Postpartum Pelvic Floor Dysfunction: Common Questions Answered

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. Hello, everyone. This is your guest host, Dawne Costantino, with the Restoring Human Movement podcast. Thank you for joining the Movement Movement. If this is your first time joining us, welcome. And if this is not your first time, then welcome back. And a reminder to all of you that we have so many episodes we've recorded now that go over nearly every part of the body, common injuries that people deal with, answering any questions or concerns that people have around those areas.

So please go back, take advantage, check those out. Today, I believe, is part three, if I'm remembering correctly, of the Postpartum Mom series. Reminder, if you've been, you know, listening to this series, you're going to hear this again of why I'm doing this podcast. If, again, this is your first time, let me just kind of tell you a quick little story of why all of a sudden we're doing postpartum mom podcasts. So I, as Dawne Costantino in the Performance Play Sports Care office, am focusing on putting out good information and helping moms starting at six weeks postpartum. Obviously, I'm there to help you through the pregnancy, help with any aches or pains that arise, help educate, help answer any questions, help give some exercises that can help ease the body, that can help strengthen you and help prepare you for what's to come.

But I'm doing this podcast specifically for postpartum moms because a very dear friend of mine came to me a couple months after her firstborn and had a lot of questions about what was going on. My mid-back hurts while I'm breastfeeding. What the heck can I do? Why does my neck hurt so much when I'm sleeping? How do, what are some stretches that I can do to get rid of that or have some control? How do I get back to strength training? She was very, very active before. So again, all of these questions that she has, she's compiled into a nice little document for me. And so I have been making a different series, different parts to the podcast of answering these questions for her, but obviously recording it and putting it out into the world for everybody else who may have these questions as well.

So that's what this is all about. I'm answering the questions for all of you and really hoping to just kind of bridge the gap between when you get released by your OBGYN six weeks-ish postpartum and told return to normal. Well, you probably don't feel very normal at that time. You don't feel like you're back in your normal body. And so I want to talk a little bit more about things that you can do during this time to strengthen, to stretch, to ease pain and discomfort, to change habits, to take care of yourself, to know a little bit more about what's going on with you around this time period. So let's hop into it.

All right. So the first question is, what is the pelvic floor? She says, I feel like everyone on the internet wants you to pay them money to help you not pee while laughing and stuff like that. But what exactly is it? To make this answer really, really simple, it's basically just a set of muscles that help support the bowels, the bladder, and the uterus. They start at the front side around the pubic bone. They stretch along the entire undercarriage and attach to the tailbone on the backside. There's many, many muscles down there that run in a lot of different direction and attach at different areas along the pelvis as well.

But basically, that's what it's there for. Support. Support and help keep all your vital organs inside of you. The way that I like to utilize and the way that I like to rehab and the way that I really know the pelvic floor best as a provider who helps people in the world of movement and in the world of pain is how the pelvic floor actually helps to stabilize the pelvis. And so basically, the way that it does this is, you know, the easiest way that I can get somebody to understand, like, you know, stabilization of the pelvis is through belly breathing. When we breathe deep into the belly, when we use our diaphragm and that diaphragm will descend downwards towards your pelvic floor, it'll push on those vital organs and those organs will then push onto the pelvic floor.

And when it does that, it basically eccentrically loads the pelvic floor. And so you can play with this pressure buildup when you breathe in and out. And that type of pressure building downward, outward, forward, backward, all different directions around your torso will help stabilize the pelvis itself. So if we're, say we're sitting right now and we just rock our pelvis backwards and forwards, okay? You can shoot the belly button forward or you can shoot the belly button behind you. You can stick your butt out like an Instagram model or you can tuck it under you like a pooping dog. Basically, these are all little areas that are different directions that the pelvis can explore.

And stability is preventing excessive motions in the pelvis itself. So if we have a stable base, our pelvis, everything above it can work a little bit better. So again, trying to make this simple, but I like to explore the pelvis and the pelvic floor and utilizing it for stability in a rehab setting. It helps a lot with posture as well. So kind of like I talked about, if it's stable down below and we find ourselves in a nice neutral pelvic position, okay? Not under you, again, like a pooping dog or forward like an Instagram model, but somewhere in between. Then everything above it, which what's attached to it is your spine, your low back, then your mid back, then your neck will all just kind of stack right into place and help aid in posture.

