Unveiling the Connection: Pelvic Health, Exercise, and Postpartum Depression

One in three women will experience urinary incontinence (UI) after children.

40-50% of women will experience some form of pelvic pain beyond 12 weeks after childbirth.

10-16% of women have postpartum depression.

What do these three conditions have to do with each other?

A study in 2018 by Swenson et al revealed that women who experienced UI in pregnancy are 235% more likely to have postpartum depression. If UI persisted or emerged into postpartum this increases to 380%.

Pelvic pain increases the risk of postpartum depression by 2.6-fold.

What this means is women who experience UI or pelvic pain during pregnancy or postpartum, especially persistent symptoms, are at risk for postpartum depression.

These findings help us to identify certain risk factors that if addressed early on may reduce the occurrence of postpartum depression or allow for early detection and treatment.

Here’s the twist.

Exercise, even just walking, has been shown to have an antidepressant effect. Even though there isn’t solid evidence for this effect for postpartum depression, it can be a good option for those who don’t want to take antidepressant medication in postpartum or can’t access a counselor.

Unfortunately, you may be avoiding exercise because you pee your pants or have pelvic pain.

So what can you do?

Address the UI & pelvic pain to be able to exercise.

You can do this by seeing a Pelvic PT to assess why you have UI or pelvic pain.

Then address the findings.

An important aspect is breathing mechanics and how you breath is impacting your pelvic health. Ideally you naturally do diaphragmatic breathing, which is physiological breathing (how we were built/designed to breath).

Diaphragmatic breathing helps you manage:

• intraabdominal pressure

• abdominal muscle length & contraction

• pelvic floor length & contraction

• fight or flight response

Unfortunately, during pregnancy these mechanics change because of baby taking up space and posture changes. You are more likely to breath into your chest in pregnancy which tightens your ribs and reduces pelvic floor muscle excursion (outward range of motion). After birth, you may switch to belly breathing as your body will use the path of least resistance to expand. Since your abs are lengthened and soft it is easier to breath here instead of the ribs. However, this puts more pressure into your pelvic floor and reduces the muscular support of your pelvic organs.

What you can begin with is restoring diaphragmatic breathing.

This entails:

• Improving rib movement through thoracic mobility exercises

• Muscle massage with balls or a foam roller

• Stretching tight chest and back muscles while strengthening breathing muscles

• Practicing breathing into your back ribs in different positions

Your PT may also find impairments unique to you that need to be addressed.

You may begin to notice a difference in your bladder control or pelvic pain just with diaphragmatic breathing. And feel more confident in incorporating more exercise, in the form of walking or PT guided corrective exercise to continue with your healing to begin to benefit from the antidepressant effects of exercise.

Your mental health is important, and unfortunately you may be more vulnerable in postpartum because of the tremendous amount of change physically, mentally, and emotionally you go through. Exercise has been shown to have a positive effect on your mental health, unfortunately, if exercising or activity causes pelvic floor dysfunction symptoms like incontinence or pelvic pain, you’re less likely to exercise.

If you don’t pee your pants or have pelvic pain, but want to make sure your body is ready to return to fitness exercise postpartum, head to my YouTube channel to test yourself.

Otherwise, if you aren’t exercising because you are peeing your pants or have pelvic pain or are afraid to return to exercise, I invite you to a set up a phone call with me to discuss how pelvic PT can help you.

Reference: Swenson, C.W., Deporre, J.A., Haefner, J.K., Berger, M.B., & Fenner, D.E. (2018). Postpartum depression screening and pelvic floor symptoms among women refered to a specialty postpartum perineal clinic. American Journal of Obstetrics & Gynecology, 218(3), 335, E-1-335.