Diastasis Rectus- Navigating the Ins & Outs: Part 2

Diastasis Rectus- Navigating the Ins & Outs: Part 2 - The Causes

Now that we know what Diastasis recti abdominis (DRA) is, it’s important to look at the causes of DRA. It’s important to note that there is not one cause of DRA so there is not one solution to fix it either. However, knowing the causes may help lower the incidences.

1.  Hormones

According to Rett, “During pregnancy, hormonal changes caused by relaxin, progesterone and estrogen combined with uterine growth may cause stretching of the abdominal muscles3, affecting mainly the rectus abdominis muscles.”

What does this mean to you and me? Well, in part one we learned that 100% of women have a diastasis recti in the third trimester and this highlights that it is NOT 100% avoidable. In fact, the hormones that our body naturally produces during pregnancy, labor and postpartum naturally lead to increased stretching.

2.  Posture

Rett also stated that “during pregnancy, it is common to have anterior pelvic tilt with or without lumbar hyperlordosis3,12,5,13 . These postural changes can affect the insertion angle of pelvic and abdominal muscles, influencing postural biomechanics.”

Basically, as a woman’s belly grows in order to make room for baby, so does her posture. It’s common for women to go into anterior pelvic tilt. Anterior pelvic tilt is best described as a basin or cup in your pelvis that during pregnancy rocks forward. Just as your cup will lose water with increased tipping, your body naturally loses its stability and support with this movement. Furthermore, due to the increased muscle stretch the abdominal muscles may actually decrease in contractile strength.

3.    Non-ideal development in childhood / Insufficient postural function of the diaphragm

Did you know that every baby is born with a diastasis? It naturally closes starting around 4.5 months when optimal childhood development includes a synergistic contraction of the diaphragm, abdominal muscles and pelvic floor muscles and the oblique chains start to be utilized.14,15 This includes the integration of the diaphragm to act as both a respiratory and postural muscle. “According to Kolar, intra-abdominal pressure (IAP) regulation & the integrated spinal stabilizing system (ISSS) can be disrupted by insufficient postural function of the diaphragm.”16,17

If during normal childhood development we don't develop adequate diaphragm activity, our body will compensate with faulty movement patterns, including rib flare or elevation of the ribs. This can cause excessive use of low back muscles and is often seen with “inadequate lateral rib cage expansion or resistance of the abdominal wall against IAP changes.”15 This means as we inhale our body is not able to maintain appropriate intra-abdominal pressure and this is often seen in chest breathing or when someone only belly breaths and does not breath into all aspects of their abdomen. You see, IAP is not inherently bad. In fact, in order to breath you MUST create IAP. Therefore, it is not IAP that makes a diastasis worse, it is the body’s inability to appropriately manage changes in IAP that can cause or worsen DRA. Intra-abdominal pressure is best managed when we develop the synergistic contraction of the diaphragm, abdominal muscles and pelvic floor muscles.

Note: For more information on the causes of dysfunctional breathing, check out Dysfunctional Breathing: The Whys.. For more information on IAP, check out For the love of all things good, stop sucking in. 

4.    Multiple Pregnancies, Twins & Age

It is believed that women who have given birth (whether vaginally or cesarean), are more likely to have a DRA. Furthermore, there is increased DRA below the umbilicus in women who have given birth multiple times.5 While there is limited studies, the one study we do have indicates that there is a higher prevalence of DRA among women over the age of 50. The reason for this is due to cumulative mechanical stress on the connective tissue of the abdominal wall, the linea alba.

5.   Not exercising

In a study released in 2005 by Chiarello, et al, it was observed that “90% of non-exercising pregnant women exhibited DRA while only 12.5% of exercising women had the condition.” Furthermore, the study showed that the DRA was more severe in all three locations of testing in the women that did not exercise.18

6.   Ineffective Exercise

Not all exercises are created equal. Ineffective exercise can be exercises that are done wrong or exercises that are less than ideal for pregnancy. These exercises MAY include:

• Sit-ups, crunches and  curls (including oblique sit-ups and sit-ups on exercise balls, incline sit-ups, roll ups)

• Reverse crunches

• Triangle pose

• V-ups & V-sits

• Double leg raises

• Bicycle legs

• Planks

• Hanging knee raises

• Pilates exercise “The Hundred”  or "roll up"

• ANY movement that creates abdominal wall bulging, coning or tenting!!!

