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Talking about the Core and Pelvic Floor- Out Loud (Part 1)

Pelvic floor? Core? 

You mean, “down there” and those six pack abs we see on Instagram?

Yes, I do mean “down there” and no, I don’t mean your six pack (well not entirely anyway!) Moms… It’s time to get to know your Core and Pelvic Floor, why they are important, and how we can start opening up the conversation about these often taboo subjects within our society.

Pelvic floor

We need to bring awareness to the pelvic floor and common yet not normal dysfunctions such as incontinence, pelvic organ prolapse, pelvic pain, and diastasis recti, so that we do not fear them. By speaking out loud about these issues we can become empowered in our strategies with how to effectively navigate the biggest challenges our bodies may ever go through.

Knowing the “Basics”

During my pregnancy, rarely did anyone tell me how my body would FUNCTION after having a baby. Throughout my birth classes we spoke about squats, breathing, and different birthing positions- ultimately everything that led up to the big day! I knew what a vagina was (FYI this is not the pelvic floor!), how big my cervix would get during delivery (the bagel image is haunting!), and remember hearing brief mentions of C-sections and episiotomies. Society, media, and courses often tell us to “listen to our bodies” but never exactly what to listen for.

No one I spoke with mentioned anything about recovery other than Kegels, sitz baths, and limiting stairs and/or driving after a C-section. I suppose I was naïve and should have sought out more information, but honestly I didn’t even know to look for more information. (How cool would it be to have not only a birth class but an are you ready for postpartum class!?)

I don’t remember hearing about:

  • The Pelvic Floor
  • Incontinence
  • Diastasis Recti/Umbilical hernias
  • Pelvic Organ Prolapse
  • Degrees of perineal tearing
  • Scar Massage
  • Pelvic Floor Physical Therapists

More than Kegels

After having my son, most conversations revolved around how he was doing and if I loved being a mom. In conversations about me, I heard phrases like: you’ll bounce back because you were ‘fit’ during pregnancy, a whispered “are you doing your Kegels”, and of course the “Wow! You look tired!” 

I had heard about Kegels for years prior to pregnancy and would pump them out from time to time, but I didn’t really know much more than I was supposed to do them. Did anyone ever tell us or show us how to do one and if we were doing them properly? I know from conversations with clients, friends, and physical therapists that many were not taught or given much more guidance than a piece of paper with some basic cues. 

Spoiler alert: I eventually found out that a Kegel marathon for my pelvic floor was something that wasn’t helping MY body and that the answer for healing incontinence often lies far beyond an isolated Kegel!

Discovery

One night, while feeding my first son, I remember sitting in bed Googling how to return to fitness after having a C-section, and that’s when I first saw the word: Diastasis Recti (DR).* There was a short article and a quick self-test which I immediately performed.

Hmmm… did I have it?

I laid down, crunched up and put my fingers in the middle of my abdomen. I was supposed to feel a gap with my fingers, the goal being to have as small a gap as possible, with anything over two fingers wide being indicative of DR.  It was about 4 fingers wide at and above my belly button. (FYI- width is not the only thing to assess when diagnosing DR- please get evaluated by a Women’s Health Physical Therapist!)

Cue all the fear, what did this mean?!

At my 7 week “all clear” check up, I asked my doctor and he did indeed confirm Diastasis Recti. However he promptly said this was normal and that it would heal. No additional follow up or referrals. No direction. It just was. I didn’t know to advocate for myself, to seek additional help and that this should only be considered the first step in our healing process during the “fourth” trimester. 

Becoming Educated

Grateful to receive the green light, I forgot about the article and immersed myself back into high intensity workouts, weightlifting, and ALL the things I loved, eager to get “my body back” and feel like me again. Only in the years that followed, I wasn’t the old me and I felt lost, confused, and alone. I leaked urine when I jumped, had an odd looking tent shape in my abdomen during movements like leg lifts and pullups, and dealt with low back, hip pain, and instability. I looked “fit” and “strong” playing the part as an active mom and athlete, however my body was telling me differently.

