More people than ever run today, whether training for leisure or competition. It is well known that running has many benefits both for your mind and body. This includes improved cardiovascular health and making you happier. Running is great for loosing or maintaining weight, strengthening your knees, making your mind sharper, adding years to your life. It is also known that running can reduce the risk of various diseases such as heart disease, type 2 diabetes, stroke, and some cancers. After having a baby there are a few things to consider with regards to your pelvic floor.

Your pelvic floor post child birth.

It is understandable that after having a baby many women want to run as soon as possible. Its important for some woman to help them recover physically and mentally. It’s also easy, cheap and quick to do right from your back door. HOWEVER what many women are not aware of are the potential risk factors for pelvic floor dysfunction if a mother does not rehabilitate adequately before she returns to high impact exercise. It’s a topic that is still underestimated and misunderstood in today’s health and fitness world. This article will review the implications that pregnancy and childbirth have on the pelvic floor. It will also offer some guidelines to consider when planning a return to running after you have had a baby.  

Pelvic health refers to the function and wellbeing of all of the structures and tissues in the pelvic area. This includes the organs and the pelvic floor muscles. Pelvic health following childbirth is significantly affected, as demonstrated by the following statistics.

Between 15-30% of first-time mums will experience urinary incontinence (leakage of bladder). A startling 1 in 5 first time mums will complain of fecal incontinence (leakage of bowels) at 1 year following childbirth. At 3-6 months after delivery up to 56% of new mothers demonstrate Grade 2 pelvic organ prolapse. This means that one or more of the bladder, bowel or uterus have fallen downwards into the vagina, at least to the vaginal opening.  

Vaginal vs Caesarean births

Physical changes that occur during pregnancy and delivery in the pelvic area are a large cause of the above conditions. Research tells us that vaginal deliveries widen and stretch the opening in the pelvic floor for baby to pass through. Recovery time for this is understood to be between 4-6 months.

During a caesarean section, the thick supporting tissue in the abdomen (belly) takes 6-7 months to regain 73-93% of its strength. Knowing that the healing process following pregnancy and delivery is extensive. It lasts longer than the common perception of 6 weeks. It is important for women to understand and protect their pelvic health. This includes reducing the risk of leakage and prolapse. By allowing adequate time for pelvic health recovery, prior to loading and stressing the pelvic floor with high impact activities like running. This will improve mothers ability to return to running. It will also limit the chance of experiencing these common but not normal symptoms both short and long term. 

Recommendations for post partum help;

Taking these factors into account, evidence-based guidelines from the UK (March 2019) recommend that women wait until at least 12 weeks after delivery prior to planning a return to running. At this stage pelvic health, strength, and impact loading should be checked for each woman to see if she is indeed ready to return to running yet.

The guidelines recommend that all women, regardless of how they deliver, seek out a pelvic health assessment with a pelvic health physio. The physio will check strength, function and co-ordination of the abdominal and pelvic floor muscles. They will also consider other factors that play an important role in healing and recovery after childbirth and may influence readiness for return to running. These may include sleep, nutrition, breastfeeding, weight and a condition that may develop in the period following childbirth called Relative Energy Deficiency in Sport (formerly known as the Female Athlete Triad). 

When to see a pelvic health physio;

The importance of seeing a pelvic health physio is further highlighted if any of the following signs and symptoms are experienced prior to, or after attempting, return to running:* 

  • Heaviness/dragging in the pelvic and/or vaginal area (can be associated with prolapse) 
  • Leaking urine or inability to control bowel movements 
  • Pendular abdomen or noticeable gap along the midline of your abdominal wall (this may indicate Diastasis Rectus Abdominis) 
  • Pelvic or lower back pain 

*these symptoms are an indication for any woman to seek pelvic health physiotherapy, not just those that have recently had a baby 

Any of these signs or symptoms of pelvic floor dysfunction need to be further tested and treated prior to continuing and progressing training. This is to ensure the pelvic floor and abdominal wall can cope with the loads and impact from running.

There is strong evidence in the literature supporting individualized pelvic floor rehabilitation. For management of pelvic health conditions such as urinary incontinence, pelvic organ prolapse, sexual dysfunction and the prevention of prolapse. Physiotherapy management at this stage will address problems found with the pelvic floor. They will also develop a strengthening and low impact exercise program to prepare your body to start back running.  

If you have any questions related to your own situation please don’t hesitate to contact our Pelvic Health Physiotherapy team in Christchurch or Rangiora at 03-383-6290.  

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