In the past several years, a lot has been learned and shared about pelvic floor health postpartum. Honestly, when I had my kids 8 and 5 years ago, I hadn’t heard much about the pelvic floor, and seeing a pelvic floor physical therapist wasn’t on my radar.
Even as more information comes out, questions still loom about the pelvic floor, when to safely return to running after having a baby, and when (or if) you should see a pelvic floor specialist.
I am here to answer these questions, with a lot of help of Dr. Hannah Poe, PT, DPT, pelvic floor physical therapist at Exhale Pelvic Health.
In this article, I will cover:
- What is the pelvic floor and why the pelvic floor is important for running
- What is a pelvic floor physical therapist, and what to expect at a visit with one
- Common pelvic floor issues postpartum and how they affect runners
- Who should see a pelvic floor therapist
- Preventative exercises new moms can take to strengthen the pelvic floor
So, let’s get going!
What is the pelvic floor?
Your pelvic floor is the group of muscles that form a sling at the bottom of your pelvic bowl, explains Poe. The pelvic floor is a very important part of your core and works in collaboration with your abdominal muscles. They hold up all the contents of your pelvis!
The pelvic floor:
- supports the bones in your pelvis,
- has an important role in your sexual function, and
- helps keep control of your pee and poop.
Why is the pelvic floor important for runners?
It’s important for runners to be aware of pelvic floor dysfunction because the pelvic floor muscles are involved in every step you take.
“Pelvic floor muscles are at the center of your pelvis which has to be able to move and stabilize you effectively to run efficiently and with good form,” says Poe.
Can pelvic floor dysfunction lead to running injuries?
Yes, pelvic floor muscles that are too weak or too tight can lead to running injuries in the hip, knee, groin, hamstring, and back.
This is because having a pelvic floor that is weak OR too tight will change the way your body moves.
Related: Running with Back Pain: Do or Don’t?
Why does the pelvic floor weaken during pregnancy?
Your pelvic floor experiences many changes during pregnancy and birth, Poe explains.
- Hormones: The hormonal changes during birth cause your muscles to relax, which impacts the structure of your pelvis and the function of your pelvic floor.
- Birth: Birth can cause more trauma, but people who have cesarean births aren’t immune to pelvic floor dysfunction either because of the changes that occur during pregnancy.
Related: Free Postpartum Running Plan
What is a pelvic floor physical therapist?
A pelvic floor physical therapist specializes in the function of the pelvic floor muscles. (By the way, a pelvic floor physical therapist is someone with the schooling and credentials to call themselves a pelvic floor PT. Pretty much anyone can call themselves a pelvic floor specialist, so it is better to look for a pelvic floor PT!)
They will be able to assess function or dysfunction and help you address any pelvic floor issues. They are like any physical therapist you might see for a running injury except their area of expertise lies in the pelvic floor!
How can I find a pelvic floor physical therapist?
There are several ways to find a pelvic floor specialist near you:
- Do a google search for someone local to you
- Ask other mothers or your OB
- Search databases such as: Pelvic Rehab, APTA Pelvic Health and Pelvic Guru
- Connect with one virtually like Dr. Hannah Poe or Dr. Carrie Pagliano (who has also provided information for mother runners here).
Does insurance cover pelvic floor specialists?
Most insurance plans should cover a visit to a pelvic health therapist. Obviously, call your insurance company and ask.
If your insurance doesn’t cover a pelvic floor therapist visit, the therapist may offer a flat rate for your visit. Be sure to ask them how they can help.
Related: How to Start Running Postpartum
How do physios check the pelvic floor?
When you see a pelvic floor physical therapist, you can expect:
- An interview: You will answer a lot of questions about your life including:
- medical and pregnancy history
- stress level
- sex life, and
- bathroom habits
- An assessment: They will perform an assessment of how your body moves, your posture, muscle strength, and coordination.
- An internal exam: A pelvic floor physio may do an internal pelvic floor exam in which they will insert a gloved finger into your rectum and/pr vagina to assess your pelvic floor muscles, including tenderness and how they can contract and relax.
The internal exam doesn’t always happen at the first visit, or at all. Poe says it’s different than the pelvic exam with the OB. “No speculum, no stirrups, and absolutely no pressure.”
If you are doing a virtual visit, then there is obviously no internal exam. The physical therapist can use the information for the rest of your assessment to guide your care.
How do you know if you need pelvic floor therapy?
The most common sign of pelvic floor dysfunction is incontinence or leaking urine.
“ANY incontinence is not normal!” says Poe. If you experience any leaking, you should see a pelvic floor specialist.
