The Elephant in the Room: Navigating the Pelvic Floor Postpartum

By Rachel Spurrier

When I was discharged from the hospital after having my first child, I was given a “welcome home” packet with information about how to care for my newborn, breastfeeding advice, warning signs to look out for in the immediate days postpartum, and general advice about my new postpartum body.  In the fog of new motherhood and extreme sleep deprivation, I barely touched the pages of literature that were there to “aid” me. I spent the initial postpartum days hobbling around our NYC apartment trying to figure out how to swaddle my baby, change his diapers, and breastfeed, all while trying to wean myself off pain medication I was given to help me cope with my badly bruised tailbone, tearing, and my episiotomy.  

Unlike many other countries, in the US, a couple xerox copies of literature are generally all the help new mothers are given immediately after having a baby, if any.  A lot of times there isn’t even a couple printouts of information hastily thrown at the mother as she’s leaving the hospital to help guide her in the unchartered world of motherhood. Aside from 6-week postpartum checkup, you’re on your own.  Unless you’re willing to pay hundreds if not thousands of dollars for a doula who may (or may not) provide a postpartum follow up or have a lactation consultant visit your home, the proverbial village of raising a child and helping the mother recover doesn’t really exist. 

When I finally got around to reviewing the literature during a neverending pre-dawn cluster feed, there was one paragraph that mentioned women should start doing pelvic floor exercises “immediately postpartum.”  I honestly didn’t really know what that meant at the time, let alone the importance of this.  Frankly, thinking about “exercising” my pelvic floor made me nauseous, as EVERYTHING hurt so much in that region.  Anything that involved sitting, squatting, or going to the bathroom was excruciating.  Walking was incredibly difficult, as was going up and down stairs. Little did I know that a relatively “normal” vaginal birth would be just as difficult to recover from than a C-section.  As a person who was very used to an active lifestyle pre pregnancy and throughout the nearly 10 months of it, not being able to do the most basic movements without debilitating pain was a huge blow mentally, emotionally, and physically.

Elephant in the Room by Mark Bryan

Friends, family, and even strangers that I came to know through online blogs told me this was completely normal to feel this way. Everyone said to take it day by day, and they were right.  One week postpartum, I was able to walk multiple city blocks and navigate subway stairs, though very slowly and gingerly.  Two weeks, I was up to over a mile.  By 4 weeks, while I still was bleeding occasionally, I was able to walk 4 miles.  It was still painful from time to time, especially when I overly exerted myself.  I had to be very careful.  And yet by the 6-week mark, I was able to go on my first 3 mile run, which (fortunately) was nearly pain-free.  Yet things felt “different” in my pelvic region in the weeks (and months) that followed.  It felt “heavy” and often sore, and I sometimes leaked urine if I wasn’t careful.  When my doctor “cleared me” for exercise at 6 weeks, I mentioned this to her.  It seemed embarrassing to talk about it at first.  It was only during that checkup that she told me my pelvic floor was weak and that I should be doing pelvic floor exercises every day, and equally as important, she told me the reasons why. She even showed me how properly release and contract my muscles.  Little did I realize that while all OBGYN’s should be encouraging their patients to do this, it’s actually not very common practice.  How many other women out there don’t even realize this is so important to not only know about, let alone do?

Pelvic floor muscles are really a hammock of support for your bladder, uterus, vagina, and rectum.  So if your pelvic floor muscles are weak, these areas won’t function as well as they should.  The pelvic floor is also part of your general core. When you think “abs” and “core”–this also includes your pelvic floor muscles.  They support your lower back (lumbar spine area) and your hips.  So, when one has weak pelvic floor muscles, there can be cascading negative effects on all these areas.  Postpartum women are more apt to suffer from these effects, as especially if there is vaginal delivery, there can be some form of “trauma” to this region. Even if there is no tearing or episiotomy involved, the very act of pushing a baby out of the birth canal stretches the pelvic floor beyond its limits and therefore strains and weakens these muscles.  And yet, it’s not just this group of the population that may have issues–it can affect everyone (men and women, of all ages), not just post partum or post menopause women.  

In my own experience, because I talked about my issues with my doctor early on, did more research on my own in the months that followed, and began to integrate pelvic floor exercises in my routine, I was able to resume my active lifestyle pretty quickly after giving birth.  Since I didn’t have any severe issues like organ prolapse and I closely monitored my progress, I even was able to run a marathon less than five months postpartum with little pelvic floor issues during training.  I was lucky.  While I am a more informed individual about the pelvic floor and more attune to its interconnectedness with my own body, I still have flair-ups from time to time, even two years after giving birth.  I still dread coughing or sneezing especially when I am running as I know I may pee just a bit.  I still get embarrassed when I talk about these “incidents” sometimes.  Even writing about my experiences gives me pause.  But being open about this is extremely important to discuss with others.  I’ve now learned so many of my friends and family suffer from a weak pelvic floor, and yet didn’t know what to do, and most just sort of accept it as “that’s life.”  I find women tend to be more apt to think we can handle this on our own, it will go away with time, or “that’s the way things are,” and not to seek help if there is an issue, no matter how minor.  We joke about peeing when we sneeze, but we may not do something about it.

However, there are some solutions.  First and foremost, it’s educating women to be more open about discussing their issues–no matter how minor–with their doctors, and their community.  And taking action to prevent things from getting worse is also key, as inaction can actually make it worse.  Having a weak pelvic floor may even prevent some women from doing things they love to do, or used to do.  Regaining strength and control to these muscles will help, and yet it takes time and regular practice as often as one brushes their teeth.  Talking the right steps to mitigate this can also be at your fingertips -whether it’s finding a physical therapist who specializes in the pelvic floor or even easier- the B-wom app, which acts as your own personal pelvic floor fitness coach.  Seeking help now will give you more confidence in yourself and allow you to move forward and take control of your life.  


About Rachel Spurrier

Rachel is a RRCA Certified Running Coach and a Pre & Post Natal Corrective Exercise Specialist, and coaches privately as well in group settings under her own business, Go & Glow.

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