Running with poor pelvic floor- what is your solution

(323 Posts)
Runlikeareindeer Sat 21-Dec-13 10:52:32

So my pelvic floor isn't great after two vaginal deliveries, one that was forceps. I do my exercises (prob too late)

I'm running again and it is often difficult to control. I've tried tena lady (well the Aldi version) but sometimes that becomes sodden and then I have a great lump in my pants.

Is there anything I can do?

AndHarry Sat 21-Dec-13 14:23:33

Go to your GP and get them to refer you to a physiotherapist. I did after having my 2 and the physio got annoyed because I wasn't tensing my pelvic floor. I was but there was very little to tense...

ShineyBlackShoes Sat 21-Dec-13 21:03:03

I had TVT in the new year and for the first time in 18 years I can walk without leaking, and if I need to run, I can and not wet myself. Drastic action and needs time off work but so worth it.

Sometimes sadly no matter how many pelvic floors you do, damage has been done and an op is all that can repair it.

Good luck

IcouldstillbeJoseph Sat 21-Dec-13 21:04:37

I'm in same boat OP and awaiting physio appt through....

Anecdotally I know a triathlete mother of 3 who uses her mooncup when competing and training - even when not on her period. She says it sits inside her in a way that supports pelvic floor and bladder and discovered it when she found it hard to wee when using mooncup during her period! So worth a try? Obviously take it out after the run and maybe use a little ky gel to insert if its uncomfortable.

IwishIwasmoreorganised Wed 01-Jan-14 22:41:36

I've just upgraded to Tena pads, but even those failed me at the end of today's Parkrun blush

I leaked a bit along the way, but not OP much but as I crossed the finish line the flood gates opened sad

I can just about cope in the winter, wearing long, black running trousers but I have no idea what to do during the summer.

I'm do try to do my pelvic floor exercises, not as often as i should probably and i'm going to try using my mooncup, but has anyone had any success with the weighted cones or electronic pelvic floor exercises?

Claybury Thu 02-Jan-14 15:20:33

Never had a bad problem as I had c sections but I do remember when I started running 5 years ago it was an issue. I'm fitter and stronger now and I rarely have problems. I know I have been lucky and I don't know how long you have been running but I would say take the exercises seriously , those muscles need to be worked, and maybe as you get stronger it will get better.
I realise everyone is different so sorry if this doesn't help!

IwishIwasmoreorganised Thu 02-Jan-14 19:21:39

I've only been running since Septmber so hope that I can strengthen up significantly during the winter.

msmoss Fri 03-Jan-14 15:40:27

Definitely get a GP referral for physio, I was referred automatically after a third degree tear, they will give you loads of exercises that you can do as it's not just a case of doing the pelvic floor exercises but incorporating them into a range of other movements, for example whilst walking along or whilst stepping up and down the bottom stair.

Pilates can also really help, I've spent the last year doing the APPI version and it's really really helped, I even managed a half marathon without wetting myself <adds that to the list of things I never thought I'd be bragging about>.

msmoss Fri 03-Jan-14 15:41:43

Oh and the pilates also helped me to run faster due to the improved strength in my core which was an added bonus.

DuckCommander Fri 03-Jan-14 15:43:07

I gave up running and changed to low impact exercises in the gym.

Claybury Fri 03-Jan-14 19:10:59

Msmoss 's point about Pilates is good. My Pilates teacher used to say the class was the most important hour of your week! For everyone but especially after childbirth.

Sunnysummer Fri 03-Jan-14 19:17:13

I third the point about the GP - my sister is a physio and says that very, very few pelvic floor problems are totally unfixable, but a lot of women have been told it is unavoidable and therefore don't get the help they deserve.

There is more that professionals can do, and it's important to address earlier rather than as you get older and the issue worsens. Good luck!

procrastinatingagain Fri 03-Jan-14 19:19:47

My gp did tell me that any exercise that makes you wee will also strengthen your pelvic floor. Was good to know that although I was pissing myself, it was doing me some good hmm

Greeneyed Mon 06-Jan-14 14:07:19

I have the same problem, just wear black shorts and hope I look sweaty!

CoteDAzur Mon 06-Jan-14 14:09:49

Get your pelvic floor sorted first. Have physio. It doesn't take very long and isn't that hard.

shock at people here telling you to wear pads etc. Surely you need to sort out the problem if you can't run without leaking pee.

gussiegrips Mon 06-Jan-14 20:20:14

Have been summoned onto this thread via my spies...

I'm a women's health physio and am in a grumpy mood, so, brace yourselves...

Some facts. Like, evidence based facts (the sciencey bit?):
1. All loss of bladder control is abnormal.
2. 1:3 women aged 35-55 wet themselves.
3. 70-80% of simple stress incontinence can be cured in 3 months by doing pelvic floor exercises.

and...

4. when you run there is x3 your body weight rattling up your leg into your pelvic floor with every single step that you take.

So. Even if you are a 7 stone weakling, that's 21 stones of pressure on your muscles.

Add to that the weight of your guts bouncing on top of the pelvic floor. And, factor in that they get tired (some folk are fine running 5k, but wee themselves trying to get to 10k) along with the rest of you, running on pavements in unsuitable trainers, too soon after having a baby when your ligaments are still all stretchy, and, well, this is why you leak.

It frustrates me to read threads like this where women accept that they piss themselves. It's a failure of my profession - we simply aren't getting the message across that beign incontinent is not an inevitable consequence of ageing or becoming a parent. Men bloody wouldn't put up with "oh, you're a daddy now, you'll just have to pad up and die a little inside".

Anyhoo.

Cure:

1. Hold for a count of 10 seconds. Imagine you are bursting for the loo and trying to "hold on". That feeling is you working your pf. Clench for 10 secs, when you let go you should feel a "drop". No "drop" into your gusset and you've lost the contraction, so work on it! 10 seconds is a magic number as there's a reflex inhibition of your urge to pee, basically, it'll buy you more time before you HAVE to go.

2. 10 quick flicks. Same contraction as #1, only "on, off, on, off, on, off etc". This is for the fast twitch fibres, the ones that should work when you do something foolish like jump on a trampoline.

3. 3 floors - imagine you've got a lift in your vagina (I know, it's a weird thing, but, it works) Take the lift from the first, to 2nd, to 3rd floor and back down again. It's a mula bhanda from yoga - works a treat.

Do those 3 exs, x3 day for 3 months. Keep breathing when you do them, holding your breath is cheating. If you get pain, stop. If you're not sure what you're doing, either have a look with a handmirror (you'll see your fanjo sort of lift as you do the contraction) or bung something willing into your vagina and give it a squeeze. NHS recommends a finger, but, there's no research that says it absolutely HAS to be a finger - just something to squeeze. Whatever motivates you's good.

The problem is one of compliance, you'll forget. I use twitter as a training tool - @gussiegrips, I tweet, you twitch your twinkle.

I'd love MN to run this as a campaign - incontinence interferes with every single aspect of your life. At the moment, it might just be interfering with your dreams of running a marathon - but, these things progress and eventually your fanny can fall right out (yep, that's what a prolapse is, a degree or another of an inverted vagina. Google image if you want to scare yourself)

Oh, and the mooncup thing works. There's some research in the states suggesting that if you are doing exercise where you're wearing a sports bra then you should also be using internal support. Like an incostress, which is a silicone tampon thingie - it works by wodging everything up there and providing a support for your bladder. You can buy them from Boots online, or direct from the company - I'm not an employee, but, it is good evidence based gadget, about £30. She used to do a discount if you mentioned that Gussie sent you - might be worth asking!

www.incostress.com

And, I disagree with the GP's suggestion that if it makes you pee it also strengthens. If it makes you pee it's stressing your poor wee pf. Hmmph.

So. In short. Yep, there's loads you can do. Don't put up with it, you really don't have to. If the exs don't help, get referred.

<wanders off muttering about the number of folk who give up exercise because they wet themselves, develop heart disease and die (quite a lot)>

IwishIwasmoreorganised Mon 06-Jan-14 21:58:17

Thanks Gussie. I needed a good talking to I think!

I will start doing my pf exs properly and regularly (I find the fast twitches really tricky after about 3 or 4) and I'm really thinking about getting an inco stress.

Have you got any idea why I only struggle at Parkrun? I can manage to run the same time/distance not at Parkrun and be fine, but the second I cross the Parkrun finish line, the flood gates open blush

Slothlorien Mon 06-Jan-14 22:04:28

Great post Gussie.
I am in same (wet) boat. Every running step wee oozes out. Even if I go for wee just before I leave. Sodden pad at the end and wet trousers. Hence I love running in the rain as no one knows. blush
3 massive babies.
Trashed.
I need to go to docs.

msmoss Mon 06-Jan-14 22:04:41

Great post gussiegrips thank you for taking the time.

CoteDAzur Mon 06-Jan-14 22:08:19

Gussie - I had two babies in France, where new mums are routinely referred to specialists pelvic floor physiotherapy and stress incontinence is definitely not normal.

I was given a prescription and sent off to physio for pelvic floor even after my elCS, because "just carrying the weight of the baby strains pelvic floor, even without vaginal birth".

It is shocking that there isn't a similar system of postnatal care in the UK.

jellyandcake Mon 06-Jan-14 22:24:37

Gussie I'm hijacking the thread! Had no problems after my first pregnancy and delivery despite 2nd degree tear but now 24 weeks pregnant with my second and am leaking daily. Am not running or doing anything strenuous but over the course of the day it dribbles out. Been doing the 10 second squeezes for 3 reps of 8, 3 times a day and planned to discuss with mw at next appt. My big fear is this being worse after a second delivery and becoming a big problem post-pregnancy. Are the exercises you recommend on this thread likely to help prevent this? I'm afraid it is inevitable!

gussiegrips Tue 07-Jan-14 09:45:52

Organised - that's not uncommon! Usually it's because if you are running in an "event" you are more careful with your hydration. Everyone around you is glugging water, so you'll tend to drink more too.

Having said that, if you find you have times when you Need-to-go-and-I-need-to-go-NOW that's slightly different. Urgency is when you have very little warning - commonly found when you put the key into your front door and wet yourself on the welcome mat. This also responds to #doyerblardyexercises, but, there's some behavioural changes which are very effective, and medication which works a treat.

But, from what you've said - it's not happening anywhere other than parkrun? Have a think about how much water you're drinking, or (lightbulb) are you using sports drinks? Things like citrus are a bladder irritant, though, I'm not sure off the top of my head which sports drinks are a problem (usually it's only rum and coke that does me in. not appropriate for park run)

gussiegrips Tue 07-Jan-14 09:47:57

Cote - yep. And, French women tend to value themselves more than UK women (sweeping generalisation, but, bear with me) so, as a culture they expect to be able to resume a sexual relationship post-birth.

They are also fans of white trousers.

MrsMarigold Tue 07-Jan-14 09:58:43

Lifting is my problem - I'm ok with running and trampolining. I try to engage the pelvic floor as I hoist the pushchair up the 16 steps to our front door but 7 times out of 10 I have to make an urgent dash to the loo. I try to get DS to walk up the steps but lifting him out seems to trigger it.

Thanks gussiegrips.

gussiegrips Tue 07-Jan-14 09:58:51

Jelly - it's not inevitable. You might have a short-term problem, but, remember, it's curable in most cases.

I wonder whether you've got a slight prolapse? (don't panic)

In the States they consider it normal to have a grade 2 prolapse after 2 vaginal deliveries. It's a bit like having a hernia in your vagina, and, up to a grade 2 you may never know. Also, up to a grade 2 (ie. nothing's hanging out your vagina) can be managed conservatively - like mine is, I do my exercises and it's totally symptom free <does a star jump to show off>

At the moment, your pf is at a mechanical disadvantage. It's supporting extra weight (placentas are massive, let alone all that extra blood and the baby!) and your ligaments are stretching because of the hormonal changes. So, your pf is inefficient, not broken.

Definitely mention it to your MW. She'll be able to check whether you've got a prolapse and check if you are doing the exercises properly.

Apart from that - don't go to the loo more often than you need to. You'll shrink your bladder and land up pishing yourself on your doorstep (see previous post, and, ask me how I know...) Peeing more than 8 times a day is too many, hang on a bit longer.

Cut down on bladder irritants - caffeine, citrus, alchohol and don't drink LESS water as concentrated pee is, ironically, a bladder irritant.

Do your exercises, and, don't worry about leaking a bit in the short term. It's going to improve, but you might find it persists until the baby's here, well, until the baby's 6 weeks or so Then, get going with the exercises and get a post-birth referral to a WH physio. In fact, there's nothing to stop you asking for a referral now.

gussiegrips Tue 07-Jan-14 10:01:19

Mrs - yep, lifting's a shocker.

Lugging a buggy and a toddler (and the shopping and giant mum bag full of emergency stuff) up steps is going to raise your intra-abdominal pressure.

Incontinence is common amongst female weightlifters for exactly this reason.

do yer blardy exercises. Might be worth getting a referral to rule out a minor prolapse (lifting can bring on symptoms from those).

msmoss Tue 07-Jan-14 10:08:48

Jelly I leaked all the way through with DS2 but have no issues day to day now and despite a third degree tear and him being enormous, so definitely proof that it needn't be a long term issue.

It is terrible that women don't realise that there is help available for their pelvic floors. I was referred automatically for physio after the third degree tear but had nothing after DS1 which was an instrumental delivery with an episotomy, I don't really see why that was less worthy of attention as I actually found it more damaging in many ways. I'm lucky in that I now know what help is available and I wouldn't hesitate to go back to my GP and get referred again if I needed to but on the whole there does just seem to be a view that this is just something that happens and we need to get on with it which is wrong.

jellyandcake Tue 07-Jan-14 11:55:12

Thanks for all the helpful advice, I will be more rigourous with the exercises and discuss with mw. It's a slow leak at the moment unless I vomit (not infrequent for me in pregnancy) - then I really do wet myself. It's good to hear that it's not inevitable for it to get worse after delivery though as that's my big fear. I can manage it during the rest of pregnancy but definitely want it fixed afterwards!

