Running with a pessary after giving birth
Updated: Jan 4
This post was originally written in April, with an update in May. It's an extended version of an update I wrote on my Instagram account at 10 weeks postpartum.
My return to running after baby number two has been a bit different to the first time around.
The biggest difference is that I decided to use a pessary to support my pelvic floor so I could start back running at 10 weeks postpartum.
To recap why that's important, the pelvic floor muscles hold up the bladder, bowel and uterus. Weak pelvic floor muscles can cause urine to leak, or cause those organs to slip down into the vagina (prolapse). The pelvic floor muscles are often weaker after pregnancy and childbirth, and they are put under even more pressure during running.
I had a relatively straightforward birth the second time around. I had a second degree perineal tear. But I didn't have any major damage to my pelvic floor. I don't have a prolapse and I don't have any leaking.
But the muscles are still stretched and there is no definite timeframe for how long they will take to tighten back up.
They have improved since my first postpartum physio appointment at seven weeks, and they are strong when I contract them. But they are still not quite there.
So while they are still doing their job now, they aren't doing it as easily as they were previously. If I put more them under more pressure by starting to run before they are fully healed, they might weaken to the point of a prolapse developing in the future.
Using the pessary was the way to get back into running earlier without taking that risk. The intention is that it's temporary until my pelvic floor gets stronger. But coming up to seven weeks later, I'm used to it now and I don't really mind how long I need to wear it for.
For the first month or so after I gave birth the second time, the idea of running seemed like worlds away. The new baby tiredness wasn't as much of a shock to the system the second time, but I felt exhausted trying to juggle looking after a newborn and spending time with my 2.5 year old.
Leaving the house was achievement. I had no energy for running.
I told the GP that at my six week check up. I was intending to wait a little while before seeing the physio because I didn't any energy for running anway. The tear had healed, so she said I could swim and go on the bike at that point.
She also advised against waiting to see the physio. She thought it was better I start working on my pelvic floor straight away so I would be ready when the desire to run came back.
So I went to my appointment at seven weeks postpartum with the same perspective that I had a couple of weeks earlier - I didn't have any energy for running.
It was unusual for me, because I'm not usually one to hold back.
She did an external and internal check on my pelvic floor, first to check where it sat at rest. I was relieved that I didn't have a prolapse, but it was a little bit disappointing to hear that my pelvic floor muscles were still quite stretched.
It shouldn't be surprising. They had just spent nine months holding up a growing baby, then stretched to the max while I was giving birth. Plus, the pregnancy hormones in my body had actively tried to make everything looser, to make it easier to get the baby out. And I'm breastfeeding, which doesn't speed the healing process up.
Those muscles had been through a lot, and there was a lot working against them.
Part two of my appointment was checking how strong my pelvic floor is when I contract the muscles. The good news there was that although they are still stretched when at rest, they were strong when I contracted them.
The physio thought that was a good sign that they will get back to where they were. In all likelihood, they will tighten up with time as they recover from the pressure of holding up a baby, being stretched during labour, when my hormones go back to normal, when I stop breastfeeding and if I work to strengthen them.
The outcome was that I wasn't going to run straight away and see how much they improved over the next few weeks. If we didn't see much improvement and I wanted to run, she said she would fit me with a pessary.
She explained that it didn't mean there was anything majorly wrong with my pelvic floor. The pessary was just to provide a bit more support while the muscles were healing, similar to the way you would tape your ankle if it wasn't at full strength.
The big bonus was that it would mean I could start running earlier than if I waited for them to tighten up to a point where she was comfortable that I wasn't risking any future damage.
I didn't really think much of it, partly because I didn't mind waiting a couple of weeks and also because I was assuming it would improve pretty quickly. I didn't have any symptoms of pelvic floor weakness, I had already started on my exercises to strengthen the muscles, I had got back into running pretty easily after my first baby was born. I was used to being strong and fit and fast. So surely I would be fine again soon.
What didn't occur to me at the time was how much not running would start to affect my headspace. I love being a mum, but after a couple of months of solely focusing on my kids, I needed to do something just for me. It makes me happier overall, and more patient and engaged with my little ones when I've been able to spend a little bit of time just on me.
So after a couple more check ups with no major improvement in the resting state of my pelvic floor muscles, I decided to get the pessary.
I could have kept waiting, kept doing pelvic floor exercises and very short runs while it improved. It could have been one week, one month, one year. It was impossible to know.
Or I could use the pessary to run straight away without having to worry about causing any damage. And hopefully the extra strength I would start to build up from running, combined with my pelvic floor exercises would mean that in a week or a month or even a year if it takes that long, I won't need it anymore.
I chose option two, mostly cause it got to a point where it was better for my headspace to be running.
But over the last seven weeks since I made that decision, it has also given me the freedom to rebuild my running at a rate that I am happy and comfortable with. Without needing to constantly wonder if I'm doing too much too soon for those muscles.
Since I've been using the pessary, I have built back up to almost 50 kilometres a week and ran a sub 20 minute parkrun. It's still a long road to get to where I was and where I want to be. But the stronger and faster I get, I feel more and more like myself.
Which makes getting the pessary one of the best decisions I have ever made.
