October is Physical Therapy Awareness Month! NAFC has long been a proponent for physical therapy as a treatment option for things like urinary incontinence and pelvic organ prolapse. Read on to learn more about how a PT may be able to help you treat these conditions.Read More
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When I was in my early forties, I suddenly found myself rushing to the bathroom constantly. The urge would strike without warning causing me to sprint there lest I want to have an accident everywhere. It wasn’t too big of a deal when I was at home – I was typically able to make it to a bathroom, but when I was in an unfamiliar place, I’d feel panicked until I knew where every toilet in the place was, just in case I needed to make a mad dash to one.
I had been at stay at home mom for the last several years, caring for my youngest daughter, but when she finally started school, I decided it was time to return to the working world. But first, I resolved to get my bladder under control – I didn’t want to be rushing from meeting to meeting with important clients with the fear of peeing my pants.
I visited my doctor and found out that I had Overactive Bladder. It’s where your bladder has sudden spasms that cause you to feel the need to empty it – even if you just went. He prescribed a medication, which helped a lot and made me feel more confident as I returned to work. I’m now exploring a procedure involving nerve stimulation that is supposed to be even more effective and won’t require me to take medications every day.
I’m so happy I got this treated before returning to work, and wish I would have done it sooner! It would have made heading to the park with my daughter much less daunting! Don’t wait to see a doctor if you have OAB. Turns out there are lots of things that you can do to treat this common (but not normal!) problem.
You're expecting and you couldn't be happier! There's literally a mini-you baking in the oven and you feel proud, excited, and even nervous about it. However, now the phrase, "you're expecting", has taken on a new meaning. Sure, you're expecting a baby, but you also may begin to throw up at random times, crave things you've never desired before, and even leak a little after a sneeze. Nobody told you that you should be expecting all of that!
You're able to get past the sleepless nights and aches and pains, but these leaks, they're not your thing. However, this too shall pass. In the meantime, you can implement a few techniques and products to make it a little more bearable.
What's Up With These Leaks?
A woman's body goes through A LOT while carrying a baby! The uncomfortable experiences are the body's way of adapting for the baby and preparing for childbirth. I mean, we've got to expect a little discomfort with a baby growing and organs shifting to make room for it, right?
Stressed Out Sphincter
You can thank your expanding uterus for putting pressure on the bladder and making you spritz when you walk, talk, laugh and sneeze. This extra pressure on your bladder is known as stress incontinence and this happens when the bladder sphincter doesn't function well enough to hold in urine.
Hormones Going Haywire
Hormones play a big part too. Relaxin is a hormone that relaxes your muscles in preparation for labor. Progesterone is also released to soften your ligaments. The result? A pelvic floor that's looser and softer, which leads to less control of your bladder.
Bladder Spazzes and Spritz
Are you frequenting the ladies room more often than usual? Then you might have an overactive bladder. This happens when the bladder starts uncontrollably spazzing out and it's a common condition for pregnant women.
Can I Do Anything About It?
The short answer is yes, you can do something about it. However, what you do about it might not actually stop the leaks. It's one of those things that you can't 100 percent control. However, there are things you can do to help manage it during your pregnancy.
Kegel exercises are helpful before, during and after pregnancy. Doing just a few sets of 20-30 Kegel exercises a day can help whip your pelvic floor muscles into shape. Keep in mind, a stronger pelvic floor can better support your uterus and bladder, which could mean fewer leaks. Plus, they'll come in handy when it's time to give birth! However, before you decide to implement anything new, like Kegel exercises, be sure to consult with your doctor first.
You're probably tempted to cut back on your water intake but that's not a good idea. Ensure you're getting the recommended amount of water each day. Otherwise, you could wind up with dehydration or an unpleasant UTI.
Could your diet be irritating your bladder? It's certainly possible. Ditch the soda pops, coffee (sorry!), tomatoes, and citrus stuff.
Products Can Help You, Too
One way to keep your leaks to yourself is by using pads, but not just any kind of pads. If you're tempted to grab one of your menstrual pads that have been stashed away for a while, please don't. They might look like they can get the job done but they won't. Menstrual pads are great for absorbing menstrual flow but not the rapid output of urine. Instead, look into bladder control pads. They're much more comfortable and offer better protection. Bladder control pads are designed to control odor, keep you dry, and let you remain discreet about your leaks.
Using a Product is Okay
A lot of women are embarrassed about bladder leakage and don't discuss options with friends or their doctor. Others feel like a few leaks aren't that big of a deal. No matter how you feel about it, you don't have to just deal with it. Doing a few Kegels and wearing a bladder control pad as a backup is a great strategy for managing leaks.
Growing a human being inside of you is going to cause a lot of physical and hormonal changes that you may or may not expect. However, one thing you can expect is to have options to make those pesky leaks a little more bearable!
What are you currently doing about leaks? Tell us about it in the comments!
This Post was brought to you by Lily Bird
Lily Bird is for all women with leaky laughs and dribble dilemmas. We squeeze when we sneeze and drip when we jump. And we think it's high time we stop saying sorry for the spritz. We provide a hassle-free monthly subscription service for bladder leak products as well as free tips and tricks for women to take control of leaks via The Chirp.
It’s a funny thing, aging. I’m 68 years old, but I don’t feel any different than I did at 20. It happens so gradually really, but it feels like it comes out of nowhere. One day, you’re sitting there with your whole life ahead of you, and then suddenly, you’re walking along, you glance at your reflection and you see an old woman looking back at you. But you don’t feel any different. At least I didn’t. Until I started having bladder leaks.
My bladder leaks crept up on me just like getting old did. I had a few accidents here and there after kids, but didn’t start really noticing them regularly until I was in my late 50’s. I told myself I was too young to have this problem; that they weren’t that big of a deal and that I could manage it on my own.