References:

1. Mota P, Pascoal AG, Carita AI, et al. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther 2015;20:200–5.

2. Reliability of the inter-rectus distance measured by palpation. Comparison of palpation and ultrasound measurements. Mota, Patrícia et al. Manual Therapy , Volume 18 , Issue 4 , 294 - 298

3. Corrêa MC, Corrêa MD. Puerpério. In: Corrêa MD, editor. Noções práticas de obstetrícia. 12ª ed. Rio de Janeiro: Medisi; 1999. p. 95-104.

4. Gilleard WL, Brown JM. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period. Phys Ther. 1996;76(7):750-62.

5. Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(3):321-8.

6. Rett, MT, Braga, MD, Bernardes, NO, & Andrade, SC. (2009). Prevalence of diastasis of the rectus abdominis muscles immediately postpartum: comparison between primiparae and multiparae. Brazilian Journal of Physical Therapy, 13(4), 275-280. Epub August 21, 2009.https://dx.doi.org/10.1590/S1413-35552009005000037

7. Sperstad JB, et al. Br J Sports Med 2016;0:1–6. doi:10.1136/bjsports-2016-096065

8. Boissonnault JS, Kotarinos KR. Diastasis recti I. In: Wilder E. ed. Obstetric andgynecologic physical therapy. New York: Churchill Livingstone, 1988:63–81.

9. Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther 1988;68:1082–6.

10. Rath, A.M., Attali, P., Dumas, J.L., et al., 1996. The abdominal linea alba: an anatomo-radiologic and biomechanical study. Surgical Radiologic Anatomy 18, 281–288.

11. Coldron, Y., Stokes, M.J., Newham, D.J., Cook, K., 2007. Postpartum characteristics of rectus abdominis on ultrasound imaging. Manual Therapy. Epub.

12. Whiteford B, Polden M. Seu Corpo antes e depois do parto. In: Whiteford B, Polden M, editores. Exercícios pós-natais: Um programa de seis meses para a boa forma da mãe e do bebê. São Paulo: Maltese-Norma; 1992. p. 10-23.

13. Artal R, O'Toole M, White S. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med. 2003;37(1):6-12

14. Sapsford R. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Man Ther. 2004;9(1):3-12.

15. Frank C, Kobesova A, Kolar P. DYNAMIC NEUROMUSCULAR STABILIZATION & SPORTS REHABILITATION. International Journal of Sports Physical Therapy. 2013;8(1):62-73.

16. KolarP,SulcJ,KynclM,SandaJ,CakrtO,AndelR, Kumagai K, Kobesova A. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012;42(4):352-62.

17. Kolar P, Sulc J, Kyncl M, et al. Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment. J Appl Physiol. 2010;109:1064-1071.

18. Chiarello, Cynthia & A. Falzone, Laura & E. McCaslin, Kristin & N. Patel, Mita & R. Ulery, Kristen. (2005). The Effects of an Exercise Program on Diastasis Recti Abdominis in Pregnant Women. Journal of Women’s Health Physical Therapy. 29. 11–16. 10.1097/01274882-200529010-00003.

*Disclaimer:

The information by Dr. Lauren Keller of Elemental Chiropractic, Inc. is provided for general information only and should in no way be considered as a substitute for medical advice or information about any particular condition. While every effort has been made to ensure that the information is accurate, Dr. Lauren Keller nor Elemental Chiropractic, Inc. make no warranties or representations as to its accuracy and accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. If you have any specific questions about any medical matter or think you may be suffering from any medical conditions, you should consult your doctor or other professional healthcare provider. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.

The Hows and Whys to Working that Sexy Core

The Whys Behind Proper Core Exercise

The "core", as defined in “The Core Muscles of Core Exercises”, is more than those six-pack muscles. In fact, it has a lot more function than making you look sexy.

The core should work together, or work synergistically. What does this mean? When training the core, you should train it as a unit, the way it works as you breath and move throughout the day. The core is a system that only functions when the entire system is working in coordination. Working one aspect of the core without considering the other parts is pointless. It’s like doing a clam shell when you are capable of doing a single-leg deadlift. It may benefit a little, but it’s not the most efficient or effective movement.

