Perinatal Blog
what to know about Gestational Diabetes
Many times, you can do everything “right” and still be diagnosed with gestational diabetes. it is not you. It is your placenta. This is a place you can refer to for education around what is happening in your body and what to expect.
What is happening to my pelvic floor?
Gestational Diabetes is defined as diabetes diagnosed in the second or third trimester of pregnancy and is associated with pelvic floor dysfunction. Gestational diabetes is primarily caused by the placenta, which produces hormones that can interfere with the function of insulin and lead to elevated blood sugar levels.
Gestational diabetes can negatively affect the rectus abdominis muscle, causing changes in its structure and function which can lead to a higher risk of developing diastasis recti postpartum and potentially contribute to incontinence. Essentially, the muscle becomes weaker and less efficient.
Hyperglycemia from diabetes has been shown to alter collagen synthesis in the body which reduces the elasticity and strength of pelvic floor tissues. This can lead to the descent of pelvic organs and an increased risk of prolapse.
What can I do to Manage Gestational diabetes?
Exercise!
Getting the body moving can be the best thng to do to help manage high blood sugar. when you exercise, the body increases blood flow which allows for better absorption of glucose in your blood.
Pelvic Organ Prolapse: What is it and what can you do?
A common postpartum dysfunction that many women face is pelvic organ prolapse. What is it, how can you prevent it, and how can it be managed?
What is Pelvic Organ Prolapse?
Pelvic organ prolapse occurs when the pelvic organs such as the bladder, uterus, and rectum, slip down from their normal position and push against a collapsed aspect of the vaginal wall. Symptoms such as discomfort, pressure and incontinence can occur.
In proper functioning anatomy, the pelvic floor muscles and ligaments hold the organs in place. During pregnancy, the pelvic floor is constantly under pressure from things like gravity, internal pressure, and the weight of the growing baby. During labor, these muscles stretch and move to accommodate the baby, which can cause strain and injury if there is trauma or tearing. During pregnancy, the body also produces a hormone called relaxin which increases the elasticity of these tissues to prepare the body to give birth. These factors can cause weakening to the pelvic floor structures which can then cause the organs to displace.
There are several different types of Prolapse that can occur:
Cystocele: when the bladder drops down and pushes against the front vaginal wall
Rectocele: when the rectum pushes against the back vaginal wall
Uterine: when the uterus slips down into the vaginal canal
Enterocele: when the small intestine pushes against the top of the vaginal wall
Prolapse can be graded on 1-4 scale generally as follows:
Grade 1: Prolapse descends 50% of the vaginal canal when bearing down
Grade 2: Prolapse reaches the opening of the vaginal canal when bearing down
Grade 3: Prolapse extends beyond the opening of the vaginal canal
Grade 4: Prolapse extends 50% outside of the vaginal canal
How to PRevent Prolapse
There is strong evidence that appropriately prescribed pelvic floor muscle training is very effective at managing and treating prolapse as long as you have a correct pelvic floor contraction, correct exercise dose, and are consistent. Find a pelvic floor kinesiologist or physiotherapist to create a plan with you!
Tips for Managing Prolapse
Avoid straining or bearing down while lifting heavy items and exhale as you do so to reduce excess pressure
Engage and coordinate your pelvic floor, abdominal muscles, core, and breath
When to contract your pelvic floor muscles
It depends! There are times when the answer is yes and times when the answer is no depending on specific movements or activities.
When should you contract your pelvic floor?
Pelvic floor contraction is helpful during workouts to build strength and awareness to the area, especially during postpartum. If you are struggling with contracting your pelvic floor just at rest, I highly recommend seeing a pelvic floor specialist to teach you how to do this.
A contraction of your pelvic floor means lifting up and in with your breath. If you recently gave birth, it is best to contract the pelvic floor even if you aren’t lifting or doing an “exercise” to start regaining the connection to eventually transfer that to exercise. Starting out with contractions laying on your back, then progressing to standing, then to movements like squats is a great way to progress and manage symptoms that may arise. If you already have a natural contraction, I recommend still thinking about actively lifting and contracting through exercise to allow that motion to become second nature.
During exercise, the pelvic floor will naturally lift up and in and you exhale or engage your deep core muscles as long as there is no dysfunction. This is what you want to work towards.
How to know if you're contracting:
Feel tension inside the pelvic bone at the front
Cue: Imagine you're trying to get into tight jeans
Cue: Try to get your hip bones to come together
When should you not?
Stretching and lengthening the pelvic floor are just as important as strengthening it.
For example, when you are doing diaphragmatic breathing, the focus is on lengthening and releasing any built up tension. If you are someone who experiences a lot of stress or anxiety, it may be beneficial to mainly focus on lengthening rather than engaging to help teach the pelvic floor to relax.
