Still look pregnant 9 months postpartum

[tillerman61]

Im 9+ months postpartum and still look 6+ months pregnant. I had twins in September 2023 at 37 weeks. I ran, biked, hiked, rock climbed and strength trained through my entire pregnancy. I followed a postpartum workout plan for 15 weeks and saw a pelvic floor PT who said my pelvic floor was very strong although I still had some incontinence with running and my diastasis recti was still 2-3 cm when I was discharged at 6 months postpartum and to just continue what I was doing. she said this was all somewhat hormonal and would improve when I’m done BF
However my core just won’t cooperate and I can barely load it (I.e bird dogs) before I cone. I’m still leaking with running. I still look very pregnant when relaxed and my waist like is still 4-5” bigger than pre pregnancy. I’m quite lean so it’s not extra body fat.
I’m planning to continue BF until a year or so. I’m strength training 3X/ week, running 4x/week and interspersing some biking, hiking and rock climbing in there now.
My question is would you just rough it out for 3+ more months and wait and see? Would you go back to PT? I considered seeing my doc and seeing if my uterus actually went back to regular size. My first 2 kids I did not have this issue at all

 

[grandpa4]

@tillerman61 You were discharged from pelvic floor PT but you still experience leaking when you're running? I think leaking is a pretty clear sign of pelvic floor disfunction and am surprised that they would have said your pelvic floor was in good shape when you're clearly so symptomatic still. I'd probably be looking for a second opinion if I were you and I certainly would not rough it out for several more months out of concern that doing so could only make things worse in the long run.

Your body might also just need more rest and for you to scale back the exercise to really be able to heal. You are keeping up with four kids now, are breastfeeding, and are following a pretty rigorous exercise routine which is a lot to ask of your body at less than a year out from carrying twins.

 

[tillerman61]

@grandpa4 Thanks for your thoughtful reply! I do think I’ll go see another pelvic PT. I’ve considered scaling back and resting for a bit too since I haven’t been able to strength train my way better. I dont feel like I’ve progressed at all core strength wise and it’s definitely affecting my ability to progress things like squats, deadlift etc :/

 

[mamabdog]

@tillerman61 Have you tried workouts that are specifically tailored to postpartum? I find it's easier to remember to be kind to my core and pelvic floor when I'm using a video that's specific for that.

What I learned from pelvic floor therapy is that it's important that the pelvic floor knows how to both be strong AND relax when needed. If its always tense (my case), when you're actually really stressing it (in my case when I did jumping jacks) it gets "tired" too quickly and fails. So you need to do pelvic floor exercises that do both strengthening and relaxing. I'm sure your therapist probably touched on this too but just sharing what I found most helpful.

You might also consider PT for your diastasis recti. It can be closely related to a lot of things that also cause pelvic floor issues.

Also, it might not be the case for you but biking causes a TON of pelvic floor issues for me. I started having leaking issues 2 years postpartum because I had started biking (stationary bike) every day.

Be patient with your body. Healing takes time. And you had TWINS! That's a lot more stress on the body typically! It can't hurt to get a doctor's opinion or more physical therapy, but healing takes time.

 

[tillerman61]

@mamabdog I did do a 14 week postpartum program through an app (SDevolution) followed by their BUILD program for a couple months. I do a lot of the core and breathe exercises from that and PT but I just feel like I cant progress past it.

And ok yes that totally makes sense. She did say I was able to fully relax but maybe when I’m running I’m tensing up trying not to pee. Also I’ve only thought about impact and not about sitting on a bike seat so that’s interesting too!

And yeah i do realize that 9 mo post twins is still only 9 months I just feel like I’m struggling way more to is time. But also twins haha yea. They did stretch me out quite a bit! And way earlier on.

 

[kflisovsky]

@tillerman61 Non-professional opinion, but I’d stop running until your symptoms improve. My pelvic floor PT told me that running is particularly hard on the pelvic floor and said I should stop if I start experiencing symptoms (such as leaking).

I agree with others saying go get a second PT’s opinion, it sounds like you could benefit from continued PT work.

