pelvic floor health

Pubis Pain aka “Lightning Crotch” or Pelvic Pain During Pregnancy: Part 2

Part 2 - Managing pubic symphysis dysfunction through exercise

Not sure what pubic symphysis dysfunction is or the causes? Check out Part 1 for more information!

The most important thing to know is that each mama is unique in her needs. For that reason, it is important to see a chiropractor or physical therapist with additional training in pregnancy and postpartum to find out what your specific needs are. With that being said, there are some general guidelines. Y’all know by now that I love mamas to stay active during pregnancy but there are some exercises that are best modified or taken out when you have SPD.

The ‘Don’ts’ of exercising with pubic symphysis pain (exercises to avoid with lightning crotch):

  • Don’t over-stretch

    • Yes, it is possible to over-stretch, especially during pregnancy when relaxin and progesterone are helping muscles and ligaments relax in order to prepare for birth. If you are doing yoga or pilates, it’s a great idea to not push mobility at the end of any pose as this can increase your risk fo stretching too much and destabilizing the pelvis

  • Avoid single leg movements for a few weeks (2-3 weeks) and slowly add them back in yo see if you can manage the load. If not, that’s OK and take them back out. If they do not increase or cause pain, it’s a great idea to add them back!

    • This includes taking out lunges, bulgarian split squats, pistol squats, warrior pose, assault bike, and step ups as all of these exercises are one-leg dominant and can increase shearing on the pelvis

  • Avoid traditional “core” exercises 

  • Traditional core exercises like sit-ups and crunches focus on activating one or two muscles independently of the core system (diaphragm, pelvic floor and all abdominal and back musculature). Working these muscles can actually pull on the pubic rami and increase pain. Core exercises like the plank are advanced and require full pelvic/core stability and joint centration (the pelvic floor and diaphragm should be aligned). It is common for mamas to compensate during this movement as their natural gravity shifts and this compensation can lead to increased pelvic and low back instability.

  • No deep squats or sumo squats

    • I love deep squats because the bottom of a squat is when the pelvic floor is most relaxed (hello benefits in labor) BUT that stretch can be too much with pelvic pain and is best to be avoided

  • Adductor stretch or adductor machines 

    • The adductors are connected to both the inner thigh and the pelvis and can definitely play a role in pelvic pain. Like most everything, it is best to figure out if the adductors need relaxed or strengthened. If you are constantly stretching and they don’t feel better, they may actually need strengthened! Vice versa, if you’ve been working hard to strengthen the adductors but they continue to be sore, you may need to calm the signal from the brain to down regulate this pain. The best way to know this is to see a professional who can guide you in what your body currently needs.

  • Fast/explosive movements 

    • We want to continue moving during pregnancy but fast and explosive movements require the musculature around the pelvis to respond quickly and when there is pain this reaction is often slower. It is easier to compensate and not utilize the appropriate muscles to create the force to stabilize

Exercises that may improve pubic symphysis pain

  • Focus on posture and pelvic alignment

    • As you stand and walk your diaphragm should be aligned with your pelvic floor — this is a neutral spine. If you drop into too much anterior or posterior pelvic tilt this can increase pain/pressure on the pubic region. So one easy exercise to stand in front of a mirror and focus on finding that neutral spine.

  • BREATHE

    • As we inhale, our pelvic floor gently descends and relaxes and as we exhale it gently lifts and contracts. This is a normal progression with diaphragmatic breathing that naturally helps to activate the deep abdominal muscles and stabilize the pelvic region with the breath

  • Balance strength and mobility

    • All movements should be slow and intentional with a focus on maintaining task-specific IAP. This intention trickles down to balancing strength and mobility so we aren’t over-stretching or strengthening a muscle that does not have its full range of motion

  • Work the glutes and adductors in synergy through movement

  • Work all of the core together

Mama, if you are struggling with pubic symphysis pain or any pelvic pain, I understand the frustration, anger and fear that comes along with it. I believe that no woman should have to suffer through pregnancy or postpartum in pain. Call 331-307-7110 to schedule an appointment today or book online. Not ready yet? That’s OK, schedule a free 15-Minute Healthy Mama strategy session today to discuss your options.

