There is a misconception that doing postpartum Kegels exercises is enough to ready the body for postpartum running. Unfortunately, these tiny contractions do not provide sufficient rehabilitation for many women—leading to injuries and dysfunction.
If you went to your 6 weeks postnatal check, got the green light, and hit the ground running with no pelvic floor rehabilitation—you are in good company. I did the same with no core or pelvic floor physical therapy or rehabilitation. I thought doing Kegel exercises postpartum was all I need to heal my pelvic floor and be ready for a high-impact sport like running.
Be sure to check out my COMPLETE postpartum running guide and FREE postpartum running plan here.
My experience with postpartum pelvic floor issues
Flash forward 7 years, and I am learning that the reason I have battled major injuries for the past 5 years is likely due to not properly rehabbing my pelvic floor and core postpartum.
I can’t blame myself. I didn’t know any better. Honestly, the field didn’t know any better. SO much is being learned—even as I write.
When I had my kids ten and seven years ago, there wasn’t much widespread education about pelvic health postpartum. And I certainly didn’t hear anything from my OB about it. I had a chiropractor who told me to do Kegel exercises postpartum. So, I did that—thinking I was ahead of the curve and doing enough.
After suffering three major injuries on my right side that have sadly sidelined me from running for most of the past 5 years (and also took away my shot of qualifying for the Olympic Trials marathon), I finally saw a pelvic floor physical therapist. (Well, I have seen two actually).
I’ve learned that I have diastasis recti (separation of the ab muscles which weakens the core) and hypertonic pelvic floor muscles (too tight), among other issues.
Related: My Experience with Pelvic Floor Physical Therapy
Pelvic Floor Physical Therapy is Advancing as You Read
I never had overt signs of pelvic floor dysfunction (see below). For this reason, I believed everything was okay. But I was wrong.
It is an injustice to women in the United States and other countries that do not provide proper postpartum rehabilitation. So much pain and suffering could be avoided if women were given postpartum pelvic floor physical therapy.
In an effort to help other women sidestep the setbacks I have encountered, I am doing what I can to spread the word about the importance of our pelvic health postpartum. I have written many articles about it, spoken about it, and urge the athletes I coach to seek pelvic floor PT—not matter how postpartum they are.
Related: Should I See a Pelvic Floor PT?
Indeed, I will not coach a runner postpartum who does not seek pelvic floor PT.
That said, this article aims to explain why doing regular Kegel exercises postpartum is not enough to rehab your floor and core. I consulted the expertise of Claire Coleman, AFAA, ACE, and NASM certified, who has helped dozens of women return to running postpartum. I also spoke with Dr. Carrie Pagliano, pelvic floor physical therapist.
Note: I am not a doctor though I did speak to one for this article. If you have concerns, see your health care provider.
Skip Ahead:
- My experience with postpartum pelvic floor issues
- Pelvic Floor Physical Therapy is Advancing as You Read
- What are Kegel exercises?
- What is your pelvic floor and core?
- The Pelvic Floor & Pregnancy
- How does pregnancy impact your pelvic floor?
- Why Kegels aren’t enough for postpartum running:
- What you should be doing instead of only Kegels postpartum:
So, let get going.
What are Kegel exercises?
Kegels are an exercise that requires the tightening, holding, and releasing of vaginal muscles. A lot of people use the metaphor of stopping the flow of urine mid-stream.
Postpartum Kegel exercises can help with:
- Urinary incontinence (urine leakage)
- Urinary urges
- Fecal incontinence (loss of bowel control)
- Pelvic organ prolapse (pelvic organs sagging or bulging into your vagina)
Related: How the Pros Return to Running Postpartum
What is your pelvic floor and core?
First, an anatomy lesson because many of us get it wrong:
A lot of people think of their core as the stomach muscles that make up the ‘six-pack’, and they generally think of the ‘muscles of the pelvic floor’ as where you push the baby out, but this is wrong, notes Coleman. “Those misconceptions in your anatomy lead to a lot of women not getting the assistance needed to fully understand postpartum recovery and what that looks like.”
Your pelvic floor is made up of pelvic muscles and connective tissues that support your internal organs in your pelvis such as your bladder, large intestine, small intestine, and reproductive organs.
These group of muscles work with your core to absorb outside pressure such as from running to protect your spine and organs. It also is essential for control your bowel and bladder function, and sexual function.