When you are running, you also don’t have to actively contract. Running is already a pelvic floor exercise from the load and impact, and being in a constant state of contraction or tension can actually lead to incontinence.
Weak or Overactive pelvic floor
There are 3 main dysfunctions of the pelvic floor that can lead to more severe conditions:
Pelvic floor tension: caused by muscles being too tight
Pelvic floor weakness: caused by a lack of muscular strength in the pelvic floor
Poor pelvic floor coordination: when pelvic floor muscles can’t be activated at the right time
Pelvic Floor Tension:
Pelvic floor muscles get tight for several reasons:
heavy lifting without managing the abdominal pressure that is created
Chronic stress or anxiety causes the pelvic floor to tighten. Research shows that the pelvic floor is the first to tighten when the body is under stress
Trauma or tearing during birth can lead to the body wanting to protect and tighten the surrounding areas, regardless of vaginal birth or c-section
Indicators of tight pelvic floor muscles:
Frequent urge to use the bathroom – tightening and compression on the bladder increases the urge to go
Urinary incontinence
Pelvic pain
Low back pain
Hip pain
Releasing tension:
Breathwork
Start incorporating breathwork at the beginning and end of each workout to engage the nervous system and relieve tension in the pelvic floor. A 4-5 minute warm up to prepare the body to exercise and a 3–4-minute cool down to relax the body can release tension in the pelvic floor, low back, hips, hamstrings, and glutes.
When you inhale, the diaphragm and pelvic contract and descend together and when you exhale, they relax and ascend to resting position.
You may also benefit from a nightly 5–10-minute cool-down consisting of breathwork and mobility exercises to maintain flexibility and reduce tension.
Hip Mobility
Many of the hip muscles attach to the same areas on the pelvic as the pelvic floor muscles which can cause tight hip muscles to affect the pelvic floor muscles.
Stretches like pigeon or figure 4 are helpful for this.
Pelvic Floor Weakness:
The pelvic floor muscles can become weak when they are overused or stretched during pregnancy. As the baby grows, the weight on your pelvic floor will cause it stretch up to 3 times it’s normal length.
Indicators of weak pelvic floor muscles:
Pelvic organ prolapse occurs when the muscles and ligaments loosen or weaken. The organs may shift and descend when there is no longer support for them. I have a more in-depth blog about this condition
Urinary incontinence is the most commonly known symptom of pelvic floor dysfunction. The muscles wrap around the urethra which helps prevent the flow or urine, but when they are relaxed, you might lose that control
Building Strength:
There is strong evidence that appropriately prescribed pelvic floor muscle training is very effective at managing and treating pelvic floor dysfunctions associated with pelvic floor weakness. Find a pelvic floor kinesiologist or physiotherapist to create a plan with you!
Most Common Types of Pelvic Pain and Tips to Help
During pregnancy, the body adapts and changes as the baby and uterus grows. This causes compensation of other muscles, mainly the core and back, to keep the body in the position that requires the least amount of effort.
common types of pelvic pain
Low Back
The spine naturally has curves to support our body. The low back has a “C” shaped curve called a lordotic curve. During pregnancy, the baby sits in front of the spine and pulls forward at your center of gravity causing that curve to become more exaggerated. This can cause soreness on the joints and tightened muscles.
Pubic Symphysis
The Pubic Symphysis is the joint in the front of the pelvis where the two pelvic bones meet.
During pregnancy, that joint widens, due to relaxing hormones and stress from the pregnancy. This can cause a lot of pain and pressure if the joint moves too much, or if there’s an overuse of the inner thigh muscles.
A lot of women feel a sharp pain when they try to walk upstairs, get in the car, roll over in bed, or step into the shower or bath. It can lead to achiness throughout the day, along with sharp pain with movement.
Sacroiliac Pain
The SI joints are located right above your tailbone, where the pelvis comes into contact with the sacrum. There are many ligaments holding that joint stable and those ligaments, and the joint itself can be a major source of pain.
During pregnancy the spine and pelvic girdle change due to hormone changes, the growing baby, the center of gravity changing, and sore muscles. This affects how joints move. This makes everyday things like walking, getting up from sitting, rolling over in bed, and bending over painful and difficult.
Pain Management
The muscles and joints are working overtime during pregnancy to support the body, so it is important to rest and do gentle movements if you are experiencing pain. Making modifications to exercises and incorporating more stretches of the pelvis can help reduce pain.
Keeping the Pelvic Floor in Neutral Position
When resting or moving, maintaining neutral alignment (rib cage stacked on hips) ensures the pelvic floor is in its strongest position.
