You’ve gotten the 6-week clearance from your doctor following the birth of your baby. You’re excited to get back into exercise. It makes you feel like yourself because life with a new baby, you feel anything but. Not to mention you’re ready to lose the baby weight.

When it comes to exercising after pregnancy, doctors often tell you to “listen to your body” — just as mine told me. But there’s a huge  problem with this piece of advice: 

You can’t properly listen to your body if you’ve never been educated on how. 

Generally speaking, it’s assumed that listening to your body means pain is somehow involved. However, there are many symptoms a woman may have not involving pain. Or at least right away.

Not to mention as a society, we are trained to believe a good workout means you push through pain and overexertion. This mindset doesn’t magically subside after giving birth. 

After my first child was born, I listened to my body like I was told. Or so I thought. 

Because I was fit before and during pregnancy, my body was strong enough to recover quickly postpartum. Pelvic health and core rehab never came up in my 6-week clearance. So I did what most women do, return to my pre-pregnancy fitness training.

Desperate to lose the weight, I was exercising for nearly 2 hours a day and felt fine. There was no pain or discomfort. 

I noticed a little pee during higher impact like box jumping and was indifferent. I figured it was a sign my body was working hard. Later I learned this isn’t a badge of honour

There are so many changes happening prenatally affecting postpartum outcomes. For one, a totally normal physiological phenomenon called diastasis recti happens, and that’s when your belly grows and abdominals expand to make room for your growing baby.  Let’s go over what these changes to your body mean for you. 

After your baby is born, your core has much less strength, leaving your body depending on your spine and other muscle groups to take on the work. Common things you may notice is your back and hips ache when it wasn’t an issue in the past. 

Then there’s your pelvic floor which is the muscular base of the abdomen, attached to the pelvis. The pelvic floor is responsible for maintaining continence, sexual function, as well as provides support to your pelvic organs. Just like what happened to your abdominals, these tissues become stretched with the weight of a baby resting on it. This leaves less support for your pelvic organs, leaving them vulnerable to pelvic health symptoms like stress urinary incontinence (where you unintentionally pee yourself when laughing, sneezing, coughing, and exercising) and pelvic organ prolapse, or POP (where one or more of your pelvic organs descend through your vagina).

Here’s what you need to know about POP

With nearly 85% of the female population experiencing pregnancy and birth, there is a strong likeliness you may be dealing with a POP. 

There are studies suggesting a prolonged active pushing in the second stage of labour and some experts say POP is caused by the forced nature of pushing as well as the birthing position (lying on your back) leaves women vulnerable. The thought is gravity isn’t able to assist the baby down the birth canal, rather being forced out through intense pushing.

Basically, POP is a result of your pelvic floor, the support system for your pelvic organs like bladder, uterus, urethra, and bowels, has lost some of its function. This is typical the the hormonal and structural changes that take place in pregnancy and the impact of labour and birth.

So throwing high-impact training into the mix on already vulnerable pelvic floor before during and after pregnancy can exacerbate any POP, even if there are no initial symptoms present.

These symptoms include:

  • Urinary, fecal,or gas incontinence (additionally,vaginal flatulence or “queefing” )
  • Back and hip pain/discomfort
  • Feeling pressure or bulging in the vagina
  • Constipation or straining to urinate

Types of POP

  • Cystocele (bladder)
  • Urethrocele (urethra)
  • Cystourethrocele (bladder and urethra)
  • Rectocele (rectum)
  • Uterine (uterus)
  • Enterocele (small bowel)
  • Vaginal vault (where the upper portion of the vagina sags down into the vagina

A pelvic floor physiotherapist will grade a prolapse based location or descent in the vagina on a 0-4 scale. 0 being normal and 4 being the most severe.

Following the birth of my second baby, I was assessed by a pelvic floor physical therapist where I was diagnosed with a grade 2 urethral prolapse. Suddenly, the leaking I had during workouts was explained.

I felt angry. If someone, anyone talked to me about pelvic health, I would have made different training choices following the birth of my first child. But there was no going back. I had to learn to be be an active women with POP. That took me two years to figure out.

These two key topics are rarely discussed by doctors and the fitness coaches postpartum women work with. Many women are initially asymptomatic, which means they have no feeling or awareness anything is happening within. And for women, when these symptoms start to show, they often get brushed off as a normal part of having a baby. 