The truth is, I was embarrassed. I didn’t want anyone to know about my leakage problem. I hid it well, or so I thought, but after a while, it started to weigh on me. Always packing a spare change of clothes, always scouting out the nearest bathroom in case of an emergency. It wasn’t until my daughter finally confronted me that I broke down.
I was visiting her at her house when I had an accident and had to change my pants. My daughter noticed and finally decided that enough was enough. She told me how she had watched me for years try to “hide” my problem, and urged me to get help. She also told me how she herself had talked with her doctor after her son was born and she had started experiencing leaks too. “The good news,” she said, “is that I’m doing so much better, and I hardly have any leaks at all anymore. I want that for you too, Mom.”
Talking to my daughter really opened up my eyes. She was right, and I couldn’t believe I had spent so long trying to hide the issue. Worse, I couldn’t believe she had gone through it too. If I had been open about it, maybe I could have offered some comfort to her, but instead she had had to deal with it on her own. I felt ashamed and embarrassed – not because of my bladder leaks, but because of my silence.
So, I decided to finally get help. After so many years of living with the problem, I didn’t realize how much it had taken over my life. And now that I’ve started taking medication for my bladder leaks, I am so much happier and freer.
I am 68, but the 20 year old still lives inside of me. And now, I can proudly say that I feel just as good today as I did back then.
Don’t wait to get help. Take the initiative to talk to your doctor and get the help you need. We can’t all do this alone and life is too short to let a day go by where this condition is controlling you. Suck up your pride, realize that we all need some help once in a while and just do it. I promise you, you’ll be so glad you did.
Alice B., San Jose, CA
After the birth of my 2nd child, I began experiencing urinary incontinence. I started leaking a bit here and there, and it only got worse as I got older. I assumed it was just a part of aging and that there was nothing I could do. And while the episodes were embarrassing, I was able to control and hide them pretty well by wearing protection and always keeping a close eye on the toilet.
However, when my youngest was 15 years old, I had my first real bowel accident, and life as I knew it officially changed. I began having more and more episodes, and eventually didn’t even want to leave the house because I was so terrified of having an accident. I stopped seeing friends. I ordered groceries and most things I needed online. I refused to go on dates with my husband. There is something that feels just a little bit worse about having a bowel accident vs. having a bladder accident – it’s messier, smellier, much more apparent, and just so humiliating that you never want others to know it is something you are going through.
I lived like this for six years before finally realizing that I wasn’t controlling my ABL, it was controlling me. I got up the nerve to speak with my doctor and was able to have a surgery that helped alleviate many of my issues.
All of this could not have come soon enough – my first granddaughter was born a year ago and to think that I may have missed out on that moment or all the wonderful ones that have followed makes me cringe. My only regret is that I didn’t do something about it sooner.
Ellen T., Atlanta, GA
I gave birth to my first little bundle of joy a year ago. My pregnancy was a dream – no morning sickness, no stretch marks - it was a total breeze, apart from the occasional leaks I had leading up to the birth. I had heard leaks were totally normal though, and figured that after baby came, everything would go back to the way it was before, so I didn’t really give them much thought.
After my baby was born, things changed dramatically. Suddenly, I was dealing with breastfeeding problems, sleepless nights, and a fussy baby that needed me 24-7. Not to mention those little leaks that I had before baby came - they were still lingering and I found myself changing my own pants almost as often as I was changing my baby. Every sneeze, laugh, and jump, caused me to leak and it really started to get me down. After all, I was in the middle of learning a new job – the most important job of my life, being a mom – and I couldn’t even get my own body to behave appropriately.
I finally talked to my doctor about it and he recommended physical therapy. I didn’t even know that was an option! But, turns out that strengthening your core and your pelvic floor muscles can really help control your bladder. This was great, because I wasn’t prepared to undergo surgery (not recommended if you’re planning on having more kids, like I am), and was really hoping to find a more natural option. So this seemed like a perfect fit for me.
My therapist started by reviewing my anatomy and showing me how all my muscles are connected. She also told me that I had diastasis recti, which is when your stomach muscles separate during pregnancy. This can really weaken your core, which affects your pelvic floor muscles too. She showed me exercises to help bring these muscles back together and strenghten my core. After baby, it’s also important to do your kegels to help get your strength back – my therapist told me that this would help me control those little leaks that I had when I placed stress on my bladder (like when I coughed, sneezed, or laughed).
It’s been 6 months since I started physical therapy and I’m happy to say that I’m leak free! I feel stronger and more in control of my body, and, more importantly, I feel better able to focus on and care for my growing baby.
I’m so happy I sought help. It makes me feel empowered, and better prepared to handle future pregnancies and babies.
New moms – don’t keep quite about this. Talk to your doctor and get help. There’s no need to suffer in silence.
Merrell N., Austin, TX
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Barbara Jennings was 6 weeks postpartum when she realized that something wasn’t right. “I had been feeling some pressure in my vagina for a while, but figured it was just a part of the normal healing process after vaginal delivery.” When she finally got the courage to explore a bit, she found something that surprised her. “I felt a smooth lump protruding slightly from the opening of my vagina. I was horrified, and so scared!”
What Barbara was experiencing is called a pelvic organ prolapse, and it’s not uncommon. A prolapse happens when the vaginal walls become too week (due to things like childbirth) and the organs that are supported by them fall into the pelvic floor basket, sometimes protruding from the vagina. It’s not a curable condition, but can be improved by behavioral modifications, or surgery if necessary.
“After doing a lot of research, I learned that physical therapy could be done to help strengthen the muscles of the pelvic floor and improve symptoms of prolapse”, said Barbara. “I had never even heard of physical therapy for that part of the body, but because I knew I didn’t want surgery, I signed right up.”
Women’s Health PTs are a thing, and they treat everything from prolapse, like Barbara experienced, to pelvic pain, incontinence, back pain, diastasis recti, and more. But how do you know if you need one? And at what stage of life do you see them?
