The ideal exercise routine for postnatal incontinence

After childbirth, you may feel changes in yourself and your body, some more discrete and manageable than others. Adjusting to these can sometimes feel like they are stripping you away from doing the things you love like exercising – especially at a time when your life is going to be particularly busy!

One of the most notable changes in women is the loss of strength within the pelvic floor muscles, leading to postnatal incontinence. And we understand that this probably means you won’t want to hit up the treadmill at the gym anytime soon.

That’s why we teamed up with specialist pelvic floor physiotherapist Amanda Savage to discuss how you can defy leakage with an exercise routine, starting by focusing on your pelvic floor before gradually ramping things up.

If you are experiencing bladder or bowel leakage after giving birth (and this can happen after a Caesarean too), it is highly likely that this is because the pelvic floor muscles have been stretched and weakened from carrying the weight of your baby through your pregnancy. They may also have experienced some further injury during the delivery, sometimes you know because you have stitches, but sometimes you don’t even know they have been strained.

The pelvic floor muscles need to be exercised to rebuild their strength and tone in order to help keep the bladder and bowel tubes properly closed preventing leakage when you cough, sneeze or move fast, and to help you ‘hold on’ when you need to delay a bathroom visit! Your abdominal muscles will have been stretched too and these need exercising back to full strength so that you can use them to help lift the weight of the baby without pressure on your back or bladder.

However, in the very early days and first few weeks while your body is healing after the birth, don’t be frightened by the idea of having to do hundreds of pelvic floor exercises every day. The priority in the first few weeks is to get swelling down to make you feel more comfortable, encourage blood flow to the area and start reminding the muscles what to do.  

Simply stop every couple of hours, relax completely in a chair (or lying down), focus on the area around the bladder and bowel openings.  Release any tension, especially if you have felt sore or vulnerable.  You can’t work muscles that are tense.  Next, try to slowly ‘pulse’ the pelvic floor muscles, as best you can, thinking of promoting blood flow, loosening stiffness and making a brain-floor connection again.  Make this a part of your ritual of feeding the baby and you won’t forget!

As you are less sore, you can now move to the ‘exercise’ stage.  You will find a video as well as free downloadable leaflets including essential advice and exercises following childbirth written by physiotherapists from the charity POGP.  These have pictures of rest, changing and feeding positions, getting in and out of bed, and bowel emptying as well as specific advice for after a Caesarean.  There is also all the detail of how to do pelvic floor exercises as well as starting and progressing with abdominal exercises.

Aim to do your “fast" and “slow-holding” pelvic floor exercises for 10 repetitions each, properly, three times a day. After each feed, MOVE your body – especially your spine, with stretches like leaning sideways and arching backwards to counteract all the forward-ness of caring for little ones.  Once a day find just 10 minutes to really focus on connecting to your abdominals.

Foundation Pilates and yoga moves are perfect for getting started on reviving your core.  There are lots of postnatal resources for moms online to get you started.  Ideally also find a local postnatal class to keep you accountable and make sure someone is checking your technique.  

Watch out for abdominal ‘doming’ – if an exercise makes your tummy pooch, bulge or ‘peak’ it is too challenging for you at the moment – make that exercise the goal but use the level before to train to get there.

Great exercises to do at home are:

Bridging - start lying on your back with your knees bent, feet flat.  Draw in your abdominals and pelvic floor muscles, then lift your bottom in the air.  Try to hold steady, using your abdominals and bottom muscles (not your neck and shoulders) to keep the lifted position for 2-3 slow breaths.  Lower slowly.  Repeat 10 times.

Knee folds - same start position.  Draw in your abdominals and pelvic floor muscles, keep them working gently, now imagine balancing a glass of water on your tummy.  Keep the water absolutely still as you fold one knee up, over your hip.  

Then slowly put that foot back down where it came from, and without letting the imaginary glass move, change feet.  Imagine climbing a giant set of stairs - you need to move from one leg to the other keeping good abdominal and pelvic floor control. In real life think of this exercise every time you go up the stairs!

Double knee folds - when single leg folds get easy, increase the challenge by first bringing one leg up, keeping it there, and then bring the second leg up - this is surprisingly much harder!  Any sign of abdominal pooching stick with single knee folds a bit longer. 

Squats - fabulous for bottoms and if you “think core” as you do them you will activate your abdominal and pelvic floor muscles too.  Don’t worry too much about ‘form’ at this stage. Put your feet wherever is comfortable.  Deep or shallow to start.  Just get yourself moving, building up stamina and strength.  You can stretch your arms out ahead of you as you squat down for extra challenge.  Work for one minute without stopping.

