Hayley O'Hara 9/21/23 Hayley O'Hara 9/21/23

If you’re doing Kegels for pelvic floor recovery after birth, you could be causing pain with sex — here’s why.

When we think of pelvic floor (PF) training, Kegel exercises are commonly the first thing that comes to mind; however, these exercises make up only a small portion of the rehabilitation process for the pelvic floor muscles after birth.

During birth, the pelvic floor muscles are stretched quite significantly to accommodate for the baby passing through. It naturally takes several weeks after this event for the pelvic floor muscles to regain their contractile abilities again. This normally happens gradually and doesn’t require specific training.

We use our pelvic floor muscles to control our bowel and bladder, to support our pelvic organs (uterus, rectum, bladder), and we use these muscles during sex. These are some pretty important functions and so it's natural to see decreased function in these areas during this recovery period after birth. This can present as:

Urinary leakage
Pelvic pressure
Decreased sensation
Decreased connection with your pelvic floor

This is a vulnerable time for your pelvic organs. They are lacking support from the pelvic floor and are susceptible to uncontrolled pressures from lack of core coordination with our muscles of breathing.

This contributes to higher incidences of pelvic organ prolapse (POP) after childbirth — when the rectum, uterus, and/or bladder prolapses through the wall of the vagina. The main symptom of POP is a bulging sensation around the wall of the vagina and/or vulva. This may be accompanied by urinary leakage and/or abnormal bowel movements, but these symptoms naturally occur after birth due to the temporary loss in contractile function of the pelvic floor and so it is important to establish whether POP is present and whether you are susceptible to POP during your postpartum Pelvic Floor Physiotherapy check-up.

After the muscles start to regain their contractile abilities, things may not be restored to normal. The pelvic floor may not:

Contract in sync with our breathing the way we need it to (lack of coordination)
Contract strongly enough (lack of strength)
Contract fast enough (lack of speed)
Contract long enough (lack of endurance)
Maintain normal muscle tone
Maintain the same neuromuscular connections — eg. you might experience difficulty voluntarily contracting them and a loss of awareness of how to connect with and contract these muscles

If you start doing Kegels and only do Kegels to strengthen your pelvic floor after birth (especially when they are done incorrectly), you could wind up with high tone or shortened pelvic floor muscles that continue to have difficulty contracting and maintain the same loss of functions above. In addition, you could be presenting with POP or birth-related pelvic floor injuries that require specialized treatment through Pelvic Floor Physiotherapy.

Working on the coordination, lengthening, endurance, timing, and awareness of these muscles is equally as important as working on strength. If this is neglected during the first 6 weeks after birth, you may end up experiencing pain and/or a loss of sensation during intercourse despite being cleared to have sex by your healthcare provider. This can actually worsen over time as neural pain pathways become stronger in association with sex.

Sex doesn't have to be uncomfortable after birth. Make your experience a positive one by seeing a Pelvic Floor Physiotherapist & try my online Heal with Hayley postnatal program for pelvic floor and core training after birth. Read more below!

I encourage you to see your Pelvic Health Physiotherapist after birth and seek out programs that prioritize core and pelvic floor recovery. I created Heal with Hayley, my online postnatal recovery program, for this exact purpose because I could not find a program that combined fitness with recovery in this way.

Send an email to hayley@pelvicgoddess.ca if you have questions about recovery after birth. Both 2 month and 4 month options for the program are available depending on your unique postnatal recovery needs ✨

Hayley O'Hara 9/14/23 Hayley O'Hara 9/14/23

Four Common Postpartum Exercise Mistakes to Avoid

Postpartum recovery isn't straightforward or one-size-fits-all. It's more than just avoiding certain exercises. You have to do what is right for your unique recovery needs. Here are the most common mistakes new mothers make when returning to exercise after birth that often lead to injury and worsening of conditions like urinary incontinence, diastasis recti, and pelvic organ prolapse.

Starting too soon

One of the most common mistakes is beginning exercise too soon after childbirth. Wait until you receive clearance from your healthcare provider, which typically occurs around 6-8 weeks postpartum. Even with this clearance, it doesn’t mean that you should start high intensity exercise and running - for these activities it is recommended to wait at least 3 months after birth. However, you can typically get started on your pelvic floor and core recovery right away! The first step is to see your Pelvic Floor Physiotherapist for exercises that are specific to your recovery needs and fitness goals.

2. Ignoring pelvic floor health

Strengthening the pelvic floor muscles is essential for preventing issues like urinary incontinence, pelvic organ prolapse, and diastasis recti. Doing Kegel exercises correctly and consistently is even more important. Schedule an appointment with your Pelvic Floor Physiotherapist after birth before jumping into exercise again.

3. Not modifying your exercises

Focusing on fitness instead of health and recovery will make you prone to injury and set you back. Modified doesn’t mean easy. Changing your workout style to adapt to your unique recovery will give you better results long-term. Always listen to what your body needs, including active rest days 2-3x/week.

Neglecting your deep core

Focusing only on outer abdominal exercises like sit-ups or crunches can place too much strain on the linea alba too soon and cause or worsen diastasis recti (separation of the abdominal muscles). Instead, prioritize exercises that allow you to fully engage your deep transverse abdominis, eg. pelvic tilts.