The first thing to know is that you can see a Woman’s Health PT at anytime. Whether you’re feeling some back pain during pregnancy, want to get checked out after baby arrives, or have difficulty picking up your grandkids without leaking, physical therapy is an option. Improvements can be seen at any age, and most physical therapists would agree that it should be a first line of defense against leaks and pelvic floor disorders.
Medications and surgery are often thought of first when it comes to treatment, but when you commit to a physical therapy routine, you’re making the effort to strengthen your body yourself, which can alleviate a lot of pain and/or leakage on it’s own. If you’re experiencing any kind of pelvic floor, back or hip pain, or if you have bladder leaks, call a physical therapist and get set up an appointment for an examination.
So, what can you expect when you visit? As with most doctor’s visits, you’re PT will ask you lots of questions about your medical history, and the symptoms you’re currently experiencing. You’ll also likely get a musculoskeletal evaluation, and if you are experiencing any pelvic floor dysfunction, an internal exam.
The internal exam sounds scarier than it actually is – rest assured your PT has performed many internal exams and there is nothing to be embarrassed about. It’s a necessary step for them to determine the state of your pelvic floor muscles, and your treatment plan.
Multiple visits are usually required to assess your improvement over time, and to ensure that you are performing your exercises correctly. Treatment is considered complete when your symptoms have improved, although you may need to continue with your treatment plan even after you stop visiting your PT.
If you experience any type of pelvic floor related dysfunction, including pain, bladder leaks, or even if you experience back pain (those muscles are all connected after all!), don’t hesitate to see a PT. It’s often a good first line of defense for these issues and may resolve them better and more naturally than medications or surgery. “Even though my prolapse will never be completely “cured”, I have seen tremendous improvement in my symptoms since I started physical therapy”, says Barbara. “I’m so glad I looked to this option first.”
Around 6 weeks postpartum, I had expected to feel a bit more like myself. I had avoided exploring anything in the vaginal area for fear of what I would find, but had felt a general heaviness since I had given birth. Not knowing for sure if this was normal, I made an appointment with my doctor to get checked out.
Upon examination, my doctor confirmed that I had a prolapsed bladder. His tone was nonchalant, as if it was totally normal and something that just happened sometimes.
I was completely shocked. What had gone wrong? And why did I never hear that this was a possibility? I immediately started blaming myself. Why had I not done more kegels during my pregnancy? Why didn’t I do more research to know that something like this could happen? Did the decision to use a vacuum during the last bit of pushing influence this? What could I have done to prevent this?
But the truth is, some women really are just more susceptible to prolapse. While a prolapse can occur for many reasons, some women have more of a genetic risk for the condition due to the strength of the connective tissues. It’s not your fault.
That being said, there are some things that may help you either avoid a prolapse, or at least improve your symptoms if you have one.
How to improve symptoms of pelvic organ prolapse
- Maintain a normal weight. If you are overweight, you are more susceptible to a prolapse due to increased pressure inside the abdomen.
- Avoid constipation. Becoming constipated can cause you to strain during bowel movements, increasing the chance of a prolapse. Ensure you are eating a high fiber diet and drink plenty of water every day.
- Keep active. A regular exercise plan keeps your weight in check, and also helps promote healthy bowels. Be sure to include your pelvic muscles in your daily workout routine too.
- Avoid extra pressure inside the abdomen. Things like lifting heavy objects, and chronic coughing, create persistent pressure, which can increase the likelihood of developing a prolapse, or making your symptoms worse if you have one. Stay healthy and avoid strenuous lifting.
Whatever you do though, don’t blame yourself for developing a prolapse. Instead, use that energy to find out what you can do to improve your symptoms and treat the condition. Talk to your doctor about your options, and find a qualified physical therapist to help you learn how to strengthen your muscles to improve symptoms.
A Guest Blog by Lizanne Pastore PT, MA, COMT
Eighty percent of the bodily changes occurring during pregnancy happen in the first trimester! Isn’t that astounding? A woman’s body must adjust quickly to a 40% increase in fluid volume, increased heart and respiratory rates and myriad other changes that may affect us in different ways. The fluid volume increase, for example, can make our connective tissues weaker—our tendons can get a little mushy and our nerves and blood vessels a bit softer. This extra fluid and tissue weakening makes us more prone to things like leg swelling, varicosities, tendonitis, carpal tunnel syndrome, or sciatica.
The hormonal changes in pregnancy play a big role in our metabolism, mood, memory and, of course, ligamentous laxity. Some pregnant women experience instability not only in the pelvis and hips, but also in the joints of the spine, elbows, and wrists. Our musculoskeletal system is taxed by these changes even before the baby gets very big. Then, as baby grows, we might begin seeing rectus abdominis separation (“diastasis recti,”) spinal problems from posture and center of gravity changes, even rib dysfunction as the ribs are forced out and up to make room for belly. Foot pain from falling arches from the sudden weight gain can occur, and on and on.
In the pelvic girdle, there is a list of other maladies that can be downright scary to a pregnant or postpartum mama. And most women are not warned about these potential problems. Pelvic girdle pain manifesting as coccyx, pubic or sacroiliac joint pain; groin or hip pain; pelvic muscle or nerve pain; plus urinary or fecal incontinence or pelvic organ prolapse are some of the more common things occurring during or after pregnancy.
After birth, as Mom is busy caring for her newborn and any other children at home—schlepping heavy car seats, strollers, laundry baskets, breastfeeding through the day and night, lifting ever-heavier babies into and out of cribs—she wonders why everything hurts, or why she feels a clicking in her pelvic bones when she lifts her leg! Well, she is busy performing exceedingly challenging tasks with a sub-optimal musculo-skeletal-neural system (not to mention sleep deprivation!)
It is well documented that both pregnancy and vaginal birth increases a woman’s risk of developing pelvic organ prolapse or becoming incontinent later in life. And many women think that leaking during or after birth is “normal” because their friends, moms, aunts, and sisters leaked, plus there are 20 different brands of incontinence pads to choose from in the drugstore, so it “must” be normal.