IwishIwasmoreorganised Tue 07-Jan-14 20:12:38

I only drink a small glass of orange juice (with breakfast) and about 300mls of water en route to parkrun and nip into Tesco for a wee before I start.

Luckily urge isn't a problem for me at any other time. The flooding is just a strange parkrun phenomenon confused

pinkangelita Tue 07-Jan-14 20:18:45

.

Sunnysummer Wed 08-Jan-14 03:34:55

I love Gussie's point about this being a good subject for a mumsnet campaign - I also know so many women who think that this is inevitable, and it has a huge impact in quality of life and also exercise as women get older.

Given that exercise plays a role in preventing so many illnesses, I wonder how many lives (and NHS budgets) could be saved by sharing this message?

EmGee Wed 08-Jan-14 20:07:21

I had both my babies in la belle France (first was forceps delivery) followed by two lots of ten-session pf 're-education'.

Alas, I still leak if I do anything like jumping or star jump type exercises. It's worse than running when I might just leak a bit at the beginning. Makes no difference if I have just been to the toilet.

I think I need to get doing the 'blardy exercises'....

gussiegrips Thu 09-Jan-14 09:30:37

Organised - I'm going to ask some colleagues about the parkrunphenomen. You've got me stumped!

I take it you usually drink orange juice without any similar effect?

gussiegrips Thu 09-Jan-14 09:48:12

Sunny - this really makes me cross. Hang on whilst I heave myself onto my high horse...

Heart disease is the biggest killer of women in the UK.

Women are most likely to give up sport as teenagers.

25% of women aged 15-25 leak during sport.

A third of people with continence issues are also clinically depressed.

Surely it can't only be ME who sees the link here? Harriet Harman was doing a review into women in sport, looking at the disparity between the sponsorship, prize money, media coverage and particpation. Stress incontinence wasn't really in the remit, but, I tried to get them to consider it as a factor. Failed, but, was worth a shot.

The thing that really angers me, like, apoplectic levels of fury, is the implications continence has on you as you get older.

An elderly person gets up at night to go for a pee (again). Tired, hurrying, and in the dark, they don't make it, slip in a puddle, fall and breaks their hip. Has that fixed (assuming they don't lie alone for hours and die of secondary problems) and is discharged home WITHOUT ANYONE ASKING "WHY WERE YOU UP AT 3am?" So, they get home, and now need to use a zimmer frame to get to the loo four times a night - eventually, falls and breaks the other hip.

25% of people over 80 who break their hip die within a year.

It's a fecking disgrace.

Simple education, delivered with sex ed, could make #doyerblardyexercises a habit like brushing your teeth. It would save a fortune.

I'm speaking at some conferences this year, so, am hoping to get my foot stamping across to People With Influence. It's really hard to get continence a public profile, the media don't want "smelly old ladies" (as one editor put it) on their papers. It's simply not sexy.

But, it really matters. And, it destroys self esteem, relationships and is a ghastly way to live - and, cheap to cure.

That's why MN would work - it's got influence, the ear of the government, it's frank and funny and allows folk to be honest and anonymous.

If we talk about being a bit leaky the taboo would be broken. Periods were embarrassing 30 years ago - I want to do the same with pish!

CoteDAzur Thu 09-Jan-14 11:10:37

"25% of women aged 15-25 leak during sport"

Hang on. Does that mean many young wine who have never carried a baby if gave birth also leak? And that mums leak at much higher percentages?

Also, do you think it's enough to remind women to exercise on their own? If we are going down the MN campaign route, it would be an idea to demand that pelvic floor physio be a standard part of post-partum health care on the NHS, like in France.

IwishIwasmoreorganised Thu 09-Jan-14 19:36:11

Thanks Gussie!

Yes my orange juice habit is a daily (morning) occurrence. Don't worry about getting to the bottom of my odd parkrun phenomonen, I have been doingmyblardyexercises much more since you first posted and hopefully that will make a difference within the not too distant future.

gussiegrips Thu 09-Jan-14 20:17:13

Cote - yep.

Having babies increases your risk, but, it's not the only risk. Family history is really significant, so, if your mum and granny leaked then you are likely to as well - and, that can start very young indeed. Mostly it presents itself only when jumping or laughing hysterically, or, amongst student age, dancing when pissed.

But, it's not uncommon - particularly amongst athletes. There's some really depressing reviews of elite athletes - trampolinists have an incidence of stress incontinence of nearly 80%. The Olympics were awash!

And, yep, having proper post-partum PT would help enormously - but, you know, cutbacks mean that most PT here is a leaflet in the Bounty pack.

There's just been a joint paper between the physios and midwives, saying that midwives will deliver pelvic floor information. I have lots of reservations about that - for a start, at that point in her life the woman is really only interested in information about how to get the baby out, then, how to keep it alive, and then, maybe how to get some sleep! PF stuff really falls by the wayside, even with the best of intentions - you just forget. MW services are really, really stretched. And, they get even less education about the PF than physios do as undergrads! Pre-post partum stuff they are experts at, but, they only have contact for 11 days post-birth - it's just not practical to expect them to follow up. It is, of course, important that they reinforce the message, but, if the first time you hear about your PF is when you are 14 weeks pregnant, well, it's already too late. Get the women young, at sex ed so it's not news by the time they are actually upduffed!

The government sends everyone a letter when the baby is age to start nursery. If you have leaked for 3 years, THEN you're going to listen - it'd be really easy to have a simple self-assessment questionnaire and a self-referral system to pick folk up and get them fixed.

So, I'd get a heap more WH physios. Teach PF in school as part of health and sex ed. Reinforce with MW. Get it in the mainstream media. Force pad manufacturers to put health promotion on their packaging. Ask women to self assess and self refer. Get Sweaty Betty, Nike, indep running shops to sell pessaries. Get women recognising the problem, educated about how to self manage and when to seek help - and, you know, change the world, one floppy fanny at a time.

jigglebum Thu 09-Jan-14 21:10:36

Interested to have found this thread and thanks to gussie for her wealth of information and also her desire to get the subject talked about and acted upon. I have had 2 vaginal births and did actually go to the gp to get myself referred post second delivery as I feared a slight prolapse and leaked when I ran and getting back to exercise was important to me.

The local women's health physio was a rather scary lady unfortunately (not ideal when most people are apprehensive about seeing her anyway) She assessed my very weak pelvic floor and gave me some exercises to do. She also told me I was not to exercise (as this put strain on the pf), not to drink anything brown (eg coke, tea etc), not to drink any citrus drinks (ie squashes), not to drink any alcohol, not to drink more than half a glass of liquid at a time, not to lift anything heavy (ie definitely not children, push chair etc) and if I was not prepared to follow all of this to the letter then it was pointless her seeing me and I wasn't to come - this just depressed me and after 3 sessions I gave up. I know it is all good advice but surely as a mother of 2 young children she needed to give me realistic targets. She is the only one in our area so I am loathed to re refer, therefore I took up some sport again and have to wear the inevitable tena.

gussiegrips Thu 09-Jan-14 21:16:45

I'm sorry your physio was scary, jiggle.

I don't like her.

And, whilst the information she's given is correct, I disagree that you can't make any difference. Realistic goals is the POINT!

Where are you? PM me and see whether I know anyone else (WH PTs often don't even advertise as they are busy. As for mens health PTs, well, I know where to find them too, like hens' teeth, them)

CoteDAzur Thu 09-Jan-14 22:20:57

I saw physios after both births and never heard anything about what I shouldn't drink.

If they do their job well, you drink whatever you like.

WideAwakeMum Thu 09-Jan-14 23:02:05

Fab thread, thanks! Wondering if anyone knows why I wee every time when wearing a tampon running but only sometimes when not wearing tampon?? Asking as wonder if a pelvic floor support will make me wee in the same way.....? Ran tonight, it was a damp evening grin

gussiegrips Fri 10-Jan-14 09:27:02

I see what you mean, Cote - but, if you have an overactive bladder then watching what you drink can make a real difference.

Stress incontinence is a simple weakness issue. Overactive bladder is what happens when you pee yourself once, and then go more often to stop it from ever happening again. That reduces your bladder capacity, so, eventually, you need to go lots. So, the women who know where ALL the loos in the town are, these are the folk with OAB, and avoiding bladder irritants can make a big difference until you increase the size of the bladder. (by using a bladder diary, #doyerblardyexercises, sometimes some medication)

gussiegrips Fri 10-Jan-14 09:30:03

Wide - that's possibly a hormonal thing.

The muscles attach onto ligaments. Ligs are affected by progesterone/oestrogen changes, so lots of folk find that they leak at some times of the month and not others.

I'd guess it's not the tampon, or the positioning, but, a hormone effect making everything a bit more stretchy (women who get low back pain/achey joints with their period) means your pf sags a little lower. Naice.

CoteDAzur Fri 10-Jan-14 13:07:58

Ligaments bind bone to bone. I think you mean tendon, which binds bone to muscle.

I have weak tendons (genetic), by the way, so have researched this subject quite a bit & have lifetime experience. In my very humble informed-layman's opinion, a muscle's strength is (fortunately) not dependent on weakness of the tendon that attaches it to the bone.

Specifically re pelvic floor, the way I understand it is that the inability to hold pee is due to the weakness of the muscle and not the tendon that attaches it to the bone. Please correct me if I'm wrong.

Tendon weakness manifests itself in other ways which I will not bore this thread to tears with smile

CoteDAzur Fri 10-Jan-14 13:11:49

And my humble informed-layman instincts wink are also telling me that Wide's leaking when running with a tampon might have to do with the engorged tampon pressing on the bladder. See diagram here.

gussiegrips Fri 10-Jan-14 13:40:40

Yep, Cote, you're right about that. But, pelvis anatomy is a bit different from other joints as there are muscles that originate/insert onto soft tissue. And, the deep layers of the pf are mostly ligament and gristle.

Here's a terrific resource from pelvic guru who's an American Physio/Brainbox.

And, yep, simple weakness responds to simple muscle strengthening. But, there are other causes of incontinence, and, often, they present together.

The tampon actually pushes up onto the base of the bladder, a bit like a splint. incostress image

Hypermobility is a big risk factor for these issues.

CoteDAzur Fri 10-Jan-14 14:19:43

In many of us who have carried & gave birth to children, there is some degree of bladder prolapse, which means the tampon can very easily press on the bladder itself. The fact that Wide experiences stress incontinence when she has a tampon clearly shows that it is not acting like a splint in her case.

My problem is not hypermobility, by the way. It is a weakness of the fabric of the tendon, which means that my tendons are easily damaged/torn.

WideAwakeMum Fri 10-Jan-14 19:46:17

Thanks Gussie and Cote, your thoughts are very much appreciated - really great links too, I don't think I have ever had anyone pay so much attention to my leaky PF!

Yes, you see if I run when AF is in town without a tampon (and just bleed into pants - sorry if TMI) then I don't leak wee (well I might a bit, but only in the same way that I would at other times of the month, not the flood that I get when the tampon is also in town). With a tampon in then I will always wee, a biblical flood in fact.

So looking at the way the splint position and picture of it, that is the rather like a tampon... most odd, I don't really get it. Those anatomy pictures do show though that there is pretty clear interaction between tampon position and bladder, and I guess that is why the splints are helpful for some, but therefore the reverse would be true for me. Thinking mild prolapse going on, what do you reckon confused?

WideAwakeMum Fri 10-Jan-14 19:48:07

Oh and two VBs, one with forceps lift-out. Lonnnnggggg pushing stages in both!

jellyandcake Sat 11-Jan-14 19:19:42

I have been doing the exercises as recommended by Gussie (doing some as I type!), have been strict about actually doing them 3x a day and not holding my breath hwhile I do them and - I haven't leaked as much. Is it really possible that there could be an improvement in under a week? I really feel like the fast twitch and lift ones are effective when I do them!

I definitely experience more leakage on a work day than à day off, maybe because I am on my feet and active all day at work whereas today - a totally dry day - I have stayed in playing with my toddler on the floor most of the day. But it has been less overall this week than before I started doing these exercises. It makes me very hopeful!

Oh, and my birth was very quick - even though ds was my first baby he came out on one push. It was a really big push! I wondered if a whole baby coming out in one go had traumatised my of and am planning to follow the mw's guidance to try and slow it down next time!

jellyandcake Sat 11-Jan-14 19:20:37

pf not of!

jellyandcake Sat 11-Jan-14 19:22:19

And I do have hypermobility which has led to some foot problems, I guess that could be a contributing factor too?

LauraPashley Sun 12-Jan-14 00:19:40

Praise The Lord for this thread!

Can I ask a pf exercise question? I think I must do them wrong, as it starts to give a really uncomfortable sensation in my lower abdomen- it reminds me almost of the pain of cystitis? Am I twitching the wrong bits?!!

MinkBernardLundy Sun 12-Jan-14 00:37:40

I went to see physio. did exercises religiously for weeks. 5 x daily.tapering off to 3 times after about three months.

It did make a difference but not completely. i do some quite full on exercise at time. moving and lifting weights. also if I run and shout at same time e.g. running after small childshouting stop before they do something stupid hmm

also if I get a cold it all cones flooding back sad

Tried aqua flex or whatever it is called. that working until i got thrush. unrelated. must get back into it though as that seemed to be helping.

I am not keen to get TVT - hard horror stories but had heard there might be a gel injection treatment? Anyone heard about that?

MillyRules Sun 12-Jan-14 00:51:15

Running is bad for your pelvic floor, especially if you have a slight prolapse. The impact when you land on the floor with each foot causes jarring. I stopped running because of this but do lots walking instead. Less impact.

MillyRules Sun 12-Jan-14 00:52:23

O and I have also found that doing pelvic floor exercises at least every hour if not more every day keeps it up in place.

