We understand that postpartum is a time of recovery and rebuilding strength. But when you’ve experienced pregnancy loss, postpartum may not feel like it fits the season that you find yourself in at this moment, let alone returning to exercise after miscarriage or infant loss.

While you may not need or want to dial your fitness all the way back, being intentional in your return to exercise can help your body recover and help you maintain your long term fitness goals.

No matter whether you’ve experienced an early miscarriage, a stillbirth, or infant loss, your loss and your ability to get the recovery support you need matters.

Do you need to rehab your core and pelvic floor after a miscarriage or stillbirth?

Yes. If you’ve experienced a pregnancy, even if the pregnancy ended in loss, core and pelvic floor connection and a progressive return to fitness can help your body recover and help you maintain your long term fitness goals.

With pregnancy comes changes in the body, including hormones, postural adjustments, size of the uterus, constipation, etc. These changes can lead to an increase in pressure on the pelvic floor.

This increased pelvic floor pressure from pregnancy, even if only for a brief time period, can lead to an increased risk of core and pelvic floor disorders such as incontinence, pelvic pain, pelvic organ prolapse, or diastasis recti.

How to return to exercise after miscarriage vs a stillbirth?

There are more considerations for returning to fitness after pregnancy loss than simply knowing what trimester you were in when the loss happened.

Other things that can impact your recovery and return to fitness:

• What surgical interventions (if any) did you have? Ex: D&C, episiotomy, c-section, etc
• Did you have any complications? Ex: excess bleeding, high blood pressure, pelvic floor concerns
• Support and mental health. Ex: are you getting a decent amount of sleep, able to fuel your body with food, staying hydrated.

It’s not as simple as first, second, or third trimester. So how do you know what’s ok to do and what’s moving too fast? You can listen to your body, but when you don’t know what signs or symptoms to listen for or if you feel like your body betrayed you, that can be a difficult place to start.

Here’s a simple breakdown of common factors that you can take into consideration to figure out where you should start with your recovery and return to fitness.

• If your loss occurred during the first trimester, you had no medical complications, AND you had no medical intervention (outside of medication) – you can return to fitness close to where you left off. You may want to slow things down a tad, reduce the weights slightly, and add in some supportive core and pelvic floor work for best results.
  
• If your loss occurred during the second trimester, you had no medical complications, AND you had no medical intervention (outside of medication) – This is a time to take a slight step back. You can lift, but maybe you should try tempo and lighter weights instead of high intensity, high reps, and high load. Your body would likely benefit from mobility, core, and pelvic floor routines.
  
• If your loss occurred during the third trimester or later, OR you had medical complications, OR you needed surgical intervention – your return to fitness is going to look similar to a traditional postpartum path. Connecting to your core and pelvic floor, working on breath, balance, and a slow progressive return to strength will be key to helping your body through recovery.

Returning to exercise after miscarriage or infant loss isn’t a black and white event. You can speed things up or slow them down based on how you’re feeling in the moment and what you need in your recovery.

While you may not feel like you’re currently in a state of postpartum, being intentional in your return to exercise after pregnancy or infant loss can help your body recover and help reduce your risk of core and pelvic floor disorders and help you to maintain a lifetime of athleticism..

If you’ve experienced a pregnancy or infant loss, or are a coach helping your athlete through their loss, we’re here for you. You don’t have to go through your recovery on your own.

For more on how to support yourself or loved ones through pregnancy or infant loss, take a listen to Episode 12 of the Practice Brave Podcast where Brianna Battles and Casey Thomas-Hardesty discuss the spectrum of pregnancy loss and how to best support one another during this time.

Read More: Core and Pelvic Floor Basics

We often have a skewed idea of how long the body takes to heal postpartum. Even in the absence of core or pelvic floor symptoms the body does not “bounce back” in a handful of weeks. Even someone with a routine vaginal delivery with no interventions or complications, your body will still be recovering for months, not weeks. So how do we return to exercise postpartum? Read on to learn.

Do you have to wait until 6 weeks postpartum to start exercising?

No. While the 6 week postpartum visit with your medical provider isn’t a green light to return to exercise as you were pre-baby, it’s also later than ideal to begin exercises for your core and pelvic floor recovery.