But this is wrong; leaking and pelvic organ prolapse is common, but not normal or OK. The same holds true for back or pelvic pain. Sure pregnancy puts demands on our bodies, but there is no reason to “put up” with pain, leaking, prolapse, numb hands or legs! There is a health professional who knows all about this—a physical therapist specially trained in women’s health issues and the pelvic floor. These PT’s are special – they understand the pregnant and postpartum body and are experts in negotiating a path to health and strength for women with special concerns.
After an initial assessment, which often includes a thorough pelvic muscle exam and possibly even a biofeedback analysis, the woman is prescribed a home program. This program may include a combination of postural or corrective exercises, motor training or strengthening exercises, bladder and bowel re-training, special instruction to change movement strategies to limit stressors on the body, and even self-care techniques for pain or prolapse, such as self massage for constipation, or gentle inversions for prolapse.
Wouldn’t it be amazing if every pregnant woman and new mama could have a visit with a PT like this? Guess what – they can! If you are reading this article and are pregnant talk about this option with your doctor. And if you have friends, sisters, aunts and co-workers who might be pregnant or new moms, talk to them about it. Tell them to ask their doctors for a referral to woman’s health physical therapist!
Need help finding a qualified PT? Visit the NAFC Specialist Locator to find one in your area.
About the author: A physical therapist for 29 years, Lizanne has specialized in treating women and men with complex pelvic floor and pelvic girdle issues since 2005. She has worked primarily in San Francisco and the Bay Area, running a successful private practice for the past 18 years. She writes, lectures, and teaches about pelvic health at the professional and community levels and is currently a board member of the NAFC.
The relationship between urinary incontinence (UI), pelvic floor disorders, and vaginal birth is a hot topic. Popular magazines and some scientific journals claim that vaginal birth is a cause of urinary incontinence, which has fueled the debate about another equally hot topic: cesarean delivery by maternal request! The presumed logic is this: if vaginal birth leads to UI, then cesarean delivery should be done to prevent it. In fact, questions surrounding causes and prevention of UI, as it relates to vaginal birth, are far more complex. Scientific studies done to date have shown no conclusive evidence that vaginal birth causes UI or pelvic floor disorders. Until we have more answers, cesarean deliveries done to protect the pelvic floor are unwarranted.
What is a “Birth Plan”?
It is never too early to learn what you can do during childbearing years to protect your pelvic floor and bladder health. A Birth Plan is a paper document you develop that serves as a communication tool between you and your healthcare provider. It describes how you would like to be cared for during your pregnancy, labor, and birth. A Birth Plan helps you and your provider focus on practices and procedures you believe are important to include or avoid. Everyone wants a healthy mother and baby – that is a given. However, there are many pathways to achieving a safe, normal vaginal birth, a healthy infant and a healthy, satisfied mother and family. A Birth Plan simply places these thoughts in writing. During the course of your prenatal visits, a Birth Plan encourages conversation with your provider about the processes and procedures that occur in the hospital during labor and birth that may affect your bladder and pelvic floor.
Tips For Determining a Birth Plan
During your pregnancy, ask your provider to teach you the correct method for doing Kegel exercises. When done correctly, Kegels help strengthen your pelvic floor during pregnancy and after birth.
The obesity epidemic in the United States has led to changes in recommendations about weight gain in pregnancy. Ask your provider about the optimal weight gain for you. The old adage, “eating for two” no longer applies. Obese mothers who give birth to excessively large infants are more likely to experience postpartum bladder troubles whether having a vaginal or operative birth.
Pregnancy provides the ideal time for women to quit smoking. Cigarette smoking is a risk factor for urinary incontinence. Your healthcare provider has many suggestions to help you quit once and for all.
Once in labor, being upright allows gravity to assist with your baby’s descent instead of working against it while lying on your back.
New evidence shows that “gentle pushing” or delayed, non-directed pushing techniques can minimize pelvic trauma and are more protective than “forced pushing.”
To protect pelvic floor muscles, nerves, and connective tissue, express your desire to avoid the use of episiotomy, forceps and/or vacuum extraction. There is more than a decade of research that an episiotomy need not be performed unless there are indications for such intervention (e.g., fetal distress). Episiotomy, especially midline, has been shown to increase a woman’s risk of anal sphincter injury and not to reduce the risk of other pelvic floor disorders. Patients should discuss whether or not to have an episiotomy and be certain that their doctor will not use one, other than in extreme situations. Sometimes however, these maneuvers may be necessary for you or your baby’s health.
For help in writing a Birth Plan that works for you, consult your library, pregnancy resources, your healthcare provider, and the Internet. Your healthcare provider can guide you about trusted web sites.
When you were pregnant, everyone joined you in counting down the days, weeks, and months until your baby would be born. Now that your little one is here, the countdown is over. But that doesn’t mean the woes of pregnancy are over.
The fourth trimester, or the recovery period and adjustment period of your body after birth, is a very formative time period. This month is filled with changes in your body, your household, and your baby’s body. Now that your little one is out of the safe cocoon of your womb, they’re learning to latch on to you for feedings and lay near you for warmth and comfort. All the while, your organs are resituating themselves and your hormone levels are skyrocketing to fuel these shifts.
Although everyone knows about the exterior changes that come after having a baby, many women are still surprised to feel so out of control with their bowels and bladder.
Childbirth—cesarean or vaginal—does a number on your organs. The trauma of childbirth weakens your pelvic floor muscles, often leaving them feeling like they had their own personal cross fit session.
Understand the level of work your body has done for you and react appropriately. The fourth trimester is a period of rest and recuperation. To treat yourself like anything else will only put you at risk for less than ideal symptoms in the long run.
