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Childbirth can have a profound effect on your abdomino-pelvic and pelvic floor muscles and can lead to separation of the abdominal muscles and incontinence. Statistics show that over 316,000 people in Australia experienced severe urinary incontinence in 2009.
The Pelvic Floor:
The pelvic floor muscles form a sling beneath your bladder, uterus and bowel and provide support to prevent the prolapse of those organs, while helping you to control bladder and bowel function. Exercises are aimed at strengthening these muscles to minimise the associated problems and should be commenced within twenty-four hours after childbirth and continued throughout life.
Exercise for Power:
The pelvic floor muscles are those that you would use to stop yourself from passing wind and to stop the flow of urine. Squeeze and lift these muscles as strongly and as quickly as you can. Don’t be surprised if you are not able to do this immediately after birth. It may take some time to elicit a response from your muscles. Do not hold on to the contractions but repeat them about ten times, resting for a few seconds between each one. Keep your thigh, stomach and bottom muscles relaxed while exercising and do not hold your breath!
Exercise for Endurance:
Later, after a week or more, you can begin to hold the contractions for a few seconds. Aim to build up to ten contractions held for ten seconds each, three times a day. These exercises can be performed in any position such as when you are breastfeeding, driving in the car or peeling vegetables in the kitchen. Make them a regular part of your day - for life.
Occasionally during pregnancy the rectus abdominis muscles, or 'six pack', may be stretched to such an extent that the connective tissue uniting them down the midline of your abdomen tears apart. A gap between the muscles will then be palpable and is known as 'diastasis recti'. This condition can contribute to weak core muscles, pelvic floor dysfunction and back and pelvic pain.
To test for the condition lie on your back with your knees bent up and feel along the midline for any gap. A one to two finger gap is considered normal. Gently lift your head off the bed. If you have severe diastasis recti a bulge will appear extending down the middle of your abdomen, usually around your 'belly button', between the left and right side muscles.
Small diastases may correct themselves spontaneously by about six weeks after giving birth. Simple exercises may be of benefit with the aim of retraining the action of various muscle layers of the abdominal wall such as the transverse abdominis and pelvic floor muscles. To engage your transverse abdominis muscle draw your belly button back towards your spine as you slowly exhale. Hold for ten to thirty seconds and repeat ten times. Do these exercises three times a day.
If you have a gap that is wider than four fingers you should consult a physiotherapist for assessment and a controlled exercise program. With good supervision and guidance the degree of separation can be substantially reduced within about six weeks. Care must be taken not to twist or rotate your pelvis or to strain your abdominal muscles. Avoid such exercise as sit-ups and straight leg lifts.
The illustration below shows the paired rectus abdominis muscles (in red) with the linea alba connecting them down the centre. (Adapted from an article by Jonathan Fitzgordon of Core Walking for Pain Relief.)