Pelvic floor muscle exercises can and should be started as soon as possible after childbirth – before leaving the maternity clinic even! The starting of exercising is highly dependent on the delivery method, previous activity level, and the type of exercise to be done: in other words, there is no one correct answer. Every woman, pregnancy, and childbirth is different.
During pregnancy, pelvic floor muscles are subjected to an increasing amount of pressure that stretches the tissues. Even when tissue damage is avoided in childbirth, the pregnancy seriously strains the pelvic floor muscles. The subsequent stretching and loosening of the muscles increases the risk of bowel and urinary incontinence and uterine or vaginal prolapse.
Exercising the pelvic floor muscles prevents urinary incontinence and improves circulation in the pelvic floor area, boosting metabolism and supporting speedy recovery. You can try to compress the lower belly gently in order to activate the deep abdominal muscles soon after childbirth.
If you exercised regularly during the pregnancy and the childbirth went well, you can start exercising and stretching gently immediately after childbirth once you feel ready for it. It is advisable to allow the body to rest and recover for a few weeks after childbirth, possibly until after the postpartum checkup, except for gentle compressions of the pelvic floor muscles and the deep abdominal muscles, as pregnancy and childbirth place a lot of strain on the woman’s body and it is hugely important to give it time to heal.
You can test your pelvic floor muscles by stopping the flow of urine when peeing or e.g. in a shower by inserting a clean finger into your vagina and contracting your pelvic floor muscles together and upwards. You should feel tension and a minor squeeze around your finger when the muscles are activated. If it is difficult to feel the tension, you can try to also contract the anus muscles, as this might help.
Pelvic floor muscle exercises can be started with e.g. a gentle contraction and identification exercise.
You can be in a sitting position or lie down. Contract the anus first and then the vagina. Imagine bringing the ischia towards each other, in other words, contract the muscles also horizontally (side to side).
The direction of the movement should be upwards, i.e. imagine that the pelvic floor muscles are a lift that rise a few floors upwards.
Hold the tension and movement for around 10 seconds and relax the muscles for a while. Do this by lowering the pelvic floor muscle lift to the ground floor and imagine bringing the ischia away from each other (side to side).
Repeat 5-10 times.
The muscles will strengthen significantly in only a few months (or weeks!) if you exercise regularly. You should learn to always contract the muscles before sneezing or coughing and when lifting e.g. a shopping bag or a child.
Listen to your body and how you feel and how much energy you have for exercising. For example, the pace of recovery and readiness for exercise can be very different in case of a mother who gave birth by C-section and a mother who gave birth by vaginal delivery.
It is advisable to start gently regardless of the delivery method. Pregnancy and lactation hormones affect the joints, making them looser even months after the pregnancy, childbirth, and end of breastfeeding. For this reason, training too hard too soon should be avoided. As a general rule, the same kind of exercises can be done during the recovery from childbirth as the women are instructed to do during pregnancy.
In addition to pelvic floor muscle exercises, walking is the best way to start the training. Walking with a pram is a good alternative but Nordic walking is excellent for the core if you are able to leave the baby at home. Nordic walking generates just the kind of rotation at the core that promotes recovery. Outdoor air reduces stress, refreshes the mind, and subsequently also helps prevent postnatal depression.
When you feel that your energy is restored and increasing, you can extend your walks. And if you feel tired, take it easier. Rest when your body needs it.
Although we are sometimes in a rush to start training, it is better for the body in the long term if we listen to it. Taking it slowly at the beginning pays off, as your overall recovery will be quicker.
Everyone benefits from the training of the pelvic floor muscles and walking, but start exercising carefully and increase the intensity slowly if:
If you had a C-section, it is advisable to wait at least until you have had your postpartum checkup before starting exercising (except for training the pelvic floor muscles and walking).
Swimming should not be started until after the postpartum checkup and at least one week after the postpartum discharge has stopped, because your womb is more sensitive to bacteria and infection during the recovery period. After a C-section, swimming can be started once the stitches have healed and the doctor or a nurse has verified that the wound has healed.
Training of the abdominal muscles should not be started until the core (the pelvic floor muscles and the deep abdominal muscles) is in good condition. Starting abdominal muscle exercises too soon after childbirth can make urinary incontinence worse, not better. Another important reason for waiting before starting to train the abdominal muscles is their stretching and possible separation of the direct abdominal muscles after childbirth.
The severity of the separation varies, and it is especially important to be careful with exercises that form a bump on the belly, because they can pull the direct abdominal muscles even further apart. Such exercises include e.g. sit-ups, planking, transverse abdominal muscle exercises, and feet lifts.
Ask the doctor to check for separated abdominal muscles in the postpartum checkup. While the spontaneous recovery takes roughly a year, the healing is the quickest during the first month. During that time, the body benefits from rehabilitating exercises and the help that they provide.
It is recommended that intensive aerobic training be avoided until the pelvic floor muscles are in good condition (there is no urinary incontinence) and the joints have recovered from the pregnancy and childbirth. This can take several months.
If you suffer from urinary incontinence or the feeling of pressure in your vagina, your pelvic floor muscle area may have become damaged. In such a case it is advisable to contact a physiotherapist who specialises in the pelvic floor muscle area or a personal trainer who specialises in exercise during and after pregnancy.