Even if you haven’t heard of the term “diastasis recti” or “DR”, chances are you have probably heard of the “Mommy Tummy”. Diastasis can be one underlying cause resulting in the appearance of a “Mommy Tummy”. So what exactly is diastasis recti and how can you tell if you have one?
This condition is a midline separation between the left and right halves of one of the abdominal muscle layers called the rectus abdominis. This layer of muscles is what we traditionally refer to as our “6-pack abs” (yes, they’re in there!) and they naturally separate during pregnancy along the connective tissue called the linea alba to accommodate for the baby as she/he grows inside your abdomen. This is completely normal during pregnancy, and in fact, 100% of women will have this type of abdominal separation by the end of their pregnancy and immediately postpartum. For many women, the diastasis will heal slowly postpartum as the two halves of the abdominal wall return closer together. But without specific exercise, 45% of women will still have a midline abdominal separation at 6 months postpartum and one third of women will still have a diastasis at 1 year postpartum! ¹
The separation itself isn’t necessarily cause for concern, but can result in feeling of weakness with activities such as picking up your kids, reaching out to lift something, getting on and off the floor, or sitting up from bed. It can also result in a feeling of abdominal organs wanting to “fall out” when exercising on hands and knees or belly-down positions. You may notice a pronounced “coning” or “doming” shape to your abdomen when sitting up or leaning back. Because the abdominal muscles work together with the pelvic floor, diaphragm (breathing muscle), and deep back muscles as part of our core, a weakness in the abdominals can create more strain on the back or pelvic floor resulting in issues such as chronic low back pain, sciatica, urinary leakage and even painful intercourse.
So what’s a woman to do? Well, the good news is that through specific exercises targeted at the deep abdominal layers and breathing/pelvic floor connection, you can close the gap, create better tension along the linea alba and create better support through the core. A pelvic floor physical therapist can assess the extent of your diastasis and how you are able to transfer load through the core. She can also assess the muscles of the low back and pelvic floor to see how they are working with the abdominals and breathing muscle as part of your core team. A pelvic floor PT can instruct you in specific exercises to help rebalance the core system, relieve pain, and tone through the abdominals. She can instruct you in exercises to avoid as you are healing and provide hands-on treatment to help release any “stuck” areas of tension. Sometimes, therapeutic taping techniques can be used to provide additional support for the short-term as you learn how to turn on the deep abdominal muscles again postpartum.
What about sit-ups, crunches, push-ups and planks? There are a lot of blogs out there with lists of exercises to avoid or never perform again if you have a diastasis. In reality, there are no hard and fast rules that can be applied to everyone with abdominal separation. Even exercises like sit-ups and crunches can potentially be performed with a diastasis if you have learned the specific techniques to manage the pressure going forward into the abdominals. Every exercise needs to be evaluated on an individual basis, and your pelvic floor PT can help you create a list of “safe to perform” vs “avoid for now” and help you modify an exercise to adapt it to your current strength level as you progress.
In summary, no matter how long it’s been since you’ve been pregnant, working with a pelvic floor physical therapist can help you to create positive changes in your body including strengthening, toning, and pain relief! If you would like to get started on healing today, click on the book now button above to request an appointment.
1. Sperstad JB, et al. Br J Sports Med 2016;50:1092–1096. doi:10.1136/bjsports-2016-096065. https://bjsm.bmj.com/content/bjsports/50/17/1092.full.pdf
The short answer: yes! If you are like me and like to know the research behind the answer, keep reading below.
If you or a close woman in your life is struggling with a feeling of pelvic heaviness, pressure, or a bulge/lump in the vagina, we would love to help you feel more like yourself! As you read above, there is a very good chance that your symptoms will improve with skilled instruction and training with a pelvic floor physical therapist. Click on the Book Now button above to fill out an appointment request, and we will be in touch shortly!