Exercises You Can Do Early Postpartum

The early postpartum period is a time to rest, recover, and rehab. During this phase you’ll want to focus on connecting to your core and pelvic floor through breathwork, gentle core contractions, and pelvic floor lifts. You can also use this time to gradually increase your walking distance and non-exercise daily activity.

Some exercises we love for early postpartum:

• Prone breathing
• Glute bridge
• Rocking

Learn more with the free e-book: 6 Exercises for the First 6 Weeks Postpartum:

Vaginal Birth vs Cesarean Section

While recovery for a vaginal birth and a cesarean section are the same in many ways, there are a few differences.

A c-section cuts through multiple layers of muscle and tissue. You’ll need to allow time for the scar to heal before increasing the intensity or load of your workouts. Once the scar is healed, you may also find scar massage beneficial to improve the look and feel of your scar.

Even though you may not have given birth vaginally, that doesn’t exempt you from the need for pelvic floor recovery with a c-section. Pregnancy itself still puts excess pressure onto your pelvic floor. You’ll want to take the time to rehab your core and pelvic floor to help reduce your risk of complications and improve your long term athleticism.

Postpartum core and pelvic floor disorders

While incontinence, pelvic organ prolapse, and diastasis recti are not specifically pregnancy or postpartum disorders, having a baby does put you at a higher risk for those core and pelvic floor issues. As you reintroduce movements postpartum, it’s important to note if any core or pelvic floor symptoms appear and adjust your exercise accordingly.

Since how you do an exercise typically matters more than which exercises you do, there’s not an easy safe vs unsafe list of exercises when it comes to core and pelvic floor health. Instead, we look at symptoms and if you can adjust your movement strategies to help you reduce your symptoms. Some strategies may include breathing patterns, alignment, and tension management.

When to return to lifting postpartum

No matter how much you lifted prior to or during pregnancy, you aren’t exempt from a low and slow return to lifting postpartum. You’ll need to progress not only in weight but also in exercise selection, intensity, and endurance as well.

Starting around 6-8 weeks postpartum, you can begin to add light load to your workouts. Since this is a vulnerable time in your healing, it’s not recommended to add high volume, high intensity, or high load training at this time.

Before increasing the intensity of your workouts, it’s important to first master bodyweight movements, breathing strategies, and learn to reduce tension to ensure you’re not sending excess pressure down into your pelvic floor or out into your midline.

When to return to impact exercise after pregnancy

A return to impact exercises like running or jumping is not recommended prior to 12 weeks postpartum. Before you start adding impact, it’s important to focus on rebuilding core and pelvic floor connection, balance, and single leg strength.

Once you are ready to add impact, you’ll want to begin by introducing impact drills to help your pelvic floor train coordination. If you’re able to progress through impact drills without symptoms, the next step is moving on to interval training and speed work before working to build endurance.

While it may seem like a slow jog would be a better reintroduction to running, interval speed work is actually less impact on the pelvic floor. With the slower jog, you’re more likely to strike the ground harder and more often with your feet leading to more pressure on the pelvic floor.

Postpartum exercise does not have to be boring, but it’s important to respect the changes your body has experienced, and begin your return to exercise with self awareness and a strategic recovery plan. Your body has changed, your lifestyle has changed and what you do now can help set you up for a LIFETIME of athleticism, allowing you to continue to do the activities you love for years to come.

If you’re ready for strategic, relatable programming that bridges the gap between core and pelvic floor rehab and the fitness you want to do, join the thousands of other athletes inside The 8-Week Postpartum Athlete Training Program.

Rehab your core and pelvic floor, rebuild your strength, and return to the fitness you love.

When you’ve been diagnosed with pelvic organ prolapse, it can be so easy to fall down a rabbit hole of worry that you can’t exercise with a prolapse. You may see advice that warns you from squatting, running, or high intensity workouts like CrossFit, but that doesn’t have to be the case.

Just because you’ve been diagnosed with prolapse or are experiencing prolapse symptoms doesn’t mean you can’t return to doing the activities that you once loved. Keep reading below for tips on how to continue exercising with prolapse and how to help reduce symptoms with exercise.

