What's really going on down there?
Updated: Feb 2, 2018
In order to start exercising again post partum, it's really important to understand what's going on in your body during pregnancy, during delivery, and after. Now, everyone's experience is going to be different, depending on fitness and health going into pregnancy, any complications, variations of delivery, how many babies you've had, etc. However, we all share the same fundamental anatomy, and go through the same biological process of baby on the inside, to baby on the outside.
Let's start with the anatomy. Your pelvic floor is made up of several muscles, layered together to create a dynamic sort of "sling" at the base of your pelvis.
looking down from above: your pelvis and pelvic floor muscles
The pelvic floor opposes forces from gravity and internal organs. It also controls the emptying of your bladder and bowel. In a healthy person, the pelvic floor is able to respond to forces like walking, sneezing, coughing, jumping, running, and going to the bathroom all without a second thought. During pregnancy however, the demand of the pelvic floor to support weight increases daily as the baby grows. Additionally, hormones increase the laxity of all your ligaments and tendons in order to prepare the pelvis for childbirth, which essentially means everything is less stable because all the joints in your body are looser and the surrounding supportive structures are softer. This, in turn, increases the demand on your pelvic floor and surrounding pelvic musculature to maintain adequate support.
Then, after working harder than usual for 9 months+, your pelvic floor has to stretch out to allow a baby to pass through...whoa!
This is what happens in a normal healthy vaginal birth. But there are so many other things that can happen during birth...pushing for a long time, tearing, prolapse, vacuum assist, forceps assist, babies with large heads, twins (or more!), multiple childbirths, you get the idea. You can imagine then, your pelvic floor undergoes at minimum a small amount of trauma (to a large amount of trauma) during childbirth, after a potentially stressful 9 months of pregnancy. No wonder it doesn't always work that well afterwards!!
Let's talk about tissue healing. No matter what your childbirth experience was, your body needs to heal. Some will heal faster than others, and this depends on so many factors (a few which we just outlined above). Basically, after the initial event of giving birth, your body goes through a few days of inflammation, followed by a tissue repair phase called proliferation that lasts anywhere from days to several weeks. The final stage involves tissue remodeling, and this can take weeks to months.
I always tell my patients that it takes your body a minimum of 6-8 weeks to heal, and this is just to get you to a point where you are healthy, not necessarily back to higher level activities like running. Take a sprained ankle for example...a "medium" sprain might heal in a few days to a few weeks, but you wouldn't go from crutches to running right? Not if you were smart about it. People do in fact run on healing sprained ankles, sometimes they end up being fine, but sometimes they just take longer to heal because they aren't getting the rest they need, sometimes they just chronically hurt, and sometimes they don't get back to normal and can easily re-sprain.
Now think of your pelvic floor. You are 6 weeks post partum and cleared to start exercising again. You haven't exercised in weeks, you're sleep deprived, you probably aren't showering regularly, and you probably only have ~20min to get in some exercise. Running gets you a lot of "bang-for-your-buck," in terms of fitness, plus it might get you outdoors for some fresh air and away from the overwhelmingly beautiful chaos that is newborn mom life. But it's only been 6 weeks and you're likely barely wrapping up the tissue healing phase and moving into the beginning of the remodeling phase...meaning, those tissues are ready to support normal life and a gradual increase in exercise, but likely can't take high loading activities like running yet. So now, if you think back to that sprained ankle that is still sore but you're running on it anyways, it's the same thing as running too soon after childbirth, except that instead of having a sore ankle that takes longer to heal, symptoms manifest differently. It could be soreness or pain in the pelvic floor area, could be pain with intercourse or with toileting, or it could be pain free but you pee your pants during your run, or you can feel a prolapse. Maybe your cesarian scar hurts, or you start to develop low back and hip pain?!
What I'm saying, is that it's important to consider how your tissues are healing in order to determine when it's appropriate to start loading them up again. Your body needs time to adapt to the demands that we put on it, and if you gradually increase the stress on your body, it will gradually adapt. If you go past the adaptation zone, or start demanding activities you're not ready for, you could be in trouble.
This is where we can help! If you truly have a lingering issue, then you may need physical therapy or further medical care. If you just want some guidance, then it's a great idea to utilize a coach, a post partum specific class, or a group (like Mums On The Run USA!) to safely increase your fitness in a supportive environment.