CoteDAzur Sun 12-Jan-14 10:21:42

Re impact - Changing your running style from heel strike to mid-foot strike will significantly reduce the impact of running. This is important not only for pelvic floor but also for your joints. Google "barefoot running" - as in, running with minimal shoes.

Imho every runner should read the book Born To Run which started the barefoot running trend. It is a great account of the author's time with a fascinating tribe of ultra runners in Mexico.

gussiegrips Sun 12-Jan-14 10:54:04

Re prolapse and tampons - think of a prolapse as a hernia in the vagina.

So, like abdominal hernias, they can be better and worse depending on activity.

If the hernia's at the front the bladder drops down into the vaginal vault, if it's at athe back it's the rectum. Couple of other possibilities, and you can be lucky enough to have a full set.

So, the tampon thing can be a symptom - folk with prolapses often notice they can't tolerate using them because of pain or because they fall out, some folk notice leaking is better with them. No hard and fast rules, it's more observation of a change from the norm.

gussiegrips Sun 12-Jan-14 10:55:19

risk factors - yep, long pushing stage is a big risk factor.

I feel your pain. <looks at 3 giant headed children with slight resentment>

gussiegrips Sun 12-Jan-14 10:58:26

Laura - you shouldn't get pain of any sort with PFexs. I'd suggest you see your GP.

Not to panic you!

It is possible to have a pf which is too tight - pelvic floor dysfunction. Like having a spasm in your neck after a whiplash, you get pain when you use the muscle. Easily treated, but, doing the exercises will make it worse.

Common in folk with birth injuries (big tears, muscle damage, forceps, bad luck)

Go and show your fanny to a medic and ask for a referral to a women's health physio. It's usually easily sorted.

gussiegrips Sun 12-Jan-14 11:02:43

Mink - yep, those are all symptoms of weakness.

The dull things about the pf is you have to do the exercises every single day, or they stop working. Bad design.

Interesting you mention the cones - there's a bunch of good gadgets on the market, and some blooming awful ones.

Aquaflex has good evidence behind it.

There's no independent study saying that gadgetry will improve things faster, but, there is a study saying that people commit better to doing exs if they've bought something. Which makes sense - if you've spent £30-£80 on something, well, you're going to get your money's worth.

Aquaflex is about £30, you can get it in Boots - but, TBH, if you're thinking of parting with cold hard cash, pay a private physio to see you.

gussiegrips Sun 12-Jan-14 11:07:28

Milly, yep, I concur.

If you've got a prolapse the best thing you can do is give up running.

But, runners, don't want to hear that. And, you've got to weigh up the health benefits and mental health benefits of exercise. This mysterious "runner's high" (never got it myself, I'm not a runner) is something folk don't want to give up.

So, then, it's managing things to encourage compliance.

But, yep, if you've got above a G2 prolapse, or have had a TVT, and insist on signing up for a marathon...well, I'd be very nice to your face and raise an eyebrow as you left the clinic.

Re changing running style - yep, heard about it. Seems to be tricky to put into place though, and, some folk struggle with knee pain/hip pain from the change. Must work for some though.

MillyRules Sun 12-Jan-14 16:48:51

I also find that if I don't squeeze when lifting anything heavy then it can feel a little bit dropped. So I squeeze all the time now.
I think I actually squeeze quite a lot, possibly every couple of minutes I do an elevator lift. Its the only way to manage it and to keep it all good.
I also squeeze a lot when out walking as its harder then as more pressure pushing down so does it good.
I had a very long first birth with a large baby. She turned out to have the cord round her neck so was bungeeing up and down but they didn't notice until near the bloody end. So a lot of pushing had gone on to no avail. Bloody midwife even blamed me and said to my Husband that I wasn't trying....ha ha ha ha!!!! Bloody cheek....reminded me of all my school reports....."Milly could try harder and is too talkative in class" lol!!!!

My slight prolapse didn't happen until I hit my 50s though and occurred with the start of the menopause so I was very fortunate to not have had any trouble till then. Still, not complaining as it is good and manageable. After all the scare stories and the amount of hospitals being sued for the "net" repair I would not go down that route myself.

CoteDAzur Sun 12-Jan-14 20:10:21

gussie - re changing running style:

(I want to tell you a bit about this, because I think your patients could really benefit from it. I certainly wish any one of the four physios I went to over 12 months had pointed me in this direction)

Since changing my running style to a midfoot strike, my knees have stopped hurting and the calcifying tendinopathy on my hip has disappeared. For this, I read the book (Born To Run - Christopher McDougall) and watched YouTube clips of heel strike vs midfoot/forefoot strike. Most importantly, I changed my shoes - 'bye-bye' to well-cushioned but practically zero-support Nike shoes and 'hello' to proper running shoes with real support. Basically, the less the thick soft heel cushion, the less you can land on your heel (because it bloody hurts). I strongly recommend all runners to go for gait analysis at a specialist shop before they buy their running shoes.

To get a feeling for midfoot strike, recommend your patients to run with just their socks on the treadmill or barefoot on sand (where possible) for a while. Take it slow, building up from about 5 minutes per session, because this running style uses different muscles than heel strike. Then, when they put their running shoes on, they will be able to continue with this style. Especially if they have also changed their heavily cushioned shoes by then.

Midfoot strike shortens your stride, which (1) lessens the impact, and (2) changes the angle at which the impact travels through joints & muscle, with the arch of the foot absorbing impact etc.

There is a lot of info about all this online. Please take the time to look into it and share it with your patients.

MillyRules Sun 12-Jan-14 21:10:31

gussie you can still get a good high from walking especially hill walking etc. I went from normal running outside to running on a really good treadmill but even that wasn't good with a slight prolapse. So walking it is. I also do weights to keep my muscles toned.

CoteDAzur Sun 12-Jan-14 21:42:37

Sure, you feel good after walking (or any other outdoor activity) but it's not the same thing as what we call "runner's high" which follows high-intensity cardio activity over a sustained period of time.

There are some fascinating studies on this subject, if anyone is interested. Like this and this, for example.

WideAwakeMum Sun 12-Jan-14 23:00:27

Gussie, thanks so much, that gives me food for thought and I've been diligent with pf exercises today following this, so will get my head out of the sand, will keep them up and consider asking my lovely GP for a referral. Am thinking I'm a bit collapsy down there. You have my utmost respect for your three heads !!!

Cote, I'd agree that there are ways to reduce impact, and minimal is good, with higher cadence, short strides and gentle footfall. I mainly run trail and believe tarmac to be the worst surface to run on (well, except concrete). The minimal style is a good, a hybrid option though is "Hoka" running shoes, they were designed for ultras and have 4mm heel to toe drop like other minimal shoes to encourage mid or fore foot strike, BUT they are hugely padded in the soles, I wear them when I have no choice but running on evil tarmac. Just wanted to mention this option.

LauraPashley Sun 12-Jan-14 23:23:37

Thanks Gussie! I am planning to go anyway re the whole continence thing, but felt I couldn't really without having tried the exercises first! I do wonder if I am using the right muscles though - do you hav any good links to an idiots guide to how to do them?

MillyRules Mon 13-Jan-14 00:46:20

Cote I agree its not the same as a runners high but to stop your bits falling even more its just best to not run. That's the advice given by those experts in the field unfortunately.

TheDoctrineOf2014 Mon 13-Jan-14 01:12:29

Gussie you are fab!

MillyRules Mon 13-Jan-14 01:53:00

But two suggestions are to get a ring pessary to insert to keep everything up or some find inserting a tampon works.

CoteDAzur Mon 13-Jan-14 07:31:07

This thread got me thinking if the doctors here who love episiotomies have a point. Pretty much everyone I know had one during birth, including me, and none of us has a stress incontinence problem. I hated the midwife who did my episiotomy and caused me much suffering over many months, but I wonder if she did me a favor in the long run.

MinkBernardLundy Mon 13-Jan-14 11:19:58

I had an episiotomy still have problems. But I did carry twins and both delivered with forceps. so I guess I am lucky I can hold it in at all

I have weakness on one side- probably caused by the scarring.

but this thread has been great because every time i see it in my threads I am on I start clenching grin

learnasyougo Mon 13-Jan-14 12:35:09

I had an episiotomy (and forceps and 3 hr second stage) and it wrecked my pf. I had total urinary incontinence for weeks after birth (no control whatsoever. Adult nappies for me) but since then I'm now up to just stress incontinence. (a massive improvement to quality of life, let me tell you).

The ten seconds hold, is it just one of those and then ten quick flicks or ten x 10s hold, then ten quick flicks? I've been doing the latter about 6x a day but it's made my pf go into spasm a couple of times so I've cut back to 3. should I just be holding for yen seconds once each time?

gussiegrips Mon 13-Jan-14 12:44:29

Laura yep - here's my recommendation by Jane Appleyard, who's a smasher. pelvic floor with a pebble --not as dodgy as it might sound--

gussiegrips Mon 13-Jan-14 12:45:44

But, best way to tell for sure is to stick something into your vag and give it a squeeze. Preferably something that you can feel to assess if you can, indeed feel a contraction, or something attached to someone else who can tell you if they feel a contraction on their thing carefully placed in your vag.

It's a glamorous life.

gussiegrips Mon 13-Jan-14 12:53:21

re running - Milly's quite right, running will simply make your bits fall out. If you have a prolapse it will make it worse. Fact, scientific, evidence based, undisputed, fact.

However, runners wanna run. Most Some of them simply can't/won't contemplate giving it up, so, then it becomes a matter of risk management, partly to give them time to get their heads round a lifestyle change.

Being prescriptive and saying "do this, this and this, and don't come back until you have done them" simply doesn't work. Or at least, I can't get that to work for my ladies. Encouraging someone, educating them and getting them to do their own risk assessment and set their own goals does work. Eventually. Failing that, showing pictures of prolapses and frightening them with horror stories can be fairly effective. I'm not very nice.

gussiegrips Mon 13-Jan-14 12:55:34

Milly - yep, pessaries can be great. And, there are some ring pessaries which can stay in place during sex, which can be handy.

The NHS tends to offer pessaries to older women. And, ususally it's the cheaper plastic ones and not the nicer silicone ones.

One of the things I'd like to see is younger women being offered pessaries, they can be a really good conservative management of quite significant prolapses.

gussiegrips Mon 13-Jan-14 12:59:34

Cote - the episiotomy/tear debate is an interesting one and ongoing.

But, statistically, there isn't any difference between epis/tear and the incidence of incontinence. It's the degree of damage that matters, certainly episiotomy increases risk, but, a 3rd/4th degree tear or muscle avulsion is a bigger risk.

gussiegrips Mon 13-Jan-14 13:02:05

Learn - one ten second hold, then ten quick flicks. You can do more, but, not if it causes pain or fatigue.

It is confusing. But, well done for the work you've done so far, it's great to see that you're getting it back. It's a grim way of life.

MillyRules Mon 13-Jan-14 14:07:01

gussie what is your role.....you know so much smile

MillyRules Mon 13-Jan-14 14:10:10

As I mentioned mine didn't prolapse until I started menopause but within a week of doing pelvic floors it had gone back up slightly and within a month I was pretty well unaware of it. But I did the exercises every hour and do them now two years on all the time. OH says he feels me grip him so know they work grin

CoteDAzur Mon 13-Jan-14 16:23:28

"statistically, there isn't any difference between epis/tear and the incidence of incontinence. It's the degree of damage that matters, certainly episiotomy increases risk"

I was saying the exact opposite - i.e. episiotomy protecting against future incontinence (which, incidentally, was the reason they gave me at the hospital and I never believed). I know "the plural of anecdote is not data" and all that, but episiotomies are the norm around here and there doesn't seem to be anyone suffering from stress incontinence. (Lots of my friends run, do bootcamps, triathlons, jump with their kids on the trampoline etc. we are all in our 40s, with 2-3 children)

I should clarify that I'm talking about mediolateral episiotomy here (cut to the side), and not median episiotomy which cuts into the anal sphincter and is indeed associated with the risk of incontinence.

DayAfterYesterday Mon 13-Jan-14 19:20:19

I've just noticed this thread, after the birth of my second child 2 years ago my pelvic floor has steadily got worse. When I need the loo I have to go within minutesits its not to bad when I'm still but if I'm moving, walking its really bad. but worse than that Im leaking during exercise, even if I go immediately before starting I leak soon as I start jumping about so I run again and empty some more that usually hold things for a little while then starts again :-( It really upsets me I'm not even 30! I've tried doing my pelvic floor exercises but not noticed an improvement, I can stop mid flow so know I'm using the right muscle bit can't contract on a finger I can't feel it! I must be really bad

gussiegrips Mon 13-Jan-14 19:29:10

I'm a physio, Milly. I work in women's health and am sort of Militant about this stuff. I see it as a feminist issue, it's utterly ridiculous that pf stuff is so badly addressed in UK.

I have a hobby of stand up, so I did a Fringe show last year, Gusset Grippers, about pf. It was evidence based practice disguised as scatological humour, and, went better than I expected. My thinking is, if you make them laugh they'll talk, and talking breaks down the taboo, so folk will get informed and know what to do and when to seek help.

I'm cobbling together a book. Currently gotten as far as the "lift the flap" section, which is both a joke and serious point.

There's lots of academic information on pf, but, I do feel that there's a desire amongst women for factual and accessible information. May as well do it myself.

gussiegrips Mon 13-Jan-14 19:35:03

Cote - yep, I see what you mean. Epis is to reduce the risk of a shocking tear, once you've got a torn sphincter you're going to need surgery to fix it. So, yep, epis has it's place.

But, they used to be used routinely, and, that's not appropriate as the incision is in itself an injury and increases risk.

I'm pleased that your friends are leak-free! though, I suspect that some of them might be lying, stats are that 1:3 of us do pee on trampolines

gussiegrips Mon 13-Jan-14 19:36:29

DAy, might be worth getting a referral. Do the exercises x3 day (or follow the fine example of the devotees of hourly exs on this thread!) and give it 3 months.

Follow me on twitter, I'll nag you.

