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.  

Your Guide To Eating During The Holidays For A Healthy Bladder

Eating Well To Maintain Good Bladder Health

The holidays are well upon us, and for many, this means an influx of all types of delicious holiday food and drinks.  Maintaining healthy eating habits is always at the top of mind for my family and me, but during the holidays, it’s sometimes easy to let our guard down.  Sneaking an extra cookie from the batch made for my son’s class treats, having that extra glass of wine at the holiday Christmas party – it can all add up.  And if you have symptoms of Overactive Bladder (OAB), as I do, these little extras can make them even worse and end up putting an unwanted damper on the holiday season.

At my last appointment, I asked my physician for some tips on how to best manage my diet during the holidays to ensure that I’m not running to the toilet every five minutes.  She told me that the best rule of thumb is to try to stick to your normal eating plan as much as possible.  “After all”, she said, “you probably already have a good idea of what types of foods irritate your bladder and increase your symptoms.” (Ahem, chocolate, I’m looking at you.)  So, keep it simple and try to stay the course.  However, she said, if you must indulge (it is the holidays after all), do so sparingly.  And try to avoid the below foods as much as possible, since they are known bladder irritants.

Alcohol. 

That glass of wine or champagne may seem like a good idea, but alcohol is a diuretic, meaning it creates additional urine in the bladder.  This can cause an increase in urge incontinence, and may also trigger symptoms of overactive bladder.

Coffee and tea. 

Like alcohol, coffee and tea act as diuretics, causing more frequent trips to the restroom.  In addition, they contain caffeine, which can irritate the bladder and create stronger urges.  Limit coffee and tea as much as possible. (I know, I know – I am cringing as I type this at 5 am!)

Soda and fizzy drinks.  

These drinks usually have caffeine, as well as carbonation, which should both be avoided.  In addition, many of them contain artificial sweeteners, which are believed to be a bladder irritant.

Chocolate. 

Unfortunately, chocolate contains caffeine, which may cause bladder irritation.  (I had to use a little restraint to not shout at my doctor for this one.)

Sugar.

While sugary treats may be difficult to avoid around the holidays, you should do your best to limit things like cakes, cookies, and candy.  My doctor explained that sugar –even in inconspicuous forms like honey – can irritate the bladder.  If you must indulge, try to do so sparingly and try to avoid foods containing artificial sweeteners.  This can be a bummer around the holidays, when delicious treats abound, but look at it this way – I just gave you an alibi to avoid your Aunt Marta’s fruitcake this year.  You’re welcome.

Spicy foods.  

Things like curries or many spicy ethnic foods can irritate the bladder and increase symptoms of OAB and incontinence.  Try your best to avoid them.

Acidic foods.

Increased acid in things like citrus fruits, tomatoes, and cranberries can worsen bladder control.

Processed foods. 

Many processed foods contain artificial flavors and preservatives that can irritate the bladder and worsen incontinence symptoms.

I’ve been pretty good so far this season.  Not only are the above tips helping to keep my bladder healthy and avoid accidents, they are also helping me keep my weight in check – something that I think we all struggle with during the holidays. My doctor said this is important too, since increased weight gain can also contribute to a decrease in bladder control.  

Probably the best tip my doctor shared with me is to keep a food diary to track what I eat and to determine how it affects me.  I’ve been at it for a couple of weeks now and it has really helped me identify my “problem areas”.  Not only that, it also keeps me honest – no more stealing a handful of M&M’s from the candy dish as I walk past it.  And while the temptation is sometimes hard to pass up, knowing that it’s helping me stay dry makes it worth it.  And just think, come January, when everyone else is trying to work off those extra pounds they accumulated during the holidays, I’ll already be one step ahead of the game. 

Do you have any diet tips for the holidays?

How I Survive Traveling With Incontinence (and Three Kids)

How I Survive Traveling With Incontinence

I’ve never been one of those moms who can fly by the seat of her pants and wing it. Especially when traveling.  A mother of 3 kids, I have to be prepared – always.  My 3 year old has an accident?  I’ve got it covered with an extra change of clothes.  My 5 year old decides to throw a tantrum mid-flight?  The iPad is completely stocked with games and movies to calm him down. My 6 month old begins wailing?  I’m like a ninja with her bottle – from bag to lips in two seconds flat.  Friends and family are often amazed at my level of preparedness – I’m a master, and I wear the badge proudly. 

When I developed Overactive Bladder (OAB) after the birth of my second child, my philosophy was no different.  I plan and prepare for the unexpected for myself, just as I would my children.  As the holidays approach I’m looking forward to a trip back home to see my family.  Our whole kit and caboodle are going to be coming along for the ride and you can bet that a little OAB is not going to stop me from having a fabulous time. 

So, in case anyone else may be suffering from OAB or incontinence, here are my top 7 tips to help you make it to your destination with ease.  

1. Plan ahead and know your route.

If you are driving to your location, you have the advantage of being able to stop relatively easily.  Plan your route ahead of time and determine rest stops to make regular bathroom breaks.  This will help you avoid waiting too long to relieve yourself, which could result in an accident.

If you’re flying, try to book your seat on the isle if possible, and as close to the restroom as you can.  This will ensure you have easy access in the event you need to get to a restroom quickly.

2. Leave enough time for extra stops. 

Be sure to leave early, and plan to make at least a few extra stops.  Whether you are traveling by car, or flying, it pays to have some time built in for emergencies. 

3. Bring along an extra change of clothes.

In the event you do have an accident, having an extra pair of clothes handy will save you from embarrassment, and discomfort for the rest of your trip.  I know, I know – we moms already have enough to pack with all our kids stuff.  But trust me when I say you don’t want to be dealing with a screaming toddler and wet pants for the second half of your flight.  If you are flying, be sure to pack these in your carryon so you have them with you at all times.  It’s also a good idea to bring along an extra ziplock bag for any soiled clothing.  Additionally, hand wipes and an antibacterial cleansing product will keep you feeling clean and fresh.

4. Remember all your supplies.

This list will vary depending on what you normally use and how severe your incontinence is.  But, it’s always a good idea to carry along a few extra disposable pads or underwear.  (And if you’re flying, wearing a pad “just in case”, even if you normally don’t wear one, can be a life-saver as well.)  Pack some of these in your carryon too, in the event that your luggage gets lost, or you experience delays at the gate. Also think about what you will need when you arrive at your destination.  Depending on your accommodations, bed protection, deodorized liners for disposal of products, sanitizing or cleansing products and lotions may also be useful.

5. Limit liquids a few hours before your trip.

While it’s never a good idea to completely avoid liquids, limiting them a couple of hours before you depart may help you get through the first leg of your trip a bit easier.  It’s also a good idea to pass on the beverage cart if you’re flying, in order to avoid having to make an extra trip (or 2!) to the restroom.

6. Look into medications to manage your bladder.

If you feel that absorbent products alone are not enough to keep you from having an accident while traveling, you may want to ask your doctor about any potential medications that he or she may recommend.  Be sure to do this well in advance of your trip, since some medications, like those indicated for overactive bladder, can take anywhere from 2 to 4 weeks to become effective.

7. Request a note from your doctor with a list of any approved medication or special instructions that may be useful to you when flying.

Flying with medications can be made easier if you have a note from your doctor.  Additionally, if you have any special medical conditions, a doctor’s note with special instructions may help you when asking for special requests (like preferred seating on planes, priority boarding, etc.).

I can’t wait to spend the holidays with my family this year.  And, though my OAB may present a little extra challenge, I know that with the above plan I’ll be sailing through the airport effortlessly.  Well, as effortlessly as you can with three kids. And a husband. So, four kids really.