In our first Pelvic Floor week, I laid out what I find to be a helpful, foundational, and holistic understanding of the pelvic floor. Based on a combination of anatomy, Chakra theory, and yoga, I believe this helps foster reverence and discipline for the recovery and continued care of this part of our bodies and selves.

This week, I will set out some simple principles for rehabilitation, strengthening, and general pelvic health that it is useful to keep in mind as you live and move. We are a group of mothers at very different stages of the journey, from pregnancy, through early motherhood and beyond to the menopause; it is always a good time to start working with your pelvic floor.

These are the simple principles that I stick to when it comes to pelvic floor work:

Heal from the inside out

Work from the bottom up

I have to credit this approach to my wonderful friend and birth doula Maren, who was by my side for every single one of the 60 hours or so of Ella’s labour, and who will I hope join us here when she emerges from her own newborn bubble!

Let’s start with inside out: This is a reminder to start small and subtle, before you progress to any larger or stronger movements. Start simply with the breath. Our breath is the central tool for the recovery and integration of this part of ourselves, and is something you can begin working on from the day of birth. If you have never been pregnant, it is likely that when you engage your abdominal muscles or perform a movement that is inherently ‘core-based’, your pelvic floor will automatically begin the movement by hugging up and in to support the strong lifting action that your body is performing. After going through pregnancy and any form of childbirth however, it is quite likely that your body’s natural response to ‘core work’ will forget (sometimes completely) your pelvic floor. By this I mean, when doing abdominal work or movements that require core strength (and the exhale breath alone qualifies as this in those early days) you might find that your abdomen contracts but your pelvic floor does not engage, or that your abdomen kicks into gear before your pelvic floor does – the reverse directionality from what we are after for functional strength.

By focussing on small movements like the breath, we give ourselves a simple landscape within which to reprogramme our bodies and brains, reminding our body that the exhale begins in the pelvic floor, before rising up through the abdomen as we knit together the central muscles of our core. Done properly and consistently in those early days of postpartum (but started at any time in our postnatal lives) you will likely discover that breathing ‘correctly’, with the most functional transfer of muscular engagement is a lot of work! If you begin lying down, and eventually work on maintaining the same action while sitting upright, you might find that to breathe in this way soon after birth, is a workout in itself.

Continuing the principle of inside out, the breath-only approach can gradually include performing the breath in different positions, and while performing small movements, before you eventually incorporate it during larger more complex, expressive, or high-intensity movement if that is your thing.

As already suggested by the directionality of pelvic floor before abdomen, we move onto the principle of ‘bottom up’. If we do not focus on this directionality, but instead start working on core strength with a body that squeezes before it lifts, you may find that your core is effectively pushing your internal organs down onto a pelvic floor that is lacking in tone or function. This can lead to further weakening of the pelvic floor and occasionally organ prolapse, and it why it is not a great idea to start postnatal exercise by ‘doing sit ups’ or crunches, or by focussing first on your abdomen when it comes to core strength. Build the floor first, before you put the walls up.

Working in this way, and focussing on a part of our body that is unseen by anybody else, experienced only by ourselves, is a powerful statement of self-care. The breath is a meditative environment for us to come back into quiet relationship with ourselves after we have weathered the turbulence of pregnancy and childbirth, a practice to come back to which can support us through our own unfolding matrescence.

By beginning our pelvic floor work with simply breathing, we can also bring ourselves back into connection and understanding with a body that is much-changed. Early motherhood for me, both times around, was physically characterised by a frequent feeling of disconnection. I think this exists in part because we have a memory of our body ‘normally’ feels, but it is a memory of a feeling that has not been quite true for nine months and counting. And so we are at risk of moving through the world as a foreigner in our bodies, a landscape that shifts and swells and shrinks at a speed we have never before experienced. If we take just five minutes each day to meet our body where it is now, on this day, feeling into all its unfamiliar corners with our breath, we are able to move from a place of self-knowledge and understanding, and this can be a powerful tool for stability in those untethered early days.

Later this week I will go through a series of exercises to take you from the breath and beyond, to movement you can build into your day for the rest of your lives.