Let’s Be Frank About: The Leaking That Comes Back
As a pelvic floor physiotherapist, I have the pleasure of being one of the first providers a new mom seeks out to help support the early stages of her postpartum recovery. These appointments typically revolve around assessing your core, your pelvic floor strength, and any pain that might be lingering or building since birth. Within a couple months, some gradual strength based exercise, core & pelvic floor isolation work, most people’s original symptoms totally resolve and they think “Ahhh How nice, I’m back!” But the reality is, that was only step one.
The truth is, there’s no rush in getting to the fully rehabbed’ finish line because realistically, it takes a hell of a lot longer than anyone expects. This is partly because you can’t rush recovery, but also because there’s no time or capacity to put in the work when you’re in those first 6 months postpartum. So initially, it’s so important to cover the bases of any early postpartum heaviness, leaking, or pain so that you can go about your everyday life as symptom free as possible. But the next steps are crucial to thoroughly rehabbing one’s body, so that they can get back to ALL physical activity they used to do, symptom and hesitation free. For some reason though, there’s this misconception that just because you did the baseline work, you should be able to then start running or doing jumping jacks no problem-o. Wrong-o my bud.
Let’s not forget that your pelvic floor is just like any muscle in your body. When recovering from a muscular injury, the initial acute recovery is important to regain function and reduce pain or inflammation but the subsequent months of progressive overload are essential for full return to sport and often make or break the risk of re-injury — which in PF world = leaking or heaviness. Hence why I see people early postpartum… and then often again at 1 year postpartum or whenever they really start moving their bods.
So in light of the stages of muscle strain rehab - here are the stages Frank considers essential for postpartum recovery.
PHASE I: IMMEDIATE POST-BABY (0-3 WEEKS)
Goal: reduce inflammation, let body heal
How: rest, nourish, gentle mobility, lotssss of gentle breath work and relaxation
PHASE II: EARLY POST-BABY (3-6 WEEKS)
Goal: reintroduce regular daily movements and range of motion through the body especially core & PF
How:
Start spending more time on your feet, moving mindfully with “good” form using your breath to manage pressure and reduce excess load of your pelvic floor.
Daily PF & Core contract / relax work to build range of motion, safety, and gentle engagement
Body weight Frank workouts 👌 focusing on using the core breath to integrate your core & PF into movement
Why: your body is typically very tight and protective after having a baby and taking it easy for a few weeks. Mindful body weight movement is an excellent way to create safety and space without overloading your still recovering body. Figuring out how to engage your core & PF early on can be hugely beneficial for reducing PF symptoms & resolving diastassis.
PHASE III: 6 WEEK “CLEARANCE” (6-12 WEEKS)
Goal: Start progressively loading the body through all functional movements with increasing weight
Why: The things is, our muscles don’t change without stimulus/load but overloading too quickly can cause an increase in leaking or heaviness. Frank prioritizes gradual load while also teaching you how to best manage pressure and what signs to look out for if you’re overdoing it or doing it wrong.
this is typically where people start feeling symptom free, stronger through their core & PF and then stop progressing their rehab
PHASE IV: THE NEXT STEP - MORE LOAD (3 - 6 MONTHS)*
Goal: Start exposing and building your pelvic floor’s capacity to contain more jumpy / higher loads. Introduce more complex full body movement & strength.
How: Frank’s Next Step - Return to Run / Impact program
Slowly introduce bouncing movements that are within your symptom limit where you’re not gripping or compensating.
Strengthen the surrounding parts of your pelvis (core, hips, posture) that help support your pelvic floor
Why: Your pelvic floor will not learn how to contain bouncy pressure unless you slowly reteach it. Learning where your body’s limit is and training at that given level is KEY to rebuilding PF coordination, strength & leak free bouncing. Going from 0-jumping jacks often causes a lot of vulnerability down there, leaking or feelings of “somethings gonna fall out.” These are typically just signs of it being too much too soon but more often than not people think — "well if I just keep doing it, my body will learn!” When in reality when we do too much too soon, we create poor compensation patterns because peeing your pants while you jump sucks and your body will do whatever it can to try to prevent it!
*the asterix is there to emphasize that this time could be WHENEVER you're feeling ready for that next step but it can be as soon as -
PHASE V: EARLY RETURN TO SPORT (6-12 MONTHS)*
Goal: Participate in more sport specific activities
How: Actually do the thing you want to be doing, while using modifications necessary to meet your body where it’s at.
Continue supporting you body with proper mobility and release work (increasing load = more tension!)
Continue increasing strength training to meet increasing demands of activity.
Why: You don’t need to be perfectly rehab to reintroduce something you love, but you may need to modify the how. For example, if you want to be playing soccer then great! Let’s get you slowly reintroducing running, while starting to focus on more lateral jumping. lateral strength work, and some foot drills that replicate your sport.
PHASE VI: UNRESTRICTED RETURN TO SPORT (8-12+ MONTHS)*
Goal: Get back to your activity, unrestricted and uninhibited and notice what the missing pieces are if any!
Considering all this… why are we feeling “behind” when we’re not back to our regular physical selves at 6 weeks postpartum? Give yourself a break! Even an injured hamstring who didn’t have a baby to feed and lose sleep over would take at least 6 weeks to recover… and months before getting back to sport. Slow & steady - you got this.
If you’re interested in joining Frank but not totally sure you wanna commit, try the 7 day free trial for the Postpartum Workout Platform.
Of course if you need any support at any of these stages, pelvic floor physio is here to help. If you live in Calgary, book in to see me in person here.
Let me know if you have any questions!
Rachelle Bonneville
