By Anna Scammell

Masters-trained Women’s Health Physiotherapist

Q. What can I do about my ab separation?

 So much! Firstly it’s important to understand what abdominal separation is – the stretching & weakening of the connective tissue (linea alba) between your rectus abdominis (6-pack) muscles that can occur during pregnancy, causing these muscles to move further apart. 

 There is no such thing as one miracle exercise that will heal this. It’s about committing to a combination of exercises & lifestyle changes during pregnancy & postpartum.

 The foundation to ab separation rehabilitation is learning how to correctly activate & isolate your transversus abdominis (deep abdominal muscles) and pelvic floor muscles. To learn this, you need to have a consult with a Women’s Health Physiotherapist who will use a Real-time Ultrasound machine to image your muscles & teach you this activation.

 From here, it’s really important that you start loading the abdominal wall & muscles in safe positions with correct alignment & technique. Postnatal Pilates 3 x week is a great way to do this, as Pilates focuses on core stability. While your abdominal separation is healing, I recommend avoiding advanced abdominal exercises, such as sit ups, crunches, planks, table top, double leg lowers, boat pose or anything else that causes strain in your abdominal muscles or gives you back pain. You can eventually progress to these ab exercises but it’s key to work on your foundational muscles in other positions first & progress to these exercises under the guidance of your Women’s Health Physio.

For more information on abdominal separation click here.

Q. Is it too late to fix my ab separation?

 Never!

 You can learn how to strengthen your core muscles (deep abdominal & pelvic floor muscles) & improve your ab separation no matter how many years postpartum you are. 

Every woman’s body & the amount of separation it experiences is different, so the severity of your separation (width & depth) may impact the extent of closure you achieve. 

 I strongly recommend you make it a priority to see a Women’s Health Physio & start safe strengthening ASAP!

Q. What exercises cause abdominal separation?

 Exercises per se don’t cause abdominal separation but they can make it worse. During pregnancy it’s important to start modifying the way you move to reduce strain through your abdomen i.e. avoid movements that causes doming or tenting of your tummy. Once your belly starts to pop, I recommend rolling onto your side to get out of bed rather than sitting straight up. Continue this into early postpartum as well. 

 In terms of exercises, I recommend avoiding advanced abdominal exercises (sit-ups, crunches, planks, double leg lowers) & high-impact exercise (anything involving running/jumping) once your belly has popped (commonly in the second trimester).

Q. Will my ab separation ever close fully?

 No – because they’re not meant to! Complete closure of your abdominal muscles is anatomically impossible so this is not the aim.

 The amount of separation that is classified as normal postnatal is <2.7cm at rest at the umbilical level. This is translated to approximately 2 fingers or less in width.

 The other thing to consider is the depth of the linea alba i.e. how deep the fingers sink into your midline tummy. We want to try to improve the thickness & depth of the linea alba, as well as the width. 

 Sometimes women can get fixated on the gap, but it’s important to consider the function of your abdomen. My aim as a practitioner is to get you back feeling strong again, restore function and doing the exercise you want to do, without any back pain. 

Q. What is the pelvic floor & what changes after you have a baby?

 The pelvic floor is made up of muscles, connective tissue, ligaments that run from your pelvic bone to your tailbone like a sling. It is an incredibly important structure because it:

·     Supports our internal organs (bladder, uterus & bowel)

·     Keeps us continent

·     Has a sexual function 

·     Provides core stability

·     Makes up the birth canal 

The changes that happen to your pelvic floor after birth are dependent on a number of factors such as – the strength of your muscles before birth, the birth preparation you did, the size of your baby, the length of second stage labour, whether you had forceps/suction, how many babies you’ve had, your genetics & what you looked after yourself postpartum.

 In saying this, pelvic floor weakness is common after birth with 1 in 2 women experiencing a prolapse and 1 in 3 experiencing bladder leakage. This is why doing everything you can to help prevent pelvic floor weakness during pregnancy & postpartum is pivotal.

