When it comes to returning to exercise after giving birth, running continues to be one of the most popular exercise activities due to its convenience. The majority of runners in the United States in road races are women, with the most popular distance being the 5K. A common mistake for mothers following childbirth is returning to activity too soon, and without proper instruction and evaluation of their exercise form. At N2 Physical Therapy, we examine the abdominal, hip, and gluteal muscles, as well as pelvic floor muscles and can give great advice on running postpartum.
High impact activity, such as running, is associated with a sudden rise in pressure throughout the abdomen as well as forces between 1.6-2.5 times one’s body weight throughout the body. The pelvic floor functions to provide strength and stability during activity in order to support the pelvic organs and prevent leakage of urine or feces during high impact activity. For many women, instruction and supervision is needed in order to be able to perform a correct pelvic floor muscle contraction, especially if they did not train these muscles before birth.
Key signs/symptoms
There are a number of pelvic floor and/or abdominal wall dysfunction include:
- Leakage of urine or feces when running or when coughing/sneezing/laughing
- Urinary urgency or frequency that is difficult to defer
- Urgency with bowel movements that is difficult to defer
- Sensation of heaviness/pressure/bulge/dragging in the pelvic area
- Pain with intercourse
- Constipation
- Diastasis Rectus Abdominis (separation of the abdominal muscles)
- Pelvic pain
- Low back pain
Leakage of urine or feces
When women experience leakage of urine or feces, multiple factors may be contributing. Your pelvic therapist can assess all factors in order to allow you to participate in exercise and activity without leakage. It is not abnormal for women to attempt a heavy program of kegel or pelvic floor squeezes, and actually have their symptoms worsen. It is vital to have a full assessment in order to avoid worsening symptoms.
Urinary urgency or frequency, Urgency with bowel movements
Many women refer to themselves as “having a small bladder,” due to going to urinate frequently or having strong urinary urges that are difficult to defer. In reality, you likely do not have a small bladder, but rather overcommunication between your bladder and your pelvic floor muscles. Urgency with bowel movements can occur with urinary urgency as well. For women who exercise regularly, urinary urgency/frequency or bowel urgency can actually worsen due to poor movement patterns. Your physical therapist can assess your voiding habits in order to allow you to regain control over the communication between your bladder and pelvic floor.
Sensation of heaviness/pressure/bulge/dragging in the pelvic area
Commonly referred to as prolapse, many women postpartum find they experience a sensation of heaviness or pressure in the pelvic area. Some women describe it as “something falling out,” particularly after prolonged periods of standing or higher impact activity, such as running postpartum. This sensation can make participating in regular exercise or completing daily activities challenging and uncomfortable. Your pelvic physical therapist can assess your pelvic floor for prolapse and develop an activity program that addresses your prolapse symptoms.
Pain with intercourse
Birthing a child, whether by vaginal or cesarean delivery, can cause numerous changes to the pelvic floor. One of the most common symptoms postpartum is pain with intercourse and/or pain following intercourse. Delaying appropriate physical therapy treatment can actually worsen your pain symptoms and prolong your time towards recovery. Your physical therapist can assess the structures involved that are causing your symptoms and develop a plan towards participating in pain-free intercourse.
Constipation
Many people are surprised to find that pelvic floor physical therapy can address constipation and other bowel issues. The pelvic floor muscles are responsible for controlling bowel movements. Without adequate coordination and muscle length, producing bowel movements can turn into a painful and dreaded experience. Chronic constipation can result in recurring hemorrhoids or even anal fissures. Your pelvic physical therapist can work with you to re-educate the coordination of your pelvic floor and address any difficulties you may have with bowel movements.
Diastasis Rectus Abdominis (separation of the abdominal muscles)
There is a correlation between diastasis rectus abdominis and pain/dysfunction in the lower spine and pelvis. For many women postpartum, a chief concern is addressing the characteristic “doming” in the abdomen from separation of the abdominal muscles due to the sensation of decreased core stability. Pelvic floor physical therapy is effective at treating diastasis rectus abdominis with individualized exercise programs aimed at strengthening the inner core.
Pelvic pain and running postpartum
During pregnancy, many women attribute pelvic pain to growing pains and expect their symptoms to resolve following birth. Unfortunately, that is rarely the case and women find themselves confronted with persistent pelvic pain postpartum. Whether the pain symptoms occur at home, at work, or while running, it is not normal to experience pelvic pain at any point. Your physical therapist can perform a full assessment of the many factors related to pelvic pain, including maladaptive movement patterns, muscles that have too much tension, and decreased core strength.
Low back pain
Numerous studies have linked low back pain to pelvic floor dysfunction, particularly in the pregnant and postpartum population. This is no surprise given the anatomical proximity of musculoskeletal and neural structures in the low back and the pelvic floor. An evaluation by a pelvic physical therapist is especially needed for women who have undergone physical therapy treatment at an orthopedic clinic for their back pain without resolution of symptoms. For many women, pelvic floor is the missing puzzle piece to their back pain symptoms, especially postpartum.
Women can benefit from individual assessment and pelvic floor physical therapy to address any of the above signs/symptoms. There have been numerous research studies supporting the benefit of pelvic floor physical therapy during pregnancy, due to the many changes to a woman’s posture and muscle strength and coordination. In addition, research studies have also examined the timing of pelvic floor activity for women postpartum as well. These studies revealed that the pelvic floor muscles are active prior to intentional movement, such as lifting the arm or leg, and highlights the essential role of the pelvic floor in providing postural responses during activity.
At N2 Physical Therapy, we can develop an exercise program that is appropriate for your specific goals and lifestyle postpartum. We currently offer physical therapy visits through telehealth, which allows for sessions to be conducted remotely in the comfort of your own home. Not only is telehealth convenient, but many women find a combination of telehealth and in-clinic visits beneficial due to its reduced costs and time commitment compared to in-clinic visits alone. Whether it is addressing diastasis recti, leaking urine when running, or returning to your pre-pregnancy level of activity, we are available both remotely and in person to help you achieve your goals. Let us help you get back to the life you deserve!
About Dr. Bomarito
Patty Bomarito is a pelvic physical therapist specializing in the prenatal and postpartum population. Her background as both an engineer and a long-distance trail runner allows her to provide individualized guidance for women aiming to return to running postpartum. As a mother to two children, she has a personal understanding of the challenges to returning to running following vaginal and cesarean delivery.
References:
Dalal, Khushboo, Amrit Kaur, and Mahesh Mitra. “Correlation between diastasis rectus abdominis and lumbopelvic pain and dysfunction.” Indian Journal of Physiotherapy and Occupational Therapy 8.1 (2014): 210.
Goom, Tom. “Returning to running postnatal–guidelines for medical, health and fitness professionals managing this population.” (2019).
Gottschall, Jinger S., and Rodger Kram. “Ground reaction forces during downhill and uphill running.” Journal of biomechanics 38.3 (2005): 445-452.
Leitner, Monika, et al. “Evaluation of pelvic floor muscle activity during running in continent and incontinent women: An exploratory study.” Neurourology and urodynamics 36.6 (2017): 1570-1576.
Runningusa.org: 2018 U.S. Running Trends Report
Sjödahl, Jenny, et al. “The postural response of the pelvic floor muscles during limb movements: a methodological electromyography study in parous women without lumbopelvic pain.” Clinical biomechanics 24.2 (2009): 183-189.