I get it. I’ve been there. You’ve had your six-week check and are cleared for exercise. After housing another person inside your body for nine months, your body doesn’t look like it used to. Even after having twins, I was surprised how long I still looked like I was about 20 weeks pregnant. And even though I am not a runner, it made me want to go running. Or something.
However, you need to remember that your body has been through a lot, and things are not going to be exactly as they were before straight away. If you are itching to get out there, there are a few things you should check before you start.
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1. Do you have any red flags that your pelvic floor is not ready?
These include:
Any urinary leakage at any time. This is not normal. Let’s make sure that one is clear… not at ANY TIME. Not when you are coughing, not when you are sneezing, not when you are jumping, not when you are running. It should not happen.
Feelings of urgency to get to the bathroom. You should always be able to delay long enough to get to a toilet. If you have to drop what you are doing to run to the toilet, this is not normal.
Any feelings of heaviness or a dragging sensation in the pelvis. Some people will say they feel like they are not supported and if they don’t sit down something will fall out of their vagina. These are early symptoms of pelvic organ prolapse and should not be ignored.
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2. Check that your pelvic floor is ready to handle high-impact sport.
The pelvic floor is the support structure under the pelvic organs (including the uterus). Both the pelvic floor and the uterus have been stretched during pregnancy and childbirth, and they take time to come back to their normal length. If you perform high-impact exercise too soon, and the pelvic floor is not back to its optimal length, you could develop a prolapse.
The easiest way to think about this is that the pelvic floor is like a trampoline mat. When it is pulled nice and firm, the organs won’t bounce as far underneath the trampoline when they are bouncing up and down as you run. If the trampoline mat is stretched and already sitting lower, the organs will be dropping down even farther into the pelvis as you run.
This is what we want to avoid and why it is important that your pelvic floor, aka trampoline mat, is nice and firm to start with.
Firstly, you need to check that you can switch on your pelvic floor. Easiest way to do this is to try and stop the flow of urine the next time you go to the toilet. Can you stop it? Can you stop it straight away? Can you stop it completely? This will give you a pretty good indicator of the strength of your pelvic floor.
When you run, though, even if your pelvic floor is strong, you won’t be able to hold your pelvic floor the whole time you are running, so how much pelvic floor muscle tone you have at rest is also very important. The jump test is also something you could try. [Please note I recommend you should have received your six-week clearance from your health care provider before attempting this (as the absolute minimum), but really 12 weeks would be better.]
Wait until you have a moderate to strong desire to empty your bladder. Find some space, and jump up and down 20 times. You can do it with a skipping rope if you have one. You should stop immediately if you lose any urine, get any pain, or feel a heaviness or dragging sensation in your pelvis. These are all signs that your body is not ready for running yet. If you find that it is not a problem, follow it with 3-4 big coughs and see how your body feels with these as well. Again, if you feel any symptoms with this, your pelvic floor is not up to standard for high-impact sport yet.
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3. Check whether you have an abdominal muscle separation.
An abdominal muscle separation occurs when the outermost abdominal muscle stretches during pregnancy, and the two muscle bellies that normally give the six-pack stretch away from each other. If the connective tissue that holds the muscle bellies together does not stiffen back up again after childbirth, this is when we say there is a "rectus diastasis," or abdominal muscle separation. If it doesn’t close, you are more likely to develop lower back pain, or incontinence or a prolapse, so running is not a great idea.
Checking it is actually quite easy to do yourself. Lie on your back with your legs straight, place your fingers horizontal (across your belly) about 5cm above your belly button. Lift your head off the floor as if you were going to do a crunch. Can you feel a space between the muscle bellies? If you can, how many fingers can you fit inside the space? Less than two fingers is not considered to be a concern unless you are seeing your abdominals muscles bulge up through the space when you lift your head off the floor.
If it is greater than two fingers, or if you can see the center of your tummy bulging up into a peak when you lift your head, then you don’t have enough abdominal stability yet for high-impact activity. You need to do more core stability training first.
If you are worried about still looking pregnant after giving birth, an abdominal muscle separation could be the cause.
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And if you are chomping at the bit to grab your runners and start pounding the pavement again but haven’t cleared the three checkpoints yet, go easy with yourself. Pregnancy and childbirth are a big deal, and your body goes through a lot. You need to give yourself time to heal, and it’s not worth the rush. Choose some low-impact exercise for now, like walking, swimming or cycling, and concentrate on strengthening that core and pelvic floor.
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