I'm about to say something controversial: You don't necessarily need to give up running if you have a prolapse or symptoms of pelvic heaviness. Depending on the extent of the prolapse and your ability to manage intra abdominal pressure and the forces on the pelvic organs, many women are able to continue high impact activities such as running without worsening pelvic heaviness. Here are some of the basics that I often assess first with my clients who have a symptomatic prolapse who wish to continue running:
Did you know that 86% of women have pain with first vaginal sex after childbirth and nearly 1 in 4 still report pain at 18 months postpartum¹? Although it's quite common, sex shouldn’t have to hurt after childbirth! Here are some reasons why it might and what to do about it:
Whatever you do, don’t suffer in silence! As you can see, there are many reasons why sex may not feel the same as pre-baby so it is definitely worth reaching out to a trained professional like a pelvic floor PT. We perform a thorough evaluation to determine which reason(s) are wreaking havoc in the sheets and will provide you with a customized action plan to take back the bedroom.
¹McDonald EA, Gartland D, Small R, Brown SJ. Dyspareunia and childbirth: a prospective cohort study. BJOG 2015: http://dx.doi.org/10.1111/1471-0528.13263
There are many simple lifestyle changes you can make that will help protect your pelvic floor and keep your bladder happy and bowel running smoothly. The recommendations below were made by the Continence Foundation of Australia and the original article can be found at the reference listed below.
Drink Plenty of Fluids
Eat a Healthy Diet
Maintain a Healthy Weight
Practice Good Toileting Habits
If you develop urinary leakage when you cough, sneeze, or exercise, know that incontinence does NOT have to become your “new normal” or “just part of being a woman”. Connect up with a pelvic floor PT to learn exercises to help the pelvic floor- especially if these muscles been weakened by obesity, pregnancy, childbirth, heavy lifting or a chronic cough. Seek out a pelvic floor physical therapist to discover how pelvic floor PT can help get rid of leaks for good.
Want to work with us? Fill out an appointment request form here.
What is the best exercise for the core? As a pelvic floor physical therapist, this is a question that I get asked quite frequently by my clients; especially with the rise of the buzzword “core” in the health and fitness community over the past decade. But before we can dive into the exercises for the core, we must first have a more complete understanding of what exactly makes up the core.
When we hear the word “core”, most of us picture the washboard abs called our rectus abdominis and probably think of sit ups, crunches or maybe planks. But in reality, the core lies a little deeper than the muscles that make up your six-pack. We all have four layers of abdominal muscles, and the deepest layer is called the transverse abdominis (TrA). Your transverse abdominis wraps around your abdomen and acts like a built-in back brace to stabilize your trunk prior to leg and arm movements and to create tension in order to transfer load or force.
But the core is actually made up of three more muscle groups in addition to the TrA! Let’s think of the core as a 3D cylinder instead of a 2D rectangle. We have discussed the muscle on the front of the cylinder but what about the back, top and bottom of the cylinder? The muscles that help to stabilize the back of the cylinder are called your multifidi. These are short muscles at each segment deep in your low back on either side of the vertebrae. The base of the cylinder is made up of your pelvic floor muscles that fill in the bottom of your pelvic bowl. These muscles act as a sling to support all of your pelvic and abdominal organs.
The top of the cylinder is made up of your diaphragm, which is why you may notice that you find yourself holding your breath during strenuous lifting or a challenging abdominal workout if the rest of the core players are not optimally doing their job to help provide stability. Breath-holding isn’t good for your core because it increases your intra-abdominal pressure which can place extra strain on your back, abs, and pelvic floor and put those structures at risk of injury.
In order to optimally improve your core, you need to be sure that you are addressing the deepest layer of muscles on all 4 aspects of the cylinder that we discussed above. The order and timing that the muscles fire is also extremely important for optimal stabilizing function. Typically, these muscles are “on” at a low-level to some extent all the time and we aren’t even consciously aware of their timing and firing. However, studies have demonstrated that in people with low back pain and during pregnancy and postpartum, the timing and firing of these muscles becomes disrupted and sometimes reversed or non-existent!
A great core exercise is one that takes into consideration how the breath (diaphragm), pelvic floor, abdominal muscles and back muscles all work together with the correct coordination and timing. There are many different ways to accomplish this, from breathing while supported on your back to incorporating into household tasks or Olympic lifting. In pelvic floor PT, we assess how your core is functioning in its parts and as a unit, and we teach you how to engage your core with the correct coordination and timing during tasks that may be difficult or painful. So the answer to “what is the best exercise for my core” is really that there is no one-size-fits-all exercise that will be perfect for everyone but we want to start thinking beyond just isolating the abs.