Urinary Incontinence & Your Period

Lately I have heard more and more women ask about incontinence that only occurs at certain times of their cycle. For some it is the week before their period starts and for others it is only during their period that they notice increased incontinence. Unfortunately, the research on incontinence and a woman’s monthly cycle is seriously lacking. Luckily, we do have one study that gives a little insight into cyclical incontinence. The study showed 41% of women notice their incontinence is cyclical and of those women 42% notice symptoms just before their period and 36% of women notice increased symptoms during their period.3

 

Leaking Before & During your Period

While we need more research on cyclical incontinence, it can be helpful to look at the research we do have—specifically increased incontinence during menopause.  Menopause, like the premenstrual time frame, is when the natural production of estrogen declines. In fact, estrogen levels are lowest right before, during and immediately after the period. These low estrogen levels can decrease ligament laxity and increase ligament stiffness.4 What this means is that approximately a week before menses occurs there is a drop in estrogen which is believed to decrease the strength of the urethra, the tube that connects that bladder to the urinary meatus (how we get urine from the bladder to the outside).

The human body is an amazing thing - it changes and adapts to the hormones that our body naturally releases and the pelvic floor is no different. In fact, the pelvic organs as well as the surrounding connective tissues are all estrogen-responsive, meaning the tissues respond and adapt to fluctuations in estrogen.2 We commonly see this effect in women with stress incontinence who are pre-menopausal due to lower levels of estradiol being produced.1  With the decrease in estrogen, the  pelvic floor and surrounding ligaments are unable to appropriately adapt to changes in intra-abdominal pressure, causing increased incontinence due to the decreased strength, increased stiffness and decreased ligament laxity.

These natural fluctuations in estrogen may also affect the orientation of the cervix. The change in orientation can affect the sphincter of the urethra, or the ability to start/stop the flow of urine efficiently and effectively. This helps us better understand that increased incontinence before and during our periods may be due to the decrease in estrogen which changes the pressure around the urethra causing it to lose elasticity and not being able to fully close and stop the flow of urine.

Leaking When Using a Tampon or Menstrual Cup

By inserting a tampon or a menstrual cup we are naturally altering intra-abdominal pressure (IAP). Altering our ability to appropriately create and maintain IAP, we alter our body’s ability to properly adapt to the environment. This is done through either hypertonic (tight) muscles that are unable to properly relax and therefore unable to create a strong contraction because it is always contracting or hypotonic (reduced tone) and are not able to create a strong contraction.

Leaking only when using a tampon or menstrual cup may also be a sign of a cystocele (bladder prolapse) masking stress urinary incontinence. A cystocele can cause the urethra to kink and actually block the flow of urine. By using a tampon, it acts as a pessary to reduce the cystocele and unkink the urethra allowing for the proper flow of urine. Unfortunately, in some cases, this proper flow of urine reveals incontinence that was previously hidden by the cystocele.

What can we do about it?

As there are structural changes taking place, it may be a good idea to re-frame your workout based on your cycle. If you are one of those that notices increased incontinence prior to your period or during, it may be a good idea to transition to lower impact exercises or focus more on the rest and recovery phase of health. Now that is not to say that you can’t exercise, it may just be a good idea to swap out double unders or box jumps for BIRTHFIT functional progressions or unilateral farmers carry or even Russian kettlebell swings.

As with any leaking or incontinence issue, it is important to be evaluated by someone with extra training in pelvic floor health. That way a care plan can be created based on your specific needs. To find one in your area reach out to your BIRTHFIT Regional Director for local resources or check the Herman & Wallace Certified Pelvic Rehabilitation Practitioners or the list of APTA’s Women's Health PT.

 

Resources

1.    Lu Y1, Lang JH, Zhu L. Estrogen receptors in pelvic floor for female stress urinary incontinence. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2007 Jun;29(3):402-6.

2.    Tzur T1, Yohai D1, Weintraub AY1. The role of local estrogen therapy in the management of pelvic floor disorders. Climacteric. 2016 Apr;19(2):162-71. doi: 10.3109/13697137.2015.1132199. Epub 2016 Feb 2.

3.     Bidmead J, Cardozo L, Hooper R. The impact of the menstrual cycle on urinary symptoms and the results of urodynamic investigation.BJOG. 2001 Nov;108(11):1193-6.

4.     Reese M, Casey E. Hormonal Influence on the Neuromusculoskeletal System in Pregnancy. Musculoskeletal Health in Pregnancy and Postpartum: An Evidence-Based Guide for Clinicians. January 2015. (pp.19-39).

“You’re Cleared for Exercise”

Simply because we were cleared for exercise doesn’t mean our bodies can handle weightlifting or running without creating pain or causing urinary leakage. Just because we were cleared doesn’t mean certain movements will cause or worsen a diastasis recti or abdominal tenting/coning.