Please tell us a bit about yourself and what it is you do…
My name is Taryn Watson, I am a I am a physiotherapist specialising in Women’s Health & Continence (yep, a physio for your nether regions) and I own a business called FitRight, which provides physio-led Pregnancy and Postnatal Pilates/fitness courses, and education workshops, all around Perth (and launching in Mandurah soon too!)
This stemmed from always being passionate about exercise in the childbearing years, and being frustrated and sad that well-meaning new Mums were constantly coming to see me suffering from prolapse, pain and incontinence, having assumed that being given the all-clear by their obstetrician at 6 weeks post birth meant that they could just ‘listen to their body’ and return to the vigours of Boot Camp and Crossfit without doing any specific assessment or management of their weakened core muscles first.
I spent many years running exercise classes for new Mums as a solo venture, but there was so much interest and such long waitlists that I thought why not put together a training program for other Physios, and and have a whole network of classes? All classes having bookings and admin done centrally, and all require a pelvic floor and abdominal muscle pre-assessment with a specialist physio and are rebatable on private health insurance.
I feel like, one step at a time, FitRight is doing its bit to decrease the horrendously high statistics of vaginal prolapse (50% of women who have had a vaginal birth) and incontinence (1/3 of women).
We provide easier access to exercise with a specialist, and help Mums know when they are ready to get back into the exercise or sport that they love. As of March, FitRight will be in 13 locations (with another 3 on the horizon) with over 25 Physios. I have also created an educational video series on post birth rehab and I regularly post low-impact, pelvic floor friendly mini workouts to social media.
What is/are the most common issues you see women for during or after pregnancy?
The most common issues that pregnant women and new mothers come to see us about are joint and muscle pain (usually in and around the hips and pelvis), bladder or bowel leakage, vaginal prolapse and abdominal muscle separation.
We also encourage women to see us even if they don’t have any of these symptoms, simply for a pregnancy and a post-birth check up, to assess how their pelvic floor and abdominal muscles are coping with the inevitable stretch and hormonal changes, and also to ensure early diagnosis of things like vaginal prolapse, which can often be silently getting worse without women realizing.
Should all mums check in with a physiotherapist after having a baby?
Yes, I honestly believe that we could decrease the horrendously high rates of issues like prolapse and incontinence if it was the norm to have a post birth pelvic floor and abdominal muscle assessment with a physiotherapist at about the 6-8 week mark.
Why not be proactive instead of reactive, and prevent issues rather than waiting for them to occur either in the near future, or (most commonly) at menopausal age?
We go to so many check ups post birth, with the paediatrician, the child health nurse, the obstetrician, the GP…. but have a think about those appointments. What percentage of that was about the health of the baby and the feeding process? Did anyone ask anything about you and your body, other than perhaps if you would like to know about your contraceptive options or getting you to fill in a questionnaire about postnatal depression? Probably not. And if there was any information given to you about when to restart exercise and physical activity without that person doing a thorough pelvic floor and abdominal muscle assessment, then they are probably just guessing and giving you a ‘recipe’ recommendation.
Pelvic floor is a bit of a mummy buzzword, especially after pregnancy! What exactly is your ‘pelvic floor’, why is it important to look after it and any advice on reconditioning and maintaining a strong pelvic floor after babies?
Your pelvic floor muscles are the sling of muscles that run between your pubic bone at the front, your tail bone at the back, and your sit bones out to the side. They are literally the ‘floor’ of your pelvis. Together with a whole lot of connective tissue, they support the pelvic organs (they stop your bladder, womb and bowel from dropping down, which is called ‘prolapse’), they keep you continent (they stop bladder and bowel leakage), they help support the spine and the pelvis, and they enable you to have enjoyable intercourse. Pretty important muscles!
It’s normal for your pelvic floor to stretch and potentially weaken during pregnancy, due to the weight of the baby and the pregnancy hormones that make everything a bit stretchier to prepare for birth. That’s why we recommend getting your pelvic floor muscles assessed (by vaginal exam or an abdominal ultrasound) during and after pregnancy so that you can be given an individualized exercise program to keep them functioning well.
There are other things in life that can also cause your pelvic floor muscles to weaken – being overweight, doing high load or impact exercise, constipation and chronic coughing or sneezing are some examples. A specialist physiotherapist can help you to manage all of these issues as well so that as you strengthen your pelvic floor, you aren’t inadvertently weakening it at the same time.
Is it normal to pee yourself during high impact activity/sneezing/coughing etc once you’ve had babies?
The short answer is – no! It’s not! It’s very common, but I think as a society we need to be careful that we don’t confuse ‘common’ with ‘normal’.
If you leak with high impact exercise, sneezing, coughing etc, you probably have what is called ‘Stress urinary incontinence’, or SUI. This can be very well managed in most cases with lifestyle changes, exercise technique changes, and pelvic floor muscle training, especially if you are proactive in doing something about it while it’s still only a small amount. Surgery may need to be an option for some women down the track, but the majority of women can be helped with more conservative measures.
How soon can women return to exercise after pregnancy? And are there any exercises they should avoid?
There are certain exercises that I would recommend starting from day one after having a baby, such as pelvic floor muscle exercises and gentle stretches. For most people, going for a 5-10 minute walk in the first week or so and building up to regular 30-45 minute walks by the 6 week mark is a good aim, remembering that vaginal heaviness or caesarean scar pain are signs that you’ve pushed yourself too hard and you need to scale back.
I think that everything else on top of that is completely individualized.
I actually get quite frustrated when I hear that someone was told ‘by 6 weeks you are safe to do this, and by 3 months you can do this, and don’t run until your baby is 6 months old, etc’.
This completely misses the point that all women will have done different amounts of exercise during pregnancy, will have had different injuries during childbirth, will have responded differently to the pregnancy and breastfeeding hormones etc etc etc. I can think of some women that were ready to resume high impact exercise at only a couple of months after birth, and others who still weren’t ready at 12 months.
Some exercises in particular are best avoided until you’ve had an individual check up, and these are high impact exercises (running, jumping, skipping etc), heavy loaded exercises (with weights, ropes, kettle bells etc), and abdominal muscle exercises (sit ups, planks, knee raises on the bar etc).
The take home message is that one size doesn’t fit all, and that some things that ‘feel’ OK actually might be doing damage inside your body that you may not be aware of until it gets to a more severe stage. Get to know a local Women’s Health Physiotherapist (there are a list of suggested locations around Perth on the FitRight website under ‘Initial Assessments’), and feel free to contact me at firstname.lastname@example.org for any queries that you have, or to book into one of our specific pregnancy or postnatal group exercise classes – we would love to see you!
Taryn Watson is a Physiotherapist, with a Masters Degree in Continence & Women’s Health Physiotherapy as well as a Clinical Pilates Instructor.
She is based at Fitright Physiotherapy in Ardross, Western Australia.
For more information about Fitright and the services they offer you can find them via: