Common First Year Issues, a Sarah Jane Sandy Collaboration

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Did you guys know that we have not one, but TWO, in-house nutritionists that can help you on your health and wellness journey? One of those lovely ladies, Sarah Jane Sandy, runs her own private practice, specializing in fertility, pregnancy, and all things women’s health related. She recently started a new blog series focusing on the new journey of Motherhood, and she wrote a little somethin’ somethin’ that we thought you guys might be interested in when it comes to nutrition, exercise, and recovering from birth. Note that this is just an excerpt, and the original blog post can be found here: Mama and Baby Blog Series : Common Issues in the First Year.

Today we’re going to dig deep into topics that women just don’t talk about. I’m a huge proponent of sharing stories and talking about what you’ve experienced to normalize every journey, but some things just kinda get swept under the carpet and never addressed. So let’s talk about some of those today!

Don’t forget – if there is anything that you’d like to see in this series – burning questions that you may have, experiences that you’ve learned from, whatever it may be – please leave a comment and I’ll be sure to address it!

Diastasis Recti

“Diastasis recti” means your belly sticks out because the space between your left and right belly muscles has widened. You might call it a “pooch.” Pregnancy puts so much pressure on the belly that sometimes the muscles in front can’t keep their shape. “Diastasis” means separation. “Recti” refers to your ab muscles called the “rectus abdominis.”

It’s very common among pregnant women. About two-thirds of pregnant women have it. Having more than one child makes this condition more likely, especially if they’re close in age. You’re also more likely to get it if you’re over 35 when pregnant, or if you’re having a heavy baby or twins, triplets, or more.

The condition can cause lower back pain, constipation, and urine leaking. It can even make it harder to breathe and to move normally. It’s rare, but in extreme cases, the tissue may tear, and organs may poke out of the opening – that’s called a hernia.

The muscle opening often shrinks after giving birth, but in some studies of women with diastasis recti, the muscle weren’t back to normal even a year later.

So here are the dos and don’ts:

Don’t strain. It can make matters worse. Constipation and lifting heavy things, including your kids, strain that connective tissue. Standing up and sitting down also count as heavy lifting in this case, because you’re lifting your body weight.

Do be careful with exercise. Some routine fitness moves, including crunches, sit-ups, pushups, and front planks make abdominal separation worse. So can swimming, some yoga poses (like downward dog), and doing anything on your hands and knees.

Do heal your belly. Physical therapists don’t have one standard guideline on what moves will bring the belly muscles back into line. When the connective tissue has healed, some core exercises may help you strengthen and rely more on your transverse (deep core) belly muscles instead of the outer ones. I highly recommend finding a trainer and/or studio that specializes in diastasis recti. Working with someone who doesn’t know the ins and outs of diastasis recti could cause more damage, instead of promoting healing. One of my besties – Brooke Cates, creator of The Bloom Method – has a great blog post on this: Three Mistakes Fitness Professionals Make that Permit or Even Cause Diastasis Recti.

If your abdominal separation is not too big, you may decide to live with it. But you should bring those muscles back together before you have another pregnancy. Your doctor can measure how far apart your muscles are using finger widths, a measuring tape or instrument, or ultrasound. Then she can see whether it’s getting better or worse.

Many women can close their belly gap by learning gentle movements to use while the abs are supported. Ask your doctor for advice. She may refer you to a physical therapist. If that rehab won’t work for you, maybe surgery will. An operation to correct diastasis may be called “abdominoplasty” or “a tummy tuck.” The surgeon folds and sews together the weak central ridge. It might be possible to get laparoscopy, which is surgery done with only small cuts instead of one large one. Scarring, infection, and other side effects are possible with any operation.

Urinary Incontinence

Muscles of the pelvic area require time to heal and as they heal urinary incontinence will often ease off. Urinary incontinence, the inability to hold urine, is common in many women postpartum.

The same muscles that are used to push your baby through the birth canal are used to stop urine from escaping the bladder during normal activity. For some women, coughing and laughing cause urine to leak. For others, simply walking from one room to the next involves a trip to the bathroom for an underwear change.

Muscles of the pelvic area require time to heal and as they heal urinary incontinence will often ease off. Some women also have problems with urinary incontinence due to having had a catheter if a C-Section was performed. It can take up to six months for urinary incontinence to stop and bladder control to return to normal.

Kegel exercises are suggested throughout pregnancy and postpartum for urinary continence and increasing the strength of birth muscles. After birth, losing pregnancy weight can ease up pressure on the bladder to increase urinary control as well.