CoteDAzur Mon 13-Jan-14 20:42:24

Gussie - Where were those statistics of 1:3 taken? I doubt if there is such a thing as a universal risk figure in such things, since methods of birth, prenatal and postnatal care vary so widely between countries.

gussiegrips Mon 13-Jan-14 20:54:07

But, it's not about birth, Cote. That increases risk, never having a baby isn't a guarantee of a dry life. Remember, 25% of women under 25 leak during sport. It's mainly because of flawed anatomical design.

The stats are from all the studies in pubmed that I've ever read. The UK figs tend to cite 1:4, the US and Oz 1:3. Commonly accepted, both by NICE and the US insurance firms. In fact, Tena, who obviously run a business on this stuff use 1:3 for their advertising, and, I presume they keep a close eye on all the latest research.

The figs are mainly extrapolated from the number of women presenting for help from medics. It is, however, worth bearing in mind that the true number is possibly higher - most people when asked "are you incontinent?" reply with "no", and we know that it takes an average of 7 years for a woman to seek help.(certainly, anecdotally speaking, I find most women over 40 with kids raise their eyebrows with mention of a trampoline. Indeed, you don't even have to use the words "pelvic floor" or "incontinent", "trampoline" is a code word almost universally recognised amongst women at school gates as meaning "oops")

CoteDAzur Mon 13-Jan-14 21:02:37

I don't live in the UK, hence my question.

I found this about France, which basically says that only 12% of women under 30 suffer from urinary incontinence.

Why do you think the French figure for urinary incontinence in young women is less than half of the UK figure?

DayAfterYesterday Mon 13-Jan-14 21:04:08

I will need to go back through the thread to double check how I should be doing them, I'm on phone so not easy to read back. So I hold for 10 seconds, how many times? And the lift thing when you relax is it back down 3 times or fully?

learnasyougo Mon 13-Jan-14 21:21:06

gussie, . I would totally get behind your campaign to get this issue talked about. it shouldn't be taboo, or shouldn't be shame, it should be out in the open, addressed, treated. my mum had had stress incontinence since she had me (37 years ago) and she doesn't seen to have any idea that she shouldn't. It makes me mad that wh physio isn't routine street difficult births or mentioned by a health visitor (say, at the 1 year check up at the latest). They are all over pnd but other party possum complications are ignored. instead women feel ashamed and only hint at there being a problem. Definitely ripe for a MN campaign.

learnasyougo Mon 13-Jan-14 21:22:07

post possum? I meant partum but must have been channelling Dame Edna. grin

Sunflower6 Mon 13-Jan-14 21:26:43

I am not a runner but I had severe incontinence after my two babies. I had a tvt op three years ago and it was life changing for me.

I couldn't cough or sneeze without leaking badly and couldn't run after my children. I couldn't do an exercise class as I leaked so much.

My surgeon told me running is terrible for the pelvic floor. My tvt has been Fantastic - it was a lot to go through, six weeks off work unpaid and recovering from surgery but worth it for me, I couldn't go anywhere without a tena lady and I don't need them now.

MillyRules Mon 13-Jan-14 23:36:03

Thanks gussie . wow....you were brave doing standupsmile and doing a book. We'll done you. smile

gussiegrips Mon 13-Jan-14 23:36:50

Cotes - that's very interesting! I haven't seen recent stats for France, it's sort of regarded as Gusset Utopia amongst PTs and MWs.

So, in France you get post-partum PT. That means women are doing their exercises correctly and are motivated to comply. This isn't news to them, as their mothers and peers will already have had an awareness of their PF seeing as how the programme is long running. So, there is an expectation that women will NOT be incontinent with motherhood or age - whereas here, it's the opposite.

I'm not aware of any studies looking at that, it just sort of makes sense to me. French women expect to be dry, so, treatment is funded. We put up and shut up, so, you know, it's not.

gussiegrips Mon 13-Jan-14 23:37:32

Oh, and, it's less than half because if you #doyerblardyexercises, it works.

gussiegrips Mon 13-Jan-14 23:46:28

Day -

1. hold for 10 seconds - you should feel a "drop" when you let go, no "drop" and you've lost the contraction. 10 secs is important because it buys you time when you are bursting, there's a reflex inhibition of the urge to pee with active contraction of the pf over 10 secs.

2. 10 quick flicks - so, on/off, on/off, on/off, on/off, on/off, on/off, on/off, on/off, on/off, on/off. Relax between each one

3. imagine you've got a lift in your vagina (weird, just try it). Lift it to the first, second, third floors and then back down again.

"we won't pee with a 10, 10, 3"

Do all of those three times a day for three months.

Any pain, or lack of improvement - see your GP.

Follow me @gussiegrips, when I tweet, you twitch your twinkle, it's remembering to do them at all that's the tricky bit. Or, set your phone to alarm x3/day - anything featuring Marti Pellow should do it.

After 3 months, do them once a day every day until you die.

Sorted.

Well, at least, sorted for 7/8 out of 10 women.

gussiegrips Mon 13-Jan-14 23:48:57

Learn - yep, and it's women in your mum's age group who really suffer. They are often very reluctant to seek help, and, are often mortified at having to deal with pads. It affects their mobility, sleep and general wellbeing.

The campaign should definitely include a possum.

gussiegrips Mon 13-Jan-14 23:51:12

Sufnlower, that's great.

TVT is good surgery, and I'm glad it's worked well for you. But, yep, it's a got a long recovery, and, of course, you still need to #doyerblardyexercises every day.

gussiegrips Mon 13-Jan-14 23:53:06

Milly - comedy's only talking. Talking's pretty much my only skill.

Plus, there's a microphone. People listen if you have a microphone, no one ever listens to a word I say normally...

DayAfterYesterday Tue 14-Jan-14 09:17:54

Thank you will make a real effort to do them everyday I think I was hoping it would fix itself. I'm not on twitter, can't figure out how that thing works!

MillyRules Tue 14-Jan-14 09:57:41

gussie I do the elevator lifts too. I try and go to twenty floors then when I can't do anymore floors I go back down the floors as far as possible so I am not just letting the muscle go, but am holding it and controlling it on the way down too. smile

gussiegrips Tue 14-Jan-14 18:36:58

Day - doesn't matter what you use to remember, just find something. Set an alarm, put it in your diary, make an association with brushing your teeth or doing the dishes - anything to get it into being a habit. I hesitate to suggest doing them every time you log onto mumsnet for fear of worn-out-fanjo-syndrome

gussiegrips Tue 14-Jan-14 18:37:24

Milly - TWENTY FLOORS?

Show off.

glassofwineandagoodbook Tue 14-Jan-14 20:22:21

Gussie - thank you. I needed a boost to really focus on my pathetic PF again. You are totally right; it's a feminist issue. For anyone who's interested, I wrote a TMI column for the Vagenda blog a while ago about incontinence vagendamag.blogspot.co.uk/2013/04/tmi-incontinence.html

It's still a problem for me. My youngest is 15 months now, I've stopped bfing (my physio said sometimes hormone levels could make it worse), but I haven't lost the weight I need to. Finding exercise that isn't embarrassing is difficult. I HATE the pads and the worry. I'm trying so hard not to let it stop me doing stuff, but sometimes it gets to me.

MillyRules Tue 14-Jan-14 20:37:17

Yep twenty.....I squeeze and tighten very slowly and try to squeeze tighter and tighter up the elevator up 20 times and then hold for ten.... then try to go down as slowly as going up.

AutumnWind Tue 14-Jan-14 21:18:16

Can I ask a question?

Most of the time I'm fine- can run and jump with a full bladder, do my exercises etc. bu every now and then (often when my bladder is quite empty) I'll just randomly leak! There doesn't seem to be any reason and if I go to the toilet, there's not to wee... Any ideas what this might be or what I can do?

Also, I've noticed lately that no matter how much I try to empty my bladder on the toilet, when I stand up and walk (I notice when I'm wearing nightdress) that I dribble a little. I would see dr, but it seems like nothing to ak about, so I thought I could ask here first...

Thank you

coffeeinbed Tue 14-Jan-14 22:03:34

The dribbling is because the urethral canal has been stretched out and bent, so some wee collects and when you stand up the wee then drips down because of gravity.
Do your exercises to strengthen the PF around it.

DayAfterYesterday Tue 14-Jan-14 22:17:34

Thanks Gussie, I've started already would be great if I could stop this happening if not I dread to think how bad it could get, so do i just do each exercise once 3 times a day? So the hold for 10 just once, the 10 flicks then the lift thing once? Im struggling with the lift thing I can do 3 levels up but can't control it down hopefully this will get easier

Same as pp I get the leak when standing up after using the loo too, its horrible

MillyRules Tue 14-Jan-14 23:12:19

When I first had my slight prolapse I did them at least every hour and it toned up really quickly. But as gussie is a physio and more knowledgable on the subject than me, maybe her three times a day is best .

runningLou Wed 15-Jan-14 15:42:11

I need to re-read this thread properly esp. about exercises as after 2 vaginal deliveries I really struggle when running (use pads), and am currently in a dilemma as I would love to do a triathlon but can't see how I could make it work with pads / changes etc sad
I had physio after both, did exercises, saw improvement day-to-day but not when running.
I also use the moon-cup for pressure, but it's not enough.

gussiegrips Wed 15-Jan-14 16:00:46

Glass - excellent article.

You are right, it's an outrage. It fascinates me, leaking is a real taboo in a society which scoffs in the face of taboo.

I did a stand up set about pissing myself, but, I dropped it as it didn't really work. It was too awkward, not for me, but the audience did. They laughed, but, it totally killed the atmosphere!

I agree with your PT, sometimes there's a problem until after your hormones settle. And weight (yeah, yeah, yeah, blah, blah, blah, you've heard all that before).

Also, though, catheters can, occasionally cause a problem. Usually resolves with time - but, I assume they've checked there's no tissue damage or nerve irritation.

And, incontinence does get to you - an estimated third of people who leak are also clinically depressed. Having less bladder control than your toddler doesn't make you feel very good about yourself...

Go back and get another assessment?

gussiegrips Wed 15-Jan-14 16:01:20

Milly <applause>

stealth boast noted

gussiegrips Wed 15-Jan-14 16:05:41

Autumn, coffee's right, that sounds like urinary retention.

It can either be that your bladder's not emptying fully, you've got a kink, or you're hopping off the pan before you've finished (usually when the kids are knocking lumps out of each other outside the toilet door)

A trick is to pee, count to 10, then try to pee a bit more.

Or, pee, count to 10, lean forwards, then try to pee a bit more.

Certainly, it's worth telling your GP, that's not a weakness thing. It might be from scar tissue, side effect of medication, something's up with your brain co-ordinating with your bladder, or, you're just in a hurry.

Often fixed by re-learning good bladder habits, and there's medication that can help.

gussiegrips Wed 15-Jan-14 16:07:31

Day, Milli's right - the more, the better.

The evidence is 70-80% improvement with x3 a day, but, the more the better. (with the caveat that you can over-do it and if you do you'll get either pain or a tired fanjo. In which case, do less)

Less than x3 day will help, but, less efficiently.

Once you've got good control, x1 day minimum for maintenance.

gussiegrips Wed 15-Jan-14 16:10:59

running - it is a problem.

The impact can simply be too much.

But, the goal of triathalon can be a big draw - so, suggest:

good footwear, avoid pavements, #doyerblardyexercises, pee before training, don't get dehydrated, keep distances low, try a pessary (incostress) and consider having a wee jumper tied round your waist and dousing yourself in water at every feeding station for camouflage.

It's not impossible, but, in the long-term some folk find it's just not worth it.

Have you been checked to see if there's any prolapse? Might be worth it, and then you'll get specific advice.

IwishIwasmoreorganised Wed 15-Jan-14 20:24:27

Gussie.

I'm doingmyblardyexercises three times a day now, usually when sitting as I drive a lot for work. I guess I'll need to transfer doing them into standing at some point will I?

When I do them though, I feel like I can contract much better towards the back and middle, but not so well at the front (where it's really needed) iykwim. What can I do about that?

Ohhelpohnoitsa Wed 15-Jan-14 20:46:39

Gussiegrips........ please tell me what actually happens when a petiebt goes to see a physio in these circumstances. How are we assessed??

gussiegrips Wed 15-Jan-14 21:00:00

Delighted to hear it, wish - have a shiney!

Yep, like any exercise programme, it should be progressive - so, lying, sitting, standing, walking, jumping like a loon in a mosh pit.

It's very common to be able to feel it around the bumhole and not around the pee-hole. That's partly because you'll be (and forgive me for presuming) more used to holding in a fart than holding in when you're bursting. However, there WILL be some muscle activity at the front if you actively contract the back - the one that makes all the muscles work is the "lift"one.

Keep going, you'll feel it as you gain strength in your undercarriage.

IwishIwasmoreorganised Wed 15-Jan-14 21:05:59

Marvellous! Thanks for your words of wisdom and encouragement.

thanks

coffeeinbed Wed 15-Jan-14 21:10:15

Sorry, just adding - you feel it more in the bum because that's where the bigger part of the PF muscle is so it's natural to feel more if there's more of it.
PF is diamond shaped.
Eventually you'll have mastered the moves and can work more on the front bits.
I think!!

Sorry, Gussie, I'll bugger off now...
As you were!
grin

gussiegrips Wed 15-Jan-14 21:22:52

Ohhelp - well, first of all, they should smile, be kind and put you at ease.

We know that most people find it excruciatingly embarrassing to get your kecks off and show your broken bits to some stranger.

So, first of all, you have a chat. You'll be asked questions about your symptoms, history, previous treatment and general health.

You'll be asked quite a lot about what you drink, how much and when. Also, how often you pee, and leak, whether you leak poo and whether there's any pattern or predictability to the accidents.

If you've had children there will be questions about pregnancy, labour and delivery, tearing/episiotomy. If you've had C-sections there will be questions about the catheter and recovery.

Then you'll be asked to undress and lie up on the couch, in the same way as a gyn exam (and, possibly the same too small paper cover if you're NHS. Private will havea bigger bit). Your abdomen will be palpated to see if there's any tenderness or constipation.