Why did I decide to share this?
It might be seen as something that is a bit personal and something that isn't commonly discussed.
But it's also something that affects a lot of people, and I think lots of women want to be able to get back into the sports or exercise routines they did before they had kids. So the more these types of stories are shared, the more these topics to be normalised.
I was seriously uninformed after my first pregnancy. I knew I wanted to get back running ASAP and I knew I needed to work on my pelvic floor. But that was about the extent of it, and that is speaking as someone who had a strong interest in returning to sport.
I was under the impression that any kind of pelvic floor weakness meant you couldn't run. It actually felt a bit scary going for the initial physio check up, because what if my body wasn't strong enough? What if I couldn't run? What if I was going to be out for awhile? I had never heard of a pessary at that point.
I did get a bunch of papers about pelvic floor with way too many words from the hospital after my first baby. I'm not sure what sleep deprived mum is going to read that information overload when she has just had a new baby and it's definitely not the same as seeing someone face to face.
The midwives who discharged me from hospital told me to do pelvic floor exercises and see my GP before I started sport. It's fair enough general advice, but I definitely needed more than that. I needed to see a physio, have a proper assessment, I needed someone to teach me how to properly exercise the muscles. And mostly I needed someone who proactively wanted to help me get back to running (safely).
The first time I have even seen pessaries mentioned in a mainstream running article was within the last month. The reasons for using one quoted in this article are very similar to the reason I got one.
It says: "It basically enables some women who are really keen to get back to exercise but do have some symptoms of prolapse or some ongoing pelvic floor issues, to keep exercising without the heaviness or leaking."
Knowing that there are ways to return to sport if you do have pelvic floor issues make it all seem a lot less scary. You don't even have to have symptoms of pelvic floor dysfunction to use a pessary (I don't). It's preventative for me. And I have spoken to other mums who are in similar situations to me, that just need a bit of temporary support to start running sooner. So it's really good to see this information being shared.
On the practical side of things:
My pessary cost $120
It's a ring style one, I believe there are other styles too
It can stay in all the time (while taking it out to clean it)
Or I can just put it in when I run (this is what I do)
It's easy to get in an out
It's comfortable, I don't actually feel it at all when I'm wearing it
It is fitted by a physio, there are different sizes and they will work out which is right for you
It's not as scary as I thought it would be!
I also want to share this because lots of people need help returning to running and that's perfectly okay.
I often think I don't need any help. But sometimes it's hard to admit that our body can't do everything we want it to. Especially if you ran through your whole pregnancy, or usually run a lot of volume or fast times. I often think I should be invincible because I've been a runner all my life, but it's a good reminder that I shouldn't be ashamed when I'm not.
As it turns out, my pelvic floor isn't strong enough on its own for me to run at the moment. But that doesn't mean I can't start back, I just need a bit of help for a little while.
And it's okay that I do. Using a pessary doesn't make me weak. It means I get to run. Which is huge for my mental wellbeing because of everything I get from running.
So I would love to see this be well known as an option for women who want to get back into sport after having kids. It has helped me so much!
Update (15 May 2022):
I am now five months postpartum, and had a physio appointment this week to check where my pelvic floor is at. It has improved quite a bit, and I'm now trying out a smaller pessary. We discussed the possibility of running without it, and she thinks I could on some of my shorter, easier runs. But because I want to run quite high volume and increase my speed, I'm going to keep using it for now.
So how do we know that it's improved? And how do we know that I need it in the first place?
Through a measurement called GH+PB (genital hiatus plus perineal body). When I saw a women's health physio after my first baby was born, she used this measurement to check my pelvic floor and I vaguely remember her telling me what it was. But I didn't ask and questions. I was all good to run, and that was all I really cared about.
This time around, I decided to get a little more info to make sure I understand what is going on with my body.
What is GH+PB?
It is two measurements combined together that show the distance from the middle of the anus to the urethra. This measurement correlates to the size of the gap in the pelvic floor muscles (levator hiatus) where the vagina, bladder and bowel pass through. The size of the gap increases when the muscles are stretched during pregnancy and labour. A larger than normal gap means a higher risk of prolapse occuring because less support is being provided to those organs.
For an explanation of this from a qualified professional, I have linked a video showing how GH+PB is measured below.
The measurements are taken at rest and while bearing down (valsalva), using this handy tool.
At my first postpartum appointment, my GH+PB measurements were about 8cm at rest and 8.5cm while bearing down. To be able to run, I needed to be at 7cm. I asked what a normal measurement was for someone who had never given birth, which while not exact for everyone, was around 6cm.
My measurements did improve slightly at the subsequent appointments before I got the pessary. But it was only this week at five months postpartum when I finally got to 7cm at rest and about 7.5cm while bearing down. That puts me right on the border of being okay to run without the extra support of the pessary.
If I was starting back running now and getting ready to build up, I would probably be comfortable not using it. But given that I have already got my volume to 60km a week and I want to keep increasing it, that would still be quite a lot of pressure on those muscles.
So for now, I'm happy to continue with the smaller size, keep supporting my pelvic floor and still have the freedom to do as much running as I like.
I also wrote a post about some of the practical things I did to help me get back into running after my second baby.