Postpartum Exercise – Is cycling really ideal?

Me @ stromlo

If you google “pelvic floor exercise, postpartum exercises”, and so on, you’ll almost always encounter the recommendation that cycling is a safe form of exercise for your pelvic floor. 

I’ve been testing this theory out over the years.

I am a mountain biker. I rode my bike again when I was 6weeks Postpartum. However, I now have a pelvic organ prolapse. I was diagnosed at 12 months postpartum after most weekends on the bike.

I never thought I would suffer a Prolapse. I thought I had done everything “right” regarding my postpartum recovery and my pelvic floor. I thought it would never happen to me, because of my fitness – I thought Prolapse only happened to those who were not fit or active. (Close to the opposite is more true).

When I was diagnosed I racked my brain as to why this had happened.  I’m sure everyone goes through this thought process. Im sure there were a number of contributing factors – the hormonal changes that occur around 12 months postpartum, my poor alignment, my stress breathing.

For me,  mountain biking exacerbated the weakness that these other factors where causing on my pelvic floor.  I do regret the fact that I started back on my bike too early. Basically it is your typical case of “too much too soon”.

The problem with prescribing cycling as a “safe postpartum exercise” is that:

  1. Cycling and Mountain Biking are two very different demands on the Pelvic floor.
  2. Do we really know if either are “safe” for an individual without knowing what their strategies are when they exercise? For example – do they have the habit of holding their breath or bearing down? What is their lower body & core strength like?

In regards to MTB and road cycling being very different, in MTB there is a lot more “sit to stand” (to go over roots and rocks)  and sustained standing/hingeing movements, jumps and drops (similar to the demand plyometrics would place on the PF) and technical skills involving balance and core strength. Mountain bikes are typically a lot heavier and require a lot more energy and lower body strength to propel forwards as well.

However, even on a flat surface (and during a spin class) I feel there is a still a lot of downward pressure to be recommending MTB to postpartum women if they haven’t learnt to balance internal pressures, or participated in any rehab for their pelvic floor and core. Also, on a bike, the act of sitting to standing exerts the highest level of Intra abdominal pressure (more than a single sit up) of any exercise that have been tested in the study that was conducted. Intra Abdominal Pressure (IAP) is what contributes to stress urinary incontinence, prolapse and other issues.

In regards to individual assessment, only a Women’s Health Physio can do that via an internal exam and functional PF testing is ideal as well.

I’m pretty well recovered now, I am managing my POP well and I am able to ride 3x week (as my time allows). Some days it feels worse than others and some trails make me more uncomfortable than others. Changing my seat set up has been valuable advice and retraining my core so as not grip my obliques and pelvic floor while in the saddle. (it’s all about retraining automaticity)

So, how can we make MTB safer for women after having a baby?

It is nearly 100% impossible to avoid rough terrain or one that requires a sit to stand maneouver whether riding on or off road. So, what can you do to avoid making the risk of prolapse, incontinence and other core and PF issues worse?

  • If you had a C-section you must wait at least 12 weeks before you return to any activity. Begin Scar tissue massage and core breathing from 6 weeks PP
  • If you had a traumatic birth with perineal tearing, avoid activity including riding until tearing and stitches are healed and begin core breathing the week you give birth
  • Drink extra water on rides if you are breastfeeding
  • In the early phases of returning to riding, try to avoid steep inclines whether sitting or standing, although, sitting is the better option, as long as you are sitting with your pelvis in neutral.
  • Also try to avoid initially very heavy gears – whether you are on a flat road and pedalling hard or during a spin class when you are asked to increase the resistance
  • Re-train the automaticity of your PF from the moment you can after birth. In off road riding when suddenly I need to stand  to get over a log or boulder or to pedal through tough terrain like sand or mud I don’t need to think about lifting my PF, I just breathe and it does it for me! It means I can also concentrate on staying on my bike!
  • Be aware on longer rides that just like any muscles, pelvic floor muscles fatigue
  • Get a specialised bike fit  – if the seat is too low or high, too far back or too far forward or if it is on an angle then your pelvis will not be in neutral, which decreases the function of the pelvic floor
  • Don’t hold your breath!