So if we know how to find the pelvic floor, if we know how to properly breathe into it, if we know how to activate it, then it can help aid in posture moving forward. It does also assist in helping go to the restroom, okay? So all these muscles, these sphincters down there will help you either not want to go to the restroom at a time that you're not ready to or will help aid in the process of doing so. Next question she has written down is, how can moms help prevent peeing while laughing? I think that this is a very common question. I think it is a very common thing that most moms deal with. I know that when I grew up, it was always like, don't make me laugh, don't make me laugh, while she uses her hands and kind of keels over and tries to prevent herself from peeing her pants.

So I've seen this a lot. I've heard this a lot. I've been asked a lot of questions around this. My understanding of this is just not having the strength, the awareness, or the mind connection to the pelvic floor to be able to stop our peeing when we want to stop it or to be able to, you know, have the control that we need to when we're coughing, sneezing, laughing, any of that quick increase in pressure, I believe it's because the pelvic floor does not get properly rehabbed after we go through labor. And so properly rehabbing the pelvic floor after labor, starting even as soon as six weeks can be a really good start with this.

Let me preface the rest of my answer with there are many, many reasons why some people have a really hard time controlling urination, frequent urination, trouble initiating, trouble, you know, voiding, trouble stopping their urination in general. And so it's really, really important for you to go and speak to a provider if you are dealing with this so that that provider, that healthcare professional can help examine you, assess you, and make sure that there's not something else that's contributing to why you have trouble around urination and controlling urination. So going back to kind of the simple answer here, though, is, you know, we go through a tremendous amount of force, almost a, almost trauma in a way.

These muscles go through a lot. They're prepared for this. They are made to do this. But nevertheless, they go through a lot when we go through labor. And so when this trauma occurs, it's important to set a foundation again, build up strength, build up awareness, build up the ability to contract, to eccentrically load. And all of this over time should help aid in your ability to control that urination a little bit better. One of the first things that you can start doing to rehab the pelvic floor is breathing. It seems like I talk about breathing a lot when it comes to this series, but it is because I'm probably biased, but I use breathing a lot when it comes to rehabilitation in low back pain, in neck pain, in hip impingement cases, in sciatic nerve issues, and in helping moms get back to what they want to get back to after they've had children.

So breathing is really, really important because it can help start to eccentrically load the pelvic floor. It can help aid in finding better biomechanical positions for you to then progress through other exercises. It truly is just the foundation for strength, the foundation for stability, the foundation through being able to be active, to be healthy, to be able to progress through whatever it is you want to progress through and doing it in a proper way to help reduce the risk of injury. So breathing and creating a connection to that area is the first step. Okay. A lot of times post-trauma, our ability to feel proper awareness around that spot has reduced a lot.

The ability to even know, like, am I even breathing into this area? Can I even feel a contraction down under? All of this stuff seems to be really, really hard after we go through, basically, it is trauma to the pelvic floor, but one that your body is obviously built to do. So breathing and creating a connection to that area, again, is the first step. All right. And I can obviously get into details, but I do think that teaching people this is just so much better when done visually. So if you want some visuals about how to do this, you know, what position should I be in? What are some different ways that I can start to create this connection?

Just go to our YouTube channel, Performance Place Sports Care. Type in belly breathing. Type in pelvic floor. Type in whatever it is that you're dealing with. And there's tons of things on there that you can take advantage of. But I know that I teach how to properly breathe into the pelvic floor in a lot of those videos. So back to answering the question. Beginning to load into the area in a gentle position. The most gentle position that you can probably start to do this in is either laying on your back with your feet flat on the floor, knees bent, or up on a chair, kind of supported in a 90-90 position.

