Our bodies are ever changing, regardless of our age, but for women in the childbearing years it can be especially challenging. The body goes through so much during pregnancy, and moms have such limited time frames to take care of themselves. The demands of motherhood, family and work life mean that women are particularly susceptible to health issues after pregnancy. After pregnancy however, it is vitally important to retrain the core muscle system due to the anatomical changes and forces that have occurred during this time.
During pregnancy, all the abdominal muscles are overstretched, and the abdominal contents are pushed up under the ribs and out to the side. The pelvic girdle is spread apart as the developing baby is demanding more room.
During the fourth through the sixth months of pregnancy, the joints of the pelvic girdle become overly relaxed due to the body’s hormonal changes. The sacroiliac joints and the pubic symphysis are greatly affected and the “pregnancy spread” occurs. The pelvis and hips become wider and the need for women to be physically stronger in their core increases because of greater load factors, (whether during pregnancy, or after) due to the need to carry, feed and handle their babies all day long.
These bodily changes are normal for women during the childbearing years, but research states that 45 percent of women will have low back and pelvic girdle pain during pregnancy and 25 percent will have this same pain postpartum. This pain in the back and the pelvis appears to be made worse by daily activities, such as transitional motions like rolling in bed, sitting to stand, prolonged sitting, standing and walking, and often during a return to sport activities.
Women’s health physical therapy becomes a key component during this time frame, especially if back and pelvic pain are present during or after pregnancy. Research indicates that often back and pelvic pain proceed pelvic floor dysfunction.
Pelvic floor dysfunction may include poor muscle coordination during daily activities, urinary incontinence, bowel constipation and sexual dysfunction. As a result, our moms are at risk for pelvic floor dysfunction. If they had back or pelvic pain during or after pregnancy, early intervention is needed before the pelvic floor then becomes a problem.
During pregnancy multiple areas in the body experience changes. These changes can occur in the muscles, ligaments and fascia. In the abdominal region, often the linea alba line, which is the middle line of your six pack, will overstretch. If this linea alba is overstretched it can’t generate good control of the rectus abdominis (RA) muscles. The abdominal muscle called the Pyramidalis, which base attaches to the pubic crest and symphysis and goes into the RA muscles, will often be disrupted due to pregnancy loads and widening of the pubic symphysis. Normal widening occurs at the pubic symphysis of 5 mm during pregnancy. In order to effectively function with your core, the body needs to be able to generate tension along the linea alba line, so that the RA and the other muscles can assist in stabilizing the low back, pelvis and the low thorax during all activities. According to Lee, “the sooner an optimal strategy for transferring loads between the thorax and the pelvis is restored, the better,” for women after childbirth.
The endopelvic fascia is a complex mix of connective tissue that is actually a fibromuscular system that supports the urethra, the vaginal walls and the rectum. It supports all the pelvic organs and is often adversely affected during vaginal delivery. This system being intact ensures a decrease in the likelihood of pelvic organ prolapse. As a result, if there is disruption of the endopelvic fascia, pelvic organ prolapse becomes more common and resulting surgical intervention is necessary, such as cystocele, rectocele etc.
Often, over-stretching of the pelvic floor muscles occurs during delivery. The pubovisceral muscle, actually elongates three times it’s normal resting length during the second stage of labor. It is often that muscle that tears, and then its lack of support directly affects a women’s continence after delivery and beyond.
As you can quickly surmise, education and prevention are needed throughout pregnancy and postpartum. The ability to teach good integration and coordination of the muscles of the core is vital. It is necessary to ensure that the pelvic floor muscles and fascia are healthy enough to sustain load, and if they are not, it is important to learn how to protect and train them. The outcomes for women’s health during their childbearing years improves steadily the sooner intervention occurs.
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Sheree DiBiase, PT, is the owner of Lake City Physical Therapy. She and her amazing staff are here for you during pregnancy and beyond to ensure you have the quality of life you desire. Call us in our Hayden office, 208-762-2100; Coeur d’Alene office, 208-667-1988; and in our Spokane Valley office at 509-891-2623 (?lakecitypt.com?).