Monthly Knowledge Drop - December
Each month we'll share answers to our favorite pelvic health questions submitted via email & Instagram! To submit a question for next month, email us at contact@ladybirdpt.com.
This month, we’re answering your questions, including:
How can I manage pelvic floor tension at home?
I pee a little every time I vomit - morning sickness is fun! What can I do about that?
Will my diastasis recti ever heal?
1. How can I manage pelvic floor tension at home?
Some people just run tight. I’m looking at you, ya teeth grinding, butt clenchers. People who walk around clenching their fist, butt, shoulder and jaw, typically also walk around clenching their pelvic floors. But most of us know how to stretch our neck, shoulders, hands and hips to help counteract that tendency to clench. We don’t all know how to stretch and relax our pelvic floor after a stressful day of clenching, which can lead to pelvic floor tension.
Here are a few main pillars for managing your pelvic floor tension at home:
Identify what’s making you tight so you can do less of that. Whether it’s holding your breath when you’re stressed, sucking in your belly all day long, or clenching your butt cheeks as you move through life, identifying what contributes to your tension can make a huge impact moving forward. If you’re struggling to identify your triggers, consider seeing a PT who can help.
Practice pelvic floor relaxation exercises, consistently. When relaxing a tight muscle, consistency is so much more important than complexity. General stretching recommendations include stretching for 45-60 seconds, 2-3 times, a few times a day. The same goes for your pelvic floor. Practicing pelvic floor relaxation exercises throughout your day can be a game changer. This can include diaphragmatic breathing in positions like child’s pose, happy baby and a deep yogi squat. It can also include using vaginal dilators and wands - read on for more on that!
Use manual therapy or self release techniques to manage tension. Manual therapy performed by a pelvic floor PT is one of the best ways to address pelvic floor tension. A pelvic floor PT can help you better understand where you’re tight, why you’re tight and perform hands on techniques to help address the tension and the underlying cause of that pelvic floor muscle tension. With that said, releasing pelvic floor tension at home can be empowering and so helpful. Our favorite tool to address tightness at home is the pelvic wand by Intimate Rose. This wand was specifically designed by a pelvic floor PT to help those struggling with pelvic pain and tightness. Check out this video by our physical therapist, Dr. Jessica Chastka, to learn how to use the pelvic wand!
Stretch and mobilize muscles surrounding the pelvic floor, including your glutes, abdomen and adductors. Our muscles do not live in a vacuum. They all interact with each other to support one another. If one muscle group is angry, the surrounding muscles tend to get angry, too. They’re great hype people. So if you’re working on your pelvic floor tension and not getting the results you want, consider foam rolling, stretching and releasing tension in the muscles that surround your pelvic floor.
2. I pee a little every time I vomit - morning sickness is fun! What can I do about that?
Contrary to popular belief, peeing when you don’t intend to is not a necessary part of pregnancy. With that said, there are a few reasons urinary incontinence occurs during pregnancy, including:
underlying weakness, tension or coordination deficits in the pelvic floor muscles
gradual fatigue of the pelvic floor muscles due to the increasing demands of pregnancy
reduced space in the abdomen and increasing intra abdominal pressure
When it comes to leaking while vomiting, intra abdominal pressure is to blame. Your pelvic floor only needs to be as strong as the task at hand. The task at hand can be running, jumping, sneezing, or… vomiting. When we do any one of those activities, the pressure in the abdomen rises. When the pressure in the abdomen rises, the load on the pelvic floor increases. Imagine intra abdominal pressure as the air in a blown up balloon. Imagine each sneeze, jump or time you heave while puking adds a sudden added burst of air into the balloon. Eventually, that balloon will fail to hold the air (i.e. pressure) and it will burst. Similarly, if your pelvic floor isn’t strong enough to manage the increased load, your pelvic floor will fail to hold the pee in your bladder and you will leak.
So what can we do about that? Addressing underlying weakness, tension and coordination deficits can help our pelvic floor hold up its end of the bargain. What you do specifically will depend on the specific state of your pelvic floor. If your muscles are weak, strengthen them! If they’re tight, stretch them! If you don’t know how to do a kegel or relax your pelvic floor, you may need to practice that coordination portion. Whatever it is, know that better bladder control during pregnancy is possible and leakage is common, but doesn’t need to be your normal. Need personalized guidance? Consider seeing a pelvic floor physical therapist.
3. Will my diastasis recti ever heal?
This is one of the most common questions I get. I wish I had a straighter answer than I do, but buckle up team, because we’re about to get into it. I like to start by countering this question with a question. I know. The worst. I’m sorry.
If we’re wondering if a diastasis recti will heal, we first have to ask this: What does healing mean? Does healing mean that there is no more separation? Does it mean the separation narrows? Shortens? Becomes more shallow? Or does it mean that there’s no more pain associated? No more weakness or limitations during activities? “Heal” is a broad term that means something different to everyone, but defining “healing” is where we need to begin.
When discussing healing, I like to use myself as an example. I have never been been given birth or been pregnant. I’ve been pretty active my entire life. I have a separation between my rectus abdominis, or a diastasis recti, that’s about 1 finger wide. It gets a little deeper at my belly button, but it stays about the same width. If I went through pregnancy, I would not expect any separation to return smaller than where it started. A one finger width separation would actually be my normal. But most people don’t go into pregnancy with that knowledge, which leaves us a little lost when talking about what “healing” means. Everyone’s starting point is a little different.
In reality, for most people, healing diastasis recti is absolutely possible. What we can heal with physical therapy and exercise is your abdominal strength, your muscle tone, any associated tenderness or pain associated with the diastasis recti. We can help get you back to doing all the activities you love to do without pain and fear, and we can help you feel better doing it. So based on my definition of healing, which is regaining strength, control and tolerance to activity, your diastasis recti can absolutely heal! What may not be possible is returning your abdominal separation to an arbitrary definition of “normal”.
Thanks so much for reading this month's knowledge drop! Don't forget to submit your questions for next month at contact@ladybirdpt.com! Ready to take control of your pelvic health? Contact us here or call us at 512-766-2649 for a free phone consultation to learn more about how pelvic floor PT can help you.
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.