Then, if you're happy, the physio will have a look at your bits to check for infection, skin problems, marked prolapse etc.

It would be expected that you'd also have an internal. By palpating inside the vagina we can see if there is any loss of muscle bulk, loss of sensation, prolapse, spasm, pain or muscle damage. Then your power will be assessed by getting you to squeeze - that's graded.

It's not compulsory to have an internal. But, it is the NICE guidelines, as, it's the best way to check the state of the muscle.

And, the thing to remember is that, yours is the latest in a long line of fannies the physio's looked at. No more startling than an elbow or a neck.

Some physios use ultrasound to show you contracting the muscle - so, they scan your tummy (much as during pregnancy) and you'll see the muscles on the screen. It's very visual, you'll do the exercise and see the muscle lift up.

For women who can't intiate a contraction at all there's a number of options - often electrotherapy which can artificially stimulate the muscle until you've gained enough power to do it voluntarily.

So, we'd expect that you would leave the appointment with a diagnosis, a treatment plan, advice about what to avoid, advice about what to do and a review appointment.

You won't be asked to do anything that you simply don't want to - there's always ways of working round comfort zones.

It is the most satisfying type of work - changes lives.

gussiegrips Wed 15-Jan-14 21:24:41

Good point, coffee!

I just like talking about farting...

hardtostayfocused Wed 15-Jan-14 21:57:29

gussie if you're still there, any thoughts on what age girls could start doing PF exercises. My DD has an overactive bladder, and as far as I can tell she is doing quite a lot of inadvertent leaking, so could this suggest weak PFs?

gussiegrips Wed 15-Jan-14 22:00:10

Hs she got a diagnosis of overactive bladder, Hard? Is she having treatment?

How old is she?

hardtostayfocused Wed 15-Jan-14 22:06:46

Yes. She's on ?oxybuticin tabs. She's only 8, so obviously doesn't have the frame of refs for doing PFs! But from things she says I think she might have quite weak muscles, and just wondered if these things can be nipped in the bud at an early age - excuse unintended pun.

(I've been completely staggered by this thread, had no idea this was such a widespread problem.)

MillyRules Wed 15-Jan-14 22:14:54

Sorry gussie blush I just got passionate about doing them to fix the problem.

gussiegrips Wed 15-Jan-14 22:34:58

So, is she wet at night, Hard?

Oxybutynin's used for OAB in adults, and also for eneuresis in kids - but, I expect there's other uses, bit outwith my knowledge base.

In bedwetting it works by reducing the amount of urine production, which should be done by a hormone. but, sometimes the body's a bit slow in getting the hormone level up, so, the kid wets at night.

In adults it reduces the "spasm" of the bladder and the urge for frequency. Can be really good, but, can cause a dry mouth which some people find troublesome.

I've not come across PFexs in kids - but, I'll ask some colleagues.

Hing oan.

gussiegrips Wed 15-Jan-14 22:36:06

Milly, it's blooming marvellous!

As long as you're not getting pain, just you carry on.

<wonder if we can get pfexs included in the Olympics. You're on the team>

Fishandjam Wed 15-Jan-14 22:58:24

I'm now following @gussiegrips grin

I'm not very leaky when doing ordinary running but it's another matter when I do a sort of military fitness-style bootcamp twice a week. 20 seconds of high-knee running on the spot and I'm Niagara fucking Falls. Even if I've been to the kharzi beforehand. Otherwise, trampolines are ok but the third sneeze gets me every time.

Looking forward to getting my exercise reminders!

Fishandjam Wed 15-Jan-14 23:05:48

PS forgot to say - two vaginal deliveries; first one = episiotomy (which then tore further, stopping just short of anus), failed ventouse, forceps. Second one = 2nd degree tear and manual assistance with freeing the baby's head, but thankfully no forceps or ventouse. Shagged lumbar spine too (degenerative disc disease and operated-on prolapse L5/S1).

MillyRules Wed 15-Jan-14 23:46:15

ha ha Olympic Pelvic Floor flexing.grin

EmmaGellerGreen Thu 16-Jan-14 00:45:36

I love this thread! It's on my watch list and every time I see it, it's pfe time! Thanks.

Ohhelpohnoitsa Thu 16-Jan-14 19:19:51

wow thanks gussie. good to know what to expect if and when. I have had 3 very big babies and things aint what they used to be!

Francois Fri 17-Jan-14 19:39:46

Gussie - what exercise do you recommend that isn't running in order to ensure you can still get that sweat inducing cardio in? Preferably gym based...

TheDoctrineOf2014 Fri 17-Jan-14 19:42:29

I would love to know that too.

Kveta Fri 17-Jan-14 19:44:22

This thread is so useful!

I am horrendously overweight, and need to find a suitable exercise to help me lose the lard. However, 2 forceps deliveries of huge-headed and heavy babies have left me like a bottle with no lid on if I try and do more than a brisk walk. I do my pelvic floor exercises daily, and am seeing GP next week about what I am pretty certain is a pelvic prolapse, and I'm hoping for a referral for physio at least. Last gp I spoke to said she couldn't refer me until I lost weight, but apparently that is not the case.

My biggest pissing issue is when I have a cold though. The minute the cold starts, my pfms just go on holiday or something, and I am completely sodden for 2 or 3 weeks until the virus clears. Will be interested to see what gp says next week though.

learnasyougo Fri 17-Jan-14 23:56:26

if you are looking for cardio that won't have you wetting your pants: cycling is zero impact and cheap. I am 30w pregnant and can cycle to work as its so easy on my body (I have traffic free route for 80 per cent of my journey to work). I never wet myself cycling and my pelvis tilts forward which helps with the prolapse, I think.

MinkBernardLundy Sat 18-Jan-14 00:17:17

Seconding the bike suggestion. you can get a great, wee free work out in the gym, on the bikes if you just crank it up and go for the heart rate work outs.
Minimal impact but still a good burn.

gussiegrips Sat 18-Jan-14 14:04:54

Gym bunnies - yep, they're right, cycling's a great option. Best upright rather than recliner.

Eliptical trainers and steppers are ok, if you've got a good technique.

Avoid rowing machines like the plague.

There's a reason gyms like you to wipe down seats, and it's not always sweat...

gussiegrips Sat 18-Jan-14 14:09:40

Kveta - certainly, extra weight creates extra muscle work, which creates more leaks (ask me how I know), but, that wouldn't preclude you from treatment. Well, not here, anyway.

Colds and hayfevers are a nightmare for those with low-swinging-sweet-chariots. All that coughcoughcoughsneezesneezesneeze knackers your wee muscles. If that happens, go back to doing the exs x3day (or, Milly's hourlies) for six weeks or so and it should go back to normal again.

Glad you're seeing the GP. Might be worth asking about pessary (if indeed you have a prolapse) to help when you're doing exercise?

Swimming's good for the start of an exercise campaign. PF friendly too.

gussiegrips Sat 18-Jan-14 14:11:14

Should have said swimming for the gym bunnies too.

Added bonus, no one sees you leak in a pool. Hurrah for chlorine!

Am joking, there's zero impact, so it's a good exercise. Also, you can do a great cardio.

TheDoctrineOf2014 Sat 18-Jan-14 14:16:40

Why is rowing bad, Gussie? It's low impact, surely?

gussiegrips Sat 18-Jan-14 14:23:32

Yep, but, people tend to have really bad technique.

To row well, with minimum pf strain you need good core muscles - you're moving your arms and legs at the same time and dealing with pulling quite high weights.

If you don't have a rock solid core you'll compensate by holding your breath, and that increases the (already spiking) intra-abdominal pressure = leak.

People with prolapses are advised to steer clear of rowing, planking, extreme yoga or pilates - as well as the usual suspects of running, trampolining, zumba.

But, remember, most of these conditions are either curable, or manageable. Doesn't mean you can't - just means, maybe not quite yet.

MillyRules Sat 18-Jan-14 16:34:56

Gussie thanks for all your so helpful information. Your brill. I have a gym in my shed in the garden. Im careful when I do weights and always sit on the bench now so that im not straining and causing pressure in my pelvic floor. I stopped running and do lots of walking which is better. I also practice doing my pelvic floor exercises when walking as it is more challenging to be walking and lifting at the same time.

gussiegrips Sat 18-Jan-14 18:26:37

And, do you think that's worked out for you, Milly? As long as that's not too direct a question!

Am impressed at the notion of a gym in a shed. I've got budgies in mine, and quails who are, ironically, prone to prolapses

Francois Sat 18-Jan-14 18:46:37

Thanks! It was the elliptical I was thinking of, I wasn't sure if it was too close to running to be a similar danger

MillyRules Sat 18-Jan-14 19:46:02

Yes, it works well. Every time I lift weights I also do a squeeze in and up at the same time so that I don't bear down.
The shed is a purpose built gym that my OH built about 8 years ago. I really have no excuse to not exercise do I.

DayAfterYesterday Sat 18-Jan-14 20:26:14

I'm doing my exercises as Gussie said but I've noticed my problems seem to be getting worse since I started back exercising any jumping even with emptying my bladder immediately before hand is making me leak a lot a few months ago it was little leaks but now it just gushes out :-( no matter how hard I try to hold it. Is the exercise making it worse? This is ridiculous at my age should I persevere for a few months before speaking to my go? Also wondered if its normal for issues to get worse when your period is due as that seems to make things worse for me

MillyRules Sat 18-Jan-14 23:14:59

I would review your exercise routine and change it to a pf friendly routine if it were me. Damage limitation and re strengthening your pf and your priorities if you don't want to go down the operation route.

MinkBernardLundy Sun 19-Jan-14 01:23:06

Physio advised me no jumping until your pf was in good shape.

What are you doing that requires jumping? As, if it is aerobic, you can usually modify it to a no jumping alternative.

And you May aswell go to gp sooner rather than later as a referral May take a while and a physio can check you are doing your exercises properly.

On a good news front, after clenching every time i see this thread, i started using my aquafkex again and got the weights up to the highest yet. weight lifting fanjo grin

nirishma Sun 19-Jan-14 01:32:06

Marie winsor 15 minute workout Pilates DVD. Use it daily and you will run without wetting yourself. It got rid of my prolapse I swear!

MillyRules Sun 19-Jan-14 01:55:00

I thought Pilates was not good for a prolapse?

DayAfterYesterday Sun 19-Jan-14 10:11:26

I'm doing the 30 day shred so jumping jacks, running on spot, skipping etc...I really need to be able to get that cardio in at home. I'm glad I'm not having any more children if having 2 has done this :-(

kelper Sun 19-Jan-14 10:16:02

Every time i see this thread it makes me do pf clenches!

TheDoctrineOf2014 Sun 19-Jan-14 11:04:24

Me too kelper

gussiegrips Sun 19-Jan-14 11:50:30

I'm chuffed the thread's running as long as it is! Am quite sure a wee PF section on MN would be useful, but, then, I'm not exactly objective <looks at "pelvic mafia" t-shirt>.

Day - yep, many people find their symmptoms change during their menstrual cycle. Oestrogen/progesterone swinging around changes the elasticity of your ligaments and tendons, so, your pf sags down ever so slightly. Agree, avoid jumping if you can, stepping would be better? Got stairs at home?

Mink - have a shiny, the wee heavy aquaflex is darn near Ninja Level of Fanjo Fu.

Milly - good point. Pilates done well can be brilliant for prolapse. Really good - infact, there's a USA medic who has a DVD of pfilates, pf pilates www.pfilates.com/. It's good, evidence based exercise (he, erm, got a bunch of women to do pilates with a sensor up their snatch to measure the forces created and designed the exercises round the results.) The music's a bit annoying (to me) but, it is good.

the problem with pilates is that if you are not strong enough to hold the pose you'll cheat. And, that's usually breath holding and poor posture,which can be enough to pop a prolapse out - same issue as with rowing machines.

so, if you've got a great teacher or trainer, go for it. If you've got a busy class and aren't really getting much attention from the leader, be careful, doing them on your own with a video - be really careful. As with any exercise, stop if you've got pain.

<away to order more pelvic mafia t-shirts>

MillyRules Sun 19-Jan-14 13:44:43

Day I understand you wanting to get fitter but the exercises you are doing are not good for prolapse and if your suffering now it could be potentially so much worse when you hit peri menopause and then menopause as things naturally drop significantly as hornone levels change. sad

MillyRules Sun 19-Jan-14 13:47:17

The aim is to prevent further prolapsing and strengthening those pf muscles which if too much jumping and high impact exercise will cause further stretching of the ligaments and possibly further prolapse.

gussiegrips Sun 19-Jan-14 18:34:30

Women don't tend to know what our bits look like, never know what a prolapse looks like. ANd, it's hard to motivate yourself to protect against something intangible.

So, in the interests of motivation...don't click if you're squeamish, surgical images.

grade2 prolapse

grade 4

complete prolapse of vaginal vault

Here's the link to the cillit bang for your eyes...

imgur.com/gallery/QkWxU

TheDoctrineOf2014 Sun 19-Jan-14 18:39:09

Going swimming tonight! Inspired by you all!

MillyRules Sun 19-Jan-14 20:42:03

Im too scared to look on that Gussie. Just cant do it ha ha!!!

MillyRules Sun 19-Jan-14 20:42:27

OMG I did it I did it ha ha.

MillyRules Sun 19-Jan-14 20:44:32

feel a bit sick actually.

MillyRules Sun 19-Jan-14 20:44:55

And sqeezing away like a mad woman.....lol!!!!

OohAahBird Sun 19-Jan-14 21:34:00

I am seeing a specialist physio at present for my pelvic floor, I do Pilates as I also ended up paralysed after birth and learning to walk again and rebuild my other muscles was higher priority than the incontinence issues. However now I am finally on the mend walking wise I am now sorting out the pf hence seeing the specialist.

My physio gave me this link as to what exercise was ok and what was not while working to sort out my pelvic floor.

