I recently touched on both pelvic floor and diastasis in a blog post around exercise during pregnancy and getting back into it postpartum. You can read that blog post here. Women who exercise on a regular basis are usually conscious of both of these things when it comes to pregnancy and doing the best for their bodies. This post is more focused on pelvic floor but read on to see how the two work together.
What is it? The muscles that support your pelvic organs, whose function include the ability to hold in and release urine, gas, and poo effectively, as well as prevent prolapse (when an organ becomes displaced). See the image below for a visual on where the muscles of the pelvic floor sit.
Why are these muscles so important in relation to pregnancy? During pregnancy, they are under significantly greater stress than they were pre-pregnancy. They can be further affected by childbirth but C-section doesn’t lessen the huge impact that pregnancy has on them.
So, I need a really strong pelvic floor? Not quite. You need a functional pelvic floor. Your pelvic floor is part of your core (along with the muscles of your abdomen, the muscles of your lower back, and your diaphragm). The important thing is that you use (i.e. contract and then relax) your pelvic floor muscles when you breathe. This then carries through to using it when you exercise and when lifting something heavy (like a deadlift in the gym, lifting a car seat, holding a baby, getting an awkwardly shaped buggy out of the boot, carrying a heavy shopping bag, lifting a baby out of a cot at 4am, lifting that same baby when they become a 15kg three-year-old etc.).
What should I do about it? Firstly, if you think your pelvic floor may not be functioning properly (e.g. leaking, needing to pee when you’ve just gone, constipation), or if feel something is not quite right or suspect you have a prolapse then it’s important to see a physiotherapist who specialises in pelvic health (mail me and I can recommend one if needed). Aside from any dysfunction, it’s important to take time to learn to contract and relax your pelvic floor in sync with your breath and alongside the other muscles of your core. In the same way that you don’t try to take as deep a breath as possible on every inhale, It’s not about max tension, but more about effectiveness.
How do I do that? You might have heard of Kegels or pelvic squeezes. Often with Kegels we’re taught to squeeze as though trying to not pee or let gas out. Below are starting steps to make it more relatable to natural movement at first and eventually daily life.
Find somewhere you won’t be interrupted for 5 mins and try the following:
1. Sit whatever way is most comfortable for you and focus on sitting tall, looking straight ahead. Eyes open or closed, it’s up to you.
2. Take 10 steady breaths. Don’t try to do anything in particular.
3. Take another 5 breaths taking notice of what’s happening in your torso;
- Is your belly going in, going out or staying still with each breath?
- Is your chest rising and falling with the inhale or exhale?
- Can you feel your ribs moving at all?
- Are you shoulders staying still or rising and falling?
- Anything else you can notice?
4. It’s likely that you felt something happening in your abdomen or belly, chest/ribs and shoulders. If you didn’t, repeat the 5 breaths and try to breath all the way into your belly and then fill your chest. On the exhale breath out from your belly and then your chest. One hand on your stomach and one on your chest might help you to feel both. You’ll probably notice your ribs expanding and shoulders lifting on the inhale and then each dropping on the exhale. If it’s not happening, try lying down on your back with your feet flat and knees bent and focus on belly and chest. We’re ready for the next step if you can feel your abdominals (AKA belly / tummy / stomach) relaxing on the inhale and contracting (pulling in) on the exhale.
5. Visualise your body breathing and imagine that as you inhale the muscles of your pelvic floor relax at the same time as your abdominal muscles. Then visualise your pelvic floor and abdominals contracting on the exhale. Visualise your pubic bone at the front and your coccyx at the back draw towards each other and lift upwards as you breathe out. Inhale and relax, exhale and contract. Repeat for 5 breaths.
6. Keep in mind the contraction doesn’t need to be maximal. We’re looking for a steady contraction throughout the length of the exhale and a general feeling of the muscles relaxing on the inhale.
Well done. You and your pelvic floor are on the way to helping each other out a lot! This much is great to do at home. To progress it into a gym environment, look for a pre/postnatal qualified coach who can make sure that you’re doing suitable exercises and most importantly doing them in a way that works for you with safe technique.
Get to Grips with Pelvic Floor Breathing
To get some breathing in at home, try to do 15 breaths: 5 breathing normally, 5 focusing on abdominals drawing in on the exhale, and then 5 with the pelvic floor lifting as well.
When this feels easy, shift 5:5:5 to 3:3:8 to increase the number of breaths incorporating the pelvic floor breaths to 8. This is great way to get going rather than expecting it all to come together immediately.
Progression and Extra benefits
The next step on from breath alone is to introduce light band work where we relax and then contract the pelvic floor and abdominal muscles at the same time as the muscles being used to do the banded exercise. A great one to start with is a light band pull apart so that we add in a pulling of the shoulder blades towards each other on the exhale.
From here we introduce other light resistance exercise and progress to the amount of resistance and complexity of exercise that works for the individual. A hex bar deadlift for example is more challenging due to load whereas a reverse lunge at bodyweight takes a little more focus as we have one leg forward and one back during each rep and each breath.
There are three great benefits that come with this. Firstly, diastasis rectus recovery is done by implementing this breathing starting with very gentle movements like hip tilts while lying on your back. Secondly, getting familiar with this breath now will leave you more prepared for future pregnancies. And third, this connection between your entire core and breath can improve your training forever. It allows for a much more functional brace to protect your spine and applies to practically all resistance training exercises.
Remember, during pregnancy and postpartum we always want to inhale and exhale steadily through the exercise. While pre-pregnancy may have involved barbell squats in the gym where you heavily braced before squatting (known as the Valsalva maneuver) and then exhaled coming out of the squat, now is the time to work on that steady breath of inhaling as you set up for the first rep or return to the start position and then exhale through the tougher part.
Want to find out more?
If you’d like any additional information on any of the above feel free to contact me (email@example.com) or you can follow me on Instagram. Small Group Training for Pregnancy ad well as Postpartum Small Group Training are both ongoing on Leeson Street* - drop me a mail if you’re interested in either one or would prefer to do 1:1 Personal Training.
If this blog was of interest then you might like our previous blogs:
- FFS Guide to Exercise during Pregnancy – Aoife MacNeill, February 2019
- Pregnancy and Postpartum Exercise – Aoife MacNeill, August 2019
- Strength Training during pregnancy – Sinead Brophy, September 2019
* If you work on the North Side of Dublin and are unable to attend Leeson Street, Small Group Personal Training and 1:1 Personal Training is also available in FFS Gym Ivy Exchange across from the Rotunda Hospital. Contact Coach Sinead at firstname.lastname@example.org for more information.
About the Author
Aoife has been a coach at FFS Gyms since October 2016. She is passionate about pre and postnatal exercise, an Olympic Weightlifter with International experience, and currently undertaking an MSc in Strength and Conditioning.
Email Aoife at email@example.com
Find Aoife on Instagram at @aoifemacneill