Take time to map out a recovery plan for your bowels and bladder so you can ease your way back to a pre-baby stage. If you are experiencing urinary or bowel leakage, or a frequent urge to go often, start with a bladder and bowel diary. Fill it out and take note of what your body is responding to and then bring it to your doctor in your next postpartum appointment.
Thinking of trying for a baby soon? Now is the perfect time to start strengthening your body in preparation for pregnancy and childbirth. And even if you’re not quite at that stage yet, the moves listed here are great for anyone to improve pelvic floor and core strength.
The pelvic floor acts as a basket of muscles that help support the pelvic organs (your uterus, bladder and bowels). Keeping them toned can not only help ease pregnancy discomforts (like urine leakage and hemorrhoids), but it can also help you later on in life as your body naturally changes due to hormones, and age. The moves below work not only the pelvic floor, but also other important muscles connected to it to ensure overall core strength.
Four Moves To Firm Up Your Pelvic Floor Before Pregnancy
There’s a reason that you’ve heard again and again that kegels are important. This exercise has long been touted by professionals as one of the most vital exercises in increasing your pelvic floor strength. Follow the instructions below to be sure you’re performing them correctly.
Identify your pelvic floor muscles by attempting to stop your urine flow mid-stream. If you can do this, you’ve found the muscles! (Note – don’t practice your kegels in this way on a regular basis – it should only be done to identify the correct muscles.)
Performing with an empty bladder, your first goal should be to tighten your pelvic floor muscles for 5 seconds. Then relax them for 5 seconds. Try to do 5 reps on your first day. As you gain confidence from your new routine, aim for 10 seconds at a time, relaxing for 10 seconds between contractions.
Be careful not to flex the muscles in your abdomen, thighs, or buttocks. Also, avoid holding your breath. Breathe freely during the exercises to keep from stressing the rest of your body.
Aim for at least 3 sets of 10 repetitions per day. The beauty of kegels is that they can be done anywhere, anytime. Try performing them during your downtime, such as waiting in line, or sitting at a stoplight.
Give yourself encouragement. These exercises will feel foreign in the beginning. But the longer you stay with this, the better your bladder health will become. As a bonus, Kegels have been reported to increase sexual pleasure as well.
Strong glutes and hamstrings are very important to the overall health of your pelvic floor. And one of the best exercises to develop these muscles is the deep squat. Squatting is actually one of the most natural forms of movement there is, however our modern-day lifestyle, characterized by long hours of sitting at a desk or on a couch, has made the squat virtually extinct. By strengthening your glutes and hamstrings, you’ll be adding additional support to your pelvic floor. Follow the instructions below to make sure you are performing squats safely and correctly.
Stand with feet slightly wider than your hips, toes pointed slightly outward.
Keep your spine in a neutral position – don’t round your back, and don’t over accentuate the natural arch of your back.
Extend your arms out straight so they are parallel with the ground, palms facing down.
Balance your weight on the heels and the balls of your feet.
Taking a deep breath, begin sending your hips backwards as your knees begin to bend.
Keep your back straight, and your chest and shoulders up.
Be sure to keep your knees directly in line with your feet as you squat.
Continue lowering your hips until they are slightly lower than your knees to perform a deep squat.
Use your core to push yourself back up, keeping your bodyweight in your heels.
Congratulations! You have just completed 1 rep!
It may help to watch yourself in a mirror as you first perform this exercise, as it is easy to perform squats incorrectly. Some things to watch for are not dropping low enough, leaning your body too far forward, allowing your knees to drift inward, and performing the exercise too quickly. Aim to complete about 2-3 sets of 10 reps daily.
Finding Your TA
Your transverse abdominus, also known as the TA muscle, is the muscle that is located deep within your core, below the six-pack muscles. This muscle is often overlooked, but it serves a vital role. The TA muscle helps to stabilize the core, pelvis and lower back, and is recruited almost anytime a movement is made. Strengthening your TA muscle will ensure that you are protecting your back and spine from extra force or pressure when you move, and will help aid in pelvic floor stabilization.
The following steps provide a very basic way to locate your TA muscle and give it a workout:
Lie on your back, with your knees bent.
Place your hand on your stomach, just over your belly button.
While you exhale, tighten your stomach muscles and pull your belly button inward. You should imagine that you are tightening a corset and flattening your stomach.
Repeat 3 sets of 10 reps each.
Once you have a good feeling for where your TA muscle is and how to activate it, you can begin incorporating the action into your everyday life - while sitting at work, standing in line, etc. Also try to practice tightening your TA muscle, like a brace, every time you perform a movement such as lifting, sneezing, squatting, etc. With practice, this action can become automatic and will aid in your core stability.
The multifidus is one of the most important muscles in aiding spinal support. The muscles are attached to the spinal column and are called upon when bending backwards, turning, and bending side to side. These muscles work with the rest of your pelvic floor muscles and TA muscle to help you hold good posture, and to stabilize your lower back and pelvis during movement. Try the exercise below to strengthen the multifidus muscle:
Lie on your stomach, with your forehead on your hands, or a towel, looking straight down. (Not to the side)
Very slowly, rotate your pelvis back slightly so that your tailbone lifts toward the ceiling. This should be a very subtle movement.
Hold for one second, then rotate your pelvis back to the floor.
Complete 3 sets of 10 reps each.
Practice activating your multifidus muscle throughout your day by keeping good posture.
Note: Even before you’ve had children, there may be times when certain pelvic floor exercises are not appropriate. And, it’s important to know that there is no “one” exercise alone that will strengthen your pelvic floor as it is supported by many muscles. Always check with your doctor before beginning any exercise program. And, if you have concerns about your pelvic floor, no matter what life-stage you are in, consult a trained physical therapist specialized in women’s health. Your Physical Therapist will also be able to ensure that you are performing the moves correctly so that you are getting the most out of your workout. Use the NAFC Doctor Finder to find a doctor in your area.