My Pilates teacher has been great at making allowances for those exercises that I cannot do and finding alternatives until my pf is up to it.

www.pelvicfloorfirst.org.au/pages/what-are-pelvic-floor-safe-exercises.html

I hope this helps those that want to exercise but don't want to make the situation worse.

gussiegrips Mon 20-Jan-14 11:35:45

I warned you for a reason, Milly...

eye watering stuff.

Of course, the grade 2 is something that's considered medically normal in the States in a woman who's had 2 vaginal deliveries. And, that's something you might see with a hand mirror, so, assuming you know what your bits looked like pre-baby you can spot it and go and see GP.

The complete prolapse is something that is usually confined to women who have had a hysterectomy and lost the ligaments that hold the top of the vagina up. Horrific.

But, erm, yep. Makes you comply!

gussiegrips Mon 20-Jan-14 11:39:01

OohAah - blooming heck, PARALYSED? Glad you are recovering, that just sounds beyond grim.

Thanks for linking the pelvic floor first site- it's a cracker. The Australian government put shedloads of cash into continence after finding it cost them $64bn dollars a year.

they indluded the cost of the associated depression, heart disease, orthopaedic injury, relationship breakdown and subsequent single parent families, loss of earnings, people moving into nurseing care as well as the obvious pads, investigations, surgery and medication costs.

UK government think our costs are £17m.

They are wrong.

KatnipEvergreen Mon 20-Jan-14 11:48:30

What is "normal" in terms of pelvic floor function?

Are there tests you can do yourself to see if everything is ok?

TheDoctrineOf2014 Mon 20-Jan-14 11:52:35

Thanks for the link.

Gussie, how do you feel about sit-ups?

gussiegrips Mon 20-Jan-14 11:59:58

Great question, Katnip.

Normal is - no leaking of pee or poo and no pain in your bits or deep in your pelvis (not even if using tampons or during penetrative sex).

That includes when running/jumping/sneezing/puking/shouting/orgasming/week before your period/pissed and dancing like a loon/trampolining/bungee jumping.

That's pretty much the test, it's more a functional measurement than being able to generate x amount of power.

Add to that, do you pee less than x8 day or x1 night? More than that's abnormal

Can you wait between 2-4 hours between feeling the urge to pee and actually being bursting? (yep, it's a long time. That's the norm)

Do you avoid caffeine or alcohol because you know it'll make you leak? Or, do you limit how much liquid you drink for fear of leaking?

And, are you aware of a dragging sensation down below?

If you don't get any of those, you're ok.

HOWEVAH...

you STILL need to do the exercises once a day, every day. Because, as you age, the muscles sag...and, it'll get you in the end.

About half the women over 50 wet themselves. Whether they've had kids or not. Menopause is a bugger.

Go on, #doyerblardyexercises.

gussiegrips Mon 20-Jan-14 12:02:37

doctrine - another "it depends".

They are ok to do if you have good core strength and no prolapse.

But, they do cause a spike in your intra-ab pressure if your technique is poor.

So, fix your feet, tuck your chin in, just lift shoulders up, breath out as you go up and in as you lie back down.

All that touching your elbows to your knees looks impressive but doesn't work your abs, it's your hip flexors that work once you're past lifting your shoulders up.

TBH, all the pilates core stability stuff is better for tummy flattening. Way better.

MillyRules Mon 20-Jan-14 12:58:28

Gussie mine is two but didn't happen until menopausal symptoms started at 51. It happened because of an episode of twenty four hour vomiting and a big sneezeshock . Two vaginal deliveries with one cord round neck which wasn't spotted for a couple if hours so much pushing and getting no where. Was fortunate that pf was fine until menopause. No leaking issues either luckily.

learnasyougo Mon 20-Jan-14 13:01:18

I definitely get that dragging, aching feeling after sex. it makes me want to avoid it. For around 24 hours after sex I always feel like I've got a lead weight in there, and it, with my insides, is going to fall out.

it's not even as if we're going at it hammer and tongs. even very gentle moves gives me the ache. it has nothing to do with orgasm (I haven't had one of those through sex since October 2012sad I think my bits are very, very broken. I can't even get off the starting blocks anymore. I only do it for DH, but then I've got aches all day, especially if standing or walking for more than ten minutes.
Is that pelvic floor or prolapse related? Will pfe fix that our is it surgery? it doesn't make for an amicable sex life. He wants and I dread. he knows it makes me ache so he rarely asks and feels bad that I get so little from it.

MillyRules Mon 20-Jan-14 13:03:06

O Learn that's sad. sad Do you do pf ....a lot?

learnasyougo Mon 20-Jan-14 13:06:10

I guess that's why three thongs can become a mental health issue.
the checklist I completed at the gynae asked: do you leak urine when you orgasm. I left it blank and squirmed when he asked me 'well, yes or no?' (that was his tone. he was an arsea nd I haven't been back).

TheDoctrineOf2014 Mon 20-Jan-14 13:06:59

Learn, please go to your gp and if you already have, please go back and see someone else!

TheDoctrineOf2014 Mon 20-Jan-14 13:08:14

Cross post.

Please try again, maybe you can ask to see a woman as a way to avoid the same gynae?

gussiegrips Mon 20-Jan-14 13:26:17

ohmaigawsh, my anaesthetist-comedy-chum has just sent me this...

Suman Biswas does a Jagger Bladder song

love it.

KatnipEvergreen Mon 20-Jan-14 13:34:34

I can say "yes" to some of those pelvic floor problems, but only the same amount before and after children. A few months after children there were more issues, especially after DD2, but I have always done pf exercises and core stability exercise which engages the pelvic floor, right from my teens and straight after birth. Still had a bit of incontinence with coughing/sneezing up to a year after DD1 and DD2 though, and certainly after/during any high-impact exercise- skipping in circuit training used to set me off, OMG. I've always gone to the loo a lot, but drink a lot of water, and can hold it if I need to.

I always (even before children) needed to go to the loo a lot before running, especially with races, but I put that down to nervous tension. Occasionally now I wee a bit near the end of a run, or after running uphill or some other strenuous effort but only a tiny bit and I've usually needed the loo most of the way round as I've had too much water before setting off. Basically now I drink less water before the run and sip more during and most of the time it's fine. Getting water intake right for running is a bit of a art though.

I had a lot of pain and soreness during and after sex the first time and for several occasions after that, not enough to stop me...a lot of people said it only hurt the first time and I found that was er, not the case. After that I have only occasionally had soreness after sex, but only if we'd be doing it, er, a lot.

What I'm saying though is none of this I find a particular problem. I think, yes everyone should do the exercises, and with caution as an overly tense pf can be a huge problem as well. But we are all made differently, and there isn't such a thing as normal/abnormal female genitalia or pelvic platform. If you have got a problem then see your GP and shout and stamp until it gets resolved if need be. But also it can be just another thing you have to have - beautiful husband, children, home, body, beautifully toned pelvic floor - Sigh.

KatnipEvergreen Mon 20-Jan-14 13:37:50

TBH, all the pilates core stability stuff is better for tummy flattening. Way better.

Core stability is very important but it won't flatten anything without combining it with strenuous cardio exercise, such as running, dancing etc.

MillyRules Mon 20-Jan-14 14:04:06

and strenuous cardio like running etc is bad for a women's pelvic floor.

gussiegrips Mon 20-Jan-14 14:09:13

Milly - post menopause is really common. The hormonal changes mean your connective tissue loses a lot of it's elasticity (wrinkles and sorry-for-themselves-bosoms) and that means your pf drops down a bit so becomes mechanically insufficient.

Bloody gravity.

MillyRules Mon 20-Jan-14 14:11:52

We're not talking about toned pelvic floors here for vanities sake Katie were talking prolapses and how to prevent them and deal with them and strengthening the pf muscles.

MillyRules Mon 20-Jan-14 14:14:17

Gussie I don't feel old enough to be menopausal. So weird . I'm 52 so of course I am but just didn't feel ready if you know what I mean.

gussiegrips Mon 20-Jan-14 14:17:41

Learn - I'm sorry you've had to put up with painful bits, it's one of the most wearing and exasperating things to live with.

The dragging sensation, worse when you are standing/walking could be a prolapse. As can painful sex - you've got a bit in the way, and it can be very uncomfortable while it's there.

But, from the way you describe your symptoms, it might be a pelvic floor dysfunction (or, both!).

PFD is too tight a pelvic floor. Think of it like a muscle spasm in your neck after a whiplash. Exquisitely tender, sore if the muscle works or is stretched and can ache for hours. PFs are muscles like any other - and it's not unusual to get trigger points or muscle spasm, particularly if you had tears/episiotomies with birth. Or, if you've had non-childbirth injury, surgery or radiation therapy to your pelvis.

Let someone have a poke about in your bits. Spasm is really easy to diagnose, and responds beautifully to treatment.

And, it's worth mentioning, an orgasm is in part a flickering contraction of your pelvic floor. So, if your pf is strong, so are your orgasms. ANd, if it's tied up in knots it is really, really difficult to achieve orgasm. Sexual function is part of your pf's job, so, it wouldn't be surprising that your sexual response is disrupted at the moment.

Go and see your GP and get a referral. And, DON'T do the exercises - if you do have spasm that'll only make it worse.

learnasyougo Mon 20-Jan-14 14:18:35

it depends on why your tummy isn't flat. in my case (a pearshape) a poochy tummy IS easily fixed by stronger abdominals because I'm naturally lean around my waist anyway (I carry my fat on my thighs and bottom - much less easy to hide). but yes, if you have fat around the middle, then stronger abdominal muscles will always be hidden behind some fat, though it will still be improved. you don't want fat AND slack abdominals making a pooch.

my running days, though, are over. Cycling and swimming for me.

gussiegrips Mon 20-Jan-14 14:19:09

Learn - that's really disappointing.

He's asking because sometimes that's the only symptom women experience, and, it's also not one they offer up without prompting.

I'd also have shut up. And, I agree, he sounds like an arse.

MillyRules Mon 20-Jan-14 14:22:06

Gussie hope yoy don't mind my asking but how are your pelvic floors? What exercises do you do? blush

KatnipEvergreen Mon 20-Jan-14 14:23:00

and strenuous cardio like running etc is bad for a women's pelvic floor

Rubbish.

Try:

Reduced risk of heart disease
Improved blood cholesterol levels
Improved heart function
Reduced risk of osteoporosis
Improved muscle mass
Improved brain function
Improved mental health

Don't run too fast girls, it make your bits fall out. angry

gussiegrips Mon 20-Jan-14 14:25:59

Katnip - nope, sorry, I don't agree with your last statement.

No one needs to put up with it.

No one.

Not people with two kids and an active lifestyle. Not people who are obese, depressed, elderly, disabled, unwell or who have had 15 kids.

80% of ALL incontinence issues can be improved with good management - that includes folk who have conditions like MS, stroke, fibroids. Only confusion really challenges continence teams.

Any leaking, of poo or pee, at all, at any time is abnormal.

I'm glad it's not interfering with anything for you, but, I'd push for you to add the caveat of "yet".

Keep doing your exercises, and, consider getting an assessment - you might find you've got an element of dysfunction or prolapse that can be treated.

But, the one thing I want people to know is that you don't need to put up with it.

<footstamp>

MillyRules Mon 20-Jan-14 14:27:45

Have you read all of this thread Katie...? Your pf seems compromised already so maybe you could take on board some of our experiences. A lot of us used to run so we do know what we are discussing here.

MillyRules Mon 20-Jan-14 14:28:58

Ooo Katnip ....sorry have put my glasses on now. lol

gussiegrips Mon 20-Jan-14 14:29:46

re abdominals and sit ups - tricky thing is rectus abdominus split. Loads of women land up with a finger or more's gap between their recti post-pregnancy. Doing sit-ups "bows" the muscles, which, look awesome as a six pack, but, aren't very powerful as they are long, thin muscles.

The strength comes from the deeper muscles, which look exactly like a corset, and do exactly what a corset does.

And, remember, fat isn't just stored on the outside, but, round organs too.

I stand by it - with good technique and a desire to show off at the gym, sit ups are fine. But, with any prolapse of pf insufficiency, you're going to either fart, piss yourself or your fanny will eventually fall out.

MillyRules Mon 20-Jan-14 14:32:14

What about yogic tummy exercises Gussie where you are just pulling in the tummy muscles themselves whilst in standing position?

learnasyougo Mon 20-Jan-14 14:32:40

how confusing. the gynae I saw (the not very nice one) asked me to bear down. I warned him I'd wee (my referral form said to turn up with a full bladder) he said do it anyway. I weed of course and he said, oh, go use the loo. (so I felt like I'd done something wrong, but I did warn him). I came back from the loo and he asked me to squeeze my of. I did. he then told me to get dressed and he'd see me next door. in his office he leaned back in his chair and said (with a dismissive gesture) it's your pelvic floor! do your exercises and come back in 3 months.

I asked him whether I did have a prolapse or not. 'yes, yes. come back in three months. give this to the receptionist'.
I'm now pregnant again, so I haven't been back. could the pf be in spasm since then? I was about 8months post partum at the time of this visit. I'm 30w pg now.

MillyRules Mon 20-Jan-14 14:35:14

bloody hell learn who do these doctors think they are ? Some of them are so up there own arses.smile

gussiegrips Mon 20-Jan-14 14:36:23

Katnip - of course cardio does all those things. Of course it's good for you. But, some people should avoid running because they've got a dodgy knee, some people because they've got repeated Achilles tears and some people because they have pelvic floor issues.

Runners wanna run. And, in my experience, nothing else will do for them. But, it doesn't mean it's always a good idea - and, yep, it can make some women's bits drop out. And, if it's a runner's bits flapping about her ankles it IS a challenge for her to continue doing marathons.

Here's the sciencey bit:

Kari Bo's paper

Nygaard's

There's a study to be done at the Commonwealth GAmes following on from work started at the Olympics. Guess what they found? Female athletes, at the peak of physical fitness, incontinent. 540 women, only 4 had sought help. Particularly prevalent amongst long distance runners, gymnasts and weight lifters.