Below are signs of a weak pelvic floor or pelvic floor dysfunction. If you experience any of these symptoms, you should see a pelvic floor specialist:
- Urinary or fecal incontinence (leaking)
- Pain with sex
- Pelvic pain
- Pelvic pressure or heaviness
- Tampons that dislodge or fall out
- Urinating more often
- Reduced sensation in the vagina
- Pain when urinating or when it’s full
- A strong urge to urinate but not being able to empty the bladder
- Pressure/bulging in the vagina
- Diastasis recti, or separation of the ab muscles (which often goes hand in hand with pelvic floor dysfunction).
Should I see a pelvic floor physical therapist if I don’t have these symptoms?
Now that’s the million-dollar question, isn’t it? There are several different opinions on the right answer.
Here’s the real question: Why not see a pelvic floor physical therapist? Running demands a lot of your pelvic floor. In fact, your pelvic floor is used with every step.
Therefore, I recommend every mother runner after giving birth see a pelvic floor PT to help with the prevention of issues such as:
- long-term pelvic pain
- incontinence (leaking urine, stool, or gas)
- and even common running injuries that have root causes connected to the pelvic floor.
Indeed, research shows a healthy pelvic floor can lead to a better overall quality of life!
“You can return to fitness confident that you have the strength and coordination necessary to handle the stress you’re placing on your body, and decrease the risk of longer-term dysfunction,” says Poe. “I constantly have people who find me later postpartum who say ‘I wish I had known’ or ‘I wish someone had told me’.”
This is a personal choice and I, by no means, am trying to fear-monger. The way I see it if you’re able to prevent long-term issues with one or a few visits, why not?
When should I see a pelvic floor therapist?
The best prevention of pelvic floor issues is to see a pelvic floor PT during pregnancy and postpartum.
Ideally, you will see a pelvic floor specialist during pregnancy for specific prevention to suit your needs. Then, you will see a pelvic floor specialist soon after birth or before resuming running to reassess your pelvic floor needs.
How long does it take to strengthen the pelvic floor?
In most cases, it takes 4 to 6 weeks of consistently doing pelvic floor exercises to strengthen a weak pelvic floor or address pelvic floor issues.
Many pelvic floor exercises are done lying down and involve using your breath to
activate and relax the pelvic floor muscles. But your pelvic floor physical therapist will
also get you up and moving to make sure your pelvic floor is ready for the stress that it
encounters during your life and while exercising.
When is it too late to see a pelvic floor PT?
The good news is it is never too late to see a pelvic floor PT.
If you are having any of the issues mentioned such as leaking, pelvic pain, pelvic pressure, or running injuries related to the hips, knee, back, groin, or hamstrings, it’s worth seeing a pelvic floor PT.
It’s never too late to balance and strengthen your pelvic floor!
5 Ways to Prevent Pelvic Floor Issues
Unclench your jaw.
If you’re walking around holding tension in your jaw, you may be holding tension in your pelvic floor.
Don’t hold your breath.
Avoid holding your breath with straining, and practice breathing when you do something difficult like moving your body or lifting.
Exhale as you move.
Take a deep breath in and EXHALE as you move or lift. For example, exhale as you roll to get out of bed after birth, or exhale as you lift your baby from the crib.
Stop doing Kegels.
Signs of a weak or overactive pelvic floor can present the same. “Just because you’re experiencing pelvic floor symptoms doesn’t mean that your pelvic floor is weak. You may have too much tension in your pelvic floor or a ‘hypertonic’ pelvic floor,” says Poe.
Doing Kegels if your pelvic floor muscles are already contracted is not helpful.
Wait to run.
Yup, I saved the worst for last, because it is the least popular option for most new moms who just want to feel like themselves again, and RUN. While you may be cleared at your OB/GYN appointment at 6 weeks to run, your doctor does not assess your pelvic floor health like a pelvic PT can.
The latest research suggests waiting 12 weeks before resuming running. This is when your soft tissues and pelvis have returned more to their pre-pregnancy state.
“The most important thing that people returning to exercise after birth need to know is that waiting longer is better,” advises Poe. “Everyone wants to hear the quick solution to get back to running sooner, but the best choice is to just wait.”
How can you start running before 12 weeks? You may have guessed it: go see a pelvic floor specialist, regardless of having issues. They can tell you if your pelvic floor is ready for the impact of running.
When you get the all-clear, I would love to help you with your running goals. Many of my athletes are new moms returning to running after having babies.
Check out my run coaching services to learn more!