Pelvic Floor

Pilates after Hernia Repair


Pilates after hernia repair offers a crucial piece of the exercise puzzle - pelvic floor and deep abdominal support!

Lately I have received several requests for exercise suggestions to help either repair small existing inguinal hernias, or assist in maintaining a hernia repair after surgery.

First of all, what is a hernia?

According to the NIH,

A hernia is a sac formed by the lining of the abdominal cavity (peritoneum). The sac comes through a hole or weak area in the strong layer of the belly wall that surrounds the muscle. This layer is called the fascia.

Basically, a hernia is an area where the intestines start to protrude through a weak area in the abdominal wall. Hernias are named for location (inguinal - groin, umbilical - belly button, hiatal - upper abdomen, femoral - upper thigh).

Hernias are caused by straining while abdominal pressure is increased - it can happen on the toilet, opening a window, or even lifting weights and/or doing abdominal exercises incorrectly.

Yes, you read that correctly. Poorly executed exercise can cause hernias and make existing ones worse.

However, correctly done exercise can help heal a hernia, especially after repair.

Exercise recommendations for pilates after hernia repair are similar to those for diastasis recti.

Once you have been cleared by your physician to exercise, it is important to avoid straining while increasing abdominal pressure. This requires careful monitoring of breathing patterns while moving and exercising.

At the beginning you should avoid most traditional abdominal exercises, such as crunches. You should also avoid overhead presses.

Focus on exercises that help engage your pelvic floor muscles, diaphragm, and deep abdominals.

Breathing correctly is the first challenge.

Listen to the first breathing exercise in my back pain video. This is the basis for moving correctly in any exercise.

Diastasis Recti and Pilates


Diastasis Recti can be both helped or worsened with Pilates. Here's how Pilates can help.

Diastasis Recti as defined by the NIH:

Diastasis recti is a separation between the left and right side of the rectus abdominis muscle, which covers the front surface of the belly area.

Most diastasis is seen in pregnant women, where the muscle separates as the woman's belly expands. I have also seen it in men after abdominal surgeries.

But at the moment I am working with many women who worsened their diastasis through improper exercise techniques during and after pregnancy.

Basically, it is crucial that the transverse abdominis and pelvic floor muscles be strengthened to help hold everything together. The rectus will typically also start to pull back together. Sometimes it will stay, and sometimes need to be sewn.

Diastasis is typically measured in "fingers" - literally how many fingers will fit in between the two muscle halves. I have personally worked with women who have had between four finger and ten finger diastasis with great success.

In terms of exercise, the approach to both diastasis prevention and diastasis repair are similar.

During and after pregnancy, until everything is working properly, avoid exercises that cause an increase in abdominal pressure that will push against the abdominal wall:

  • traditional crunches
  • overhead presses
  • heavy weight lifting
  • intense abdominal exercises (in Pilates this would mean ab series, teaser, backstroke, short box, etc.)

If the muscle has already separated, it can be helpful to wear an elastic abdominal brace to physically hold the muscles together (which is what we visualize while doing exercises).

I encourage people who have a diastasis to try Pilates to strengthen your internal abdominal brace. Please make sure that your teachers are familiar with what diastasis recti is and how to properly manage it. If they ask you to do the hundred with your head up first thing, you are in the wrong place.

If you hear more about breathing, pulling "in and up", and not bulging at your abs, you are in the right place.

Remember that even if you do require surgery to repair the separation, proper abdominal and strength training will help you maintain your abdominal corset of support after.

As an illustration, a new client came in to see me about 6 months ago with a four finger diastasis after her second pregnancy. She had been seeing a personal trainer at her gym, who was giving her crunches and overhead presses to build up strength. Unfortunately, this made the diastasis worse.

It had been about a year, and her OB wanted her to see a surgeon for repair.

After just a few months of steady, twice a week Pilates sessions, she went to the surgeon. He told her there "was nothing to repair." Success! Just proper Pilates training.

If you live in NYC and have a diastasis recti that you would like some help with, please contact me directly. If you live downtown, you can also come see me at Real Pilates.

Seriously, I can help you!

Pilates for Pelvic Floor Strength

Left Levator ani from within. In my life I have had many uro-gynecological problems, resulting in many surgeries that ended with a total abdominal hysterectomy. During my treatments and after this final surgery I really had to work on my pelvic floor. The muscles were weak, they had been moved around during surgeries, and suddenly there I was at 27 looking at buying incontinence products. Not a fun place to be!

That led me to develop breathing and exercise techniques that allow for healthy strengthening of the pelvic floor without strain. Most people are unaware that deep and supportive abdominal and back strength, along with proper breathing mechanics, are dependent upon the pelvic floor muscle working well. Once I understood that and really worked those muscles along with everything else, my incontinence improved to the point where today it is not an issue at all.

I encourage anyone with incontinence to try Pilates - it can really help!