Q. Can you start working on pelvic floor & possible ab separation during pregnancy?

 You bet! Pregnancy is the time to make pelvic floor exercises a priority to help reduce your risk of prolapse & incontinence. The key is doing your pelvic floor exercises correctly, which is why I always recommend an internal assessment with a Women’s Health Physio after the first trimester.

As I mentioned above, there is also a lot you can do to help minimise abdominal separation during pregnancy. 

 To learn how to optimise your pregnancy for birth & recovery, check out my online pregnancy program – The Pregnancy Academy. Use the code BRITTANY to get a 50% discount! 

Q. What are basic pelvic floor exercises to repair weak muscles?

You need to do 2 types of pelvic floor exercises every day:

1.    Slow: Lift your pelvic floor, hold for your endurance (between 1-10 seconds), release completely, repeat 10 times, 3 x day (each in a different position – lying, sitting, standing)

2.     Fast: Lift your pelvic floor, release straight away, repeat 10 times, 3 x day (as above)

To learn how to correctly contract your pelvic floor, you can grab my FREE Pelvic Floor Guide here.

Q. What is the best preparation for a healthy pelvic floor before birth?

·     Have an internal assessment with a Women’s Health Physio in your second/third trimester to check if your pelvic floor muscles are overactive (too tight). This is important to ascertain as early as possible so you have time to work with your Physio to reduce the tightness with the aim of having a successful vaginal birth.

·     Make sure you completely relax your pelvic floor after every contraction.

·     Learn diaphragmatic breathing (belly breathing) & do this daily from around 34-35 weeks. Click hereto learn how.

·     Use a device called the epi-no from 36 weeks to stretch the perineal muscles in preparation for birth. Alternatively you can do perineal massage yourself.

·     Learn how to “push” correctly during labour using the coffee plunger technique. This refers to taking a deep expansive breath into your belly & then forcing the breath out using your upper abdominal muscles rather than straining your pelvic floor. The idea is to push from your baby’s bottom rather than your bottom.

Q. When to start pelvic floor exercises post-birth?

 Day 1 post-birth! Start with 4-5 gentle pelvic floor contractions per day & slowly build this up to the slow & fast contractions I describe above. 

I believe starting safe core exercises in the first 6 weeks postpartum is key to optimising your recovery & feeling stronger faster. That’s why I created this E-book: Early Postpartum Exercises.Use the code BRITTANY to get a 20% discount.

Q. How do I know if I have a prolapse?

 Prolapse symptoms include vaginal heaviness or dragging sensation, feeling like a tampon is lodged incorrectly, or a lump or bulge when you wipe yourself. Some mild prolapses can be asymptomatic.

 To determine the type & severity of prolapse, you need an internal assessment with a Women’s Health Physio.

Q. What exercise can I do with a prolapse?

 Appropriate exercise for women with prolapse depends on the severity of their prolapse & symptoms, which is determined in a 1:1 assessment with a Women’s Health Physio. 

However there are some common principles that apply:

·     Stick to low-impact exercise e.g. walking, swimming, cycling. 

·     Exercise within your limits without it bringing on your symptoms e.g. stick to a 30-minute walk if 45 minutes bring on your symptoms.

·     Avoid high-impact exercise (e.g. running, jumping) & heavy weights while you’re strengthening your pelvic floor.

·     Do daily core activation exercises (deep abdominal & pelvic floor exercises)

·     Do Pilates or light strength training (light weights, resistance bands) 3 times per week.

·     Avoid exercises that increase intra-abdominal pressure (e.g. sit-ups, planks, double leg lowers) while you’re strengthening your pelvic floor.

·     Avoid low squats, weighted squats or excessive squats.

For more information on prolapse, click here to read my blog.

