This One's (Mostly) For The Women

I’m sure many of you saw the news surrounding Brittany Mahomes post on Instagram that said: “Just a daily reminder: Once you have kids please take care of your pelvic floor. Seriously. From: A girl with a fractured back." She did not provide details or context for her comment, but it sparked an important conversation. The impact of pregnancy, labor, and delivery on a woman’s body is often traumatic, but because it’s seen as a natural process, we are often not given proper resources to recover, which can lead to detrimental impacts on our bodies later in life. 

Until recently, most health research has been done exclusively on men. That info was then extrapolated to women, because we were considered “smaller men.” As a result, our unique body structure and hormonal impacts on them were largely ignored. Only now are we figuring out just how wrong that line of thinking has been. That problem has spilled over into the fitness world as well where parts of our bodies are often ignored because strength training especially has always been specific to the male body.

While reading this article I noted this quote:
"Das [a urogynecologist and pelvic floor specialist] recommends women get physical therapy soon after vaginal childbirth.

“In other countries, it’s a regular part of delivery to get physical therapy,” she said. “That’s not something we have in the U.S. It’s been established that monitored physical therapy can help rehab those muscles after delivery,” she said. “We know it can play a huge role in helping women recover.”

The simplicity of this idea and the utter lack of it in US was shocking to me. In the article, they are speaking solely about a standard labor and delivery scenario, not even including c-sections and other complicated births, which are also shamefully unsupported in recovery.

I have three awesome and wild kids. My first son was born via a 26-hour labor marathon. I’ll spare you the details but I had stitches, and by the time he was 4 months old I was still not fully recovered. The only recovery info I was given was to rest until I felt good enough to do more. I learned later that it can take a full year for a woman to recover from pregnancy and birth. My two younger sons were born via c-section. After a 6-inch incision that cut through my fascia, abdominal wall and uterus, the only recovery info I was given was “take pain meds, rest, don’t overdo it, and wait until your 6 week checkup to resume exercise.” At my 6 week appointment, the doctor checked my incision for proper healing and sent me on my way.

In comparison, I had a minor laparoscopic knee surgery. The surgeon cut two ¼ inch incisions in my knee to remove damaged cartilage that was floating in my joint capsule following a kneecap dislocation. I was given 6 weeks of physical therapy (PT) to recover from that. I attended PT weekly where I performed a variety of exercises, and my therapist also kept an eye on my progress. I was also given exercises I was to do religiously at home. After 6 weeks I was checked again by the surgeon to ensure incision healing. But he also ran me through range-of-motion tests and ensured my mobility was normal before clearing me. 

The difference in those experiences considering how much more invasive a c-section is blows my mind. That I received absolutely no advice for helping my body recover from that experience is staggering.  The implications of not recovering properly from childbirth, regardless of the method of delivery, include a weak pelvic floor. The consequences can include incontinence, weak core muscles that destabilize balance and mobility, increased risk of joint injury, diastasis recti (separation in the abdominal muscles), and even pelvic organ prolapse. Maybe don’t look that one up if it’s lunchtime. 

What is the pelvic floor?
Both men and women have a pelvic floor. It is a collection of muscles and ligaments that stretch from the tailbone to the front of the pelvis which supports the internal organs in that area, such as the large intestine and bladder. Men most commonly see issues if they have prostate surgery that damages the muscles. Physical therapy protocols exist for men in that situation, so if that applies to you make sure you look into that.

For women, the pelvic floor is also supporting our reproductive organs so it’s a crowded space, which is why it’s more common for us to have issues than men. This is especially true if we have children, where the weight of carrying a growing child for months can weaken the muscles. Also, when women are pregnant, hormones increase the laxity in all of our ligaments to facilitate childbirth. They don’t always “snap back” to their previous form afterward and can leave us vulnerable to unstable joints along with an unstable pelvic floor. Carrying a child can also compress nerves, causing sciatica. My second son was just shy of 10 pounds when he was born and I dealt with sciatica for several months. I was still given no PT, I was just told “It’s normal and will go away after he’s born.” There was no concern about the damage that could be done to my SI joints or hips by having to limp on a partially numb leg for 3 months. Now in my 40s, I deal with chronic SI joint pain.

As pregnancy progresses, in many women the abdominal wall splits in the middle to make room for the baby. I remember clearly for months after having my kids having a 3-finger width of space between my muscles when I flexed them. It is a common experience, and yet no part of recovery even mentions it, never mind what you are supposed to do about it. The lack of a stable abdominal wall can also contribute to issues downstream, impacting our hip and pelvic muscles. 

