How To Relax Your Pelvic Floor

How To Relax Your Pelvic Floor

What Is The Pelvic Floor And Why Should I Relax It?

The pelvic floor is a web of muscles that acts as a sling, supporting your bladder, bowel and uterus. It is responsible for helping you control your bladder and bowel, and also plays a role in sexual intercourse. Many women experience pelvic floor issues, such as incontinence, as a result of childbirth, obesity, chronic constipation, or other strains put on the pelvic floor. Often, a weakening of the pelvic floor causes these issues, but did you know that having a pelvic floor that is too tense can also create problems? Incontinence, trouble emptying your bladder, and even pain during sex can be signs of a pelvic floor that is too tense.

Luckily, pelvic floor tension is a problem that you can do something about. Below are some simple exercises that may help you to relax your pelvic floor muscles. These can all be done in your home, discretely, and with no equipment necessary.

Note: It is always recommended to consult a pelvic floor physical therapist prior to performing exercises related to the pelvic floor. A physical therapist can provide you with a proper diagnosis and put you on custom treatment plan just for you! Find a physical therapist in your area here!

Diaphragmatic Breathing For Pelvic Floor Relaxation:

The diaphragm works in synergy with the pelvic floor and helps to promote muscle relaxation. This is important for decreasing pain and promoting optimal muscle function.

  1. Place one hand on your chest and another hand on your belly, just below your rib cage.
  2. Take a deep breath in to the count of three, and then exhale to the count of four.
  3. When you inhale, your pelvic floor relaxes, and as you exhale, your pelvic floor returns to its resting state.
  4. Practice this breathing for 5-10 minutes each day.

Note: You’ll know that you are using your diaphragm correctly if you feel the hand on your belly rise and fall.

Pelvic Girdle Stretches For Pelvic Floor Relaxation

All of the following positions are great for practicing diaphragmatic breathing!

Happy Baby Pose:

  1. Lie on your back.
  2. Open your knees wider than your chest and bring them up towards your armpits. You may hold your legs with your arms behind your knees or at your ankles, but try to keep your ankles over your knees.
  3. You can either hold this position or gently rock on your back from side to side
Happy Baby Pose

Happy Baby Pose

Child's Pose

Child's Pose

Child’s Pose:

  1. Start on your hands and knees.
  2. Spread your knees wide apart while keeping your big toes touching.
  3. Gently bow forward, moving your torso downwards, between your thighs. Keep your arms stretched out long and in front of you.

Adductor Stretching:

Aductor Stretch

Aductor Stretch

  1. Lie on your back with the soles of your feet together and knees out to the sides.
  2. This should be a relaxing position. If you feel a pulling along your inner thighs or in your pubic bones, place pillows under your knees for support.
Piriformis Stretch

Piriformis Stretch

Piriformis Stretching:

  1. Lie on your back with your knees bent.
  2. Place your left ankle on your right knee, like a figure four.
  3. Pull your right thigh toward your chest to feel a stretch on the outside of your left hip.
  4. Hold for 30 seconds, and then repeat on the other side.

Patient Perspective: How Acknowledging My Pelvic Floor Changed My Life

How Acknowledging My Pelvic Floor Changed My Life. Pelvic Strengthening

I’ve experienced bladder leaks for about 5 years. After I had my second daughter, I started noticing leakage here and there. I always assumed it would go away, but it never did. I spent the first year attributing it all to childbirth, and let’s be honest, I didn’t really have the time to worry about myself much with a newborn baby. But, after my daughter’s first year, what I thought was a problem that would clear up on it’s own continued, and I began to take more notice. The leaks were more frequent, not less, and I started to feel ashamed about it. I’d never heard any of my friends talking about this side effect of motherhood – why was it happening to me?

I finally decided to visit my OB/Gyn to see what he recommended and he referred me to a Physical Therapist who solely focuses on the pelvic floor (yes! there really is such a thing!). The PT did a thorough evaluation and said the cause of my problem was due to a weakened pelvic floor that most likely occurred during childbirth.