Throughout my experience as a pelvic floor physical therapist I have heard many misconceptions from clients regarding pelvic PT. In this blog, I would like to provide more information to help clear up some of the most common myths out there about pelvic floor PT.
Myth #1: Pelvic floor PT is the same as “doing your Kegels”.
This is a myth that is quite widespread and I hear it from both providers and clients alike! Although knowledge of pelvic floor PT as an option for addressing women’s pelvic floor issues is severely lacking in the general public, most women I work with have heard of Kegels. Many of my clients regretfully inform me that they wish they had listened to their medical provider and “done their Kegels” after childbirth to help their pelvic floor recover. Even more women tell me at their first visit that they have started “doing their Kegels” but a) aren’t sure if they’re doing them correctly, and b) do them halfheartedly when they think of it because they weren’t informed of how many to do or how often to do them.
A quality pelvic floor physical therapist will address SO MUCH MORE than Kegels. We perform a completely different type of internal exam than you may be used to at the gynecologist. We are spending time thoroughly evaluating the tone, strength, endurance, speed and coordination of multiple layers of pelvic floor muscles and empower you with information about your body. We perform a holistic assessment including the relationship between your pelvic floor muscles and the bigger picture of your movement strategies/patterns, your posture, your alignment, and how it is all influenced by the context of your life as a person. And yes, we will also let you know if you’re doing a Kegel correctly and if you should be doing them at all. And if they happen to be part of your exercise program, you bet we’ll prescribe reps, sets, frequency and hold times.
Myth #2: You have to have delivered a baby to require pelvic floor PT. (Sub-myth: delivery via C-section doesn’t require pelvic floor PT).
Many women assume that if they haven’t delivered via the vaginal canal that they are probably exempt from pelvic floor issues. Or women who have never undergone childbirth may feel alone, isolated, and unheard if they are experiencing issues such as dyspareunia (pain during intercourse), urinary leakage (incontinence), or urinary frequency/urgency. The truth is that pelvic floor conditions can impact you regardless of your childbearing history! Past experiences, hormone imbalances, life stressors, or pelvic trauma (even old abdominal or pelvic surgeries) can influence the state of the pelvic floor.
And women that have delivered a baby via Cesarean section still had to carry that baby throughout about 9 months of pregnancy! And you bet the pelvic floor had to adapt to accommodate those changes. Not to mention the impact that changes in posture, ligament laxity, and breathing mechanics during pregnancy have on the pelvic floor as well. Check out our blog “What Does a Pelvic PT Actually Do?” for signs that indicate you would benefit from seeing a pelvic floor PT.
Myth #3: It’s too late for me to get help, I’ve let things go on for too long.
This is my favorite myth to bust! Women quite frequently express this tender fear to me at their first appointment, that perhaps they are a lost cause. This couldn’t be further from the truth! No matter what your age or how long you’ve been sucking it up and struggling silently with your symptoms, there is hope. You can always gain power in knowledge about your body, build novel body awareness, commit to some lifestyle changes or form a new habit, start up a new exercise routine, build muscle strength, learn stress reduction and breathing techniques or finally be connected to the right provider to help manage your condition. No matter how bad you think things are or how alone you feel, know that there are actually many other women out there dealing with a very similar issue! You are not alone, it’s never too late-- please reach out!
If you are reading this and weren’t even aware that physical therapy exists for the pelvic floor you are not alone! As a pelvic floor physical therapist, my job is to help bridge the gap between being told to do nothing for the first six weeks after your delivery and then suddenly being cleared for return to all activities but having no clue where to start and feeling lost in your postpartum body.
In a perfect world, it is my (clearly biased) opinion that every woman should have access to an evaluation by a pelvic floor physical therapist sometime around 6-8 weeks postpartum at least to check the state of the pelvic floor after both C-section and vaginal deliveries as well as provide tips regarding nursing positioning, proper lifting and carrying mechanics, and a stepwise exercise progression for return to activity safely. There are however some signs that you should definitely see a pelvic floor physical therapist for more individualized help.
