• How does returning to sport or exercise too soon after the birth affect my pelvic floor muscles?
• Jondelle's story - about developing a prolapse and incontinence after the birth of her baby, following returning to sport too soon.
• What about my back - can exercising too soon after the birth cause back pain?
• Ciara's story - about developing back pain after returning to running too soon after the birth
• Returning to sport - how to do it right!
• Other factors to consider when going back to exercise after the birth

How does returning to sport or exercise too soon after the birth affect my pelvic floor muscles?

Have you heard of the "Boat Theory"? This is one way to help you think about the role of the pelvic floor muscles in supporting your pelvic organs.

Imagine that your pelvic floor is the water level, while your pelvic organs (your uterus, bladder and bowel) are the boat sitting on top of the water. The 'boat' is attached by ropes (your supportive ligaments) to the jetty. Now if the 'water level' i.e.your pelvic floor muscles is normal, there is no tension on the ropes.

After pregnancy and the birth of your baby, your pelvic floor muscles can be stretched, so the 'water level' is lower. Imagine if the 'water level' stayed low for years. If your pelvic floor muscles do not strengthen up again, by you doing your exercises, then there is much more tension on the 'ropes' or your supportive ligaments. If this continues, then the ligaments can overstretch and weaken, and there is more risk of you developing a prolapse. This may occur soon after the birth, or in the years to come.

If your pelvic floor muscles strengthen back up again, then there will be no ongoing tension on the ligaments supporting your pelvic organs, and therefore less risk of developing a prolapse in the future. See What is a prolapse?

Imagine however what would happen if you added jumping, running or bouncing type of activities to a pelvic floor that was still stretched. This could further weaken your muscles and place extra tension on the supporting ligaments so they are more likely to become overstretched and weakened. This can result in your pelvic organs dropping down, as there is less support for them from above and below, and a prolapse occurring.

So you may feel fine on the outside, but be unable to see what is occurring on the inside. This is why some women may not notice a prolapse occurring until they return again to exercise, unaware that there is the risk of this happening. This is what happened to Jondelle (not her real name). Read below her story, and compare the difference with her experiences after her first and second babies.

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Jondelle's story (used with permission)

After the birth of her first baby, Jondelle (not her real name) returned to A grade sport after only 5 weeks. Jondelle had no problems day to day with her pelvic floor muscles or bladder control. Although she always went to the toilet before a game, she experienced a small amount of urine leakage while playing, and felt damp in her underwear after a game so she needed to wear pads while she played. Then she developed a bulging down below, and found out that the front wall of her vagina, which supports the bladder, had dropped down. This was called a bladder prolapse.

Jondelle went to see the Physiotherapist when her baby was 8 months old, who advised her that because her pelvic floor muscles were still weak, she should consider stopping playing sport to allow them to recover from the birth. When Jondelle coughed, her pelvic floor dropped considerably, and the bladder prolapse increased. This indicates that any time any downwards pressure occurs on her pelvic floor muscles, then this could be happening. This may include during a cough, sneeze, while lifting her baby or anything heavier than her baby, while pushing a full shopping trolley and certainly with any bouncing or running type of activities.

Jondelle's pelvic floor exercise program included trying to work the muscles together with a cough, to aim to reduce the amount of every day pressure on the pelvic floor muscles, otherwise the prolapse would just continue to worsen over time. This took a lot of concentration, and she needed to work with the Physiotherapist to learn to do this correctly. You can try to tighten your pelvic floor muscles during these daily activities to protect them from dropping down, but if you have any difficulties doing this, or are unsure if you are doing it correctly, please seek the advice of a Physiotherapist working in the area of Women's Health.

Jondelle also needed to work on her pelvic floor muscles with exercises to strengthen them. Like Alicia (see Alicia's Story, "I thought prolapses only happened to women when they got older, but I heard that younger women can get them too. Is this true?), Jondelle had not done her exercises regularly during her pregnancy, not thinking that they would affect her this way after the birth because they had weakened. Even when she returned to try sport again after her baby was 15 months old, she still experienced some leakage and felt heavy after the game in the pelvic floor area. So the effects of early return to sport can be long lasting. Jondelle needed to put a lot of work into getting her pelvic floor muscles strong again. The prolapse reduced as she did her exercises and took care with her daily and sporting activities.

During Jondelle's second pregnancy she did her pelvic floor muscle exercises diligently. She went back to the gym after 3 weeks, but did not return to sport or running. She had been focusing on using her pelvic floor muscles during the day, and also on bracing her abdominal muscles. This time she experienced no urine leakage and had not noticed a bulge in the vaginal area.