What is pelvic organ prolapse?

Pelvic organ prolapse occurs when one or more of the pelvic organs descends or collapses into the vaginal canal. The type of prolapse is named after the pelvic organ that is descending. The most common types of pelvic organ prolapse are: Cystocele (bladder), Rectocele (rectum), and Uterine (uterus).

The presence of pelvic floor symptoms is not correlated with the severity of the prolapse. You can experience valid symptoms with a grade I pelvic organ prolapse. You can also experience no change or reversal of grade yet experience a relief or reversal of symptoms. 

Is it OK to exercise with a prolapse?

Yes! Exercising is not only safe to do when you have pelvic organ prolapse, but it can also help you in your pelvic floor recovery. While there are no movements inherently off limits when you have prolapse, there are adjustments that you may need to make in order to reduce your risk of increasing your symptoms.

The following 3 tips can help to make your exercises pelvic floor-safe:

1. Avoid straining and bearing down into your pelvic floor.

While some downward pressure into the pelvic floor is normal, excess pressure or bearing down into the pelvic floor muscles can lead to an increase in prolapse symptoms.

One way to help avoid bearing down into your pelvic floor muscles when you lift is to ensure that you are bracing in a way that equally spreads intraabdominal pressure instead of concentrating pressure downward.

Try breathing into your lats. You’re more likely to get a full ribcage expansion at the start of your brace which helps to prevent you from collapsing at the top of your core and bearing down into your pelvic floor.

Not sure if you’re bearing down when you brace? A movement assessment with a coach or an internal pelvic floor assessment with a pelvic floor physical therapist can help you to determine this.

Bonus tip: Make sure you’re being assessed in the lift position (ex: squatting) and not just lying on your back.

Another way to help reduce bearing down into your pelvic floor is through breathing pattern adjustments.

 Try exhaling either through the whole exercise or through the portion of exertion in a lift. By timing this exhale, you’re allowing your body’s natural system to take place where the pelvic floor slightly lifts on exhale.

You don’t have to breathe this way forever. The goal is to practice when needed until your tendency shifts away from bearing down into your pelvic floor.

2. Reduce pelvic floor tension.

When you’re scared that your pelvic floor muscles aren’t supporting you the way they should be, it’s very easy to either consciously or subconsciously want to try to hold everything in by engaging your pelvic floor muscles.

But constantly engaging your pelvic floor muscles, ex: doing a kegel with every rep, holding a kegel while you run, or engaging throughout the day doesn’t allow your pelvic floor to perform optimally. This may actually increase your pelvic floor symptoms.

Your pelvic floor needs both contraction and relaxation. When you’re holding a pelvic floor contraction longer than needed, the pelvic floor muscles tend to become fatigued and unable to rebound as quickly or support with higher loads like they should be.

Instead of holding a pelvic floor contraction, try only contracting when necessary and having the effort of your pelvic floor contraction match the effort of your activity.

For example, carrying your laundry, deadlifting a 35lb kettlebell, and a 250lb barbell deadlift aren’t going to need the same level of bracing or contraction. 

3. Form isn’t everything, but it can matter when you exercise with a prolapse.

You don’t need to try to stay in an “optimal” form pattern with all of your movements. That’s not the way we are made to move through daily life. But if your pelvic organ prolapse symptoms are increasing with certain movements, a form shift may help to reduce your pelvic floor symptoms.

For example, if your lifting form or limitations in ankle or thoracic spine mobility have you leaning more forward in a squat, you may have increased pelvic floor pressure with that movement.

By taking a more stacked position with your ribcage over your pelvis, you’re more likely to reduce downward pressure into your pelvic floor and help to reduce your pelvic organ prolapse symptoms with that movement.

You don’t have to give up the fitness and active life that you love – you can exercise with a prolapse! By avoiding bearing down into your pelvic floor, reducing tension, and making small form adjustments, you can help to reduce your pelvic organ prolapse symptoms and return to the workouts that you enjoy.

Want to learn more about your pelvic floor symptoms and exercise? Join us for a FREE workshop to learn the strategies you need to prioritize your safety + performance while being mindful of your core + pelvic floor system.

