How to Safely Recover Your Pelvic Floor Postpartum

The Early Days

So here you are, a week postpartum sitting in bed, likely holding or nursing your new baby, your belly soft and floppy, your lady parts (and everything around it) swollen, wondering if you will ever feel “normal” again. 

The initial weeks postpartum can often feel like uncharted territory, making it difficult to discern what’s normal and how to best care for your body. At times, the need for rest and healing is undeniable, such as when simply moving from bed to bathroom feels monumental. However, there are also less obvious situations. You might feel relatively well, with a toddler eager for attention, leading you to believe you can manage more activity.

I have a few principles in regards to pelvic health when it comes to rehabbing and protecting your body in the initial weeks postpartum:

1. Rest

Your body actually needs rest more than anything else to heal.

A loose timeline is: 1st week mostly in and around your bed, 2nd week around your house and the 3rd week, maybe a walk down the block. Earlier movement or exercise does not speed up your recovery, and it often even slows it down. Focus on eating nutritious foods, high in protein and healthy fats. Get sunlight. Sleep as much as you can.

2. Pooping

Yes, I am talking about pooping.

The goal is a bowel movement every day without straining.  Why is this important? The connective tissue that holds up your pelvic organs is in a lengthened and fragile state. Straining puts added pressure on this fascia and if the strain is significant enough or repetitive enough, it can lead to prolapse of your pelvic organs.

Take the stool softeners, whether it be magnesium citrate or a docusate sodium (Bioptimizers or Calm.) Take them even when you are not constipated to prevent your stool from getting hard. Drink approximately 100 ounces of water per day if breastfeeding/pumping. A serving of electrolytes daily can aid in absorbing the water you drink. A shot of prune juice at night and a hot beverage in the morning can also do wonders in stimulating a consistent bowel movement.

3. Abdominal Supports

Belly bands can be super helpful in the first 2-3 weeks, particularly in supporting your low back. Your deep abdominals and pelvic floor muscles have been stretched out and potentially strained during birth. These muscles form your core and are designed to protect your spine, and in these early weeks they are not able to do their job well. If you have had a c-section, this is even more important.

An abdominal support is not a corset. You should be able to sit and breathe in it. I recommend wearing it most of the time in the first week, half the time in the second week, and slowly weaning off by the end of the 3rd week. For c-sections, you can extend that time to approximately 6 weeks. Two great brands are the Fit Splint by ReCore fitness or the Belly Bandit.

4. Lifting

Be very aware of how much you are lifting in the early weeks. Don’t lift older siblings in the first 3 weeks. Don’t lift the dog food or multiple bags of groceries. As I mentioned above, your core muscles are out of commission in those first few weeks so don’t overload your body.

The primary risks this helps to avoid are pelvic organ prolapse or a strain of your low back. Not lifting older siblings seems to be the hardest for moms, and I get it. They want your love and attention too. Have them cuddle with you on the couch and read a book, or snuggle with them in bed.

So when to start exercise?

I recommend starting with the breath. Specifically, connecting your breath to your core muscles. Inhale into your low ribs and belly and as you exhale, contract your pelvic floor muscles and blow through a straw to engage your deep abdominals. This should not hurt.

Around Week 3, start with engaging your core as you functionally move and lift, and then specifically with foundational exercises. I have recommended early exercises to start around 3-4 weeks on my Instagram, @merrimanpelvichealth. 

For additional guidance and instruction FitMamasTribe offers a 6-week postpartum recovery series that teaches you these foundational basics.

And lastly, What’s “normal” vs. not?

In the first few weeks postpartum, do not worry if you pee when you laugh or you have to rush to the bathroom to urinate or have a bowel movement, or if you can’t control your toots. As mentioned above, your pelvic floor is healing and not in tip-top shape. Sitting and moving may be painful due to scar tissue and/or spasms of the pelvic floor muscles. This should continue to improve in the first 4-6 weeks.

If you are still experiencing any of these symptoms (or others) after 6 weeks, reach out to a pelvic floor physical therapist. We have seen it all before and can help a lot. 

Questions or concerns about your pelvic floor? Schedule an appointment with Pelvic Health Physical Therapist Claire Merriman, PT, DPT, MTC, PRPC. Located in St Augustine, Florida.