How To Actually Listen to Your Body

Seeing your doctor is an important step in your postpartum healing process. However, it’s only one piece of the puzzle. Along with your 6-week post-partum check-up with your doctor, getting an internal assessment by a pelvic health physical therapist will give you additional information of where you are in your recovery.

When your doctor is assessing you at your 6-week check-up, they are looking for any bleeding, your cervix and uterus, and screening for postpartum depression. Some may do an internal exam or swabs to screen for cervical cancers, but they’re not looking for overall pelvic floor function.

With 1 in 3 women experiencing some form of POP after birth, you will be examined for pelvic organ prolapse. Such a condition is common but often overlooked in the 6-week check-up because symptoms don’t always show up right away or we don’t know what symptoms to look for.

Your pelvic floor physical therapist will put together a treatment plan based on their findings and help you make informed decisions when it comes to your training.

There is a high success rate in women who work with a pelvic health physical therapist for the treatment of POP. 

In my experience, I’m stronger now than I was before my diagnosis. For the most part, I’m symptom free and training at the higher intensity that pre-pregnancy. 

Like POP, stress urinary incontinence is common in postpartum women. Typically starting off with small drops, women don’t often seek treatment until it becomes a bigger issue. 

Stress urinary incontinence can happen because:

  • Pelvic floor muscles and the urinary sphincter are unable to regulate the release of urine. 
  • The body isn’t managing intra-abdominal pressure when there is stress placed upon the pelvic floor like with sneezing, coughing, laughing, and exercising. 

If women are not made aware of core and pelvic health before they return to exercise, they may begin fitness programs not knowing what to pay attention to in addition to pain. This means you need to address your core strength and pelvic floor before returning to exercise. However, it’s never too late to treat POP or stress urinary incontinence

How To Return To Exercise After Having A Baby 

See a pelvic floor physical therapist for an internal assessment as soon as possible. Most recommend seeing a pelvic floor PT within the first six to eight weeks post-partum. However it’s never too late if you’re beyond eight weeks.

Depending on their findings, they will put together a rehab program based on your needs.

Retrain your entire body. Your body has been through a lot of changes, leaving it functioning differently. With the structural changes in pregnancy, like a growing belly, your center of gravity shifts and your pelvis tends to roll under for extra support. Your abdominal wall and the connective tissue known as the linea alba stretches, which may decrease core strength and stability. 

Starting with diaphragmatic breathing and pelvic floor engagement (otherwise known as a kegel), to regain strength in the pelvic floor is the first place to start. 

You pelvic floor physical therapist may advise against a kegel if they find your pelvic floor is overactive. They will have you work on diaphragmatic breathing to teach you to relax your pelvic floor before adding in a kegel.

From there, you’ll start using body weight or light resistance, coordinating your kegel with movement in everyday life and during exercise. 

How long the retraining process takes is different from woman to woman. Some can move through within a few weeks and others may take a few months.

Consult with a fitness coach who is trained in post-partum fitness. Most coaches work under the guidance of “listen to your body” and not know what to ask in terms of pelvic health. Working with a coach who can bridge the gap between fitness and health can help to speed up your post-partum recovery as well as prevent pelvic health symptoms like stress urinary incontinence and pelvic organ prolapse.

When it comes to working with a coach, there are a few things you need to keep in mind. Not all coached are created equally when it comes to postpartum health. Most have never received training when it comes to pelvic health let alone the physical and physiological changes which occur during pregnancy and post-partum.

To find a well trained coach in your area or to work with remotely, check out the links below.

Pregnancy And Postpartum Athleticism  

Postnatal Fitness Specialist 

Certified Pre- & Postnatal Coach

3 years and another pregnancy and birth later, I’m in a place where I can look at my POP as a blessing. It gave me the opportunity to develop a healthy relationship with my body that goes beyond aesthetics. 

Like having a doula who is a labour and birth coach who also provides emotional support postpartum, it’s important to have a pelvic floor physical therapist and a coach trained in core and pelvic health on your team. Along with your doctor, they can provide you with tools you need to make educated and informed decisions when it comes to your post-partum fitness return.