Just as we shouldn’t work muscles separately, we also shouldn’t use our core without using the diaphragm and pelvic floor. In fact, our muscle activity should be tied with both respiration (breathing) and functional movement. All trunk muscles along with the diaphragm and pelvic floor help modulate intra-abdominal pressure (IAP) to create stabilization. When abdominal and back musculature, the diaphragm and the pelvic floor work together, the entire system is a well-oiled machine that has both stability and strength.

When the core is stabilized through breathing and the muscles work synergistically, the body is able to function optimally.

• Abdominal and pelvic organ support
  • Including proper and timely use of orifices (i.e. pee’ing and pooping when you want to and not just because you are vomiting, sneezing, lifting or coughing)
• Movement control and mobility
  • “Dynamic core stability for optimal athletic performance is not achieved purely by adequate strength of abdominals, back extensors, gluteals or any others muscles in isolation, but is accomplished through precise coordination of the ISSS and IAP regulation.”(1)

The Hows to Core Exercise

1. Through the Breath 

The breath (and therefore the core) should be three things - reflexive, anticipatory and reactive.

Reflexive Core & Breathing

Just as you don’t tell your eyes to close or your arm to move, you don’t want to tell your diaphragm to inhale and exhale.

Not sure what a reflexive breath looks like? Well, as we inhale (breath in), our diaphragm descends and the pelvic floor should relax, this allows the lower ribs to expand (outward and downward) and allows the abdominal wall to relax and expand. The breath inwards should be felt in a 360 degree expansion which means you should feel the breath in your pelvic floor, the sides of your abdomen and even in your back. Then, as we exhale, our diaphragm ascends and creates a gentle tension throughout the pelvic floor, abdominal wall as well as lumbar and thoracic musculature to create a support system.

Anticipatory Core (Feed-Forward Control Mechanism)

Before working, our brain sends signals that are beyond one’s consciousness to tell the body to be prepared for movement before any purposeful movement occurs

Reactive Core

All muscles that surround the anticipatory core creates the reactive core stabilization

2. Through Relaxing

Overtime pulling your abs in (aka suck your belly button in aka navel to spine aka holding the abs) creates a disconnect in the core system. So stop sucking in and forcing your abs to work, let them relax and work as they should. Not sure how they should work? Well, it’s through a reflexive, anticipatory and reactive core. You cannot have true core stability without letting your body do what it should.

What about tone?

The goal for core strengthening exercises should be to train the core to function optimally through stability, which includes a deep, diaphragmatic, reflexive breath.

But alas, I will concede and talk about those sexy abs.  When people think about the core and those six-pack abs, they often think about tone.

Tone is affected by many things including:

1. Breathing strategies
2. Posture and alignment
3. Pregnancy
4. Weight
5. Digestion and constipation
6. Nutrition and hydration
7. Neurologic disconnect
8. Poor exercise choices
9. Pelvic floor dysfunction

I know it's not the answer you wanted, but exercise is just ONE of the MANY ways to "tone those abs" and get a six-pack.

The Core Muscles of Core Exercise (aka…an Anatomy Lecture)

Understanding the Anatomy of Core Exercises

The Core Muscles of Core Exercise (aka…an Anatomy Lecture)

New Years is coming up so you are probably seeing the swarm of advertisements saying “New Year, New You” or “get your body beach ready”. When we talk about core exercises it’s important to remember what exactly makes up that core. When talking about the core a lot of  people think about the fancy six-pack muscles but there’s so much more than that. So here it goes…the core is comprised of the following:

Diaphragm

• What does it attach to?Lumbar vertebra (1-3)
  • Lower 6 ribs
  • Back of sternum & xiphoid process
• Function?
  • Concentrically contracts and lowers on inhalation
  • Eccentrically contracts and rises on exhalation
  • Helps mobilize the ribs, lumbar spine and thoracic spine

Multifidus

• What does it attach to?
  • Vertebra from sacrum to skull
• Function?
  • Important role in stabilizing the joints within the spine
  • Supports and protects the spine and pelvis to prepare movement of limbs
  • Commonly inhibited in pain

Abdominal Raphe (Linea Alba & Linea Semilunaris)

• What does it attach to?
  • Runs along anterior abdominal wall connecting xiphoid with pubic symphysis and crest
  • Receives attachment of obliques and transverse abdominis
  • Extends from cartilage of 9th rib to pubic bone
• Function?
  • Mostly collagen connective tissue

Rectus Abdominis (the six-pack…actually the eight-pack, but who is counting?)