KatnipEvergreen Mon 20-Jan-14 14:41:58

Gussie - You are just making me feel pressurised/paranoid over nothing over something that is to do with how I am, how I've always been and doesn't cause me any issues, not to do with losing function after pregnancy or vaginal birth. If I do get problems that are debilitating then I would go and see someone and not put up with it. At the moment I have nothing to "put up with".

Like the fact I'm slightly knock-kneed on my right knee and flat-footed when I run, I have orthotics in my running shoes, it doesn't mean I should stop running or immediately have major knee/foot surgery. If it causes me problems in the future then I might have to have surgery, but not until then.

I'm not about to march into the GP and make myself an appointment because I weed a little bit when I had a bad cough, or drank too much fluid before running, when 99.9% of the time I am entirely continent! If I had problems like Learn, however, I would certainly go to the doctors.

I agree with the general message that women should not put up with problems and generally be more body aware. But please don't see problems where there isn't one.

gussiegrips Mon 20-Jan-14 14:42:32

Milly - delighted to say my pf's awesome.

It WAS reduced to rubble. Three giant headed babies and I was reliant on pads. Properly pissy. I had urgency, frequency and did heehaw about it for several years. Made me sad, affected my relationship - and I KNEW what to do, just couldn't quite remember to do it. Mind you, I was so tired I couldn't remember the names of my children...

It wasn't until I wet myself at zumba and on my doorstep in front of my neighbour that I set 3 months of my life aside to "give it a bash".

No one was more surprised than me that it worked. Which is daft, seeing as how I knew the science!

But, it did. I have a G2 prolapse which is managed conservatively, and, with any luck, won't get worse.

I can run (though, I prefer not to), star jump, zumba and (gasp) trampoline. I no longer smell vaguely of pee.

That's why I landed up in women's health. I "get it". I've lived it, and I know how regaining your continence brings with it your dignity, your sense of humour and, erm, your sexual pleasure.

Fecking awesome set of exercises.

I do a 10, 10, 3 a LOT. More than x3 day. But, then, I'm in a habit now.

I didn't use aquaflex or any other gadgets, but, they have their place. Mostly, I just wanted to not be a smelly old lady.

KatnipEvergreen Mon 20-Jan-14 14:45:20

Being an elite athlete can give you all sorts of physical problems. Being fit and healthy though gives you a lot fewer health problems generally, though I agree, not everyone should or can run. Everyone should exercise and get out of breath though, which is what I meant by cardio exercise.

MillyRules Mon 20-Jan-14 14:45:22

Gussie is a physio who specialises in this sort of thing Katnip.

gussiegrips Mon 20-Jan-14 14:45:29

Katnip, I apologise, I don't mean to make you feel pressured.

You are right, some women leak from early adulthood - about 25% of 15-35 year olds. THat's one of the factors that leads many women to stop participating in sport.

But, truly, leaking is not normal. However, I take your point, if it's not a problem for you then it is not a problem.

I am sorry, I didn't mean to make you feel uncomfortable.

gussiegrips Mon 20-Jan-14 14:46:38

Milly - yoga done well is great. Like pilates. ANd, the "3" is a yogic doodah - mula bhanda I think.

KatnipEvergreen Mon 20-Jan-14 14:47:10

Thanks Gussie. It means a lot.

MillyRules Mon 20-Jan-14 14:47:57

That's how I felt too Gussie . I read everything I could on the subject and went for the exercises like a demented woman smile .

gussiegrips Mon 20-Jan-14 14:52:08

Learn - part of the issue is that pf problems are not-very-interesting bread and butter to consultants.

To be fair to them, most women will say "oh, I did the exercises, doctor, it made no difference"

No one checks whether she's doing them correctly or often enough. The NICE guidelines say you need to have an internal to establish strength, spasm, detachment of muscle, neurological or co-ordination problems.
Without doing one there's no way of telling whether you've got spasm, and, if you're 30w pregnant then your pf's working overtime as it is and it's not the time to sort it out!

Might be worth having a chat with your MW, they are great at the pregnant pf. And, then, get a referral from a physio. Who'll be nice to you or I'll shout at her

gussiegrips Mon 20-Jan-14 14:54:51

Delighted to hear it.

I'm totally getting an Olympic squad together...who wants to be in it?

The supermarket checkout queue
The between-service-stations-motorway-drive
The lugging a buggy with toddler and shopping up steps
The bus sprint
The birthday party bouncy castle

Be great telly sport!

MillyRules Mon 20-Jan-14 14:58:45

Katnip you were rather dismissive in your earlier post regarding how some of us have given up running because of our pf issues. You said that it was rubbish. So you are equally guilty here of making others feel bad.

MillyRules Mon 20-Jan-14 15:00:26

I'm in Gussie. Squeeze squeeze!!!!

KatnipEvergreen Mon 20-Jan-14 15:03:49

I apologise if I made anyone feel bad. I'm just improving my running again and training for a race so I guess it hit a raw nerve. I was really referring to people who said in the past that physical exercise damages women - in a sexist way, to keep women down, so that's what I was thinking of. Of course you shouldn't run if it causes you physical problems- my dad can't run because of his hips these days, but he loved running. He does walk a lot though and is still fit.

TheseAreTheJokesFolks Mon 20-Jan-14 15:07:21

thanks gussie for your posts.

MillyRules Mon 20-Jan-14 15:09:22

Yes * Gussie* thanks. So helpful and encouraging.grin

MillyRules Mon 20-Jan-14 15:10:03

Good for you Katnip hope you do really well smile

PenguinsDontEatKale Mon 20-Jan-14 15:15:47

Right, this is a bit of a hijack but I'm hoping Gussie might see it...

I have had mild pelvic floor issues since DD1 was born 5 years ago. In between pregnancies, I've used Aquaflex as well as pelvic floor exercises, but never got it totally fixed. It seems to be the 'speed' response rather than overall strength that causes me problems as I could do loads of weights with the Aquaflex, even on the smaller whatsit.

I am now 6 months with DC3 and trying to get through to my local physics but having a few issues. In the meantime, are there any particular exercises I should focus on?

KatnipEvergreen Mon 20-Jan-14 16:15:46

I do wonder why we all, or a lot of us seem naturally constructed so that our pf muscles are naturally a bit crap though, unless we do some recently invented exercises several times a day.

Obviously having poor muscle tone in general can cause health problems, but this seems to also happen to people who are otherwise fit and healthy.

What is it about modern lifestyles, aside from say, eating too much or not moving about enough, that causes pf problems? I've heard someone say it's due to modern toilets, and that we sit on them rather than squatting over a hole in the ground, but other than that, why should pf go wrong of its own accord? It is just the toilets?

learnasyougo Mon 20-Jan-14 17:12:45

who is to say women in the past had great pelvic floors? Evolutionary pressures have no mechanism to select for strong or better designed pelvic floors, as long as a weak one is neither life threatening nor likely to lead to poorer outcomes in child bearing or child rearing.

I wonder whether the gentlemanly habit of allowing ladies to sit, and the unseemliness of women participating in sports is as a consequence of these problems being common (and back then, not very fixable).

I'm sure this problem is as common in cultures that do squat to wee (though pooing is better done in a squat).

learnasyougo Mon 20-Jan-14 17:15:35

rather, I suspect our upright stance is the problem. As mammals, the basic design is to be on all fours and our pelvises, spines (and pelvic floors) are a compromise.

MillyONaire Mon 20-Jan-14 17:16:43

don't know if this has been said but mine improved drastically with increased fitness/running

MillyRules Mon 20-Jan-14 17:49:25

Are you saying that your prolapse improved with increased fitness and running Milly?

TracyK Mon 20-Jan-14 18:11:05

I can highly recommend katy says or alignedandwell.com
Basically, go barefoot as much as poss, very flat shoes, walk, walk, walk everywhere, sit as little as poss and do various exercises (not just pf ones)

KatnipEvergreen Mon 20-Jan-14 18:14:07

who is to say women in the past had great pelvic floors?

I'm not saying they did. It was an open question, wondering whether this is a modern or ancient problem.

MillyRules Mon 20-Jan-14 18:24:36

Apparently it does have a lot to do with our posture and the way we as women are told to stand. Pulling your tummy in and pulling your bottom in places the pelvic girdle in the wrong position. Apparently we should relax our body into a more natural position which is allowing the bottom to curve outward so that are spine naturally curves. This puts the pelvic girdle into a more natural position.

Finabhear Mon 20-Jan-14 18:40:43

I have recently, quite by coincidence, been doing a bit of googleing on this subject and found this article in the Huffington post about dancing and the pelvic floor and this my privates have a personal trainer

The second link is a great read grin

gussiegrips Mon 20-Jan-14 21:24:19

Blooming heck - this thread's brilliant for making me think! It's hard to remember what's not immediately obvious if you're not knee deep in fanjoes all day, so, thanks.

Penguin - well spotted, there are two main types of muscle contraction from your pf. Some muscles have lots of slow twitch fibres (marathon runners) which are the ones that let you "hold on", whereas some of them are full of fast twitch muscle fibres (sprinters) which are the ones which kick in when you do something that causes a sudden spike in your intra-abd pressure - coughing, sneezing, laughing, puking, shouting, jumping.

That's why the first exercise is a long hold, and the second one is fast twitches.

If you don't leak, apart from when sneezing etc, then, you probably need to concentrate on the 10 quick twitches.

Try to really clench, and then really relax, about one second apart, ten in a row. And, when you get the hang of it, you can clench along to music on the radio. Passes long car journeys rather nicely.

Aquaflex is good, but, tends to work the slow twitch fibres as you hold the cones in place.

Katnip - yep, toilet posture is an issue, but, I don't think I've seen anything saying it's a cause. I'll have a look through the papers I've got. Squatting helps straighten out the "kink" in your rectum, so poo comes out straight down. Sitting means the "kink" stays in place, so you have to work against gravity - which can be a problem if you are constipated or have a rectocele (prolapse at the back of the vagina) when part of the rectum can sag forwards into the vagina. That just wreaks havoc with your pooing. There's stuff you can do to help - but, the easiest thing is to adapt posture into a squat, either a couple of yellow pages under your feet, or a squatty potty yep, that's a thing if you're feeling flush baboom tssssh

Good luck in your race!

But, yep, the anatomy's flawed. It's the evolutionary price we pay for bipedal gait and big brains inside our not-very-developed babies' heads.

At least in the West there is help available. Watch any footage of women in developing countries and you'll see someone sitting with the heel of her foot wedged into her crotch. That's how women support their prolapse in places where there's no one to hoick it back to where it belongs. In some cultures these women are shunned. Really sad.

And, don't get me started on fistulae www.fistulafoundation.org/

That's partly why I witter on about this so much. If women's health had a higher profile in the West then these charities who do so much abroad would find it easier to fundraise. Well, I assume they would.

Milly O' - yep, some people DO find it improves. That's partly because of increased general muscle tone and weight loss, and also because when you run your core muscles are working hard (assuming you have good posture). In general though, most women find the opposite. Am pleased for you - but, still, #doyerblardyexercises!

TracyK - the work that these folk are doing is great. It's old news from a medical perspective, but, presented in a really engaging and accessible way with quite a lot of appealing products you can buy to support you. It's perfectly valid, but, I'm wary of anything that says "do this, it's good for everyone".

You could argue that runners would benefit from really working on their warm up/stretch/train/cool down/stretch/stretch/stretch - that would sort out a whole lot of gait issues. Without having to resort to fugly shoes. Honestly, I just can't take people seriously with their weird big rubber feet shoe things on. I get the theory, and I understand it works for loads of folk. Looks daft.

Fin - these are great links. Huff post are really good at promoting Cinderella issues. Why look, here's a blog from last August's Fringe....(listed in reverse order) (says pretty much everything I've said here, only, in the Huff Post, which makes me awfully chuffed with myself) www.huffingtonpost.co.uk/elaine-miller/

gussiegrips Mon 20-Jan-14 21:27:53

Good graphic on good toileting:

Florida Hospital link

PenguinsDontEatKale Mon 20-Jan-14 21:39:19

Thank you Gussie. That's really useful. Yes, generally it is sneezing, when I had a vomiting bug, sudden sprinting, jumping. Weirdly laughing has never been a problem. Nor is it an issue other than if I'm standing up (except the few times I've vomited).

I am still trying to get through the physiotherapists (not physics, blooming autocorrect) but it is brilliant to have some advice whilst I try. Really appreciate it.

TheDoctrineOf2014 Mon 20-Jan-14 23:16:48

Ah, I think I am like penguins. I can be bursting for the loo but forget about it and remember two hours later, no problems - but I truly hate vomiting bugs now sad.

Which fibres does the lift exercise work, Gussie?

gussiegrips Tue 21-Jan-14 07:41:09

The lift's a yoga move, Doctrine (I think that's the Mula Bhanda, but, I'd better check for fear of disinformation!)

It's not for specific fibres, but rather to engage all the muscles.

Usually folk find they can clench round their bumhole, but, the front's a bit dull. All the lift is an increasingly strong clench, which encourages you to use all the muscles. The visualisation of a lift helps you contract.

Front muscles are longer and thinner, more gristly and not used as often (we hold in more farts than pees) so can be harder to identify.

The other way of engaging the front muscles, if you're not sure, is to do a clench in standing and then lift up onto your tiptoes (still clenching). You should feel something in the front.

Also, a handy trick for when you're bursting in a queue, stand on your tippy toes.

OohAahBird Tue 21-Jan-14 08:08:03

I had a prolapse, after 2 years of doing lots of pf work and lots of core strength work with Pilates. At my recent internal it was considered to be so minor it was no longer an issue.

I was very pleasantly surprised, however I know that it isn't cured it is just being managed so I need to keep up the work. Which sucks in that I will have to do this level of work for the rest of my life, but far better than feeling like my bits are trying to fall out on a regular basis!