Exercise and Activity:
Regular physical activity can reduce and prevent pain. Walking or aquatic exercise can be very helpful as they are low impact and gentle movements.
Always listen to your body and stop pushing during flare-ups
Stabilizing exercises have been shown to improve pelvic floor muscle strength, core strenth, and pain severity. Here is a list to try!
GLute Bridge
pelvic tilts
modified side planks
cat cows
figure 4
It’s not just hormones and joint instability that can lead to pain. It is important to recognize factors such as lack of sleep, stress, or anxiety can impact the nervous system and increase joint sensitivity and limit serotonin. Take a look at your overall wellbeing (emotional health, stress management, and adequate nutrition) as they can significantly impact recovery.
Movement through each trimester
Keeping your body moving through pregnancy has been shown to have many benefits such as lowering the incidence of excessive gestational weight gain, gestational diabetes mellitus, gestational hypertension, preterm birth, cesarian birth, and lower birth weight.
The goal is to be active 150 minutes per week is which can be broken into smaller sessions- for example, 30 minutes per day for five days each week.
Pregnant women who were sedentary before pregnancy should follow a more gradual progression of exercise starting at 50% of their capacity. Although an upper level of safe exercise intensity has not been established, women who were regular exercisers before pregnancy and who have uncomplicated, healthy pregnancies should be able to engage in high-intensity exercise programs, such as jogging and aerobics with no adverse effects. High-intensity or prolonged exercise in excess of 45 minutes can lead to hypoglycemia; therefore, adequate caloric intake before exercise, or limiting the intensity or length of the exercise session, is essential to minimize this risk.
absolute CONTRAINDICATIONS to EXERCISE:
Ruptured membrane
PERSISTENT second or third trimester bleeding
placenta previa
preclampsia
incompetent cervix
Intrauterine growth restriction
high-order pregnancy
uncontrolled type i diabetes, hypertension, or thyroid disease
Relative CONTRAINDICATIONS to EXERCISE:
history of spontaneous abortion or premature labour
mild/moderate cardiovascular or respiratory disease
anemia or iron DEFICIENCY
malnutrition
twin pregnancy after 28th week
other medical conditions
First Trimester:
During the first trimester, there is a lot going on in the body. Your blood vessels dilate, your hormones are changing, you feel nauseous… all of these factors make it difficult to fit in exercise. Here are some way to modify your exercise routine.
Decrease the volume
You may still choose to exercise the same number of days per week but might reduce the volume by decreases your number of sets or repetitions or increase rest time. If you are feeling extremely fatigued, listen to your body and adapt.
Build Awareness to the Pelvic Floor Right Away
Build that connection early and learn how to strengthen your pelvic floor muscles.
Be Patient
Symptoms during early pregnancy are very common and it is important to be patient and kind to your body. This is temporary, and if you need to skip a workout, don’t be too hard on yourself.
Second Trimester
During the second trimester, shift your focus to strengthening the pelvic girdle, including the glutes, adductors and core, to help maintain overall stability and prepare for labor.
Reduce High-Impact Exercises
Pay attention to any signs or symptoms your body gives you when you perform high impact activities like jumping or running. If there is incontinence, it may be time to modify.
Core Exercise Modifications
Certain exercises like crunches or sit ups may lead to coning when there is too much abdominal pressure that the muscles and ligaments can’t control. This shows up as A TRIANGLE OR BULDGE IN YOUR ABDOMEN. Note when these occur, and modify or eliminate when necessary.
Focus on Your Breath
Avoid holding your breath or bearing down when you are lifting and instead exhale during the hardest part of movements.
Pelvic floor Strengthening Exercises
Glute Bridge
Bird Dogs
Clamshells
Supine Toe Taps
Seated Straight leg lifts
Third Trimester
As the end of pregnancy approaches, focus on hip openers and stretching to relieve any symptoms, and relax the body as you prepare for labor. Studies show that breathwork and relaxation techniques prior to labor can promote blood flow, reduce muscle tension, and help labor progress while managing pain so breathing exercises are key here.
Hip Stability
The third trimester is when common pelvic pains start to occur. Working on hip stability can help alleviate this.
Add in Stress Reducing Activities
Consider meditation, yoga, or more slow stretching activities focussing on diaphragmatic breathing to lengthen the pelvic floor.
Reduce Overhead Movements
Like core exercises, pay attention to coning in the abdomen and modify if needed.
returning to running
Running is a popular form of exercise for the perinatal population, but there is little advice on returning to running after childbirth. Here you can find some guidance.
Where Do I start?
an INDIVIDUALIZED approach, guided by an exercise professional is RECOMMENDED to avoid or minimize pelvic floor dysfunction, and to determine if you are recovering from pregnancy-related and childbirth-related changes.