A lot of people learn it really well in that position. Other times I need to flip them over, maybe lay them on their stomach or lay them in like a child's pose position, as long as the hips are okay with that. And starting to breathe there, that is the easiest way to know how you're, to really feel it, honestly. You'll start to feel that contraction down below. You'll start to see the belly button rise and fall. You'll start to feel your side body expand outward. If done really well, you'll feel some of your back muscles even push and activate as well. So again, breathing and loading in a gentle position.

You have to, your body has to feel safe, it has to be easy, it has to be not loaded at first, just to make sure you're doing it right. As it gets easier, you would need to then challenge it in different positions. So add a little bit of load. If you're on your back, lift your feet, support your own feet up in the air now and see if you can still breathe with this slight load added to the body, this slight challenge added to the body. If we're in a child's pose position, maybe we come up into tabletop, only now supported by our knees and our hands. Can we breathe there? Can we lift the knees up off the ground in a bear hold position?

Can we still breathe there? So a lot of this is all done in these static positions, not a lot of movement occurring besides the pelvic floor breathing and the belly breathing. Then we want to challenge it through movement, through squatting, through walking, through, let's say, getting back to strength training as a goal of yours, through deadlifting. All of this type of stuff is different ways to progress this particular skill set that we're trying to get better at again. Okay, moving on. The next question is, do Kegels really help get your vaginal muscles tighter? Are there any other stretches besides that to help get those muscles back to before baby or normal, in quotations?

I do believe that Kegels are the most well-known pelvic floor exercise, but not the only exercise. I think that there's a lot of missing information out there, but I think it's growing. I do. The more and more that I reach out to the community of pelvic floor therapists and other chiropractors who are in the world of helping moms, as well as OBGYNs, like everybody in the world is definitely learning more and trying to teach more. But I think Kegels are, you know, the first go-to and the only thing that a lot of people use as of right now. What Kegels really are is this contraction of the pelvic floor.

Let's say you really, really need to go to the restroom. And what is it that naturally occurs for you to prevent going to the restroom before you want to? It's this kind of sucking in this contraction of your undercarriage to prevent this, in the words of Dax Shepard, if you listen to his podcast, emergency evacuations before you want them to. So your body knows how to naturally do that. Obviously, if you are somebody who struggles with being able to have this control right now, then this is something that we need to start to strengthen and create better awareness around. But the contraction part of it, let me compare it to something else.

The body that's easily or let's say better well-known and better able to visualize. The bicep muscle, for example. So the ability to flex and extend your elbow. What concentric contraction of that muscle is, is basically elbow flexion, bringing your fist towards your shoulder. That is a shortening of the muscle. Then there is holding it there, which would be an isometric contraction. No movements occurring. There is still a contraction happening, but it's not happening through movement. Then there's eccentric loading. Eccentric loading would then be opening up that elbow again. In a slow and controlled fashion, where it then elongates the muscle, but it's still contracting at the same time.

We can, now bringing it back to the pelvic floor, take your muscles through an isometric and an eccentric loading. So again, going back to Kegels, Kegels is a concentric. It's that bending of the elbow. It's the shortening of those muscles. What we are missing is the isometric and the eccentric loading of those muscles. They have to be able to do all three. You have to be able to know when you're doing all of them and when to do them. So again, Kegels are one part. They're not the entire part. They can be a really great way to rehab the pelvic floor, but there is more that is also needed to properly get you back to feeling like, let's say, you're normal again.

What we actually can do is in one exercise, take you through a Kegel and a pelvic floor breathing all in one, okay, kind of cyclical motion to help shorten and elongate the muscle through its entire cycle, okay? So this is something that's not being done so far. If you're unaware of this, like what there's more to do than just Kegels, please reach out to somebody. I'm also somebody who can be a resource for you. You can give me a call. We can set up a virtual session if you want to come in in person, whatever it may be. But again, there's a lot more we can be doing than just Kegels. Hey everyone, it's Sebastian.

I'm going to hijack the show just for a second here to tell you about an opportunity that we have called the Discovery Session. A lot of people over the years have reached out to us from our YouTube channel because we have 150,000 YouTube subscribers at this point in time, probably more by the time you're listening to this. And we have a lot of people listen to this show and read our articles online. They're frustrated. People are frustrated about not being able to get back to full activity. They're frustrated they can't really trust their body. They're frustrated that they have not found any long-term answers or things to make them happy.