When her second baby was 7 months old, Jondelle saw her Physiotherapist for another check. Her pelvic floor muscles were still continuing to improve, and there was only a small drop of her vaginal wall when she did cough. This was much less severe than after her previous pregnancy.

Being far more aware this time around, and taking more care of her pelvic floor muscles during pregnancy, means that Jondelle didn't experience the urine leakage and prolapse like she did after her first pregnancy. Although she needed to compromise and use the gym for exercise instead of playing sport straight away, she was glad that she made this decision. She will now have a stronger pelvic floor now for years to come, after taking the time to work her pelvic floor before and after the birth.

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What about my back - can exercising too soon after the birth cause back pain?

After the birth of your baby, no matter how fit or toned you are, it takes a MINIMUM of 8 weeks before your stomach muscles are toned enough to support your lower back and pelvis. This means that if you go back too soon to running, sport or higher impact exercise then there is a lot more movement in your lower back than there should be. There is no way that your abdominal muscles can go from being really stretched during pregnancy (think of how long they are at the end of your pregnancy), to being shortened and firm enough to provide the support they used to for your back and pelvis.

If you watch people walking or running, you will notice that some people's backs don't move a lot at all, whereas in others their back and pelvis really wobbles from side to side. This can be the case in those first few months after the birth, where your spine is not as stable as it usually is. If you add impact or running type of activities to this, then there is a lot more strain going through your spine and pelvis than there should be. Combine this with the effects of the hormone relaxin affecting the ligaments in your body for up to 3 - 4 months after the birth, and there is more chance that could injure your back.

The post natal abdominal bracing tests and exercises that are in the booklet As Your Shape Changes, are designed to improve the strength and tone in your lower abdominals, and to improve the support that your abdominals give to your lower back and pelvis. When you miss these stages of exercises out, you may be left with an underlying weakness in the deeper abdominal muscles which help to support your lower back.

When you return to sport, even if you do wait until 3 - 4 months, then you may still find yourself with a lower back injury at some stage. The other thing at this time is that when you have a new baby to look after, your back needs to be strong now and for the future. You are doing more activities which can potentially place strain on your back, so your back is more vulnerable. For this added reason, use the exercises in As Your Shape Changes, even if you do not plan to go back to higher impact exercise right now or at all.

When you consider that waiting a few more weeks or months could save you from having problems in the future, it is worth the wait. Have a read of Ciara's story and see an example of what going back too soon can do.

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Ciara's story (used with permission)

Over 10 years ago, Ciara (not her real name) had her first baby. She enjoyed exercising and how good it made her feel. She was in the habit of exercising before the birth, so she was looking forward to getting back into it after her baby was born.

Back then there was not a lot of information about returning back to sport or exercise safely after having a baby. Ciara had never suffered an injury before, so she thought that she would be OK. She never considered what might follow.

Ciara was playing tennis 6 weeks after the birth. She took a shot, and put her back out, being bent over with the pain for weeks to follow. She remembers having to cope with carrying and changing her new baby with back pain, and how hard this was. It took quite a few weeks for the pain to go away, with Physiotherapy treatment needed to help it subside.

A few years later, Ciara had her second baby. Again keen to start exercise, she contacted a Physiotherapist for advice, asking "Will I be able to start running again now that my baby is 5 weeks old?" She was advised that as long as she felt OK, there should be no problem, as there wasn't a lot of other information around at the time regarding this.

Ciara started exercising at the gym and running 5 weeks after the birth. As she started to work harder and push herself more, her back started to hurt. She was used to pushing herself with exercise however in the past, so she continued to run even when her back hurt, for about a year.

As her pain increased however, she eventually had to stop running and have more Physiotherapy treatment. The unfortunate thing was that in the end, it took quite some time for her back to settle down, and she needed to take 2 years off running.

After this, Ciara was able to resume running, but has had several less episodes of back pain since then.

NOTE: Ciara had taken the time to ask advice, however the information available at the time was limited. There are now new guidelines called Considerations for pregnancy and post natal exercise which should be followed when returning to sport or exercise.

It is also important to get the correct advice that you should see or ask a health or fitness professional with interest or experience in the area that you are asking them about.

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Returning to sport - how to do it right!

It is important to remember that no matter how fit you are on the outside, it is your pelvic floor and back that you are trying to protect. By going back to sport or exercise before these areas have recovered back to normal after the birth, you can cause problems to develop either now or later in life. These could include prolapse, leakage of urine or back pain.