If you’ve never been pregnant, it’s likely you’ve spent little time thinking about your pelvic floor. And yet, now is exactly the time that you should be focused on it. A healthy pelvic floor can prepare you for a great pregnancy and a safe delivery, and it can prevent a host of problems that may occur after childbirth. The pelvic floor works as a basket of muscles, holding your uterus, bladder, and rectum in place. When you’re young, and your pelvic floor has not suffered the effects of age or childbirth, you usually see few complications. But sometimes, strain on the pelvic floor (like carrying a growing baby for nine month, giving birth, and the natural effects of gravity over time) can cause problems like bladder leakage. The good news? These effects can be lessened, or even eliminated, if proper care is given to the pelvic floor now. Here are the steps you need to take to ensure that you’re taking proper care of your pelvic floor, and yourself, prior to becoming pregnant.
How To Prepare Your Pelvic Floor For Pregnancy
Assemble your squad.
Finding the right team of professionals is key to keeping your health in check. If you haven’t already, do your due diligence and start seeing these health care professionals on a regular basis.
- Primary Care physician
Need help finding a health care professional? Use our Doctor Finder!
Keep a healthy weight and develop a workout routine.
If you’re planning to get pregnant, don’t fall into the trap of thinking that weight doesn’t matter pre-pregnancy – the healthier you are now, the healthier you will be during your pregnancy, and the easier it may be to shed those extra pounds after baby arrives. Not only that, but keeping your core and pelvic floor strong now will help better prepare you for pregnancy and childbirth.
Maintain a healthy diet.
Eating right is always a good idea, and it can really help you maintain your weight. In addition, keeping your diet in check can help you prevent diabetes (a condition that is on the rise in the US, and that, in some cases lead to neurogenic bladder.)
Get a well-woman exam every year – be sure to talk with your physician about general health metrics like blood pressure levels, diet, weight, and any stress that you may be experiencing. Have a regular Pap smear every 3 years if you’re between 21 and 30. While you’re at it, be sure to have a yearly breast exam to check for any unusual changes. Do your own monthly exams as well and become familiar with how your breasts normally look and feel.
Quit those bad habits
If you haven’t heard, smoking is really not cool anymore and even if you don’t believe that, consider this – aside from a host of other health problems, smoking can contribute to a leaky bladder.
Uncover any risk factors that you may have by learning your health history
Talk with your family to learn about any risks that you may have health-wise. Knowing these now can help you prevent possible health threats down the road.
Even if you only choose to follow a couple of these steps prior to pregnancy, know this: this time is all about prevention – the steps you take now to take care of your body will pay off in folds down the road. Don’t wait to start taking control of your health.
Check in with us all month to learn how to stay healthy at every stage of life.
Sometimes it's hard to open up with others about what's happening with our health. But doing so can help you gain valuable insights into your background and may help you take preventative action to avoid some conditions. Read this story about the importance of sharing your health history and the impact it can make on the entire family.
Growing up in a very conservative family in the 20’s, my Grandmother learned at an early age how to “act properly”. She was a lady, for sure, always looking immaculate, with great manners and a strong sense of pride. She was a private person – never sharing too much and kept any troubles or personal concerns to herself. She passed these traits along to my own mother and then, by default, on to me. What none of us knew, until recently, is that while acting ladylike is well and good in many cases, keeping things inside can sometimes cause rippling effects throughout generations, especially as it relates to health concerns.
You see, we all suffer from bladder leakage. My Grandmother gave birth to three children in her younger years, and as she inched toward middle age, she began experiencing the symptoms of stress urinary incontinence, causing her to leak urine when extra “stress” (coughing, laughing, sneezing) is placed on the bladder.
For her, this was simply something that she had to live with. She would never dream of talking to anyone about it, especially her doctor. It just became a part of who she was and she managed as well as she could on her own, in silence.
My mother suffered a similar fate, dealing with her bladder leakage in much the same way as my Grandmother did for all those years. It wasn’t until I started experiencing symptoms a few years after the birth of my second child that I ever knew it was something that had plagued generations of my family.
I was on the phone with my mom when, after a particularly intense sneezing fit, had to excuse myself to use the restroom. When I got back to the phone, my mother very delicately asked me if everything was ok. And though I had never spoken with her candidly about this before, I suddenly felt a need to know if she had also experienced the problem. I asked her very calmly if she had ever had “issues” holding her bladder, and suddenly it was if the flood gates had opened – she shared her struggles over the years, and also her suspicion that her own mother had experienced the same things. We decided to ask my Grandmother at our next monthly visit and finally, the three of us sat down and spoke frankly about this very common problem.
What I learned shocked me, but also sounded vaguely familiar. My Grandmother had never spoken to anyone about her issue – not even once. She purchased incontinence supplies as discreetly as she could and never even told my Grandfather that she was experiencing problems (although I can’t imagine that he didn’t know). My mother, at least, did tell her doctor, but after a trying, and failing, on one medication, decided to just try to manage it herself and live with the issue.
I had only just been experiencing light leaks for the past few months, but after hearing their stories and learning about the years of living with the condition, I was determined to do something. That very day I made an appointment with my doctor to learn my options. I read everything I could find about incontinence and before my appointment and was armed with a list of questions for my doctor.
At my appointment we talked about my options, and I started out by making several lifestyle changes – including taking a hard look at my diet, and practicing several core and pelvic floor exercises to gain some of the strength back that I lost after having kids.
It’s been about a year since my conversation with my Mom and Grandmother, and I’m so glad that I finally opened up to them and learned their struggle. Too many keep conditions such as incontinence to themselves, instead of speaking up about it – especially to those they love. Knowing that I wasn’t the only one, and in fact, that this problem likely had at least a little bit to do with genetics helped me immensely.
During my research into my own problem, I came across a study that showed incontinence that occurs before you reach middle age is likely determined by your genes. I only wish that I would have had the conversation with my family earlier.
