Information from your Chartered Obstetric Physiotherapist Postnatal Exercises and Advice

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1 Information from your Chartered Obstetric Physiotherapist Postnatal Exercises and Advice Leighton Hospital Middlewich Road Crewe Cheshire CW1 4QJ Tel: Fax:

2 Postnatal Exercises and Advice This leaflet should ideally be used in conjunction with instruction from a qualified obstetric physiotherapist. Pelvic floor muscles The pelvic floor consists of layers of muscles supporting the contents of the pelvis (bladder, womb and bowels). They are attached to the pubic bone at the front, and to the base of the spine at the back (see diagram 1). Diagram 1 Strong Pelvic Floor Uterus Bladder Pubic Bone Backbone Bowel Pelvic Floor After pregnancy and childbirth the pelvic floor muscles are often stretched and sag. The nerve supply to them may also be damaged. 2

3 What does the Pelvic Floor do? Strong and healthy pelvic floor muscles will provide support help in the control of bladder and bowels, and also increase the pleasure during sexual activity. A weak pelvic floor may lead to prolapse, leakage of urine with cough, laugh, sneeze or physical effort, and reduce sexual sensations. How to exercise Pelvic Floor muscles Sitting or lying comfortably with knees slightly apart, concentrate on your pelvic floor muscles. Lift and squeeze the front as if trying to stop the passage of urine, and at the back as if stopping the passage of wind. Hold concentration for as long as you can (at least 2 seconds increasing as you improve up to 10 seconds). This is a contraction or lift. Rest for an equal number of seconds. Repeat the contraction and relaxation as many times as you can, this will be your number - aim for 10 contractions. Also practice the same number of short, fast, strong contractions. You should not hold your breath, squeeze your buttocks or tighten your abdominal muscles when exercising. Remember you must do your pelvic floor exercises as many times as you can every day, at least 8 times. A good reminder is every time you feed the baby, or every time you turn the taps on! You must continue with these exercises until the pelvic floor is working correctly, this may take up to 6 months. After this time look after your pelvic floor by exercising it twice every day. Your abdominal muscles As your abdomen enlarges in pregnancy, the muscles stretch and lengthen and usually separate down the centre leaving quite a wide gap. Before and after separation of the recti muscles 3

4 Abdominal Muscles You may start the following exercises within hours of the birth if you feel like it: Lie with your knees bent, pull in your tummy muscles, flattening so that the back of your waist is pressed onto the bed and your pubic bone rocks up. Relax and feel the pubic bone rock back. (You may have learned this pelvic rocking antenatally - do it slowly). As you get stronger and can control your abdominal muscles you can progress to holding the previous position while you lift your head and reach towards your knees with your hands. 4

5 The following exercise can then be added: Lie on your back with both knees bent. Pull in your tummy and trying to keep it tight, reach with one hand towards the opposite ankle lifting your head up. Do this with alternate sides remembering always to Tighten your tummy before you reach over and to Relax it in between. (This is for the muscle fibres responsible for the twisting movements). If possible, do these exercises 10 times at least twice a day. Do not exercise when you are really tired and remember to have a rest every day. When getting out of bed, bend both knees, press them together and roll over onto your side. Then push yourself up with your arms. Good posture is important Walk Tall Taking up general exercise again This will depend on your general level of fitness/activity before you became pregnant! Swimming - This can be started once all vaginal loss ceases. Cycling - This is a good form of aerobic exercise for your whole body (although, it will not specifically strengthen your abdominal or pelvis floor muscles). Walking - This is the cheapest and easiest exercise AND you can do it with your baby. Walk briskly for at least 20 minutes three times a week. Jogging - When you can walk distances fast, without tiring, you can begin gentle jogging. Other sports - Can be re-started once you feel ready and have the time! 5

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8 Important Advice For further information write to: The Honorary Secretary The Association of Chartered Physiotherapists in Women s Health c/o The Chartered Society of Physiotherapy 14 Bedford Row, London WC1R 4ED TO MIDDLEWICH A530 TO NANTWICH Medical Imaging Department A August 2004 GUM SOUTH CHESHIRE PRIVATE HOSPITAL 1st Floor ICU/HDU Dining Room 1st Floor PATHOLOGY (Blood Tests) JAMES CROSS DAY CASE UNIT A & E LEIGHTON HOSPITAL X-RAY MAU Renal Dialysis Unit LIFTS PHARMACY BREAST CARE UNIT G E F ORTHOPAEDIC FRACTURE CLINIC SMITHY LANE WAU OT ECG DIET OUTPATIENT CLINICS Michael Heal Department of Urology (Urology Outpatients Clinic) LIFT Medical Day Unit 6 6A 1st Floor - Orthopaedic Unit Wards Surgical, Urology 4 1 CCU Security Office TOILETS PALS PORTERS SHOP CASHPOINT OUTPATIENT A ENT AND EYE CARE CENTRE Children's and Adolescent Unit 1st Floor Ward 18, 19 MAIN ENTRANCE PHYSIO ENTRANCE Bus Stop TOILETS B CHAPEL LIFTS WARDS A WARD 21B Lift to Patrick Murphy Unit POST GRADUATE MEDICAL CENTRE ANTE NATAL CLINIC Ante Natal Clinic & Ante Natal Day Assessment Unit entrance only C KEY A&E - Accident & Emergency CCU - Coronary Care Unit DIET - Dietitians ECG - Medical Investigations Unit ENT - Ear, Nose & Throat GUM - Genito - Urinary Medicine HDU - High Dependency Unit ICU - Intensive Care Unit MAU - Medical Admissions Unit (Ward 3) OT - Occupational Therapy PALS - Patient Advice and Liason Service WAU - Wheelchair Assessment Unit - Disabled parking spaces are available on all car parks - Car Park - Entrance TO CREWE MENTAL HEALTH Paediatric Out Patients Khrishan Chandra Children s Unit ENTRANCE TO: MATERNITY 22,23 (NEO Natal Unit Ward 24) Central Delivery Labour Ward 26 WOMEN S HEALTH UNIT Patrick Murphy Unit (Ward 25) Gynaecology Outpatients Clinic Impressions