Postpartum Pelvic Floor and Abdominal Muscle Separation

After giving birth, your body is getting used to a new normal. Leaking a few drops of urine when you sneeze, feeling heaviness between your legs or noticing a gap in your tummy are things many moms experience. The good news: for most of these, there is a lot you can do on your own. This guide is based on recommendations from the UK's National Health Service (NHS).

Leaking urine is common, but you do not have to put up with it: The NHS says pregnancy and vaginal birth are among the factors that make urinary incontinence more likely. Leaking that happens when pressure is put on the bladder, such as when you cough or laugh, is called stress incontinence. The NHS recommends seeing your family doctor for any type of incontinence; it is a common problem and there is no reason to be embarrassed to talk about it. Seeing a doctor is often the first step toward a solution.

What do the pelvic floor muscles do? These muscles surround the bladder, vagina and back passage. According to the NHS, strengthening them can help stop leaking urine, improve prolapse and improve your sex life. The NHS says that if you had a straightforward birth, you can start with walking, gentle stretching and pelvic floor exercises as soon as you feel ready.

Postpartum pelvic floor exercise (NHS):

• You can do it lying down, sitting or standing.
• Squeeze and draw in your back passage as if you were holding in gas; at the same time, squeeze around your vagina and urethra as if you were stopping the flow of urine.
• Long squeezes: Hold for as long as you can, but no more than 10 seconds, then relax.
• Short squeezes: Squeeze the muscles quickly and let go right away; repeat until your muscles get tired.
• Work up to 10 repetitions of each, at least 3 times a day.
• Keep breathing normally and do not pull in your tummy while squeezing.

The toilet can be a good reminder, but do the exercise after you have finished.

What is abdominal muscle separation? According to the NHS, it is common for the two muscles running down the middle of the tummy to separate during pregnancy; the gap is usually about 2 fingers wide. This is called diastasis recti. The growing uterus pushes the muscles apart, stretching and weakening them. This separation usually goes back to normal by the time the baby is 8 weeks old.

Check the separation yourself (NHS):

• Lie on your back with your knees bent and the soles of your feet on the floor.
• Lift your shoulders slightly off the floor and look at your tummy.
• Use your fingertips to feel between the edges of the muscles above and below your belly button.
• See how many fingers fit in the gap.

Repeat this regularly to see the gap gradually getting smaller.

What helps the separation and what to avoid: The NHS says regular pelvic floor and deep tummy muscle exercises can help make the separation smaller. Try to stand up straight and pay attention to your posture. At first, avoid sit-ups, planks and high-impact exercise; avoid straining on the toilet and heavy lifting. The deep tummy exercise the NHS recommends goes like this: lie on your side with your knees slightly bent, let your tummy relax and breathe in gently. As you breathe out, gently draw in your lower tummy like a corset and squeeze your pelvic floor muscles at the same time. Hold for a count of 10 while breathing normally, then gently let go; repeat up to 10 times.

Getting back to exercise: The NHS says it is a good idea to ask at your 6-week postnatal check before starting high-impact exercise such as running or aerobics. If you had a difficult birth or a C-section, recovery takes longer; talk to your midwife or doctor before starting anything strenuous. Your joints and ligaments stay looser for a few months after birth, so the risk of injury from overstretching and twisting movements is higher. If you join a class that is not a postnatal class, tell the instructor you recently gave birth.

Signs of prolapse: Prolapse means the uterus, bladder or bowel bulging down into the vagina. According to the NHS, it may cause no symptoms; if it does, they can include:

• A feeling of heaviness, discomfort or pressure in the lower tummy or vagina
• Feeling or seeing a bulge or lump inside the vagina or coming out of it
• Pain, discomfort or numbness during sex
• Problems pooping, such as constipation
• A feeling that your bladder is not emptying fully, needing to pee often or leaking a small amount of urine when you cough or sneeze

When to see a doctor or physical therapist?

• If you have any type of urinary incontinence (NHS).
• If you notice a bulge in or around your vagina or have signs of prolapse (NHS).
• If you cannot control your bowels, cannot make it to the toilet in time or see traces of poop in your underwear; the NHS says birth can weaken the muscles around the back passage.
• If the gap between your tummy muscles is still noticeable 8 weeks after birth; the NHS says this can increase the risk of back problems and may also cause tummy pain or discomfort in some women. Your family doctor can refer you to a physical therapist who will give you specific exercises.

The NHS reminds moms that you can ask for help at any time for any physical problem that bothers you, and that the check 6-8 weeks after birth is also a good chance to talk about these things.

Dear mom, your body carried a baby for nine months and brought them into the world. Give it time to recover, and support it with a few minutes of small exercises every day. If something does not feel right, asking for help is also part of healing.