May is Women’s Health Month. And Mother’s Day just happens to be coming up as well. Use this time with your family wisely – make it a point to ask them about their health history. You’ll be able to better arm yourself with information on your background and how to treat your own condition simply by speaking up and starting the conversation. And who knows – you may find that you have someone else who knows exactly what you’re going through who is right under your nose.
I was fairly young when I first started having bowel trouble. A consistently nervous young woman, I was constantly in a state of worry – about school, boys, and friendships – pretty much the normal run of the mill high school concerns. My mother always said I had “nervous bowels”, and my family became accustomed to stopping frequently to use the restroom on trips, and always asking me if I had to go before leaving the house. The pain I felt sometimes with bloating or cramping was attributed to my nerves. And while my family was fairly sympathetic to my condition, I experienced a lot of eye-rolling growing up when my symptoms would strike (“We have to stop for Annette again?” my brother would say. “She just went!”) It was a normal occurrence that lasted into my college years, and then later as I started a family. And while it was inconvenient and could definitely be painful at times – it wasn’t until after the birth of my first child that I thought about it as a “condition” that could actually be treated.
IBS, or irritable bowel syndrome, is when you have an overly sensitive colon or large intestine. This may result in the contents of your bowel moving too quickly, resulting in diarrhea, or too slowly, resulting in constipation. (Both of which I have experienced, although my symptoms tend to lie more in the former camp, causing me to constantly race to the bathroom for fear of an accident). Symptoms also can include cramping or abdominal pain, bloating, gas, or mucus in the stool. The condition is more common than you may think. As many as 1 in 5 American adults have IBS, the majority of them being women. And, this is not an old persons disease either – IBS strikes young, commonly in ages younger than 45.
I was finally diagnosed at age 28 – a whopping 13 years after I started experiencing symptoms, and I wish I had thought to seek help earlier. My doctor told me that there are many things that can contribute to IBS. Things like hormones, certain types of food, and stress (I guess my mother was right) may all impact IBS symptoms. Since the cause is of IBS is not known, treatments usually focus on relieving symptoms so that you can live as normally as possible.
Below is a list of treatments my doctor discussed with me.
Diet. Many foods can trigger IBS. And, while they might not be the same for everyone, there are some common triggers that have been identified:
Caffeine (including coffee, chocolate)
High-gas foods, such as beans, cabbage, cauliflower, broccoli, raw fruits or carbonated beverages)
FODMAPs (types of carbohydrates that are found in certain grans, vegetables fruits and dairy products)
One of the first things I did when starting treatment was to keep a bowel diary, which tracked the foods I ate and how they effected me. This was a huge help in learning my food triggers. I also learned to eat more frequent, smaller meals, which helped ease my symptoms. (Although those who experience more constipation may see improvement by eating larger amounts of high-fiber foods.)
Stress Management. This was a huge one for me. It turns out, your brain controls your bowels, so if you’re a hand wringer like me, it may end up making you run to the bathroom more often than you’d like. Learning ways to control stress was a game changer and I saw a huge improvement with these steps:
Meditation – Just taking the time to quite your mind can do wonders in helping you manage stress on a regular basis.
Physical Exercise – Regular exercise is a great de-stressor and, if you have constipation, can help keep things moving in that department too. I walk regularly and practice yoga 3 times per week to keep my stress at bay.
Deep Breathing Exercises – This is a great trick to practice if you feel yourself starting to get worked up. Practice counting to 10, while breathing in and out slowly until you start feeling relaxed.
Counseling – Sometimes you need someone to talk to help you work through your emotions. You may find comfort in talking with a friend or family member, or even a professional counselor, who can help you learn how to deal better with stress.
Massage – This one likely doesn’t need much explanation - who doesn’t love a good massage?
Drink Plenty Of Water. Drinking enough water just helps your body function better. And for people with IBS, it will ensure that everything moves more smoothly and minimize pain. This is especially true with those who suffer from constipation.
There are several different medications used to treat symptoms of IBS. Whether you suffer from constipation, or diarrhea, OTCs and prescriptions are available. Antibiotics are also sometimes prescribed for those patients whose symptoms are caused by an overgrowth of bacteria in the intestines. And if you suffer from anxiety or depression, like me, some antidepressants and anti-anxiety agents can actually improve your IBS symptoms too. Talk with your doctor about your symptoms and work with him or her to find a solution that’s best for you.
Other treatment options
Acupuncture. Despite a lack of data on acupuncture and IBS, many patients turn to this method of treatment for pain and bloating. Acupuncture, which is usually performed by a licensed acupuncturist, targets specific points in the body to help channel energy flow properly.
Probiotics. As research continues to emerge around the importance of gut bacteria and your overall health, probiotics may become a more common treatment option. Consuming them can increase the “good” bacteria that live in your intestines and may help ease your symptoms.
Hypnosis. Hypnotherapy has been shown to improve symptoms by helping the patient to relax. Patients practicing hypnotherapy have reported improved quality of life, reduced abdominal pain and constipation, and reduced bloating. However, most of the time hypnotherapy is dependent upon a therapist, and is usually not covered by insurance plans, making it a costly form of therapy.
I’m 37 now and have had my IBS pretty much under control for the last several years. Looking back, I can’t believe I lived with it as “normal” for so long. If you suffer from this condition, there is simply no reason to not get it treated.
Need help finding a doctor? Use the NAFC Specialist Locator.
About the Author: Annette Jennings lives in Oklahoma with her husband, 2 children, 2 dogs, and 1 cat. She's happy to be speaking up about her condition and hopes it will inspire more people to do so.
If you're reading this article, you, or someone you know, have likely dealt with some form of incontinence before. It's a common occurrence (more common than most think!), and can be a source of daily annoyance, shame and fear in our lives.