Sit to stand - Up and down from a chair, but slowly so that you can feel the effort in your legs.  Again think abs and pelvic floor as you reach the top and control the lowering down.  Once you have good control you could hold your baby while you do them.  But same warning – tummy pooching, or pressure down on the bladder area is a sign you need to spend longer on the basic version first.

While you are waiting for your diligent exercising to pay off it can also help to add more support layers from the outside by choosing the right clothes! Wear proper supportive underwear with low/wide waist bands, or a feeding ‘vest’ with a tummy support panel.  If it is winter, thick tights!  Choose firm material: close-fitting pants, leggings or track suit that help make you conscious of your posture and holding your tummy in.

If you are feeling vulnerable to bladder leaks – don’t be put off getting out and about with your baby. It is really important that you have company, form friendships and are active outdoors.  You can use liners to give you confidence (but still work on your pelvic floor for a long-term solution).  Choose a liner designed for the purpose of catching & containing liquid, not the ones designed for periods.

Liners for bladder leakage use the technology developed for baby diapers, such as little gel beads that swell with liquid, and fabrics that can wick fluid away from the surface.  This means liners can be much slimmer than they used to be, keep dampness away from your skin and have good odor control too.

When you are ready to pick up the pace, most women want to focus on getting flatter firmer abdominals – but we need to be mindful of not putting too much pressure on the vulnerable bladder and pelvic floor area.

Always aim for slow, intense, controlled repetitions of abdominal exercises.  At the beginning of an exercise session, focus on core exercises where your goal is to keep your body still (using your transversus abdominis, obliques and pelvic floor muscles). Then move your legs or arms as the challenge; in Pilates/core work this would be leg stretches, hip twists, table top; at the gym use the free weights (start 1-2 kg each hand), lat pulls, ab and adduction, leg presses and anything squat/step-up related. 

Put upper abdominal and sit-up type exercises for rectus abdomens (like headlifts, mini-crunches and roll-ups) in the middle of the session (when the core is awake and working well but not yet tired) with a maximum of 20 slow, focused repetitions – watching like a hawk that there is no abdominal bulge –   you only need to lift your head and shoulders a few inches to feel the ‘six pack’ muscles working. 

Be careful on rowing machines – you need excellent technique to avoid bearing down on the pelvic floor.  Remember abdominal muscles need stretching too – finish your session with a Pilates/yoga cobra, lying on your front pushing up through your hands.

Remember that real life is full of opportunities for camouflaged exercise: nothing is as good for your bottom (gluteals!) as stairs, stroller pushing or chasing after a toddler on a scooter!  Use any excuse to play ball, run around and swim with children.  Use any glimpse in a mirror or window to think POSTURE!

Ask your postnatal exercise teacher or a knowledgeable friend to check your abdominal technique – or take a video selfie of you doing your exercises to spot bulging abdominals!  Keep moving up the levels of challenge for abdominals (towards pushups, planks and kettlebells for example) but pull back a level before for another few days if you can’t control the movement.

You should be able to run in place comfortably and walk fast for 30 minutes without bladder leakage or back pain before you restart a running program.  Go back to the beginning of a C25K program no matter where you left off, and you will quickly progress without the disappointment of an injury.

If doing your pelvic floor exercises by yourself is not solving a bladder or bowel leakage problem then you should definitely seek further help.  A specialist pelvic floor physiotherapist will internally examine your muscles to be really certain about their function.  They can correct any problems with pelvic alignment and advise you on options for your muscles.

Sometimes muscles are tight or in spasm and old scar tissue can be uncomfortable. If the pelvic floor muscles are very weak there are clever internal stimulation or biofeedback kits you can use to help your brain correctly locate the muscles.  Do contact your GP for a referral (or in many areas you can self-refer).

Research is showing that the rest of the mind is as important for our health, vitality, curing and prevention of disease, as the rest for our body. The brain is a big muscle which needs to work in harmony with our bodies. Especially on days where your body feels exhausted, harness the power of relaxation of the body and mind with some low-key yoga or Pilates stretches and a mindfulness track.  There are lots available online – if you have toddlers, choose one they can do with you and develop good habits early.

If you don’t think your pelvic floor is working properly, or you can’t work out what to do, ask your GP to refer you to a specialist physiotherapist for a proper vaginal assessment to check your muscles.

We hope these simple steps can help you regain your confidence through exercising! If you would like more information on staving off bladder weakness, check out the rest of our strengthening pelvic floor section. And why not try the TENA Pelvic Floor Fitness app to help you start your exercise journey? Get more info about it here.