3 Post-pregnancy confidence-shakers that don’t have to be forever

When it comes to postpartum recovery, we’ve all heard it from other moms. From our dear friends. From our frenemies. Sometimes we’ve even played the role of the naysayer, ourselves.
 
“You’ll never…” or “You’ll see…” (plus a condescending look) or “Well I couldn’t fill in the blank” or “It’s just part of being a mom.” When we’re talking about pelvic and abdominal changes that seriously affect your ability to function on a daily basis, that kind of talk is more than a nuisance.
 
Pelvic changes like postpartum pain with sex can shake your confidence. Incontinence can disempower you. Dysfunction of your abdominal muscles can wreak havoc on your appearance and your physical performance. And thinking there’s no solution can thwart your spirit. But these changes don’t have to be forever.
 
The good news is that you’ve got science and research on your side to silence out the negativity. Here are 3 postpartum changes that don’t necessarily have to be your new forever. Really.
 

1. Peeing when you sneeze

Peeing when you sneeze (or laugh, or work out, or cough) is so common after giving birth that many moms think it’s normal. During pregnancy as well as delivery, the muscles at the base of your pelvis, known as your pelvic floor muscles, become stretched out and weak – and moms who deliver vaginally and via C-section are affected.
 
Those muscles are supposed to fire at just the right moment when you sneeze, laugh, work out, cough… or do any functional movement. When they don’t fire at the right time or aren’t strong enough to stop a leak, that’s known as stress urinary incontinence (SUI), and about 34% of new moms have it.1
 
The good news is that with the right kind of exercises that include correct Kegel exercises (about 50% of moms do them wrong with verbal instructions alone) 2 plus timing exercises, pelvic floor problems like stress urinary incontinence don’t have to be forever.
 
In fact, 97% of moms who see a Women’s Health Physical Therapist to work on these skills will see significant improvement with their stress urinary incontinence and 73% will have complete resolution.3 You can find a Women’s Health Physical Therapist near you here.
 
 
 

2. Pain with sex

At 18 months postpartum, 24% of moms still have pain with sex.4  And, like stress urinary incontinence, pain with sex is often embarrassing for moms to talk about or even bring up with their doctor.
 
While pain with sex can have a few different causes after childbirth, one common cause is something called hypertonicity.  If you’re hypertonic, your pelvic floor muscles contract when they should be relaxing.
 
As you can imagine, this can have serious implications for painful sex. And simply doing more Kegels won’t get you far with this one. Just like with incontinence, a Women’s Health Physical Therapist can be a lifesaver.
 
Talk to your doctor about it – don’t be embarrassed. Your doctor is there to help you, even with embarrassing symptoms, and she can point you in the right direction with an appropriate referral if needed. Trust me, your doctor has heard everything, and she won’t bat an eye at painful sex after pregnancy.
 
 
 

3. Mommy tummy

There are 2 common reasons for a mommy tummy. The first is a timing issue and the second is diastasis recti, or separation of your abdominal muscles.
 
Think of your core muscles like a team. That team is made up of a top, bottom, and sides – your diaphragm, your pelvic floor, and your deep and superficial abdominal and back muscles. During any functional movement, all day long, no matter how minor, your core muscles are working together automatically. You don’t even have to think about it.5-8
 
That team of muscles has to switch on and off in perfect order and with just the right amount of force every time they work together.  Just before you pick something up, or cough, or sneeze, or with each step when you run, that synchronous series of muscles firing and relaxing happens in a fraction of a second.  Thousands of times a day.
 
But pregnancy changes that.9 The link between those muscles is disrupted during pregnancy, and afterwards you’re missing out on doing a correct contraction of your deep abdominal muscles thousands of times a day unless you correct the movement pattern. Your daily plank regimen doesn’t hold a candle to all of those missed opportunities.
 
Make sure your postpartum exercise plan includes training in both core strengthening and core timing.
 
The second reason for a mommy tummy is something called diastasis recti, or separation of your abdominal muscles down the middle.  It’s actually not true separation – nothing’s actually torn- except in the really extreme cases.  You can do a quick test at home by following these instructions.
 
Your abdominal muscles naturally spread during pregnancy to make room for a growing baby. About 50% of the time, that separation resolves right after giving birth.10 Of those who don’t immediately resolve, there’s a natural healing process that takes about 8 weeks. Moms who still have a separation at about 8 weeks will usually need help from a clinician to improve. 8,11
 
The research is unfortunately really sparse about the best way to help fix diastasis recti. Since moms are so different, as are their pregnancies, their recoveries, and their functional demands, it’s hard to pin down a single treatment that works best using research because it involves pooled data from lots of women.
 
The best option for recovery is to receive an individual assessment and treatment plan from a physical therapist who deals with diastasis recti. But if for some reason that’s not practical or possible for you, there are some ready-made programs available to help you DIY it, and you can find those programs here and here.
 
If you do find yourself struggling silently with any of these changes, don’t despair. Get the nay-saying out of your mind with the knowledge that help is available. There is plenty of research available to show that improvement and recovery are truly possible. Put postpartum recovery at the top of your to-do list and get the help you need, no matter how long ago you were pregnant – you’ll be so glad you did.
 
 
 
References:
1. Sahakian J, Woodward S. Stress incontinence and pelvic floor excercises in pregnancy. Br J Nurs. 2012;21(18):S10-S15.

2. Shelly B. Introduction to Rehabilitation of Pelvic Floor Dysfunction and Urinary Incontinence. In: Shelly B, ed.; 2014:1-36.

3. Whitehouse T. Managing stress incontinence in postnatal women. Nursing Times. 2012;108(18-19):16-18.

4. McDonald EA, Gartland D, Small R, Brown SJ. Dyspareunia and childbirth: a prospective cohort study. Brit J Obstet Gynaec. 2015;122(5):672-679.

5. Hodges PW, Butler JE, McKenzie DK. Contraction of the human diaphragm during rapid postural adjustments. J Physiol. 1997;505(2):539-548.

6. Hodges PW, Sapsford R. Postural and respiratory functions of the pelvic floor muscles. Neurourol and Urodynam. 2007;26:362-371.

7. Smith MD, Coppieters MW, Hodges PW. Postural activity of the pelvic floor muscles is delayed during rapid arm movements in women with stress urinary incontinence. Int Urogynecol J. 2007;18:901-911.

8. Pereira LC, Botelho S, Marques J, et al. Are transversus abdominis/oblique internal and pelvic floor muscles coactivated during pregnancy and postpartum? Neurourol Urodyn. 2012;32(5):416-419.

9. Pereira LC, Botelho S, Marques J. Are transversus abdominis/oblique internal and pelvic floor muscles coactivated during pregnancy and postpartum? Neurourol and Urodynam. 2013;32(5):416-419.

10. Benjamin DR, van de Water ATM, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014;100(1):1-8.

11. Opala-Berdzik A, Bacik B, Kurkowska M. Biomechanical changes in pregnant women. Physiotherapy. 2009;17(3):51-55.
 
 

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Christine Iverson

Physical Therapist, Founder at Everymom Athletics
I received my Doctoral Degree in Physical Therapy (DPT) in 2006 and spent the next 6 years as an Army physical therapist, which was a tremendous honor. After (finally) becoming a mom in 2013 I made it my mission to educate moms everywhere about recovery and exercise after pregnancy, so I started Everymom Athletics. I live in NC with my husband, son (b. 2013), and daughter (b.2015), and together we love to hike, run, and find excuses to be outside!
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