What Will Assessments and plans look like?
There are many factors that go into the decision making process of returning to running. Some women can run through there entrie pregnancy symptom free, and others experience discomfort early on. Lots of it is simply listening to your body closely.
When assessing your readiness, a pelvic floor kinesiologist or PHYSIOTHERAPIST will look at things like:
Biomechanics:
Pelvic floor muscle strength, endurance, and coordination
Symptoms of incontinence
Symptoms of pelvic organ prolapse
Lumbopelvic strength
Lower extremity strength
Interrectus distance
Balance and proprioception
Running gait
Load and Impact:
hopping, planks, step ups, single leg squats, wall sits
Ability to walk for 30 minutes without symptoms
biopsychosocial factors:
Mental health
Fatigue
Sleep quality and habits
Milk supply
Hydration status
training history, current capacity, goals and training preferences
It is important to remember that the pelvic floor muscles are like any other muscle that must undergo rehab. For example, if you sprained your ankle, you wouldn’t go for a long run as soon as it felt better. INStead, you would take gradual steps to avoid re-injury. The same applies to the pelvic floor. Although you have medical CLEARANCE after 6 weeks, you have to build up the pelvic floor muscles tolerance before putting excessive stress and strain on it.
A guide to Diastasis Recti
There is a lot of fear surrounding diastasis recti (DRA) that there is something “wrong” when in reality, it is a normal process of the women’s body stretching and growing. DRA is a condition that affects MANY women during after pregnancy, and even women who have never gone through pregnancy experience this.
DRA occurs when the rectus abdominis muscles, which run down the front of the abdomen, are separated due to the stretching of the Linea alba (the middle tissue between the 2 rectus abdominus muscles). This creates a “gap” in the midline of the belly. By 36 weeks of pregnancy, nearly all women show some form of thinning or stretching in the Linea alba.
Exercise can be seen as a scary thing when you have symptoms of DRA. However, it can be very helpful in reducing excessive diastasis. Recent study’s have shown that there is no higher prevalence of pelvic floor dysfunction, low back or pelvic girdle pain than women without DRA.
Signs and Symptoms:
The most common sign is a “coning” belly. You may notice a triangle or buldge in your abdomen when you are trying to get up from laying down or doing exercises like sit ups.
Usually DRA is painless, but some recent studies have shown a connection to low back pain due to the of weakened abdominal muscles.
How Can You Test for DRA?
When lying on your back with your knees bent and feet flat on the floor, place one hand behind your head and put 2 fingers at your belly button.
Do a mini sit up or crunch and see if you can feel the edges of your abdominal muscles.
Place 2 or 3 fingers in the gap and take note of how many fingers you can fit, how soft the gap is, and how much tension there is or isn’t in the gap.
Preventing DRA
It is important to know that nearly 100% of women experience DRA during pregnancy which is 100% normal. Women who are not pregnant or even men actually have a small interrectus distance.
For an easier recovery, it is important to pay close attention to how your body responds to core exercises and note when “coning” happens. If there is too much pressure against the thinned Linea alba and a triangular shape in the midline of the belly is present, this means that the deep core connection is lost or the load is too heavy for the core to handle. If coning occurs, it is a sign to modify or eliminate that exercise.
Treating DRA
exercises targeting the transversus abdominis, internal obliques, and pelvic floor muscles are most often prescribed to help treat DRA.
transversus abdominis
dead bugs
bird dogs
side planks
INternal Obliques
Side Planks
Pallof PRess
Pelvic Floor Muscles
Lunges
Glute Bridge
squats
Does a C-Section affect the pelvic floor?
Regardless of the type of delivery you experience, pelvic floor dysfunction can still occur. Although vaginal delivery has been shown to have an increased risk of dysfunction (such as incontinence or pelvic organ prolapse), a c-section does not prevent them. the pelvic floor still goes through lots of changes THROUGHOUT the PREGNANCY.
Risk Factors for incontinence after birth
Incontinence during pregnancy
episiotomy
instrumental vaginal delivery
tearing
Other factors
There are many psychosocial factors that can contribute to someone’s postpartum recovery. For example, a woman might get to the pushing stage and there could be sudden fetal distress and be rushed to an emergency C-section. They had no time to prepare, there was a lot of chaos, there wasn't a lot of explanation of what's going on. That person could be at risk for heightened sensitivity to their C-section scar afterwards and may have more difficulties with mobility afterwards, not necessarily because of the mode of delivery but the other psychosocial factors that can contribute. The same can happen with vaginal births if there was lot of trauma involved in that experience.
some C-sections recover really, really well, and it is positive experience for women and some vaginal deliveries recover really, really well.