And so we're here to help. We may not be the ones to actually help you and we're okay with that. But we're hoping that if you are able to speak with us, that we can maybe give you some insight of things that you potentially haven't tried yet. And if we know people, we'll suggest those people too. So if you want to take advantage of the Discovery Session, all you need to do is go to p2sportscare.com and find the Book Now button. It's all in there. We have virtual or in-person options. You can go to the show notes for this show and find a link that'll directly connect you to us or you can call us 714-502-4243.

We'd love to help you the best that we can and we're always here to serve. Now back to the show. Okay. And then we have just a couple more questions here. Does the pelvic floor have anything to do with the tailbone or is that separate? The tailbone is a part of the spinal column as well as a part of the pelvis too. It is considered one of the last bones of the spinal column. It does have nerves that come out and around it, but it also plays a role in the pelvis because muscles that attach to the pelvis, muscles that are a part of the pelvic floor also attach to the tailbone. So yes, basically is the answer to this question.

The pelvic floor and the tailbone go hand in hand. The pelvic floor is typically muscular, ligamentous in nature. The tailbone itself is a bone. The bone is used as an anchor and then the muscles and the ligaments attach to that bone to be able to aid in movement, to aid in support. I believe that the reason why this question was given in this set of questions for the pelvic floor is because tailbone pain is so common amongst females who have just had a baby. I have seen tailbone pain come from actually a lot of different things in moms. It could truly be, you know, coming from the tailbone itself because it was a part of the process of labor.

It does get moved when baby's coming out of the tunnel. So the bone itself and the ligaments that attach to it can get stretched, overworked, and send pain signals. And so those things just need to heal and they need a little bit of help with healing. I've also seen, though, that it's ligaments in that area that are actually the ones that are creating more of the discomfort. I've also seen more of like nerve pain in this area. So kind of the sacral plexus is what we'll call it. Nerves around this area can also be one of the reasons why we are feeling discomfort. And then I've seen it as referred pain, too.

So referred pain is it's coming from somewhere else, but you're feeling it here. A lot of times I see that it can be referred pain from somewhere higher up in the spine. And then your body is just presenting it at the tailbone, especially when we sit down, getting up from sitting to standing sometimes when we're going to the restroom. A lot of different ways that we can feel this discomfort. And then the last question here is, what is one simple exercise that moms can do to help their pelvic floor? I think that you can all who have been listening now answer this question. Altogether, it's going to be starting with breathing.

Breathe into the chest, start to breathe down into the belly, start to breathe into our sides, start to breathe into our low back, start to breathe and then feel it into the pelvic floor. We had an intern one time in the office. I believe it was the intern. This is the one that taught me this. But basically, we use a lot of different cues when we're coaching exercise. So sometimes it's the way the exercise is taught. Sometimes it's the way that words are used to get somebody's brain to understand what we're trying to accomplish. Cueing a lot of times goes a long way when it comes to coaching exercise properly for our person.

And so we had an intern one time who really talks about breathing into the butthole. There's a time and a place to use that cue. I think it's also you just got to make sure we're telling it to the right person. I think those of you who are listening to this right now can Google about that a little bit. But that's really truly what it feels like when you're doing it properly. It feels like you're sending your breath all the way down to the booty hole. And so if we do feel some contractions down in there, you can even honestly take your hand, sit on it and start to breathe and you'll feel contractions into your hand.

That's how you know you're doing it right. So my answer to this is what is one simple exercise that you can start to do? Practice your pelvic floor breathing. Practice it on your back. Practice it in child's pose. Practice it in sitting. Practice it in standing, walking and in exercise. And so again, if you need some visuals on this, reach out to me. Go to our YouTube channel, whatever it may be. But there's a lot of different ways this can be taught. Some of you may get it right away. Keep practicing on your own. Others of you might need some help. So please reach out if you feel like you need that.

Thanks for listening, guys.