• What does it attach to?
  • Arises from pubic symphysis and runs vertical to typhoid and costocartilage of 5th and 7th ribs
  • Contained in rectus sheath (which is derived from external obliques, internal obliques and transverse abdominis)
• Function?
  • Important in forced exhalation
  • Helps with strength termination

External Obliques

• What does it attach to?
  • 5th-12th ribs
  • Connects with fibers of serrates anterior and latissimus dorsi
  • Connects to iliac crest
  • Crosses the pubic symphysis
• Function?
  • Stabilize the pubic symphysis (with anterior pelvic floor muscles)

Internal Obliques

• What does it attach to?
  • Connects to thoracolumbar fascia posteriorly (via transverse abdominis tendon)
  • Connects to anterior iliac crest and lateral inguinal ligament
  • Posterior fibers connect to 11th and 10th ribs
• Function?
  • Accessory muscle of respiration
  • Forms inguinal ligament with transverse abdominis
  • Rotates and side-bends the trunk by pulling the rib cage and midline towards the hip and lower back, of the same side with contralateral external oblique

Transverse Abdominis

• What does it attach to?
  • Connects to thoracolumbar fascia with tendon and iliac crest
  • Connects to the lower 6 ribs and lateral aspect of inguinal ligament
  • Inserts into linea alba
• Function?
  • Forms inguinal ligament with internal obliques
  • Helps support the spine and internal organs

Psoas

• What does it attach to?
  • All lumbar vertebra bilaterally
  • Lateral edges of vertebra from T12-L4 (and intervertebral discs!)
  • Lesser trochanter of femur
• Function?
  • Stress response shortens the psoas
  • Affects structural balance
    • Commonly seen in an anteriorly tilted pelvis and/or rib thrusting

Pelvic Floor

• Function?
  • During breathing, raises and lowers synergistically with the diaphragm
  • Works to control the spine and pelvis by offering support for abdominal and pelvic organs
  • Supports the urethral and anal sphincters (what you pee and poop out of)

Superficial Pelvic Floor

• Composed of bulbocavernosus, ischiocavernosus, superficial transverse perineal, external anal sphincter
• Function?
  • In women, it contributes to clitoral erection and orgasm
  • Helps empty the canal of the urethra

Deep Urogenital Diaphragm Layer

• Composed of deep transverse perineal
• Function? Supports central tendon of perineum through perineal body

Pelvic diaphragm

• Composed of levator ani (pubocococcygeus, iliococcygeus, coccygeus), piriformis, obturator internus
• Function?
  • Support pelvic viscera
  • Closes back part of pelvic outlet
  • Keeps vagina and rectum closed
  • Facilitates birth

Up Next? Learn about the The Hows and Whys to Working that Sexy Core!

Dysfunctional Breathing: The Whys

Dysfunctional Breathing

“Breathing becomes dysfunctional when the person is unable to breathe efficiently or when breathing is inappropriate, unhelpful or inefficient in responding to environmental conditions and the changing needs of the individual.” (4)  Dysfunctional breathing and it's effects can be found:

• For the love of all things good, stop sucking in
• Must I pee when I sneeze?
• Understanding the Different Breathing Options

BUT WHY?

But one thing in health that is sometimes over-looked is the why. Why do we have dysfunctional breathing or what are the causes? There are three main causes of dysfunctional breathing:

1. Developmental Adaptations

During the first year of life, our bodies should go through an ideal developmental pattern that helps create a stabilization system and helps form posture. Two studies (Vjota and Prechtl) both indicated that 69.7-72% of children develop normally while ~30% have abnormal development. (5) 

This is one reason developmental kinesiology and the work of Dynamic Neuromuscular Stabilization (DNS) are important. Both address the ideal developmental pattern that can be adapted as an adult for the 30% of the population that may not have developed a strong stabilizing system in infancy.