 

[tillerman61]

@kflisovsky Thanks! It’s so hard not to run because it’s my way of getting myself out, my babies in the stroller and my two older kids on bikes out for some movement but I know it’s just a temporary thing. And I do think I’ll go to another PT

 

[kflisovsky]

@tillerman61 That absolutely makes sense! Hopefully this will feel like just a small break to invest in getting yourself back to 100% so you can spend many happy healthy years of movement with your family

 

[mygodisawesome]

@tillerman61 Please see a different pelvic pt. “Strong” is a pretty unhelpful term and overly tense often is the cause of stress incontinence (peeing while running) some DR may not be completely fixable but based on what you’re saying it sounds like there is still plenty to be done.

 

[mygodisawesome]

2 finger widths is considered “healed” btw take that with a grain of salt. Distance isn’t necessary a helpful measurement if it’s still deep/squishy and not super functional. For many our default muscle tone in our belly is just a bit rounder postpartum so there may be some expectations to manage

 

[tillerman61]

@mygodisawesome Yeah that all makes sense

 

[mygodisawesome]

@tillerman61 Personally I would look for a private practice pelvic pt that has some sort of hybrid program. You probably don’t need to be seen in person THAT often and more so need a good program with follow up.

 

[positiveness]

@tillerman61 What was your postpartum workout plan? Was it under the eye of a personal trainer? You sound plenty strong but it looks like you're not able to manage your intra-abdominal pressure if you're coning during bird dog. I would definitely go for a regression and take your time before progressing.

I.e. from your quadruped position just step one foot back into a half plank and see if you can use your breath to keep your core engaged. Then try adding the reach of the opposite arm, while still keeping the back leg down. See how that goes for awhile and then try adding the lift of the back leg. Just one example! Hope that helps and good luck!

 

[tillerman61]

@positiveness I did the SD EVOLUTION postpartum app program so not under a personal trainer but I was going to PT during that time. But I think she kind of didn’t know what to do with me so might go see someone else.
I’m still doing a lot of super basic core stuff but just can’t seem to progress, but maybe I’m trying to progress it too quick and need to back up and start over

 

[positiveness]

@tillerman61 Ah, got it. I agree with others to see a different pelvic PT, but it might also be helpful to look up Dr Sarah Duvall on YouTube. Managing intra abdominal pressure can be really tricky and it takes a good amount of mind body connection to master it.

If you're feeling like you're very proficient at the super basic core exercises but can't seem to advance then you might just be choosing too big of a jump in progression. Take small steps in progressing! Add challenges to the basics by changing tempo (slow it way down, which increases time under tension, add holds), adding light weights/resistance, increasing ROM, etc.

 

[miller]

@tillerman61 I don’t have specific experience with what you’re dealing with, as I had a singleton c section and haven’t had as severe of diastasis recti or pelvic floor issues as you. That said, I found diastasis recti ab workouts specifically tailored towards post partum to make a huge difference. I can send you some workouts if you’re interested. Before pregnancy I could do lots of pull-ups, post partum I lost the ability to do even 1 because of my core. I did a few PT workouts and within 2 weeks I was up to 5 pull ups already.

 

[tillerman61]

@miller Yeah I cannot really get a pull up right now and it’s so frustrating!

 

[m5comp]

@tillerman61 After my first, my DR did improve up through about 12 or 18 months pp. It really did take a while to get the best it was going to, but it never got 100%. I was also a 2-3 and got down to a 1-2.

I just hit a year pp with my second and am still 3+ and deep/squishy. Better diligence with deep core work would probably help, but I also think that if you carried large (suspect so with twins) there is a certain amount of damage that cannot be undone.

But you should still be in pt if you’re leaking urine. I’m not sure why you were discharged.

 

[tillerman61]

@m5comp Yeah mine is deep and squishy still . When I engage my recuts it does close down but I can’t maintain my TrA with very much load and I cone :/
I think I’ll go back to PT like everyone has suggested

 

[heavenonearth]

@tillerman61 Sounds like you already know to get a second opinion. While you're there, I would specifically mention wanting to improve your core and DR in addition to the incontinence. My postpartum PTs had me do some pretty intense breathing exercises that focused on the core that I've never come across on YouTube.

Also, hello from another September bumper! My core is currently MIA as well. Actually probably worse than I was when I was still in PT due to returning to work and not finding the time to work out.