My OB said I can start exercising. So I did. But my pelvis feels like an alien and I pee everywhere. What do I do? Part 2 of 2.

In part 1 of this blog series, we laid out an all-too-common scenario that postpartum mothers face when they are ready to return to exercise. We discussed individual pre/postnatal considerations, risk factors, and sign/symptoms to watch for when returning to exercise. So, as promised, part 2 highlights what you CAN do in those first 3 months postpartum. Goal being = optimize postpartum recovery and prevent and manage those “common but not normal” conditions that we women talk about (ie, I pee when I sneeze…My pelvis feels heavy and not normal…I feel like I no longer have abs because I can’t even sit up in bed….I can’t exercise because my pelvic region hurts and I leak!). Some of these answers in part 2 may surprise you.

First 6 Weeks

1. Rest, restore, heal. If you are going to load your body and tissues eventually, proper healing is necessary. Your body is an amazing machine and when healing is given the time and acknowledgement, the body knows what to do. Abdominal diaphragmatic breathing (refer to this post for more tid bits) can be super helpful in calming the nervous system and working through any muscular tension that builds up. There’s no need for you to ‘kegel’ until you’re blue in the face. In fact, it’s best that you don’t. Allow for a natural re-organization of the tissues to occur and simply just breathe well. Re-establishing muscle control in the pelvic floor muscles and abdominals will come eventually.

2. Support your GI (gastrointestinal) system. This seems kind of funny to bring up in a post about postnatal return to exercise, but the GI system is so innately connected to the immune system, and without either of these, exercise is difficult. Nourishing the building blocks of proper eating, hydration, and nutrient absorption is key in being able to even have the energy to resume exercise in the first place. Returning to exercise too much, too soon can put the immune and GI systems into overdrive. You will return to running and exercise much more effectively if you nourish yourself and support your GI system (and therefore your immune system) early on in postpartum. Refer to this post for ideas of how to ‘right the postpartum GI ship’.

3. Simple walking. So many times I’ve heard postpartum moms say “I tried running the other day and it felt like my insides might fall out” or “I went for a jog, and my back and hips were killing me!” Start with walking. Using walking as a form of exercise is a great idea, especially early on postpartum. You can bond with your newborn, get some fresh air, and simply move again without having to dial up the intensity. It seems so simple and can be so underappreciated. Walking is good for all major systems of the body, so it’s efficient and effective. It even reminds the pelvic floor muscles what gravity is (which is good for natural tissue re-building).

Second 6 Weeks

1. Physical therapy exercises, simple yoga, and Pilates-based exercises. If your goal is to return to marathon training and/or Cross-fit, more power to you! However, starting small is key. If you participated in prental yoga or Pilates, most of those types of exercises are sufficient in starting to build gradually back into exercise. As you attempt to build strength, don’t forget the importance of lengthening and letting go (especially those pelvic floor muscles). Muscles need a chance to learn how to relax so they can strengthen. We wish America was like France , where it is a given that all postpartum moms receive pelvic floor PT. After all, getting individualized treatments from a skilled pelvic floor therapist helps ensure that you are turning the right muscles on and off. Since we’re in America and still working on the system, if you’re not able to see a pelvic floor PT, an excellent resource to start: Pilates Anytime . It has safe prental/postnatal mat classes and education for you to consider using on your own watch in your own home.

2. Build gradually and keep and eye on any symptoms that may arise. For return to running, build training volume (ie, distance/time) prior to increasing training intensity (ie, pace). The general consensus is that a total weekly running distance/time should not increase by more than around 10% per week. This may seem slow when you are starting with very low training volume (such as running just a few minutes), but slow and steady wins the race. Include walk breaks to reduce fatigue initially and eventually you can reduce the walk breaks. What about your Pelaton you ask? Same concepts apply. Begin with light, resistance-free spinning for ~10 minutes and build gradually. Biking is a little different because perineal (ie, undercarriage) support and bike fit are important for prevention. Be sure that your bike fits you, and watch for symptoms if spinning and road/mountain biking is your jam. When increasing jogging, biking, or general exercise, what happens if you feel pain? Mild musculoskeletal pain (0-3/10 on a pain scale) that settles quickly after the exercise session and doesn’t last later into the day or into the next day is often acceptable.

3. Specificity. Keep in mind that all postpartum moms have different exercise preferences (walking, running, spinning, yoga, Pilates, hiking, swimming, Cross-fit, team-based sports) and needs. So it’s important to train with specificity to your desired athletic endeavor. This is when the team approach comes in if you’re struggling with getting back to your activity without symptoms. Use pelvic floor/women’s health physical therapists, pre/postnatal personal trainers, and pre/postnatal yoga & Pilates instructors if you need assistance. YOU know your body best, but if you’re wondering where to go from here, simply ask for help.

A last little tid bit on daily mothering duties. Let’s be honest, your daily mothering duties can often feel more exhausting and physically demanding than any form of exercise within the first 3 months. These activities do count. Mindfulness strategies and postural modifications (often learned in yoga, Pilates, and physical therapy) are helpful in carrying you through your daily tasks. Research suggests that daily mothering duties (laundry, picking up children, house chores, yard work, etc) can be more load on our tissues than certain exercises. This is food for thought when considering that exercise shouldn’t be thought of as scary or dangerous and nor should your daily mothering duties. Your daily duties can actually help keep you gaining strength and endurance. All of you postpartum moms, with and without pain, are strong, sturdy, and innate healers! Loading your body via daily activities and light exercise is so great for healing and your overall mental & emotional health. We just want to make sure that you feel confident in your journey, and that your activity increases are balanced out with rest and rejuvenation in all phases of postpartum healing.

To sum it up: embrace natural healing (including your intuition if something doesn’t feel right), enjoy the process, be patient, don’t be afraid to challenge yourself within reason, ask for help along the way, and most importantly…have fun!

(Resource: Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population, published March 2019, Tom Goom, Gráinne Donnelly and Emma Brockwell)

Published by kacannon

Kelsea Cannon, PT, DPT, PRPC is a physical therapist and pelvic health specialist who feels passionate about helping women restore wellness and balance in their lives. Her dedication lies in merging her comprehensive orthopedic, pelvic health, and Pilates expertise to manage pregnancy-related concerns, such as pelvic & low back pain, pelvic organ prolapse, urinary incontinence, diastasis recti, c-section scars, painful intercourse, and bowel dysfunction. She promotes an interdisciplinary approach and is a believer in helping women establish their ‘dream team’ of care providers. Her main goal is to support and inspire women using an integrative approach to help them be successful in reaching their personal health and wellness goals.

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