2. Physiological / Medical

Hyperinflation of the lungs causes air to get trapped in the lungs. This hyperinfalation, often seen in COPD, asthma or emphysema and severe pneumonia, and congestive heart failure causes the diaphragm to shorten and lose its power and efficiency. (3)

In 2001, Hodges et al stated that the coordinating function between the diaphragm and transverse abdominis are frequently reduced in respiratory disease. (2) When the diaphragm contracts it is unable to properly lift and expand the lower ribcage and instead the lower ribs are pulled inward during inspiration creating what's called a Hoover's sign.

2. Emotional / Psychological

Both psychological and emotional stress can alter the diaphragm’s control. Dysfunctional breathing has been shown to be present in 11% of the normal population, 30% of asthma sufferers and 83% in people suffering from anxiety. (4) It has been reported that voluntary breath modulation accounts for 40% of the variance in positive feelings such as joy and negative feelings such as fear, sadness and anger (7).

In 2001, Umezawa found that breathing modification is the most common self-regulation strategy for relaxation and stress management. (6) Chaitow stated that in “Overbreathing: A Mind-Body Vicious Circle” that over-breathing and anxiety go hand-in-hand as anxiety increases the sympathetic system which causes an increase in breathing rate which leads to excessive carbon dioxide loss and in the end lead to a decreased pain threshold and more anxiety and overbreathing. (9) In 2010, Meuret stated that reducing hyperventilation “has emerged as a potent mediator for reductions in panic symptom severity and treatment success.” (8) Furthermore, studies have shown that conscious control of ones breathing can improve anxiety, depression and panic disorders. (11)

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2546439/
2. Hodges et al. Postural activity of the diaphragm is reduced in humans when respiratory demand increases. J. Physiol. 2001 Dec 15; 537(Pt3): 999-1008. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2278995/)
3. Hoover CF. The diagnostic significance of inspiratory movements of the costal margin. J Am Clin Sci 1920: 633-46
4. Courtney R. The function of breathing and its dysfunctions and their relationship to breathing therapy. Int J of Osteo Med. 2009;12:78-8
5. H. F. R. Prechtl and B. Hopkins, “Developmental transformations of spontaneous movements in early infants,” Early Human Development, vol. 14, no. 3-4, pp. 233–238, 1986.
6. Umezawa A. (2001) Facilitation and Inhibition of Breathing During Changes in Emotion. In: Haruki Y., Homma I., Umezawa A., Masaoka Y. (eds) Respiration and Emotion. Springer, Tokyo
7. Respiratory feedback in the generation of emotion. Pierre Philippot, Gaëtane Chapelle & Sylvie Blairy. Cognition and Emotion. Vol. 16, lss. 5, 2002.
8. Meuret AE, Ritz T. Hyperventilation in Panic Disorder and Asthma: Empirical Evidence and Clinical Strategies. International journal of psychophysiology : official journal of the International Organization of Psychophysiology. 2010;78(1):68-79. doi:10.1016/j.ijpsycho.2010.05.006.
9. Chaitow L Gilbert C Bradley D. Recognizing and Treating Breathing Disorders. Elsevier Health Sciences; 2013.
10. Ley R. The Modification of Breathing Behavior Pavlovian and Operant Control in Emotion and Cognition. Behav Modif. 1999;23(3):441-479.

Must I pee when I sneeze?

Must I pee when I sneeze?

We know that abdominal bracing and diaphragmatic breathing  is beneficial to core strength and stability because “as one inhales, the diaphragm moves downward in unison with the abdominal muscles and pelvic floor to eccentrically contract and regulate the volume of the abdominal cavity. By regulating the volume, the intra-abdominal pressure is also controlled.” Now, let’s focus on the other beneficial aspects of proper breathing and bracing, pelvic floor strength.

I commonly hear women say “I don’t like to do that movement because I will either pee my pants or fart.” Unfortunately, many women are told this is normal and to be expected because they gave birth. In fact, “at three months postpartum 34.3% of women admitted to some degree of urinary incontinence…” (Wilson, 1996). The thing is, it may be common but it is not normal. An article from 2001 stated that “the data are highly suggestive that leaking urine may be a barrier to physical activity, especially among mid-age women.” No woman should have to worry about exercising, sneezing, coughing, yoga or jumping rope for fear of losing control of their pelvic floor musculature and peeing their pants or farting.

