Congrats! You've Been Cleared to Return to Exercise in the 4th Trimester

It’s been 6 weeks. Your check-up goes ‘well’ and you’ve been cleared to return to exercise. So you lace up your running shoes, head out the door (possibly pushing a stroller?) and go for your first run. 

For some, all may go well. For others (many, many others!), there may be symptoms. The focus of this blog is to discuss a few possible symptoms. What is normal and what isn’t? 

Peeing in your pants. Common, not normal. Pelvic PTs use a balloon model to describe the pressure system of the deep core (including your pelvic muscles). Please see our other videos and blogs on these details as this is SO IMPORTANT TO UNDERSTAND. Sometimes the muscles of the balloon cannot regulate pressure well and when this happens, that darn urine escapes the bladder. Knowing WHERE the problem is in the balloon is key to correcting urinary concerns. 

Urinary Urgency. Common, not normal. Sometimes with impact (running, jumping, etc) the bladder muscle gets irritated. This may increase your urgency or even cause urgency that leads to incontinence. It’s the feeling of “I have to go right now” and then you may or may not make it to the toilet in time. Sometimes this can even happen when there isn’t much urine in the bladder!

Pooping in your pants. Common, not normal. See the ‘peeing in your pants’ section and replace the word urine with poop and the word bladder for rectum and there you go. 

Heaviness or pressure low in the pelvis. Common, not normal. This may be a sign that the pressure system is off. It is the optimal pressure INSIDE the balloon that keeps pelvic organs supported and in the right place. If the pressure is off, pelvic organs may adjust their position in the pelvis. 

Difficulty keeping a tampon in. Common, not normal. If you are so fortunate to have your period return early on (like me at 6 weeks, ugh), then you may be returning to exercise and returning to menstruation at the same time. With impact activity and a poor pressure system, it may be difficult to keep the tampon in place and it requires constant re-positioning. One solution (either temporary or, if you like, more permanent) is the Flex. This is actually a disposable menstrual disc that stays in place better (based on my experience and those of my clients!) AND can be worn up to 12 hours. I have no affiliation AT ALL with Flex, other than I like the product. 

Pain. Common, not normal. A small clarification here. Muscle soreness? Sure. Low back, hip or pelvic pain? Not okay. You are just 6 weeks out from the marathon of delivery. A 2-3 day marathon for some. Plus, you still have hormonal influences throughout your entire body. Breastfeeding? Even more hormonal influences on your ligaments and joints. Decreased spine, core and pelvic control may cause pain when exercising.

So...if I have symptoms, what should I do? There are many options! 

  • Ignore them and hope they go away (not recommended)

  • Pretend Kegels can fix everything (also not recommended)

  • Give yourself ample time to heal and SLOWLY return to exercise (good advice)

  • See your Pelvic PT who will support your body specific to its unique needs (best advice)

As a pelvic PT, the advice is simple. New recommendations indicate that no person who has given birth should return to running prior to 3 months postpartum! Once you are cleared for exercise (at 6 weeks-ish), it may not be time to lace up those running shoes just yet. There is a graded and therapeutic approach to returning to impact activity. This starts with loading your deep core (including your pelvic muscles) gradually over a period of time. We need to retrain the muscles of the balloon to all communicate and coordinate in order to effectively attenuate pressure with impact! Think of it in Phases. In Phase 1, we chose loads that your body can currently tolerate (may be LOW loads) without symptoms (see list above!). Good, now Phase 2. All the way to the last Phase which is going out for that two to three mile run pushing the stroller up/down hill. 

As you can see, it is not as simple as just doing your kegels (you’ve heard this by now I am hoping??). The postpartum body is complex with lots of cogs interacting within the machine. A pelvic PT is the expert in helping you discover exactly which cogs need some love and support in order to optimize function and quality of life.  

All women’s bodies are unique. If you would like to talk about how the above relates to your specific condition, feel free to contact me on FB. If you'd like to read more, you can visit our blog here or our YouTube Channel here.