 Did you know that your diaphragm and pelvic floor work together to support your body?
These two muscle groups form a crucial part of your core, working in harmony to maintain stability and function. The diaphragm helps with breathing, while the pelvic floor supports your pelvic organs. 🫶 When you inhale, the diaphragm contracts and moves down, creating space for your lungs. This action can also help the pelvic floor to relax. Conversely, as you exhale, the diaphragm lifts, encouraging the pelvic floor to engage. Whether you’re practicing yoga, pilates, or just focusing on your breathing, remember the synergy between these two vital muscle groups!
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 Navigating Postpartum: Common Pelvic Floor Symptoms to Watch For
As you embark on your recovery postpartum, it’s important to be aware of some common pelvic floor symptoms that might arise after giving birth. It’s a crucial aspect of postnatal recovery; understanding what’s normal can help you take the best care of yourself and know when to seek help. Here are a few symptoms you might experience:
 Healing after a C-section involves more than just rest—it’s about gently strengthening key muscle groups to support your recovery. Here’s what to focus on:
 Navigating recovery after a C-section can be a rollercoaster, but knowing what to expect can make it a bit smoother. Here’s a quick guide to what you might experience in the days and weeks following your C-section:
Weeks 1-2: Settling In You’ll be moving around more each day, though it’s important to take it slow. Gentle walks can aid recovery. Pain should start to lessen, but keep up with prescribed medications. Ask friends and family for help! Weeks 2-6: Take it easy You can gradually increase activity, but avoid lifting heavy objects or strenuous exercise. The skin will look mostly healed but there is still lots of healing going on beneath the surface (for example, uterus and the connective tissue). Weeks 6-8: Getting Stronger You may still feel some discomfort, but it should be manageable. Attend your post natal check appointment to ensure everything is healing as expected. Assuming all is well you can start some scar massage. I’ll post some simple massage techniques to my stories. Week 8 onwards Most women feel much better by this point. You can gradually return to more normal activities, but listen to your body and pace yourself. If you want to return to exercise, start with low impact and/or body weight strength programmes. Monitor for any pelvic floor or abdominal issues such as leaking, heaviness or diastasis. If you are concerned see a GP or a pelvic health physio. Remember, every recovery is unique, so take it one day at a time......You’re doing an amazing job! 🤱✨ Drop any questions you have below or share your own recovery tips! ❤️ 
.Pink and raised scars are pretty common... and people tend not to realise that there is something that can be done about them! Both these treatments can be carried out at home once your physiotherapist has explained how to implement them.
The NICE guidelines recognised silicone as a good treatment option for hypertrophic scars. Dressings are available on prescription on can be purchased online. My favourite silicone option is Kelo-cote scar gel. There are other in clinic interventions such as laser treatment, but massage and silicone is a great place to start.  Diastasis is a whole body issue. So much focus can be placed on TVA that the rest of the core cylinder can be forgotten. Our core is not designed to work as individual muscles, but as a "cylinder" of support comprising of the diaphragm, TVA (deep abdominals, pelvic floor and mulitifidus (deep spinal muscles). When we re rehab a diastasis, the whole core has to be involved.
If any non-core muscle is restricting any element of the cylinder, it is also going to have an affect on the deep abdominals. For example, if your obliques are tight and your diaphragm is not moving freely as you breathe, one element of the core cylinder is restricted. When you try and do your core exercises, the lack of diaphragm engagement is going to make the whole core less well engaged, reducing the effectiveness of the core exercise to heal the diastasis. So if you've tried a load of core exercises/pilates and you haven't seen the results your looking for, consider seeing your local woman's health physio for a thorough assessment.  G. Donnelly. POGP CONFERENCE 2018 Diastasis rectus abdominis: physiotherapy management. Journal of Pelvic, Obstetric and Gynaecological Physiotherapy, Spring 2019, 124, 15–19 This acronym was developed by Grainne Donnelly, as a proforma for assessing and managing diastasis. The acronym covers the key areas of assessment:
1.Person - understanding who you are treating and their personal journey 2.Posture 3.Patterns (of movement - eg. abdominal bracing) 4.Respiration- (is breathing optimal for core recovery?) 5.Ribcage (assess compensatory strategies, flaring, asymmetry, infrasternal angle) 6.Load (assessing the abdominal wall with different types of load) 7.Defect (Are there any other defects? eg hernia) Assessing each of these areas will help you identify factors that could be contributing to an ongoing diastasis. Addressing any compensatory strategies, suboptimal breathing, altered movement patterns and postural changes will ensure your rehab is bespoke and address the function of the abdominal wall, not just the gap. This is such a great road map for how to approach diastasis holistically and FUNCTIONALLY. If you treat diastasis go read it!!! You can read the full article here: "Donnelly G. (2019) Diastasis rectus abdominis: physiotherapy management. Journal of Pelvic, Obstetric and Gynaecological Physiotherapy 124 (Spring), 15–19.  You may have been told that you shouldn't plank, run or do various sits up with a diastasis. Spend a little time on google and you will find lots of diastasis "safe" and "unsafe" exercises.
The fact is that everyone is different, because diastasis isn’t a blanket diagnosis and functional ability varies person to person. One person may dome when they front plank, but be fine when they do a sit up; some one else might be the opposite. It's so important to get a proper assessment of the linea alba and core muscle activation doing functional movements, otherwise you may be missing out on that high level yoga class unnecessarily. A physiotherapist can assess the size and tension of a diastasis gap, but also the functional movements or exercises that doming. Once this has been established, a suitable strengthening programme can be given to regain strength and control to prevent doming in those specific movement planes.  Diastasis refers to a separation of the rectus abdominis muscles across the linea alba. Diastasis occurs naturally in pregnancy, but can continue in some women in the postnatal period. The presentation of diastasis can vary, so thorough examination is important. Here are some of the factors that can vary from person to person.
1. Width and Depth It is important to assess both the width and the "softness" of the gap on palpation. An ongoing gap with firm tension shows that there is good abdominal strength, and often rehab is not required. A gap with soft tension tends to pose more issues with doming and will require rehab. 2.Location The separation might be more pronounced at different points along the midline of the abdomen (see above image). The gap is commonly largest around the belly button area, but can occur higher or lower. 3.Associated Symptoms Often diastasis goes hand in hand with other core related symptoms such as incontinence and back pain. Understanding these variations can help healthcare professionals assess and guide appropriate treatment, which may include exercises and physiotherapy.  It can be tempting to think you might be able to self treat a pelvic floor problem. Add in a few kegels to your day and all will be sorted right?
- Not all pelvic floor problems are solved by kegels (doing pelvic floor contraction work), for example: certain pain conditions or tight/hypertonic pelvic floors - If a contraction is appropriate but your technique is wrong, it won't be effective. - Part of pelvic floor rehab is starting at an appropriate level and then progressing appropriately. If you start at the wrong level or don't progress at the right time you may find you don't improve. - It's imperative to make your pelvic floor rehab activity/sport specific to ensure you achieve full resolution of your symptoms during higher lev.el activity Conclusion? Get your GP to refer you to your local NHS physio service or contact your local private pelvic floor physio for a full assessment and treatment. |
AuthorClaire is a women's health and sports Physiotherapist. She is the owner of Spring Physio and is based in East Sussex. Archives
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