July Knowledge Drop
Each month for our newsletter, the Lady Blurb, we'll share answers to some pelvic health questions you've submitted. The questions below were taken directly from you! To submit a question for next month, comment below or email us at contact@ladybirdpt.com.
**The answers to these questions are not meant to be used as medical advice. These answers are not meant to take the place of a skilled physical therapist or discussion with your medical provider. If you are experiencing concerning symptoms, please contact your physician.**
This month, we’re answering:
I leak when I sneeze. What can I do to prevent this?
Will I be able to get rid of my ab separation (diastasis recti)?
I’m on my period, can I still see my pelvic floor PT?
1. I leak when I sneeze. What can I do to prevent this?
Urinary leakage with sneezing is a common complaint, with 1 in 2 women experiencing urinary incontinence. Urinary incontinence is when any amount of leakage of urine occurs at an unwanted or unexpected time. This can occur with strong urgency, during which you can’t hold it long enough to make it to the bathroom. This type of leakage is known as urge incontinence. It can also occur with a cough, sneeze or jump which is known a stress incontinence.
Leakage with sneezing, as well as other forms of stress incontinence, can occur for a number of reasons including:
Weakness or decreased coordination of pelvic floor muscles
Weakness or decreased coordination of abdominal or hip musculature
Tension or reduced flexibility in the abdominals, pelvic floor or hips
Movement impairments in the diaphragm
If you’ve leaked with a sneeze one time when your bladder was full towards the end of pregnancy, don’t worry too much. But if this is a recurring issue for you, the knack exercise can make a big difference.
What’s the knack reflex?
The knack reflex is a reflex that typically occurs with an increase of pressure in the abdomen (intra-abdominal pressure). When you cough or sneeze, your pelvic floor is supposed to reflexively engage or lift to help counteract the increase in pressure from above. But there are some reasons you may lose your knack reflex, like pregnancy, childbirth or injury to the pelvic floor. For those who do not have the reflexive pelvic floor contraction, you can train your body to intentionally engage during this same trigger using the knack exercise.
The goal is to teach your pelvic floor to once again reflexively respond when you cough or sneeze. We achieve this goal by practicing intentionally engaging these muscles.
Here’s the knack exercise:
Step 1: Inhale and feel your pelvic floor relax.
Step 2: Exhale and lift your pelvic floor muscles.
Step 3: As soon as your muscles are engaged, cough.
Step 4: Once you’re done coughing, relax your pelvic floor.
Step 5: Repeat 5-10 times, a few times a day!
Whether you leak with a sneeze, while running, or any other time in life, remember that there are a number of reasons you may be experiencing leakage. Working with a pelvic floor PT is the best way to determine why you’re leaking and create a personalized plan to help get you dry. Contact us for an appointment here.
2. Will I be able to get rid of my ab separation (diastasis recti)?
Last month we got a message on instagram that said “I’m 6 months postpartum and I have an ab separation. I don’t think it’s gotten better in the last few months which is frustrating because I’ve been working out for like 30 minutes a day, 4-5 times per week. Will I be able to get rid of my ab separation?”
Diastasis recti is a hot topic in the postpartum recovery world and we’ll do our best to break it down today.
What is a diastasis recti, or ab separation?
The official name for a diastasis is diastiasis recti abdominis. A diastasis recti abdominis is a separation of your right and left rectus abdominus muscle along a fascial sheath called the linea alba. These separations vary significantly in width and depth.
Why does a diastasis recti occur?
A diastasis recti happens due to chronic strain from increased intra-abdominal pressure. They occur towards the end of all pregnancies in order to make room for the baby as they grow. Diastasis recti can also occur in older adults as a result of a chronic cough, chronic constipation or other conditions that lead to chronic increase in abdominal pressure.
As the pressure is sustained in the abdomen, the linea alba gets strained, leading to a thinning and widening of this tissue and a separation between the rectus abdominis.
Will my diastasis recti go away after pregnancy?
Whether or not your diastasis recti comes together after pregnancy depends on a number of factors, including but not limited to:
Your genetics: Genetics are a huge part of why some folks have a lasting diastasis recti postpartum and why others don’t. Your collagen tissue make up significantly impacts the size of your diastasis recti as well as the rate of healing postpartum.
The size of your abdominal separation pre-pregnancy: I’ve never been pregnant and I have a .5 finger width separation, so I know if I was recovering from birth that I wouldn’t expect my separation to come together closer than that. But most people don’t know the size of their separation heading into pregnancy. Knowing where you started before pregnancy can help set more realistic healing expectations.
Your abdominal muscle coordination and tone: Not all workouts are created equally. If you’ve been working out and you’re not seeing results, you may want to check in with a pelvic floor PT or experienced fitness professional to ensure that you’re doing the right workouts for your body. Additionally, it’s not just about what you’re doing but also how you are doing it. It’s easy to do even the best movements by relying on muscles you’re not actually intending to strengthen. Sometimes you just need to change the way you’re doing what you’re doing to get the results you’re after.
Hypertrophy of your rectus abdominis: Traditional exercise recommendations for diastasis recti has people avoid rectus abdominis strengthening, but hypertrophying the muscles that are separated is one way to help reduce the width and depth of the separation.
Whether or not your diastasis recti will go away entirely is dependent on a a number of factors that are within your control as well as a number of factors that aren’t. If you haven’t worked with a perinatal pelvic floor PT or an experienced postpartum fitness professional, I’d recommend starting there to make sure you’re getting the most out of your efforts.
And it’s important to remember that no matter what, an abdominal separation is not necessarily a sign of weakness. If your genetics and history do not allow for your diastasis recti to come together, that doesn’t mean you can’t regain the strength you had prior to pregnancy. An abdominal separation does not necessarily equal abdominal weakness.
3. I’m on my period, can I still see my pelvic floor PT?
This is one of the most common questions we get in the office.
If you’re on your period, you can still come to pelvic floor PT! There is nothing your pelvic floor physical therapist can’t do while you’re menstruating as long as you consent to treatment while on your period. This includes abdominal work and pelvic exams.
In fact there may be even benefits to coming in to PT while on your period. Your pelvic floor PT can use a number of techniques to reduce period pain, including manual techniques to:
Improve lymphatic drainage
Reduce soft tissue restrictions in the abdomen and pelvic floor
Improve mobility around the lumbar spine and hips
If you’re on your period, there’s no need to cancel your appointment. In fact, you may leave feeling better than you came in!
Working with a pelvic floor physical therapist can help address sexual dysfunction, bowel and bladder concerns and help you prepare for pregnancy, birth and postpartum recovery. Contact us here to learn more about setting up an appointment with us, today!
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.