Vaginal vs. Casearaen 

There’s a thought that urinary incontinence must be more common in vaginal births because the baby is coming through the birth canal. In fact, a study from 2007 done by Press showed that “Although short-term occurrence of any degree of postpartum stress urinary incontinence is reduced with cesarean section, severe symptoms are equivalent. This begs the question of why is the rate of urinary incontinence the same among all women?

Breathing & Incontinence 

In 2006, an article was released in the Australian Journal of Physiotherapy that concluded “unlike obesity and physical activity, disorders of continence and respiration were strongly related to frequent back pain. This relationship may be explained by physiological limitations of co-ordination of postural, respiratory and continence functions of trunk muscles.” This relates back to the connection the diaphragm has with the pelvic floor and all abdominal musculature - they must work in unison to provide stabilization. This was further addressed when Smith found in 2014,  the “relationship between BP, incontinence, respiratory problems, and GI symptoms in which the presence of one symptom is associated with the development of another.” Difficulty with optimal breathing and pelvic floor control (urinary leakage or farting) actually go hand-in-hand.

The importance of the diaphragm

The diaphragm, which works with the pelvic floor and abdominal musculature is important when looking at the cause of urinary incontinence. In 2015, Park released an article stating that “Diaphragmatic motion and contraction of the PFM correlate with breathing.”

It is improper breathing patterns altering the pressure on the pelvic floor that leads to incontinence. You see, “during normal respiration, or in the event of coughing or any other physiologic diaphragmatic alteration, a symmetric change in the pelvic floor can be observed…it also ensures the steadiness of the human trunk and maintaining urinary continence during respiration and coughing” ( Bordoni, 2013)

In the Therapeutic Management of Incontinence and Pelvic Pain: Pelvic Organ Disorders by Laycook and Haslam, they focused on breathing in order to improve urinary incontinence. They state, “it is considered essential to maintain co-activation and breathe in a slow, relaxed manner” and the use of isolated breathing patters is dysfunctional.” They further stressed the need for intra-abdominal pressure by stating “co-activation of the abdominal, erector spinae, diaphragmatic and pelvic floor musculature is essential to developing the intra-abdominal pressure for spinal stability.”

Improving the leak

A study done by Hung in 2016 focused on treating urinary incontinence by retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function. The results showed that “both amount of leakage and number of leaks were significantly lower in the training group (p < 0.05) but not in the control group. More aspects of quality of life improved significantly in the training group than in the control group.” This is great news for many women because it highlights the fact that many don't have to continue peeing their pants or farting if they do specific exercises to help strengthen the abdominal musculature, pelvic floor and diaphragm activation.

Dynamic Neuromuscular Stabilization (DNS) focuses on the inherent movement control system in the brain in order to activate the body’s stabilization system through proper use of the diaphragm. Functional progressions, which were created using DNS principles, focus on moving through a functional position. Laycook stated that “to improve performance, muscles are best trained with movements as similar as possible to the desired work. Therefore, exercise is most appropriate in a functional position.” This is important to remember because all exercises given to improve the pelvic floor should be done in movements that mimic ordinary function.

Results of exercise 

We know that peeing your pants when you exercise or sneeze is not normal and we know that the functional movements based off of DNS principles will improve the leakage. It’s also important to look at the long term effects because let’s be realistic, nobody wants to put in a ton of work and not see results. Dumoulin in 2014 released an article stating that, “the review provides support for the widespread recommendation that PFMT be included in first-line conservative management programmes for women with stress and any type of urinary incontinence.” In 2000, Morkved released a study showing there was not only statistically improvement in urinary leakage at 16 weeks postpartum, but exercise can improve leakage at 12 months postpartum too.

The gift of normalcy

While it may be common, peeing your pants when you exercise is not normal. In fact, it is a sign that you need to work on breathing and core stabilization. In order to find someone who can appropriately help you navigate this concern, it is important to find someone trained in DNS or a women’s health physical therapy.