Photo used with permission from: Katie Baracella, PT, DPT of The Movement Ministry

“Coning with Diastasis Recti” Photo used with permission from: Katie Baracella, PT, DPT of The Movement Ministry

Tired of wearing black shorts and making “pee” jokes with my girlfriends every time we jumped, ran, or sneezed, I took action and began my education on the pelvic floor, core, why they matter, and why we NEED to talk about them. I’ve spent thousands of dollars and hundreds of hours in the last year learning more about how we can navigate these issues for women (and men) so that we don’t depend on Depends™ and so our kids don’t ask why we do jumping jacks differently than them!

Common not Normal

Repeat after me, we do not have to live with:

  • leaking urine
  • ongoing weakness throughout the core and back 
  • pelvic pain
  • painful sex
  • feeling like there is no help for pelvic organ prolapse
  • pain from C-section incisions or perineal tears

We do not have to live with these issues just because we are mothers. These are common issues for women, men, young, old, mothers or not- however, they are not normal and we shouldn’t be made to feel as if they are. We can REGAIN FUNCTION and HOPE.

We Need to Start Talking

  1. 1 in 4 women over the age of 18 experience episodes of leaking urine involuntarily. (2)
  2. 66% of women with Diastasis Recti have some level of pelvic floor dysfunction. (3) 
  3. The current estimate for Pelvic Organ Prolapse is approximately 27% for 30-49 year olds and 30% for 50-89 year olds (4) .
  4. Chronic pelvic pain affects approximately 1 in 7 women.  (5) 

Common Signs of Pelvic Floor and Core Dysfunction

  • Leaking of urine- any amount, even just a little bit some of the time!
  • Urine frequency or urgency
  • Pelvic pain, low back or hip pain
  • Weak core- with doming, coning of the midline (Linea Alba)
  • Constipation
  • Painful sex
  • Scar tissue adhesions from C-sections, episiotomies, or perineal tears
  • Heaviness, bulging, or a feeling of a tampon falling out of your vagina

(this list is not all encompassing, please contact a Women’s Health Physical Therapist or your Doctor)

Help and Hope

These issues are common, yet very few people know that there is help available to manage them with a team of professionals including Pelvic Floor Physical Therapists, Therapists/Counselors, and specialized Fitness Professionals. We don’t like to talk about the pelvic floor and our “private” problems out of embarrassment, shame, or fear that we might be the only ones. Therefore many women give up what they love while others may ignore symptoms and carry on as long as they can before seeking out help is unavoidable.

We all deserve better and the opportunity to thrive if we are experiencing these issues! One of my favorite quotes is from Brene Brown who writes, “Courage is contagious. Every time we choose courage, we make everyone around us a little better and the world a little braver.” Moms, let’s be brave, let’s talk out loud and make those around us feel a little better and a little stronger.

Brene Brown

“Courage”

Stay tuned for Part 2 where the Core and Pelvic Floor become not so private!

Additional Resources:

*(Diastasis Recti is a separation of the abdomen and thinning of the fascia between the sides. DR is estimated to occur nearly 100% of the time during pregnancy allowing bodies to expand and make room for baby- which is normal.¹ In most cases, the separation returns to “normal,” but in some, the DR may not functionally recover, potentially leading to issues such as weakness and instability. For more information click this link.)

1. Fernandes da Mota PG, Pascoal AGBA, Carita AIAD, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther. 2015 Feb 20(1):200–5. Link

2.  Incontinence Link and National Association for Incontinence- Facts and Statistics)

3.  Spitznagle et al 2007 https://www.ncbi.nlm.nih.gov/pubmed/16868659 

4. Luber K, Boero S, and Chloe J The Demographics of pelvic floor disorder: Current Observations and future projections. 2001; 1496-1503.

5. Mathias SD, Kupperman M, Liberman RF, et al. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet. Gynecol. 1996 Mar, 87(3):321-7.

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