Erica was lucky. Some new guidelines had been developed by the Physiotherapist she was seeing for advice on returning to sport after having a baby. Talk about timing it right, as they had not been available before this.

Erica was a triathlete, so was keen to get back into training, but to do it safely and wisely, as she had heard about how people could experience problems after if they did go back too soon. Having swum regularly during her pregnancy, she still felt 'swimming fit'. She had been swimming at least three times a week, between one and a half and two kilometres a time, including drills, sprints and kicking. She had avoided a lot of breast stroke, mainly preferring freestyle, so had placed no strain on her lower back or pelvis by doing this. She had also stopped butterfly early in her pregnancy because it hurt her tummy too much.

Once her bleeding stopped, Erica was again able to return to the pool, which of course places no strain on the pelvic floor muscles or back. Once she was comfortable after the birth, she also started cycling again. Cycling again places no strain on the pelvic floor muscles, although your abdominals do need to strengthen to support your lower back, before you start heavier training eg hills. This can take a few months after the birth, but should occur as you do your bracing exercises recommended for after the birth in As Your Shape Changes. At the same time your fitness level should be improving again, so the two should coincide together several months after the birth.

It was running that Erica took the most care with. She was aware of the boat theory, and that the effects of the hormone relaxin took up to 3 to 4 months to leave the body. She also knew that it was important for her abdominal muscles to get firmer and stronger again before she started running. The guidelines she followed were Considerations for Pregnancy and Post Natal Exercise, which come with the booklet As Your Shape Changes. They recommend that you test your abdominal and pelvic floor muscles (as outlined in As Your Shape Changes) before returning to running, sport or higher impact exercise not before 12 - 16 weeks. Erica also used the tests and abdominal exercises in As Your Shape Changes before attempting running. She found that these and other similar post natal bracing exercises toned her abdominal muscles really well, particularly as she did them regularly, even with her baby on the floor next to her.

Erica went for a light run to test it out around 8 weeks, but she actually could feel her pelvic floor muscles 'bouncing' while she was running. So she waited until 13 weeks before trying again. Her pelvic floor muscles felt fine when running slowly on flat ground. As her running fitness increased and Erica started to run hills around 6 months after the birth, then she again felt her pelvic floor muscles not feeling as strong as they used to be. After 8 - 9 months she could run hills and run hard, with no problem or feeling of any weakness in her pelvic floor muscles.

It is normal for women who really enjoy exercise to want to get back into it soon after the birth. This is a good thing. Exercise brings many benefits, and also provides the opportunity for some time for yourself while someone else looks after your baby, which can be a welcome break. Women also want to exercise as they may feel flabby and not toned. But it is important to consider what type of exercise you do initially, and how quickly you go back to higher impact exercise, sport and running.

Use the guidelines in Considerations for Pregnancy and Post Natal Exercise and As Your Shape Changes to help you make the right decisions about your exercise choices. Also consider alternatives if you enjoy running, such as water running with a buoyancy belt. This can be hard work pushing against the water, and can be done with no impact on your pelvic floor or lower back. Other low impact activities which are safer choices include swimming, walking, walking on a treadmill with hand weights or a small incline, cycling and low impact aerobic or post natal exercise classes.

You can return to your previous activity levels after 16 weeks, providing that your pelvic floor muscles are back to normal. If you are pregnant, now is the time to test and record your 'normal' pelvic floor fitness in your booklet, so you have a 'normal' to aim for after the birth.

If you do feel any vaginal heaviness, urine loss or back pain during or after exercise, you should slow down or reduce your intensity level, and wait a bit longer. You should also seek further advice or treatment from a Physiotherapist working in the area of Women's Health if any problems persist.

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Other factors to consider when going back to exercise after the birth

Often women can be tired in the first months after having a baby. This can be due to interrupted sleep, the extra demands of motherhood and also breastfeeding. There is the chance that due to fatigue, you are more likely to become injured if you push yourself too much during exercise. It is important to listen to your body and how you are feeling. Be aware of any 'warning signs' of pain or discomfort and take care, slowing down if necessary to let them subside, rather than pushing through at this time.

While you are learning to breast feed (if you breast feed) and look after your baby, you may not have the desire to exercise in the first few weeks or months. During this time you can still be strengthening your abdominal and pelvic floor muscles in preparation for when you do feel ready to return to exercise. You may still find that walking is an exercise that will get you out of the house, and one that you can do with your baby and maybe your partner or a friend.