I’ve never been what you would call athletic. I have a gym membership but don’t visit all that often. I sit at work all day, and get most of my exercise running around after my two girls. And God knows I could stand to lose a bit more of the baby weight.  So when my PT said that she was going to put me on a workout program to get things back in shape, I was a bit worried. But her workout was low intensity – lots of walking to get my weight down (which would help put less pressure on my bladder and pelvic floor) and simple exercises that would strengthen not just my pelvic floor, but my core muscles too.

After 3 months of doing the workout I had lost about 8 pounds and my stomach and glut muscles were noticeably more toned. I also was noticing much fewer leaks and was able to control my bladder much better than before. And after 6 months of performing the workout, the leaks had stopped all together.

I can’t tell you what a difference this simple workout routine has made in my life – not only do I feel stronger and more in control, but it’s given me more confidence in the ability to change my body both in look and in function. I’m so proud of myself and my only regret is that I didn’t do something sooner. Ladies – if you’re experiencing bladder leaks, visit a PT and get on a workout program! It will literally change your life. It did for me!

Kimberly V., Englewood, CO

What Is The Pelvic Floor? (And Why Should I Care?)

What Is The Pelvic Floor and Why Should I Care?

If you’ve never thought much about your pelvic floor, you’re not alone. Most people don’t give this section of the body much consideration until it’s too late – they become incontinent, or worse, suffer a pelvic organ prolapse as a result of pregnancy, obesity or chronic constipation. But the pelvic floor is one of the most important muscles in the body, and ignoring it can have potentially great consequences later in life.

Anatomy

Let’s begin with a little bit of anatomy. The pelvic floor is a basket of muscles that supports some pretty major organs – your bladder, rectum and uterus in women, and your bladder, rectum and prostate in men, to be exact.  The muscles stretch across the pubic area from front to back and from side to side. They are typically very firm and thick, but are also flexible and are able to move up and down (kind of like a trampoline).

These muscles are very important in supporting the organs listed above, and are essential in maintaining control over our bladder and bowel. The pelvic floor muscles also play a large role in sexual function for men and women, and provide support for the baby during pregnancy. 

Over the course of our life, many things can compromise the stability of the pelvic floor, leading to things like incontinence, or pelvic organ prolapse. Obesity, childbirth, chronic coughing, chronic constipation, or other things that put strain on the pelvic floor can cause it to weaken. And with age there is often a weakening of the connective tissues of the pelvic floor.

What You Can Do To Protect The Pelvic Floor

The good news is that much like the other muscles in the body, the pelvic floor can be trained and strengthened over time.  By learning to strengthen the pelvic floor, you may be able to prevent or even eliminate symptoms of incontinence or prolapse.

Read: 4 Moves to Help You Strengthen Your Pelvic Floor Before You Get Pregnant

There are many exercises you can do to strengthen the pelvic floor. Kegels are great at isolating the pelvic floor muscles, but because the pelvic floor connects to many of the muscles that create your “core” (your diaphragm, transversus abdonminis, and multifidus), you also need to incorporate workouts that build strength in those areas as well. And remember – it’s not just about tightening. We need to ensure that our muscles are neither too tight, nor too loose. Learning how to relax the pelvic floor is just as important as learning how to strengthen it, since a pelvic floor that is too tight can create weakness and cause problems too. Like any other muscle in the body, we are looking for our muscles to be strong and flexible. 

Symptoms Of Pelvic Floor Tension

  • Constipation

  • Painful intercourse

  • Pelvic Pain

  • Inability to empty your bladder completely

  • Painful urination

If you experience these symptoms, we recommend that you see a pelvic floor physical therapist prior to starting any strengthening program. Performing strengthening exercises on a pelvic floor that is already too tight can create additional problems, or make any existing issues worse.

Symptoms Of Pelvic Floor Weakness

Learning how to strengthen, and relax the pelvic muscles can help with pelvic floor weakness.

Want tips on how to improve your pelvic floor strength? Check out these great resources:

Incorporating Pelvic Floor Exercises Into Your General Workout Routine – 3 Best Moves To Add Now.

It’s All About The Base

Ask The Expert: Can Pelvic Floor Exercises Really Help My OAB Symptoms?

Men And Kegels – The Ultimate Guide

Note: If you are experiencing symptoms of either pelvic floor weakness or tension, we strongly advise you to see a physical therapist specialized in pelvic floor therapy. A physical therapist can help provide you with a diagnosis and put you on a custom treatment program specific to your needs.