Pelvic floor pain during pregnancy may seem like a normal thing, but there are exercises and lifestyle tips to help you manage that pain. It’s not something you just have to live with!

Let’s take a look at some of the more common types of pelvic floor pain you may experience during pregnancy and what you can do to help manage it.

Is pelvic floor pain normal?

As your pregnancy progresses, pressure from the growing baby and growing belly puts extra strain on the pelvic floor and pubic bone. That extra pressure is a normal part of pregnancy.

However, just because excess pressure on the pelvic floor is normal, doesn’t mean pain needs to be normalized.You can have pressure without pain. You can also find ways to help reduce pressure down into your pelvic floor during your workouts.

If you’re experiencing pelvic pain during pregnancy, the first step is to check in with your medical provider. A pelvic floor physical therapist or occupational therapist is also recommended.

Pelvic floor therapy during pregnancy can help to greatly reduce pain caused by multiple factors as well as help to prepare your pelvic floor for delivery.

What causes pelvic floor pain?

There are numerous possible causes for pelvic floor pain during pregnancy. Let’s look at the 3 most common:

Symphysis Pubis Dysfunction

There’s a space between the right and left side of your pubic bones at the bottom. This is called the pubic symphysis.

During pregnancy, you can sometimes have more than normal movement at this space creating pain with movement, especially single leg movement. Many people describe this pain as a sharp stabbing pain in the crotch earning symphysis pubis dysfunction the nickname “lightning crotch”.

Pelvic Floor Tension

It may seem like you want to maintain a tight pelvic floor, but pelvic floor tension can actually contribute to pelvic floor pain. Instead of doing a high volume of kegels or subconsciously holding tension in your pelvic floor throughout the day, aim for a coordinated pelvic floor – one that contracts when needed and relaxes as well.

Sacroiliac Joint Pain

The sacroiliac joint is where the hip bone meets the sacrum. Pain here can feel like a sharp pain in the back of the pelvis and may or may not travel down the thigh. 

What can I do to help?

Lifestyle Adjustments

Here are simple lifestyle adjustments that you can make to help manage pelvic pain during pregnancy:

• Wear supportive shoes with little to no heal
• Sit down when putting on pants
• Keep both legs together when getting in and out of a car or bed
• Sleep with a pregnancy pillow or a pillow between your knees
• Wear a support belt or undergarments
• Stop sucking in your belly, clenching your glutes, and tensing your pelvic floor throughout the day
• Reduce stress

Exercises to Help Pelvic Floor Pain During Pregnancy

Strengthening your core and glutes and practicing pelvic floor relaxation can be a great place to start to help manage pelvic floor pain in pregnancy.

Glutes

While you may feel more comfortable reducing single leg exercises if you’re experiencing certain types of pelvic pain during pregnancy, you can still strengthen your glutes to help support your pelvis.

• Side Lying Hip Abduction
  Using a ball with this side lying hip abduction helps to give compression around the pelvis while also strengthening through a full range of motion

Core

You want to focus on the deep core muscles when navigating pelvic pain. Try this exercise:

• Kneeling Hip Thrust with Banded Pull Down
  Take a big 360 degree inhale then exhale just before you start to thrust. Continue your exhale as you complete the thrust and band pull. As you exhale, gently contract your transverse abdominis muscles.

Pelvic Floor Relaxation

Visualization can be really helpful when trying to focus on relaxing the pelvic floor. Try this exercise below:

• Supported Child’s Pose
  Take a big diaphragmatic inhale to lengthen the muscles of the pelvic floor. Then slowly exhale as you let some of that tension within your body go.

Note – You’re not bearing down into the pelvic floor here. Instead, you’re allowing your pelvic floor to naturally expand as your diaphragm lowers. Can’t focus on your pelvic floor? Focus on relaxing your glutes here instead.

You don’t have to put up with pelvic pain as a normal part of pregnancy. These lifestyle factors and exercises can help you manage pelvic pain during your pregnancy and beyond.

Want to learn more ways to navigate symptoms that occur during pregnancy?
Learn how to continue the workouts you love during pregnancy while keeping your body and baby safe with our free guide: How to Adjust Exercise in Pregnancy.