Some of the same treatments used for urinary incontinence during pregnancy are used for postpartum control. Controlling constipation can also help prevent leaks after giving birth. Full bowels can put pressure on the bladder causing urine leakage from time to time. Constipation can be controlled with a diet filled with tons of vegetables, fruits and high fiber starchy vegetables and increased water intake.

Wearing protective pads can help you feel a bit more in control of wetness and odor that is associated with urinary incontinence.

Painful Postpartum Sex

Many women do not desire sex after childbirth because of pain, or fear of pain, during intercourse. The time it takes for a woman’s desire to return to previous levels depends largely on her birthing experience:
  • Women who deliver with the assistance of forceps tend to take longer to feel comfortable during sex.
  • The same goes for women who experience internal vaginal tears.
  • Women with swelling after childbirth and/or any breakdown of the perineum (the external region between the vulva and the anus that is made up of skin and muscle) also tend to take longer to feel comfortable during sex.
After delivery many obstetricians usually tell their patients “nothing in the vagina for six weeks”, or “no sex until the 6-week postpartum visit.”

There are several reasons for the recommendation for delaying postpartum intercourse:
  • allowing the woman’s genital tissues to heal, especially if there was an episiotomy or tearing
  • allowing a cesarean skin or uterine scar to heal
  • avoiding infection to the genitals and the uterus
Six weeks is usually when the uterus should have returned to its pre-pregnancy size – this is the last of the major physical postpartum changes .

Studies have shown that the average woman resumes sex after 6 weeks, with a median time of 3 months, other studies found that 1 in 5 first time mothers took 6 months to feel physically comfortable during sex, and another study found that over 50% of women were still having less frequent sex at 12 months after childbirth.

The bottom line? Postpartum sex can be awkward, uncomfortable, and potentially painful. Don’t feel pressure to have sex 6 weeks postpartum – wait until your body is ready, and you are both physically and mentally ready.


Hemorrhoids are swollen, and sometimes inflamed blood vessels, veins in your anus and lower rectum. As many as half of all pregnant women get hemorrhoids during pregnancy, particularly during the third trimester. If you have had hemorrhoids prior to getting pregnant, you are more likely to develop them during pregnancy. Similarly, if you’ve had hemorrhoids during pregnancy, you are more likely to develop hemorrhoids after your pregnancy.

Hemorrhoids are bulging and swollen veins in the rectum. They can be internal hemorrhoids that are located inside the lower intestine or they can be external hemorrhoids, where they protrude out from the anus.

During pregnancy, an enlarged uterus puts pressure on these veins. Add the extra weight you are carrying, along with constipation and the straining and pushing you had during labor, and you might see yourself with a case of postpartum hemorrhoids.

The most common symptoms of hemorrhoids are discomfort, itching, bleeding, and pain. You may notice streaks of blood on the toilet paper after using the bathroom. Bleeding hemorrhoids may seep mucus that can leave your skin irritated. If your hemorrhoids are internal, it is not unusual to see blood in your stool. In some cases, you may feel a lump near your anus as a result of hemorrhoids.

Fortunately, there are a number of things you can do to get relief from postpartum hemorrhoids:
  • Place an ice pack to your hemorrhoidal area a few times a day. Ice is helpful to reduce your discomfort and decrease the swelling of your hemorrhoids.
  • Use a witch hazel cold compress.
  • Soak your bum in a warm sitz or tub bath.
  • Use pre-moistened wipes after each bowel movement instead of dry toilet paper. It is important to keep your rectum and anal area clean if you have postpartum hemorrhoids.
  • Drink plenty of water and eat foods, like fruits and vegetables, that are high in fiber. Doing so will help reduce constipation.
  • Speak to your healthcare provider about recommending a topical hemorrhoid-relief ointment or medicated suppository.
The important point to note is that hemorrhoids are common both during pregnancy and after. If the above tips don’t help improve your hemorrhoid symptoms or if they begin to bleed, contact your healthcare provider right away.

To read more about Breastfeeding, including how to handle some potential complications, check out the rest of this post here: Mama and Baby Series : Common Issues in the First Year.

A great way to get back into the swing of things in the first year after giving birth … check out a REBEL class! Obviously wait until your body is ready - don’t push yourself too hard - but know that we’ll be waiting for you, with our studio doors wide open :).

Another great option to ease back into things is by training one-on-one with one of our personal trainers. We are realistic in goal setting, and we can explain what to expect in each session. We can also optimize each session - with your end goals in mind. Our trainers get to know your body and what you’re capable of and tailor each session to YOU.