Why A Healthy Pelvic Floor Is Important

Why A Healthy Pelvic Floor Is Important

Why A Healthy Pelvic Floor Is Important

Why The Pelvic Floor Is Important

If you follow along with NAFC on a regular basis, you know how much importance we place on maintaining a strong and healthy pelvic floor. It’s a vital part of maintaining continence, alleviating symptoms of pelvic organ prolapse, and even reducing lower back pain. And don’t get us started on the benefits a strong pelvic floor has on sexual intercourse. It’s no wonder we focus so much on this magic group of muscles!

The pelvic floor is essentially a web of muscles that acts kind of like a basket holding up some pretty vital organs: the bladder, bowel and uterus.  When these muscles become weakened – from things like childbirth, heavy lifting, chronic coughing; basically anything that puts a lot of pressure on it - it can cause a loss of bladder or bowel control and can increase the risk of prolapse.  Weak pelvic floor muscles can also put strain on other muscles (the pelvic floor is connected to many other muscles in the body!) causing them to work overtime to make up for the lack of support in the pelvic floor. This imbalance can cause pain in other areas of the body too (lower back pain or hip pain for instance).

For these reasons, it’s important to make sure you’re incorporating pelvic floor and core exercises into your workouts each day. And don’t worry – the workouts don’t have to be long or strenuous. But just like every other muscle in the body, they need attention in order to maintain the strength needed to function properly. 

So, how do you get a strong pelvic floor? Some simple, daily exercises are all you need. We’ve teamed up with the folks at Carin to help you get started. Read below for information to how NAFC readers can get a free Carin Wearable Set

What is Carin?

Carin’s smart underwear is a new way to not only measure and manage leaks, but also to improve your pelvic floor strength so that you can get on with your life and eliminate those pesky leaks all together. It’s the only wearable pelvic floor exerciser on the market – painless, noninvasive, and high-tech. 

Carin Smart Underwear Set

Carin Smart Underwear Set

What’s Included in the Carin Smart Underwear Set?

Carin comes complete with a unique pair of highly absorbent underwear that can manage any leaks you may have. The set also comes with a sensor that snaps in the underwear, detects your body movement and monitors leakage. Finally, the Carin app helps you track your leaks and also sets you up on a daily workout plan to help you get stronger and manage leaks.

Carin Sensor

Carin Sensor

Carin App

Carin App

How Does It Work?

The Carin exercise program contains two parts: a weekly measuring routine and a daily exercise routine. The Carin smart underwear is worn for at least 24 hrs. with the sensor snapped in. This is the ‘measuring day’. The sensor will detect the body’s movements and track any leakage that might occur. Based on leakage, the app will then begin to recommend specific exercise routines to help you strengthen your pelvic floor in an effort to reduce leaks. There is a weekly plan of video exercises ready for you to do for 10 minutes each day. 

After the second time of wearing the smart underwear, an intelligent algorithm calculates progress made within the Carin app. The app shows the impact of exercise by counting the reduction of leaks.  80% of women using Carin have reported seeing progress between 20% to 100% in as little as 4 weeks!

 


See Carin In Action

Want a sneak peak of what to expect with Carin? Watch the video below!

What Is A Pelvic Floor PT And How Can One Help Me?

What Is A Pelvic Floor Physical Therapist And How Can One Help Me?

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.”

The Pelvic Floor As We Age. A look at how it changes through the different phases of life (pregnancy, menopause, etc.).

The Pelvic Floor As We Age, Pregnancy, Menopause.

A Guest Post By Michelle Herbst, PT

As women age, their birthing history and overall muscle weakness may catch up with them.  A healthy pelvic floor can be achieved as we age but often little attention is paid to the pelvic floor until it starts to fail. It can be difficult for women to seek medical attention due to feelings of embarrassment and despair. But, advances in health care and knowledge of the aging process allows today’s women to seek effective treatments.

Let’s step back and take a closer look at the pelvic floor as we age.

