Postpartum Abdominal Binding

Our postpartum clients often ask us about abdominal binders, and whether they are a safe and effective way to regain abdominal function after birth. Many cultures have a long history of abdominal wrapping in the immediate postpartum period; modern products and programs have popularized the practice and advertise it as a way to correct abdominal separation (diastasis recti) that often occurs postpartum. We acknowledge the wisdom and importance of long-standing traditions, but also recognize that some practices are not right for the majority of postpartum moms. 

With a small number of exceptions, we do not recommend this practice for our clients, as it can adversely affect the pelvic floor (and the core in general) and does not show long term efficacy in correcting diastasis. For women following cesarian birth, gentle compression with a Baby Belly Band, snug camisole or high-waisted underwear can be beneficial to reduce soreness and speed healing. However, this compression should be discontinued within the first two months postpartum.

Explaining why this occurs requires an understanding of the “core.” The core is composed of the diaphragm, lumbar muscles, abdominals and pelvic floor, functioning together in one closed system. A good image is one of a soda can – the system is closed, meaning that pressure generated in one location affects other sides of the “can.” If a woman wears an abdominal binder wrapped tightly in the center of the core, it increases pressure upward and downward. The diaphragm is no longer able to expand as far to allow filling of the lungs with air, and pressure is increased downward onto the pelvic floor (the bottom of the can). In most postpartum moms, the pelvic floor is weakened after pregnancy and birth, and many experience urinary incontinence and pelvic organ prolapse. Women with diastasis recti are even more likely to have these symptoms of pelvic floor muscle weakness. If excess downward pressure is generated downward on the pelvic organs (bladder, uterus and rectum), the pelvic floor cannot adequately oppose it. For a woman who is already experiencing urinary leaking, pelvic or vaginal heaviness, or other symptoms of pelvic organ prolapse, wearing a binder will only worsen those symptoms. For women who are not experiencing those symptoms, they may notice them upon wearing a binder.

Simply put, wearing an abdominal binder may change the shape of the abdomen and size of an abdominal separation while someone is wearing it, but it does not actively train the abdominals and pelvic floor in relationship to the core as a whole. For long-term recovery and function, exercise and re-education of the core muscles is the most effective treatment. We recommend working with a physical therapists or exercise professional who specialize in postpartum recovery.

Pregnancy and Pelvic Floor Exercise

In our daily work with expecting mamas, we are constantly reminded that pregnancy is a time of information overload. Advice comes from all directions - family, friends, doctors, midwives, doulas, class instructors, books, magazines and the internet - and many women and their partners simply don't know how to make sense of it all.

As pelvic floor physical therapists, we frequently discuss concerns brought to us by our pregnant patients about the safety and efficacy of pelvic floor muscle exercise during pregnancy. With the volume and diversity of information available on this topic, it's easy to see why a lot of women are paralyzed by fear of doing the "wrong" thing.

So what's a mama to do? Our answer, ultimately, is the same that we would provide to any woman who comes to us with signs of pelvic floor dysfunction. It depends. 

Generalizing exercise prescription for any population of people, pregnant or not, will never completely address the needs of any one of those individuals, and may prevent many from getting relief from their symptoms. The state of pregnancy creates common features among many women, but each enters her pregnancy with a unique physical, gynecological and psychosocial history that must be determined by a thorough history and physical examination before any conclusions about the most appropriate type of pelvic floor exercise can be made. 

The most important "rule" about pelvic floor muscle exercise is that it should work to cultivate a strong, flexible and coordinated muscle group. Our best physical function occurs when our pelvic floor muscles can achieve a full range of motion during voluntary contractions and relaxations, respond appropriately to postural demands as a component of the deep core, provide stability and force closure to the pelvic girdle and lumbar spine, and adequately support pelvic organs against intra-abdominal pressure.

During pregnancy, it is very important to practice relaxing into the sensation of pressure and stretch felt at the perineum (see our home page video about perineal massage!). But it's also important that pelvic floor muscles can contract strongly and with good endurance to provide needed stability for the pelvic bones and give support to a growing uterus and pelvic organs (including the bladder). As with all things in life, moderation of all of these factors is the key.

The path to to get to this ideal state depends entirely on where our muscles begin - some individuals will need to work primarily on motor control and coordination, some will need to practice voluntary contractions, and others will need to focus on voluntary relaxation. The reason that our jobs stay so interesting is that every body is unique - so let's treat them that way! 

What is a Kegel, Anyway?

The "Kegel" was first described in 1948 by Arnold Kegel, an Assistant Professor of Gynecology at University of Southern California. In his quest to treat "genital relaxation," he realized that the strength of the pelvic floor muscles was an important component. He developed a "perineometer" to measure pelvic floor strength, and coined the term "Kegel" to describe the voluntary contraction of the pelvic floor muscles. 

So really, a Kegel is one man's attempt to describe the "concentric" (shortening) action of the pelvic floor muscles to achieve the goal of lifting and supporting the pelvic organs. He certainly blazed some important trails for the description and measurement of muscle strength, and his discoveries laid a foundation for the successful conservative treatment of many pelvic conditions.

HOWEVER. Kegel is not the last word on pelvic floor muscle activity! Ideas have evolved and the body of evidence-based practice has deepened and widened significantly since the mid-century. A Kegel is no longer the only tool we have in our toolbox, and we understand that this type of exercise may actually not be helpful for many types of pelvic floor dysfunction. A physical therapist trained in the specific evaluation of the pelvic floor muscles will not only evaluate how the muscle can squeeze and hold (a Kegel), but how well it can relax. A Kegel is only half the story, if even that much! What's more, if you would benefit from Kegels, you may need to be doing them in a different position than in sitting or standing! Depending on your strength and endurance, your PT may prescribe pelvic floor exercise that will be more efficient and give better results. 

Kegel AH. "The nonsurgical treatment of genital relaxation; use of the perineometer as an aid in restoring anatomic and functional structure". Ann West Med Surg. 2 (5): 213–6.