For those living with Multiple Sclerosis (MS), bladder dysfunction is often present and can greatly affect the quality of one's life. Symptoms such as hesitation, interrupted or weak flow, incomplete emptying, incontinence, frequency, and pain are reported by many who suffer from MS. However, there is hope. Many treatments are available to those living with this condition. Watch the videos below to see how Amy, an MS sufferer, bravely describes her struggles with neurogenic bladder, and her amazing transformation after she started treating it with Botox.
Amy's Before Video
Amy's After Video
A guest blog written by Michelle Herbst, PT
Congratulations! As you prepare for your baby there is a lot to think about. Doctor’s appointments. Baby showers. Child care. Nervous talks with the Dad-to-be. And, don’t forget - YOU. When you start sharing your news - everyone will give you advice. Some stories will be embellished for the good and others will be overstated for how difficult their pregnancy was. But, keep in mind - this is your experience.
Some Moms-to-be have problems with leakage. Others do not. A positive pregnancy test does not mean you will develop incontinence or a prolapse - which is a descent of the pelvic organs into the vaginal canal. But, normal changes during pregnancy and the process of labor and delivery can set up the conditions for incontinence and prolapse to occur.
So, here is my advice as a Mom and a physical therapist for preparing your mind and body for your big day.
You will read about these. Your OB Nurse will ask, ‘Are you doing Kegels?’ But, why are Kegels so important during pregnancy?
Performing Kegels during pregnancy can help you prevent or manage bouts of leakage, and will also help you tune in and tone the muscles that will help push and slide your baby out of the birth canal. Here are a more few reasons why Kegels are so important:
- To establish a mind-body connection of how the kegel muscles feel when activated.
- To help create stability of spine and pelvis as your baby grows.
- To prepare for the arrival of your baby and protection of your pelvic organs during delivery.
Labor can be quick or long. Labor can be easy or difficult. You do not get to choose. But, with preparation of your mind and muscles, along with the skills of your birthing team, the end result will be you holding your precious new baby.
Thoughts on Kegels during Pregnancy:
Think of the pelvic floor as a muscular sling that is tethered between your pelvic bone and tailbone. During pregnancy and labor the pelvic floor muscles lengthen but also need to be able push. The goal of performing Kegels during pregnancy is to improve the strength and function of the pelvic floor as well as encourage lengthening of the pelvic floor muscles.
When performing a Kegel it will feel like a gentle tightening and lifting up and in of the muscles between the pubic bone and tail bone. You may also feel a slight tightening between the belly button and pubic bone. That is your abdominals helping out too. That is OK. Now, hold the Kegel as you inhale and exhale. Relax, and let your pelvic floor muscles return to a normal resting tone or sensation.
The Kegel is a cyclic contraction. It is a shortening of the muscle fibers followed by a relaxation and lengthening of the muscles. If you contract the pelvic floor, and follow that with another pelvic floor contraction without focusing on letting the muscles relax and lengthen, you are training the pelvic floor to become shortened strong muscles not the lengthened strong muscles needed to help push and slide your baby out.
Yes – squat. Deep squatting is a normal position to void and give birth. Performing a deep squat as an exercise will help you prepare for the positioning and muscle work needed during delivery. Deep squatting will open your hips, aide in lengthening the pelvic floor and strengthen your glutes.
How do I do this?
Slowly work into a squat. You may want to or need to keep your squat shallow by holding onto the back of a sturdy chair or counter top as you start bending at your hips and knees. Keep your gaze forward. Work on keeping your knees behind your toes or stacked above your ankle. Think about keeping your shins perpendicular to the floor. If you are able to get into a deep squat, you may want to place your hands at your chest and gently push your elbows to the inside of your knees.
How long and how many?
This will depend on you. You may want to focus on working into and holding the deep squat. Once you have achieved a deep squat you can work on relaxing into this position. Or, you may want to perform slow repetitions of a shallow squat to standing position and put your emphasis on tightening the glutes when returning to standing.
There really isn’t a right or wrong way – just your way and your focus or intent of the exercise. Pay attention to how you feel and listen to your body.
There will be aspects of your pregnancy and the arrival of your baby that you will not be able to control. But, remember, this is your story. You can prepare your mind and body to set up the best possible set of circumstances to deliver a healthy YOU to motherhood.
Each month, we ask an expert to answer one of our reader's questions. This month we're happy to welcome Victoria Yeisly, DPT as our expert contributor.
Question: I’ve heard that in Europe it is standard for most women to begin physical therapy to strengthen their pelvic floor as soon as they have given birth.
Do you think women in the United States should be seeing a PT after having a baby, regardless of whether they are having symptoms or not?
Expert Answer:Absolutely! I support this practice for any woman after having a baby, including both vaginal and C-section deliveries. Think about it, during the pregnancy, the body changes so drastically, so quickly! Ligaments loosen; alignment changes, hormones fluctuate, and anywhere from 20-50 lbs may be gained. Then, you either push a baby out of your vagina or have a major abdominal surgery. To think that the body just heals and is “back to normal” 6 weeks postpartum is just ridiculous. In the OB practice where I work, there are 4 of us pelvic floor PTs integrated with the doctors and midwives to help serve this population so women can return to pre-baby function with greater ease and comfort. In my opinion, this should be the standard of practice for all women. At minimum, doctors and midwives should at least be making each woman aware of this treatment and let them decide if pelvic floor PT should be a part of their postpartum rehabilitation.
Have a question you'd like answered? Ask us! Your question may be featured in an upcoming Ask An Expert post!
About Our Expert: Victoria Yeisley, DPT, has been exclusively practicing pelvic floor physical therapy for the past eight years, with an emphasis on prenatal and post-partum care. She currently lives in Chicago, IL, and practices at Northwestern Medical Group OBGYN, where she is integrated into the OBGYN healthcare team, as well as working at Chicago Physical Therapists, a private practice. Victoria is passionate about the care and support of women during the childbearing years and her goal is to increase the awareness of the importance of women's health and treating pelvic floor dysfunction throughout the lifespan. She is currently pregnant with her first child and expecting in June of 2016!