The pelvic floor is a sling supporting our abdominal and pelvic organs. It is made up of our muscles and connective tissues which I like to think of as our active and passive pelvic support structures. The pelvic floor muscles, or active pelvic support structures, create a muscular sling whereas our passive pelvic support structures are made of connective tissue called fascia. Fascia is a spider-web like material traveling through and covering the pelvic floor.

The active and passive pelvic support system are one in the same. They are knitted together interlacing creating a dynamic basin of support. Healthy pelvic support system work together controlling our sphincters, limit the downward descent of the pelvic organs and aide in sexual appreciation. Damage or weakness to the pelvic support system may result in symptoms of pelvic floor dysfunctions resulting in leakage and pelvic organ prolapse.

The pelvic floor over time.     

Pregnancy, child birth and the post-partum period is a time of great change. The interlacing nature of the active and passive pelvic floor support systems protect the mother and baby as they both grown. Child birth calls on the pelvic support system to push and slide the baby out into the world. The pelvic floor muscles can heal in as quickly as 6 weeks after delivery. But, the physical strain of living and creating new life can be taxing on the pelvic support system leaving it overstretched and weak.

The prescription is often kegels and post-partum kegels can be hard to do. The muscles are lengthened, very weak and trying to ‘reconnect’ to their nerve supply. In an attempt to ‘get it all done’, the post-partum mom is often multi-tasking while doing kegels. Their brain is preoccupied, sleep deprived and foggy. Despite good intentions, many new mothers ‘muscle their way through’ relying on other muscle groups to assist or do the job of the pelvic floor. Overtime with due diligence and a sleeping baby – the brain fog lifts, kegels are consistent and pelvic floor muscles recover allowing the new mom to return to and enjoy life’s pleasures and adventures.

Life continues to click at a fast pace.  The biological process of aging ticks away. The passage of time can be bittersweet. In the 3rd through 5th decades of a woman’s life, she will begin to experience a gradual loss in overall muscle strength and tensile strength of their connective tissue. In their 4th and 5th decades, peri-menopause ushers in a decrease in circulating estrogen and progesterone. The conclusion of these gradual changes are marked by menopause which is typically complete during the 5th decade. Life starts to catch up with you. The birthing of children, past injuries, the development of chronic health conditions and your family history may predispose the active and passive support system to overall weakening and loss of integrity resulting in leakage, organ prolapse and decline in sexual function.

What Can you do To Strengthen The Pelvic Floor?

1.     Protect and strengthen your active pelvic support system by engaging in a strength program and doing your kegels. Peak muscle strength occurs in twenties or thirties. And, unless a woman is engaging in a strength program she will begin lose muscle mass and strength.

2.     Protect the passive pelvic support system by avoiding straining during bowel movements and avoid holding your breath while lifting, pushing and pulling. The passive pelvic support system can not ‘fix itself’ and will need to rely strength of the active pelvic support system. So, revisit number 1 again and again and again …

3.     Stay healthy and seek out your doctor’s advice when you are sick or notice your first sign of leakage or prolapse. The treatment often times isn’t as bad as you think it will be.

 
Michelle Herbst, PT

Michelle Herbst, PT

 

The Mama Body: Physical Therapy During And After Pregnancy

Physical Therapy During And After Pregnancy

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.  

How a 'Birth Plan' Can Help Protect Your Pelvic Floor

How A Birth Plan Can Help Protect Your Pelvic Floor

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.

What No One Told You About The 4th Trimester

what to expect after you've had the baby

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. 

4 Moves To Help You Strengthen Your Pelvic Floor Before You Get Pregnant.

How to firm up your pelvic floor before you become pregnant.

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

Kegels 

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.

  1. 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.)

  2. 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.

  3. 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.

  4. 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.

  5. 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.

To learn more about kegels and the variations of kegel exercises that you can perform, review the information on our website found here, or check out one of our most visited blogs here.

Squats

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.

  1. Stand with feet slightly wider than your hips, toes pointed slightly outward.

  2. Keep your spine in a neutral position – don’t round your back, and don’t over accentuate the natural arch of your back.