1. You are having accidental urinary or fecal incontinence (leakage) that continues to occur beyond six weeks after delivery. This could be happening during a cough, laugh, or sneeze or during activities such as walking, stairs, bending over, running, or jumping. It could also occur due to a strong overwhelming urge that is difficult to control or without you realizing that leakage is happening. Even if the amount of leakage is just a couple drops, it is still beneficial to address it sooner rather than later, as it is a sign of a larger weakness in the core muscle system. Leakage doesn’t have to be something to laugh off or that is “just part of being a mom”; it is something that can typically be completely resolved.
2. You have a feeling of increased pelvic heaviness/pressure or the sensation of pelvic organs falling down. This is a sensation related to pelvic organ prolapse, which occurs when the bladder, urethra, vaginal wall, uterus, small bowel or rectum is collapsing downward. You can have a greater risk of developing a prolapse after childbirth just due to the amount of pushing and pressure down on your pelvic floor during delivery, as well as some of the hormonal changes that contribute to increased ligament laxity during pregnancy to allow for birth. The good news is that you can learn strategies to help protect your pelvic floor as it is healing in order to avoid continued excess pressure on the pelvic organs. A pelvic floor physical therapist can also teach you how to strengthen the muscles in the pelvic floor and in the core in order to help better support the pelvic organs as well.
3. You are having pain or discomfort when returning to sexual intercourse with your partner. Sometimes this discomfort can be due to scar tissue from perineal tearing or an episiotomy or even C-section incision. Sometimes the discomfort can be due to extra tension in the muscles of the pelvic floor- remember these muscles had to work extra hard all throughout your pregnancy to help hold the baby up- so sometimes they need to be retrained how to relax again. Whatever the cause of the pain, your pelvic floor PT can help figure out the reason behind why the pain is occurring and develop a plan to be able to be intimate with your partner without pain.
Of course, there are other issues postpartum such as diastasis recti (abdominal muscle separation or “mommy tummy”), symphysis pubis dysfunction (SPD), and coccyx (tailbone) pain including other joint pains that can develop due to the repetitive activities you are now performing on an hourly basis as a new mom (think feeding, lifting, carrying) as your body is still healing. A pelvic floor physical therapist can help you address any and all of these potential issues that arise throughout the fourth trimester and the postpartum period. Luckily, even if your medical provider doesn’t refer you to a pelvic floor PT, you can seek out a pelvic floor PT on your own in New York State without a referral. To get started with a free consultation or to book an initial evaluation, contact firstname.lastname@example.org.
Dr. Julie Berube is a pelvic floor physical therapist who is on a mission to revolutionize the standard of healthcare for women in Central New York. She is the owner and founder at LiveWell CNY Physical Therapy, LLC in Syracuse, NY.
We all can develop some toileting tendencies that over time, can be detrimental to the relationship between our bladder and our pelvic floor muscles. It becomes especially important to address any of these “bladder bad habits” when a woman has a pelvic floor condition such as stress urinary incontinence, urge urinary incontinence, pelvic organ prolapse (cystocele or urethrocele), overactive bladder, or interstitial cystitis (painful bladder syndrome), to name a few. Even if you aren’t currently experiencing any of these conditions, it never hurts to be proactive and address any counterproductive behaviors to ensure your bladder remains healthy and happy.
Bladder “bad habit” #1: Hovering over a toilet seat. I think as women, we are often guilty of doing this in public bathrooms or when traveling. The reason why we want to avoid hovering over the toilet seat is twofold. First, hovering disrupts the natural reflex that should be occurring between the pelvic floor muscles and the bladder. When the bladder is filling, the bladder muscle should be relaxed or “off” and the pelvic floor muscles are “on” to prevent leaks from occurring. When you get to a toilet, the bladder muscle turns “on” to empty the bladder, and the pelvic floor should relax or turn “off” to allow emptying to occur. If you are hovering, both muscle groups are “on” at the same time and working against each other.