Pelvic floor exercises

First, ensure you have clearance to exercise from your doctor. While you want to move your body, you want to be gentle as you get started. It takes several months for ligaments to regain their shape, and the swift change in postpartum hormones can cause dizzy spells. Move carefully and focus on your form and contracting the active muscles. 

One of the most well-known ways to exercise the pelvic floor muscles is to practice Kegel exercises, which means contracting and releasing the muscles that control the flow when you pee. While there certainly isn’t any harm in doing so, it is a bit of a simplistic suggestion for a complex problem. While targeting a muscle area has its purposes, it ignores the other connected areas, such as the hips, glutes, and abdominals. Doing only Kegels would be like doing only triceps extensions and hoping to get a ripped upper body.

One of the best things women can do for overall pelvic floor health is to perform a variety of squats such as front squats and sumo squats, along with deadlifts and good mornings. Even performing the motions with no added weight or minimal weight, forces you to contract the entire impacted area, including your pelvic floor, your glutes, abs, and a variety of hip and pelvic muscles.

Banded glute bridges and single leg bridges are also very helpful. 

The complex moves involved with squats and deadlifts especially also hit the inner thigh, which can easily become weak and tight and throw the pelvis out of balance which can lead to lower back pain, hip pain, and even knee problems. 

What about the abs? 

The separation of the abdominal muscles is called diastasis recti. As usual, movement hero Katy Bowman has an entire book dedicated solely to this problem. I highly recommend it for anyone who has given birth even if it was years ago. If you are considering pregnancy in the future, it is also a good read as prehabbing – rehab prior to an expected event like pregnancy or surgery – those muscles before hand makes recovery easier. 

I have personally found that carrying weight on the front of my body has had more impact on my abdominal wall than most core-focused work. Sometimes when I am Rucking I will flip my Ruck around and carry it on the front of my body. Carrying the Neon Buffalo is also a great option. As both Dan and I have focused more on Rucking in the last year, we’ve definitely noted the benefits of carrying a weighted load on our bodies. Carry weight on your back, but also your front and sides. Kettlebell Farmer Carries are something I do when I am pacing while I talk on the phone, for example. Goblet squats are another good option. 

Katy’s prescription for dealing with diastasis recti includes plenty of walking, squatting, floor sitting (which requires us to change positions often and hold ourselves upright with our core), carrying weight on our bodies, and arm hangs, such as from a pullup bar. 

One of the best things you can do is to wear your baby on your body and go walking regularly. You can essentially ‘Ruck’ your newborn. The full-body movement increases blood flow which speeds healing, it gets you outside into the fresh air and sunshine, and it even enhances bonding with your new wildling. Of course, don’t hesitate to leave the baby with your partner or a sitter so you can get out by yourself as well. 

What if I had kids years ago or never had them at all? 

Pelvic floor health still matters! If you had children year or even decades ago, you could see issues related to their births that come up way down the road, especially incontinence which is very common in women who’ve had children. 30% of women experience that symptom alone, and it can show up years later. Some women even start to see their internal organs shifting around, which can necessitate wearing a pessary, which is a sort of “safety net” that keeps pelvic organs from prolapsing. Sometimes surgery is even necessary to correct issues that can result from a weak or damaged pelvic floor that never recovered properly. There is no such thing as too late, even if you have already suffered some symptoms of a weak pelvic floor, you can make improvements even past retirement. 

Even in women who never had children, this can be an issue as you get older. The pelvic floor is just as much a part of our muscular infrastructure as our glutes, quads or biceps. They are part of maintaining our bodies thoroughly so they can provide us with proper alignment and smooth movement throughout our lives.

Ignoring the pelvic floor while training everything else is like ignoring your house foundation because you want new windows. It is a basic foundation that keeps everything in our abdomens in place. I don’t know about you, but I’d like my organs to stay where they are supposed to! 

Unfortunately, women’s health has been ignored for a long time in the medical world. We have sports trainers who assist baseball players with hangnails to optimize their pitching but we have little support for a woman who just carried a bowling ball around for months and evacuated it from her body in a traumatic fashion. Whether or not your doctor recommends PT for your recovery, there is a lot you can do to protect your pelvic floor health and heal your abdominal muscles so that they can support you for decades going forward. 

Have a wild weekend, everyone!
-Kim