  3. Extend your arms out straight so they are parallel with the ground, palms facing down.

  4. Balance your weight on the heels and the balls of your feet.

  5. Taking a deep breath, begin sending your hips backwards as your knees begin to bend.

  6. Keep your back straight, and your chest and shoulders up.

  7. Be sure to keep your knees directly in line with your feet as you squat.

  8. Continue lowering your hips until they are slightly lower than your knees to perform a deep squat.

  9. Use your core to push yourself back up, keeping your bodyweight in your heels.

  10. 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:

  1. Lie on your back, with your knees bent.

  2. Place your hand on your stomach, just over your belly button.

  3. Inhale.

  4. 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.

  5. 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.

Multifidus

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:

  1. Lie on your stomach, with your forehead on your hands, or a towel, looking straight down. (Not to the side)

  2. Very slowly, rotate your pelvis back slightly so that your tailbone lifts toward the ceiling. This should be a very subtle movement.

  3. Hold for one second, then rotate your pelvis back to the floor.

  4. 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. 

 

Gender Neutral Pelvic Floor Tips

Gender Neutral Pelvic Floor Tips

Simply stated - the pelvic floor isn’t just a female thing - it is a muscular sling supporting the pelvic and abdominal organs of men and women.  The pelvic floor helps keep us dry.  More than 50 percent of men over the age of 60 experience bladder control issues due to an enlarged prostate.  

Before I share my best pelvic floor tips for both sexes, we need to agree on the following three truths: strengthening a weak pelvic floor may improve bladder control and confidence, utilizing my tips in conjunction with seeing your healthcare provider will create the most optimal effect, and it’s important to allow yourself to have a bad day here and there.  

Here are my best pelvic floor tips.

Start a Bladder or Bowel Diary

For a week, keep track of your trips to the bathroom, your leaks and how much and what you are drinking. Note any trends with fluid intake, time of day and activity level in relation to using the bathroom and your leaks. Your documentation may help your health care provider order tests, make a more accurate diagnosis or prompt a referral to a specialist.But, please consider what you can do with the information. Are there any trends you are seeing? Do you have more problems in the morning, afternoon or evening? Do you need to space out your fluid intake?  ou may be able to cue into changes that may positively impact your bladder control and confidence.  

Drink more water and consider cutting down on alcohol and caffeine

Many newly incontinent persons incorrectly assume if there is less water in the system there will be less water to pass. Cutting out water, or significantly decreasing water consumption, while continuing to consume alcohol and caffeine at normal previous levels may aggravate the bladder and make the leakage problems worse.  Hydration with plain, old water is one of the keys to improved bladder function.  And, revisit your diary – it may be possible that alcohol or caffeine may be a trigger to your leakage pattern.  Do you need notice you have more problems with bladder control after a glass or two of coffee or your favorite cocktail?  

Kegels

Yes – we need to talk about this.  Men can do Kegels and should do Kegels to improve bladder control.  Kegels are not just meant for women.  Repetitively performing Kegels will improve pelvic floor muscle function, strength and endurance.  Kegels should be a habit like brushing your teeth. The truth of the matter is - if your pelvic floor muscles are in better space they will be better able to support you and keep you dry.  Here are some cues that may help you or your loved one perform a Kegel.   

 Return to the idea that pelvic floor is a muscular sling.  It supports your abdominal and pelvic organs kind of like a hammock running along the base of pelvis – front to back and side to side.

  • Gently pull the pelvic floor up and in towards your navel as if trying to protect yourself from a blow to the belly. When you do this – you may feel a gentle tightening of the muscles underneath your navel. Your tailbone may gently rises up and in. Continue your normal breath. Keep in mind, the Kegel, I am recommending is not 100% effort but a gentle tightening of the muscular sling.

  • Continue breathing and hold the Kegel for a few seconds. Then gradually relax. Repeat until you’re fatigued or have completed your goal.

That concludes my list of my best pelvic floor tips. What are your best practices?

About the Author, Michelle Herbst: I am a wife and mother with a passion of helping women live to their fullest potential. I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

About the Author, Michelle Herbst: I am a wife and mother with a passion of helping women live to their fullest potential. I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

Incorporating pelvic floor exercises into your general workout routine - 3 best moves to add now.

