Your body slowly returns to its prepregnancy equilibrium during the first 4 to 6 weeks after adding a new baby to your family, but a few lingering changes are common. Many women feel a loss of strength in their pelvic floor, resulting in incontinence or difficulty with sex, but there are simple treatments for these issues. While the differences in your body can be unsettling, remember that this is a period of transition, and many of the changes will revert when your hormones rebalance.
Incontinence and Your Pelvic Floor
Many women find “leaking” during workouts to be an unwelcome by-product of having had a baby. The cause of urinary incontinence (UI) after vaginal birth is primarily the weakened muscles in the wall of the bladder. Babies in utero rest their weight on the bladder and pelvic floor, which can weaken those muscles during pregnancy and labor. The process of vaginal birth further weakens the nerves that control the bladder. While bladder control should return after you heal from birth, many women continue to experience difficulty and more frequent trips to the bathroom. Workouts, particularly running or other high-impact exercise, can also prompt UI, which is frustrating for the many women waiting in long bathroom lines at races.
To reduce the incidence of urinary incontinence (UI), lower your consumption of diuretics, such as alcohol, tea, coffee, and carbonated drinks—with or without caffeine. If diet and bladder training don’t work for you, talk to your doctor about medication, nerve stimulation, or surgical options.
Exercises for the Pelvic Floor
There are surgical treatments and prescribed medication that can help with severe cases of UI, but you can also strengthen your pelvic floor with Kegel exercises. After you have your baby, you have more options for strengthening the pelvic floor to alleviate vaginal pain and to treat incontinence and prolapse. You can do any of these exercises once the postpartum bleeding has stopped.
In addition to these exercises, it is possible to “retrain” your bladder by going to the bathroom on a schedule every day, before you have the urge, and slowly increasing the time between bathroom visits. If you have not returned to your prepregnancy weight by the end of your baby’s first year and experience UI, you may find that healthy weight loss can restore your bladder control. If bladder control is a concern, always use the bathroom before a workout, regardless of whether or not you feel the urge. This could help get you through a class, ride, or run without needing to make a stop.
Kegels: Pull your vaginal and rectal muscles up and in at the same time to contract so that you’re squeezing and lifting simultaneously. These are performed as you exhale (not when you breathe in). Resist tightening your ab, glute, or leg muscles as much as possible. One set is 8 reps lasting 5 seconds each. Perform 1 set 3x/day.
For Vaginal Pain or Pain from Sitting
Lie on your back with your knees bent and feet flat on the floor. Imagine a compass on your abdomen: Your belly button is north, your pubic bone is south, and your hip bones are east and west. Pull your belly button toward your spine so that your pubic bone tips up, then tip your pelvis west, rotating around so that you then tip east. Return to the original position, then reverse directions. Perform 8–10 reps.
For Uterine Prolapse
Sit on the floor with your knees bent and a ball between your thighs. Squeeze your thighs together, contracting the vaginal muscles as if you’re trying to stop the flow of urine. Hold each contraction for 10 seconds. Perform 2 sets of 10–12 reps.
Adapted from Fit and Healthy Pregnancy by Dr. Kristina Pinto and Rachel Kramer, MD, with permission of VeloPress.