The “core” is made up of several muscles that wrap around your body like a corset, to support your spine and protect your organs. The main core muscles most impacted by pregnancy include:
- the rectus abdominus (the six pack abs),
- internal obliques,
- external obliques, and the transverse abdominus muscles.
Related: Is 6 Weeks Too Soon to Start Running After Having a Baby?
The Pelvic Floor & Pregnancy
How does pregnancy impact your pelvic floor?
During the process of growing a baby the central part of your rectus abdominus, a cartilage section called your Linea alba, softens and separates to allow your belly to grow and make room for the growing human inside of you.
As this is happening all your core muscles soften and move aside so that you can allow that baby to grow. If this didn’t happen the baby would be squished up inside, you even more than they already are and it would be uncomfortable for you both, notes Coleman.
Whether you have a vaginal delivery or cesarean birth, your core muscles have been through a stretching and loosening process and have endured trauma:
“I’ve heard lots of women tell me that since they had a c-section they don’t need pelvic floor therapy. Not true! Everyone who has carried a baby needs pelvic floor therapy, including women who had had a C-section!” says Coleman.
Related: Solutions for a Tight Pelvic Floor
Why Kegels aren’t enough for postpartum running:
Now, knowing that you have all these muscles that are affected by pregnancy, it can be easier to see why Kegels aren’t enough to rehabilitate the core and pelvic floor in mother runners. Unfortunately, these tiny pelvic floor contractions only work one very small muscle in a large series of muscles that are impacted by pregnancy (and childbirth).
“The days of pelvic health being just about the pelvic floor are long over. We do need to consider the pelvic floor in the context of the whole body, pressure systems, activity demands, genetics, ortho/neuro/gyn etc.” says Dr. Pagliano.
If the larger muscles aren’t supporting your anatomy, then this tiny little pelvic floor contraction is not going to make much of a difference. In fact, you could very well over work and over tighten that muscle to make things a little painful down there, warns Coleman.
“All actions of your body center on your trunk (core), so a weak and unsupportive core can lead to injuries in the extremities, like hip, knee, foot, shoulder, neck, etc.”
It all needs to heal postpartum. And that takes time.
Dr. Pagliano adds, “It’s also about changing the narrative from a strong floor to a floor that is coordinated, can respond to impact and unexpected demands, that is symptom-free and meets your activity demands. You can have a super strong floor and not have coordination and you’ll still leak on high impact exercises.”
Personally, this has been my experience. I am currently undergoing physical therapy to ensure my pelvic floor and deep abdominal muscles are coordinating well with my other muscles to ensure stability when running. Weakness is not my problem, but coordination is.
What you should be doing instead of only Kegels postpartum:
Don’t wait for obvious physical problems such as leakage, coning of the abs when doing core work, or pain in the pelvic area, lower back, or abdominal pain to see a pelvic floor PT.
If you have any sort of pain and have had a baby (even if it was 20 years ago), or are pregnant, find a pelvic floor PT now. (You can find one here).
Signs of a weak or uncoordinated pelvic floor and core could be less obvious. For example, all of my running injuries have been on my right side. Coleman says when her clients have this, she urges them to get their pelvic floor screened and 9 times out of 10, then have a weak or uncoordinated floor.
The body is complicated and therefore it needs stability through a range of motions, she adds—not just the obvious ones such as doing leg lowers.
There are many wonderful online resources to help you start your journey to pelvic floor rehab:
- Every Mother
- Get Strong Mom app
- The Full Bloom Method
- Exercise to reconnect breath to your core.
- Prenatal & Postnatal Strength Program with reCORE Fitness
- Carrie Pagliano’s 10-Step Postpartum Screen
However, for the best results, you should see an in-person pelvic floor therapist to give you an individualized and targeted approach.
Any time is the right time to see a pelvic floor PT. It’s not just for pregnant women, or the new mother fresh in the postpartum period. It is never too late (as I learned) and always a good idea to see one. It should be standard care postpartum, but until it is, we must advocate for ourselves!
Know you are not alone–but it is NOT normal to have leakage or pelvic pain!
If you want guidance with your running goals including running while pregnant or postpartum, check out my run coaching services. Also, be sure to check out my free training plans:
- Postpartum Training Plan
- After a Break Training Plan
- 5k Training Plans
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- Half Marathon Training Plans
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- Strength Training Plan