3 Pelvic Floor Exercises to add To your workout routine now.

A guest blog written by Michelle Herbst, PT

Pelvic Floor Exercises, or Kegels, is the contraction of the muscles between the pubic bone and tailbone. When a pelvic floor exercise is performed, the person should feel a gentle tightening and lifting sensation in the lower abdomen and perineum. The pelvic floor muscle contraction is complete when the muscles relax and let go of the contraction.

Please keep in mind these tips when performing a pelvic floor exercise to protect yourself from undue harm. One, you must be able to maintain your breath and therefore be able to inhale and exhale while performing a Kegel and avoid breath holding or bearing down. Two, your muscular effort should be around 75 to 80 percent. If you are exerting 100 percent effort, you are likely using the pelvic floor muscles and many other muscle groups as well.

There are many variations and progressions of a Kegel exercise.

Here are 3 ways to incorporate pelvic floor exercises into your daily routines.

Exercise One: Kegel Progression

The pelvic floor muscles are made of two muscle fiber types – fast and slow. Therefore, Kegels can be progressed by varying the hold time and intensity of the muscle contraction. One of my favorite progressions is simply lengthening the hold time followed by a few quick pelvic floor contractions. For example, a Kegel can be held for 5 seconds followed by 5 quick contractions. This Kegel Combo can be done in any position – seated, standing or lying down. It can be done to the beat of music while seated at a stop light or at the end of a cardio or lifting session when you are your mat working the abdominal exercises.

Exercise Two: Kegel with Breath Work

Yoga is the all the rage and you my find your zen when performing a Kegal with breath work. While your yoga instructor is cueing you in inhale and exhale think about what your pelvic floor. Typically, during focused breathing such as in a Yoga Class, there is always slight tension on the pelvic floor. However, you further engage the pelvic floor muscles when you forcibly exhale. During this type of exhalation, the pelvic floor muscles tighten further along with our deep abdominal muscles to push the air up and out of our lungs. Try it. It may transform your yoga practice.

Exercise Three: Kegel with Plank

Plank. It is a much loved and hated exercise. It is a great way to fully engage our core. And, to reap the benefits of the plank - you must focus on the pelvic floor. If your wrists and feet can tolerate a full plank – go for it! If you need to modify, do a half-plank on your knees. Or, try a wall plank by standing with your feet an arms-length away from the wall and placing your hands on the wall.

Here are a few head to toe cues to get you planking.

When in plank, the hands are stacked under the elbows and shoulders. The chin is slightly tucked lengthening the back of the neck. Your shoulder blades are pulled down and back towards the spine. The chest opens and the pelvis is slightly lifted. Your legs are hip width apart. In full plank, your ankles are 90 degrees as you weight bear through the toes. Now, draw your focus to your pelvic floor muscles.  When you tighten the Kegel muscles, you may feel like your tailbone lift up and in. Hold your plank and breathe. Smile too – you just may enjoy how strong you feel.

 
Michelle Herbst, PT

Michelle Herbst, PT

 

Bladder Health and Sex

Bladder Health and Sex

Understanding what is normal during sex and what is unusual can be challenging. After all, sex is a very private experience and differs for every person. Generally speaking, there is no reason for your bladder to empty during sex or for you to feel extreme discomfort or experience pain during sex.

As you can guess, the health of your bladder can directly affect your sex life. 

Two common reasons individuals experience pain or discomfort with their bladder during or after sex are: bladder pain syndrome and stress urinary incontinence.

Interstitial cystitis/bladder pain syndrome (IC/BPS)

Bladder pain syndrome is the continual sensation of pressure or pain on the bladder. This syndrome typically affects women and leaves individuals feeling as if they have to urinate when they don’t have any urine to pass.

Consider making dietary changes and practicing bladder retraining so your bladder begins to hold more urine before experiencing the urge to go.

Relax before engaging in sex to ensure as little stress as possible. Stress can cause flare-ups and trigger discomfort.

Stress Urinary Incontinence

Stress Urinary Incontinence or SUI occurs because of weak pelvic floor muscles and/or a deficient urethral sphincter. This weakness can cause the bladder to leak during exercise, coughing, sneezing, laughing, or any body movement that puts pressure on the bladder. If sex is particular jarring, SUI can be affected.

Consider exercises to strengthen your pelvic floor and limit caffeine intake. Always empty your bladder before sex.