Q. Can I have another vaginal birth with a prolapse?

If you have a mild prolapse (stage 1 or 2), it’s very likely that you will have another successful vaginal birth. Subsequent births are often quicker/easier because the body has done it before. However, this is a decision that needs to be made with input from your healthcare provider & Women’s Health Physio, taking into consideration the severity of your prolapse & your personal preferences.

 It’s essential that between subsequent pregnancies/births, you do your pelvic floor exercises diligently & all the other prolapse management I mention in my blog to improve your pelvic floor strength & the position of the prolapse as best as you can before the next birth.

Q. Can intercourse worsen a weak pelvic floor?

 No – intercourse is safe to do with a weak pelvic floor. The sensation you feel (or your partner feels) may not feel as strong as it did previously.

 Intercourse is actually a good time to do some pelvic floor contractions. This can help to improve your sensation & help elicit an orgasm!

Q. Why do I leak if I have tight pelvic floor muscles?

 Because tight pelvic floor muscles do not equal strong pelvic floor muscles! When we cough, sneeze or jump, our pelvic floor muscles are meant to contract subconsciously in response to the increased intra-abdominal pressure. This happens to support our urethra & bladder and prevent leakage. However if your muscles are tight, they are already in a contracted/tense position so can’t then contract to support the bladder when you need it. This can result in leakage. 

 To work properly, the pelvic floor muscles need to be completely relaxed & have no tension/tightness. When the muscles are in their resting position, they can contract to their full potential & stop us from leaking.

Q. What do I do if my pelvic floor is too tight?

 You need to re-train your muscles & re-learn where “off” is. Your brain-muscle connection currently thinks “on” is “off” – if that makes sense! So we need to teach the muscles to completely relax & get them used to being in this rested position all the time. This takes time & practise. 

 A great technique to achieve pelvic floor relaxation is diaphragmatic breathing because your diaphragm & pelvic floor work together, so when your diaphragm descends your pelvic floor relaxes too. To learn diaphragmatic breathing click here.

It’s really important that you completely let go of your pelvic floor muscles after a contraction. Your Women’s Health Physio will guide you through this via an internal assessment.

Your pelvic floor may also have tension, trigger points or scar tissue (post-stitches) contributing to the tightness. Your Women’s Health Physio will help to release this tension and can teach you how to do this yourself at home.

Another good technique to do is called bodyscanning. This is where you bring your awareness to your body throughout the day & notice if you are holding tension in your stomach, bum & pelvic floor. Take several breaths into your belly & focus on relaxing your muscles. Do this several times throughout the day.

 Last but not least, stress is a huge contributor to pelvic floor overactivity. Just like we can hold tension in our shoulders in response to stress, we can also hold tension in our pelvic floor without realising. So it’s really important that you try to reduce your stress levels – ideas are to organize some alone time (away from kids!), have a epsom salt bath, book a massage, go for a walk, read a book or meditate.

Q. I’m too embarrassed to see anyone for my leakage!

 I understand how hard & embarrassing this issue can be, but please know that there is so much you can do to treat it! I have helped 1000’s of women resolve their bladder leakage & be completely dry. I know you can achieve this too! 

Take the first step by finding a reputable Women’s Health Physio in your area who can support you through this journey. We talk to women every day about pelvic floor issues so it’s nothing to be embarrassed about in our eyes.

 About Anna:

Anna Scammell is a Masters-trained Women’s Health & Pelvic Floor Physiotherapist in Sydney, and Founder of The Whole Mother. Anna specialises in pregnancy, postpartum & the pelvic floor, offering women home visits, clinic consults and online consults. She is also the Founder of The Pregnancy Academy– an online educational & exercise program to teach women how to have a stronger, healthier pregnancy, smoother birth and faster postpartum recovery. Anna combines her 12+ years of clinical experienceand evidence based knowledgeto educate and empower women around the world.

Connect with Anna:

Email: anna@thewholemother.com

Website: www.thewholemother.com

Social: @the.whole.mother

Online Pregnancy Program: www.thepregnancyacademy.com.au