muscle are not split. When the muscles have been stretched, they cannot work as well to support you, which can lead to aches and pains in your back.

It is important to start toning up these muscles as soon as you feel well enough. Start with the deep muscles as they reduce the strain on your back and pelvic floor (Stage 1). Once these exercises become easier, you can go on to working the outer muscles (Stage 2).

Stage 1

This first exercise works on the deepest muscle of the stomach, which acts like a corset. It stabilises the spine and pelvis, helps flatten your stomach and draws in your waistline.

Starting position

For the first 6 weeks, you should exercise in a comfortable position, with a pillow between your knees. You can choose to lie on your side or on your back with a pillow under your head, your knees bent and your feet flat on the floor or bed.

• As you breathe out, gently draw in the lower part of your stomach, squeezing your pelvic floor muscles at the same time
• Let go slowly Repeat this exercise 4 or 5 times, with a few seconds rest between each one.

Aim to build up slowly – contracting the muscles for no more than 10 seconds and repeat up to 10 times. Try to keep your back still during this exercise. You should be able to breathe and talk while you do this exercise.

Stage 2

Once you are comfortably exercising the deep muscles, you can go on to Stage 2.

The pelvic tilt

• Lie in the position shown and begin with the deep stomach exercise in Stage 1
• Tilt your pelvis back and flatten your back on the floor or bed
• Hold this position for a maximum of 10 seconds

The Head lift

• Lie as in the position above
• Lift your head only
• Hold for a few seconds
• Release gently
• Rest for a few seconds

How to progress the exercise

Once you feel confident with the head lift, you can:

• Hold the head lift for up to 10 seconds; do not forget to keep breathing!
• Raise your head and shoulders up higher Remember
• Squeeze your pelvic floor muscles as you do the exercise

Do not allow your stomach to bulge while you exercise It may take several weeks before you get to this stage; this is nothing to worry about.

Caring for your back

As well as strengthening your stomach muscles; here are some other ways to reduce the risk of getting aches and pains in your back, as you care for your new baby.

• When changing your baby, try to make sure your baby is on a surface at waist height. If it is not, it is best to kneel down, keeping your back as straight as possible.
• When feeding your baby, sit on a hard but comfortable chair. Make sure your back is well supported. Placing a small, rolled towel behind your lower back helps. Make sure that your feet are supported and flat on the floor.
• Carry your baby in front of you; avoid carrying your baby on one hip.
• Bend your knees and keep your back straight when lifting.
• Kneel at the bath side rather than leaning over
• Lower the cot side when lifting or lowering your baby
• Keep your baby close to you when moving him/her in and out of a car seat If you have to carry the baby in the car seat hold it in front of you, not on your hip, or put it on a wheeled frame/buggy.

Restarting normal exercise

We recommend that you wait until after your 6-week postnatal check, before starting to exercise regularly again.

Top tips

• Push the pram or buggy briskly. Remember to keep your back straight. Walking is good exercise, so try and get out as much as you can
• Borrow or buy an exercise DVD, as this is a good way to work out at home. You could get a friend or your children to join in
• You can try swimming when your postnatal bleeding (lochia) has stopped, any abdominal wound has healed and any pelvic pain has settled
• Join a postnatal exercise class. Many postnatal exercise classes let you exercise with your baby
• Before restarting or beginning exercise at the gym please discuss with a member of the gym team or a personal trainer
• Wait for 3 months before starting a more strenuous aerobic or high-impact exercise

Contact

If you carry out the pelvic floor and stomach exercises regularly you should return to normal function over time.

If you have any ongoing problems, you should ask for advice from a pelvic health physiotherapist. To see a Physiotherapist, you can self-refer online at: www.gloshospitals.nhs.uk/physio

Physiotherapy Department Tel: 0300 422 8527