We hope this peek into how your bladder health can impact sex was helpful. If you have experienced any of the symptoms noted above and haven’t talked to your doctor, it’s time to schedule an appointment. Additionally, we feel it’s important to share your health with your partner if you continue to have sex while experiencing some of these bladder health concerns.

Join us on our forum to talk more and learn how others have dealt with issues like these.  

Preparing Your Pelvic Floor For Pregnancy And Beyond

Preparing Your Pelvic Floor For Pregnancy

Preparing Your Pelvic Floor For Pregnancy

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.

Realistic Expectations:

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.

Kegel:

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.

Squat:

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.

Your Story:

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. 

 
 

Ask The Expert: Physical Therapy After Childbirth

ASK THE EXPERT

ASK THE EXPERT

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!

The Importance Of Posture

The Importance Of Posture

When talking about incontinence and the pelvic floor, we often tend to hear advice about strengthening our muscles with exercises such as Kegels.  However, did you know that one of the best things you can do for your pelvic floor on a regular basis is to keep good posture?  Maintaining proper posture helps to keep the pelvic floor in the most optimal position to give good support and can prevent our muscles from being too loose ore to tense. 

So, what is good posture?  And how do you know if you are achieving it?  It takes practice, but with a little concentration you can learn how to hold good posture in both a standing and a sitting position.

We love this guide by Tasha Mulligan over at Hab-it on how to find your neutral spine and hold it in both a sitting and standing position.  Check it out, and start implementing good posture as one of the most essential tools to help you keep your pelvic floor in alignment.

Can massages benefit your pelvic floor?

Treatment options for pelvic floor pain and weakness run the gamut from kegels, squats, physical therapy to biofeedback. One of our favorite (and most undervalued) options for people needing to tighten the ‘basket of muscles’ is the power of massage.

When your muscles are tight, pushed too far, or are pinched when they should be relaxed, massages can help alleviate the tension.

We made a list of some of our favorite articles on the topic, below. Take a read, then talk to your physical therapist-- or find a physical therapist-- and get a plan in motion.

Pool Time Can Be Pelvic Floor Time

You know pool time and summer time go together like peanut butter and jelly.  But did you know that having a weak pelvic floor doesn’t mean you need to be left out of this summer tradition? I’m here to challenge that lie you’ve been hearing.

But, first a little physics lesson. When you are in the pool, your weight presses down into the water. The water presses back on you. You are lighter than the water you have displaced. You float. You are buoyant. Buoyancy is your friend.  

So, what does this have to do with the pelvic floor? And, a weak pelvic floor at that?

Being in the pool, diminishes the effect of gravity on the pelvic floor muscles. Additionally, the internal organs ‘float’ taking more pressure off weak pelvic floor muscles. Experiencing the diminishing effects of gravity on your pelvic floor will make it easier to contract and relax weak pelvic floor muscles. Your summer time pool time is a great opportunity to learn what an engaged or relaxed pelvic floor feels like. Additionally, you may experience success in the water that you do not normally experience on land with pelvic floor contractions and lifts. For some people, the buoyancy effect gives people the freedom to do exercises in the water that would normally cause leakage on land such a walking, jumping or running.  

Now you’re probably asking how you can make this work for you?

Plan ahead and be proactive with what you might need in the pool. It sounds silly, but if being in the pool is a nerve wracking experience, making sure you have nothing hindering you.

Here are my five tips for getting in the pool:

  1. Void prior to getting into the pool. Emptying the bladder will take the pressure of you and your pelvic floor.

  2. Get over yourself. No is watching what you are doing. You will be OK.

  3. Enter the pool slowly. If you plunge right in - the pelvic floor reflexively tightens protecting you from leaking.

  4. You do not need to have equipment. Your exercise plan may simply include focusing on contracting and relaxing the pelvic floor, varying your hold times and trying to hold the pelvic floor contraction for longer periods of time.

  5. Think beyond the pool side. You can walk in chest height water to challenge the pelvic floor too. Or, maybe take a few laps for the fun of it.

Pool time CAN BE pelvic floor time. Now, go and enjoy yourself!

About the Author, Michelle Herbst

I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.