On a positive note, you can try this:

  • Learn to hinge well. Most of the time on the bike is in some sort of hinge/bent over position. In the gym I love doing deadlifts because they feel AMAZING for my pelvic floor  – but take note, that might not be the best movement for you. When I deadlift, I use the piston breath and I KNOW when to stop loading the bar.  Although it is pretty hard to sync the core breath up with whatever is coming at me on the terrain, what Im doing in the gym is retraining the automaticity of my PF so that I don’t have to over think it on the trail!
  • Learn how to use your breath for sustained hold positions as well
  • In the beginning maybe try using a more upright bike position. Maybe you could use a recreational bike or try changing the stem and raising the handlebars as  leaning forward will put more strain on the PF muscles
  • Get your bike set up by a professional who understands the pelvic floor. You need to “spread the load” evenly through your sit bones
  • Wear a pessary if you have Pelvic organ prolapse.  If you have prolapse, a pessary will give your pelvic floor the support that it needs and hopefully prevent further straining.
  • If you are considering cycling or mountain biking you cannot forsake a pelvic floor assessment with a good women’s health physiotherapist FIRST
  • Riding at certain times of the month. The menstrual cycle and the hormonal cycle can mean good or bad for your pelvic floor. Cycle your training and go easy on the bike during the weeks leading up to your period
  •  Learn the “core breath”  here
  • Build up your glute max. Pregnancy changes the glutes’ response. After birth you need to retrain the firing pattern to make sure they are working well. ( you can also learn this in my ebook, click the link above)
  • Try having some chiropractic adjustments to relieve stress and adjust your pelvic alignment. There is only so much you can do to improve your posture, but if your hips are twisted and your nervous system is not feeding your muscles (including PF) or organs well, riding long term is not going to feel as good as it could.

It’s also what you do the other 23 hours of the day that affects your pelvic floor. Do you hold your breath? Do you have poor posture? Do you bear down? Do you forget to do your pelvic floor exercises? Do you strain on the toilet?

What I’m trying to say is this – that the longer you stay off your bike after  birth, whether it is mountain biking, road cycling or spin classes the better! What is the rush for you? What is the risk vs reward for you if you jump straight into what you used to do 6 weeks after birth?

If I could do it all over again, I would opt for flat terrain cycling to rebuild my fitness and quad strength first for at least a few months after the WHP assessment (And put away the dumbbells too).

I think there needs to be more clarity on the type of cycling that is deemed “safe” for the postnatal population, and some deeper guidance so that women all over the world can avoid pelvic floor weakness and dysfunction, especially since this demographic is rapidly growing!

I have collated everything I have learnt, know and experienced here into the “ultimate core restore” eBooks:

Ultimate Core Restore + Postpartum Athleticism Ebook Stage 1 – Start Here for Diastasis Recti, Pelvic Floor, New Mama’s!

Leave a comment and share your story!

xx ali

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6 Comments »

  1. This is a very good blog for us MTB rider with a prolapse. I am getting a bit older now and have cycled for over 25 years now. Love the mountain trails but struggle now, so I have treated my self to n Ebike and am loving it, still a bit worried about bumpy tracks with the prolapse but it’s good for moral and keep the pounds off. I am a bit concerned about using a pessary as I was woundering about it cause sores inside if you have any help with that I would like to hear.

    • Hi Kim, thank you for your comment! As we get older it is true that the pelvic floor tissue thins and prolapse can become more pronounced. But not always. It’s great that you have got an ebike to take the load off when climbing hills etc.

      pessaries are usually very successful and just like a tampon you do not feel them. They are 100% safe (unlike vaginal mesh surgery) and can be removed easily at home and cleaned or kept in for over 12months. It really depends on the type of prolapse you ha r and what stage it is but I recommend you try a pessary before considering other treatment. Is there a women’s health physio in your area?

      • I have seen the woman’s health physio and although helpful she doesn’t really understand what I really do. I have a cyostele prolapse in a mild state. Is there different pessaries for different sorts of prolapse. Have had a look and think I will try them. It’s good talking to someone. Thank you.

  2. Thanks for sharing this story! I was shocked to learn at about 10 weeks pp that I had a stage 2a prolapse 😞
    My expectations of returning to mtb have been significantly adjusted now. This was only a month ago but with the exercises and Pilates given by my women’s health physio i am starting to feel better. I’m not sure if she’s being overly cautious but has estimated at least 12 months to recover before any mtb. I’m allowed to road ride on the flat and no standing.

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