Second, when you hover over the toilet seat, your pelvic floor muscles can’t fully relax because they are working as part of your core to support you in this semi-squatting position. If the pelvic floor muscles can’t fully relax, it is difficult for the bladder to fully empty, and this can put you at risk of developing urinary retention. If urinary retention is occurring, you may notice that you are having multiple little small voids less than an hour apart. Because the bladder wasn’t able to fully empty, now you are getting the urge to go again and you just went!
Bladder "bad habit" #2: “power peeing”! So as we mentioned above, in the normal emptying reflex, the bladder muscle is on and the pelvic floor muscles should be off to allow emptying to occur. Many of us women are just too busy to have time for peeing! Many women tell me that they sit down and try to hold their breath to bear down or use their abdominal muscles to try to increase their flow rate and just push the urine out faster. As much as I understand that we are all busy, we need to take time to just sit down, relax, and allow emptying to happen. Bearing down to get the urine out faster again disrupts that normal bladder/pelvic floor muscle reflex and can also put you at risk of pelvic organ prolapse. Holding your breath or bearing down using your abdominal muscles can really put a lot of excess strain on all the connective tissues that hold up our pelvic organs!
Bladder "bad habit" #3: Going “just in case”. So what I mean by this is minimizing the amount of times you urinate without feeling a true urge to go. For example, say you are going out shopping for the day or out for a drive and you don’t feel an urge to urinate but you decide to go “just in case” before you leave the house. Or say that every time before you leave for a run you decide to do the same thing. Or another common example is when a woman is waking up during the night to nurse her baby and she decides to urinate before she goes back to bed since she’s up anyway. Now the key here in all of these situations is there is no urge or sensation of needing to urinate, but she decides to go anyway.
Over time, this can train the bladder to associate certain situations with a signal or urge to you that you need to go, when in fact the bladder is not very full at all. The bladder starts to associate that it’s time to empty every night at 3am long after you are nursing for example, or every time you are getting ready to leave the house. It starts to give you a strong urge when it is only ¼ full instead of when it’s ¾ full. What I would suggest is wait until you have a true urge to urinate, and only go before leaving the house without an urge if you know that there won’t be any bathrooms available when you’re out and about.
Now that you know more about your bladder and its relationship to your pelvic floor, you can start to make some of these simple changes in your bathroom habits. Your pelvic floor and your bladder will thank you! Of course, if you want to learn more about your bladder, pelvic floor, or if you are dealing specifically with any of the conditions that I mentioned at the beginning of the blog, don’t hesitate to reach out to a pelvic floor PT for help!
So what got you into pelvic floor PT? This is a question that I get asked fairly often by clients as they get to know me. Honestly, I never envisioned myself as a pelvic floor PT and in fact, earlier in my career it was an area of PT that I had written off for myself without knowing much about it. But it’s funny how life works and how suddenly the thing I was sure I would never do became one of the things I am most passionate about.
A combination of life events, witnessing first-hand the vast gaps in women’s pelvic healthcare, and ignorant marketing commercials all fed into this little flame of passion within me that I can only describe as a call. A definite calling that even though I didn’t know much about pelvic floor PT, and no matter how much easier it would be to stay in my comfort zone, I needed to do everything I could to learn more and to let women know that they are not alone, they should not feel ashamed, and there IS help.
This is the wrapper from a Dove chocolate that I snagged when I was taking my first Herman and Wallace continuing education course to be trained to perform internal pelvic floor muscle evaluations and treat women with pelvic floor conditions. I knew I was in the exact right place at the exact right time when I opened up this wrapper and saw “It’s your call”.
Since having the opportunity to work with women with pelvic floor conditions, I have witnessed so many amazing life transformations. It is so rewarding to be able to empower a woman with knowledge about her body and to be able to see her take that and run with it. To be able to sometimes be one of the first people to say, you are NOT crazy and you are not the only one with this issue, and there are actually so many things we can do besides “just learning to live with it”.
So yeah, that’s what got me into pelvic floor PT and that’s what keeps me loving to do it.
Dr. Julie Berube is a pelvic floor physical therapist who is on a mission to revolutionize the standard of healthcare for women in Central New York and the Syracuse area.