Mine was always really noticeable when I had my period, especially when I went to the loo.

But you can help yourself feel better through the right exercise, I hope this helps

MillyRules Tue 21-Jan-14 09:07:39

Ooahh really inspiring post. smile

Finabhear Tue 21-Jan-14 09:38:22

Try this to help engage the pelvic floor a bit more.

Stand with your feet hip width apart, now reorganise your weight distribution so that you have 50% on the balls of your feet and 50% on your heals (most people stand on their heals) and plant your big toes as if you are trying to push something away from you with your toes. Next you can either visualise or actually place an empty bottle of water between your heals and hold it there so that it doesn't drop.

This exercise engages your deep hip external rotators (Gemellu's and obturator internus), it is not a buttock clenching exercise as that just activates your glutes, you should just feel the deep muscles at the base of your bottom activate. Now try the PF exercises smile

The great thing about your deep hip external rotators is that they are also anti saggy bottom muscles that will help to give you an nice, round, pert bum when they are toned (which takes a while as I think they are mainly slow twitch muscle fibres).

KatnipEvergreen Tue 21-Jan-14 09:44:06

I get constipated two days a month on my period, but I never sit there and strain. Rest of the time, really soft healthy poo (sorry if TMI). I am ready for it now with diet and taking senna for two nights helps a lot.

I can do all the pf exercises but what I always find more difficult is isolating areas to do one bit at a time. It's like learning to waggle your ears a bit though smile

This DVD was good when I was pregnant and immediately afterwards, but she got you to isolate 3 areas. I could only ever manage two!

http://www.amazon.co.uk/The-Pregnancy-And-Postnatal-Workout/dp/B0002FR01U/ref=sr_1_20?ie=UTF8&qid=1390297073&sr=8-20&keywords=antenatal+dvd

MillyRules Tue 21-Jan-14 12:10:36

Thinking about it we don't give birth in a pf friendly manner ....do we....squatting or on all fours would put less strain on our pelvis as the baby would be in a more natural exit position

runningLou Tue 21-Jan-14 14:44:07

Anyone know whether Tai Chi can help with pf strength?? Am thinking of taking a class at the gym - my pf has got so much worse recently and I can't work out why sad

MillyRules Tue 21-Jan-14 14:49:01

How old are you running?

Finabhear Tue 21-Jan-14 15:15:56

Milly you have a point about birthing positions, you can give birth in Amy position you choirboy it's not always encouraged. My midwife was horrified when I wanted to squat to deliver ds2grin

learnasyougo Tue 21-Jan-14 16:15:05

I'm not surprised! I'd be as shocked as she was if you'd wanted to squat on a choirboy while giving birth. shock

MillyRules Tue 21-Jan-14 16:22:26

ha ha ha ha ha omg ha ha!!!! That was funny Finabhear....have you read what you said about choirboys and poor Amy....lol

Finabhear Tue 21-Jan-14 17:00:18

Bloody phone!! [Blush]

Finabhear Tue 21-Jan-14 17:01:06

blush
I'll never use the app again blush

MillyRules Tue 21-Jan-14 18:03:47

ha ha.

runningLou Tue 21-Jan-14 21:33:34

Just turned 34 Milly.

gussiegrips Wed 22-Jan-14 07:03:58

Running - I don't know of any specific studies on tai chi - but, it makes sense. It's all about control, balance, breathing and is low impact. Certainly wouldn't do any harm.

Nor am I aware of any research looking at the benefits or otherwise of choirboys...

learnasyougo Wed 22-Jan-14 12:26:41

having been very diligent at 60-100 per day of pfe, I have had an entire week of no leaks.

I don't think I could run or jump yet, and I've only sneezed a couple of times, clenching my pf when I do, but no more just dribbling when I'm standing up and no leaks when I lift my toddler.

Marvellous improvement in the last month or so.

TheDoctrineOfSnatch Fri 24-Jan-14 10:25:38

Cycling at the gym today. So glad I know the best exercises now.

gussiegrips Mon 27-Jan-14 12:32:17

Learn, that's absolutely brilliant! This sort of news makes me very happy!

Leaking less than your toddler is a real mental lift, I remember it well!

Keep going!

gussiegrips Mon 27-Jan-14 12:32:46

Doctrine, how did you get on with the cycling?

gussiegrips Mon 27-Jan-14 12:34:14

I've got some film footage of me at a comedy club doing the pelvic floor stand up. I'm attempting to put it up on youtube, after some bullying encouragement from physios.

I'll put the link on here once it's up.

Ignore my bad hair day, please.

TheDoctrineOfSnatch Mon 27-Jan-14 13:55:00

Good thanks!

KatnipEvergreen Mon 27-Jan-14 17:47:49

After posting on this thread last week I got cystitis, which I've never had before, and actually needed proper incontinence pads!

The thread did make me more focussed on doing pf exercises, so I was doing them as recommended. I do wonder if I overdid it and that's what made some urine get trapped in my bladder and caused the infection?

So bloody annoying, I'd just got over my cold and was running really well sad

GinghamChic Mon 27-Jan-14 22:06:39

tvt all the way!
you will be so annoyed you didnt get it sooner

runningLou Wed 29-Jan-14 06:21:06

Is that the taping surgery? I've spoken to a consultant about this and she said she wouldn't do it due to my age (34) as it needs periodically renewing every 10 years or so and that would add up to a lot of renewals over a lifetime and also each time it was slightly less effective.
What did your consultant say? What age did you get it done?

gussiegrips Wed 29-Jan-14 18:13:17

Been away for a few days, middleykid's wheeze drama again. Back home, all good. Hurrah for the NHS.

Katnip, I'm not aware of a link with doing the exercises causing cystitis. There IS a link between holding your pee midstream (that used to be an exercise) and what you describe, a backflow of urine, and UTIs. Which is why that's now recommended to be done as a "check" not more than once a week.

Hope you're feeling better.

Gingham - Glad the TVT has worked for you. It is great surgery, it's been well used for 15 years and has worked well for millions of women.

Running, yep, it's a tape that slings behind the urethra, hoicking it all up a bit. Certainly, they need replacing (10-15 years) and, yep, I'd agree with the surgeon that the longer you can stall it for, the better.

That's not to say that I in any way disapprove! It's a big operation, a good 6 weeks recuperation time, and, guess what, after you've had one, you've STILL got to #doyerblardyexercises!

I do know women in their late 30s who've had the procedure with great success. Suppose much of it depends on the particular surgeon?

Fishandjam Wed 29-Jan-14 20:11:21

I have been doing my blardy exercises most punctiliously. Went for a parkrun on Saturday and NO LEAKAGE WHATSOEVER! I usually get a dribble or two, so that's great. Thank you gussie for the Tweets!

The high knees run-on-spot at bootcamp still gets me, but I read a solution for it on a ladies' running club website - a super super plus Tampax. Tried it and it works a treat (at least while I'm still toning up the PF. Am hoping to be able to crack walnuts with it by next Xmas).

learnasyougo Thu 30-Jan-14 13:37:39

cough cough, sneeze. I have a cold sad boo.

but DRY PANTS grin yay. I've been removing dry tena ladies for a week and a half now. I've not run anywhere (please, I'm 7 months pregnant) but considering I couldn't even walk downstairs without leaking a bit If my bladder was full, I'm amazed. I think before, I was overdoing the long hold ones (hundred a day) and not enough of the quick flicks. I now do a mix and seen better results.

OhBabyLilyMunster Thu 30-Jan-14 14:36:30

My best thread. Thats all smile

coolkat Thu 30-Jan-14 18:27:09

Great thread. Off for a run with my pad! Doing exercises much more and hoping not to need them very soon smile

googlenut Fri 31-Jan-14 16:54:30

I haven't read all the posts here but we really can't use evidence from papers on elite athletes (who are probably running 100 miles + per week) to say that running is bad for women.
Running is an amazing activity for women - most even training to half marathon level will be doing less than 20 miles per week.
You will have to come up with much better evidence than these papers to say amateur women runners shouldn't be doing it and I hope no one reading this thinks they shouldn't be.

gussiegrips Sun 02-Feb-14 09:34:30

So pleased to hear that some of you are noticing a difference - I remember the wonder of being able to run for a bus without leaking well! It's magic!

Google - you are right to be sceptical. But, let me clarify, I'm not saying that running is bad for all women. The evidence is that if you have pelvic floor weakness, pelvic floor dysfunction, are less than six months post-partum, menopausal, or have any grade of prolapse then running will increase your risk of incontinence because every running step you take means there is x3 your body weight in impact going through your pelvic floor and the muscles are not mechanically able to manage that.

This is a really good website with loads of advice about pf and exercise Australian site pelvic floor first

It's based on evidence. Sciencey bits are all on pubmed - loads of em.

So, if you love running, and you want to run, and nothing else will do - well, you're not going to stop it even if you are wetting yourself. So then you should try to minimise your risk - shorter distances, use internal support, good footwear, avoid tarmac, do your pelvic floor exercises.

I'm off for a run now. stop laughing I seem to have accidentally entered a 10k in October which is quite a stretch seeing as how I can't quite manage to run the length of myself. I can swim or cycle forever, but, running and breathing at the same time? Too hard. I am following my own advice and am aiming to not knacker my PF. Who wants an update about whether or not the streets of Edinburgh are awash in the next hour?...

googlenut Sun 02-Feb-14 13:56:03

Well gussie I'm probably your worst nightmare - ran through three pregnancies, back running soon after birth (won't tell you how soon because even I think I was ridiculous!) and now menopausal and training for a half marathon.

CoteDAzur Sun 02-Feb-14 14:20:17

"running and breathing at the same time? Too hard."

No it's not. You pant. Two steps = breathe in, two more steps = breathe out.

Breathe as deeply as possible. Blow out your lungs.

As you start running faster and your lungs are on fire this doesn't suffice, try three steps = breathe in, 3 steps = breathe out.

gussiegrips Sun 02-Feb-14 16:19:00

Fair enough, google. I'm glad it works for you, I do understand that running gives folk a buzz that is very satisfying. And, the thing about stats and research is that there is always someone who's the exception to the rule. If you don't have many risk factors you're far less likely to leak, but, most of us do, and that's why the research is so clear.

Cote - I'll try it, thanks. Most of my body parts have different rhythms to each other. Co-ordination's not my strong point, but, I did the run and was smart enough to choose a route downwind. That helps no end. And, possibly wearing a voluminous cagoule that works like a sail - I fair whizzed along.

Should have done a bit more stretching though. Stiff!

googlenut Sun 02-Feb-14 16:31:33

So is their research showing that your average leisure runner has made their pelvic floor worse by running? I would like to read if so. Just not willing to extrapolate from papers about elite athletes. In one if the papers it said gymnasts had the worst pf damage. I would guess that a lot of elite gymnasts and runners are pushing their bodies to the max and also possibly have eating disorders as well or certainly restricted eating.

Meglet Sun 02-Feb-14 18:34:51

I can't remember when I started doing PV exercises, probably early / mid 20's, and well over 5+ years before I had dc's. I used to read lots of fitness magazines so maybe I heard about them from some articles.

Anyway (I'm thinking a think here.....), maybe sanitary protection manufacturers need to include information on pelvic floor exercises in the leaflets in tampon / towel boxes. I know I used to read those things when I first started my periods. It would get teens early and not leave it until they've had problems in later life.

NumptyNu Sun 02-Feb-14 21:37:26

I've been told by both a gynae and a pelvic floor physio to definitely give up running. Had 3 x vag deliveries and have very minor prolapse and am working with the physio on strengthening the pelvic floor in order to prevent need for surgery.

I was distraught, as I love running, but unless I wanted to make things worse or dramatically reduce chances of improving them, I'm told to stick to swimming or cycling.

ropealope Sun 02-Feb-14 21:45:27

Hi I know this post is from last year but thought I'd message as I'd like to recommend foofoofunclub (yes, that's right!)
I feel back to 'normal' 2 vaginal births (one forceps) later after completing 2 courses. Fun, informative and sorts you out!!!

Runlikeareindeer Sun 02-Feb-14 22:02:05

Oh my. For some reason this didn't show up in my threads I'm on, so I didn't realise all the replies

It is from this year though.

I will read through tomorrow.

IwishIwasmoreorganised Sun 02-Feb-14 22:08:27

I've been very food at doingmyblardyexercises, but very poor at going out running recently!

I am hopeful that I might be able to report back favourably soon, and, who knows, maybe even be able to join the hoardes for a post parkrun coffee one day (so far have ahd to sit on a towel and a bin liner and rush home).

gussiegrips Sun 02-Feb-14 22:32:43

Google, no, I'm not aware of research looking at that - but, Id be very happy to see it done!

The research shows, categorically, that women with stress incontinence or pelvic organ prolapse will worsen their symptoms by engaging in activities which are high impact.

So, that's about 30% of the general population aged mid 30s to 50s.

Some of them run, some of them don't. All of them will reduce their risk by doing their bloody exercises.

I understand the draw of running, I do see that, if you are a runner, nothing else compares. But, I'd like to improve awareness, if you know the risks you can manage them - because, living with leaky nethers is both rubbish and (usually) fixable.

It causes misery. And, it shouldn't.

gussiegrips Sun 02-Feb-14 22:36:57

Meglet - yep, I'd love that. When I'm in charge of the world, I shall insist that companies that profit from incontinence print health promotion advice on their packaging. If you had to read a reminder about #doyerblardyexercises every time you used an incontinence pad, well, that'd help compliance.

gussiegrips Sun 02-Feb-14 22:40:20

rope - I've heard good things about foo foo funbox but, I haven't seen the pack myself.

Not yet, I'm hoping to go down to Jenny's Women's Health Summitin London next month, she's got some excellent speakers on at it.

gussiegrips Mon 03-Feb-14 22:06:58

Rope, I'm giving mis-information. Jenny Burrell's no longer selling a do-it-yourself box, it's all now round classes. Doh. Things change so fast!

gussiegrips Mon 03-Feb-14 22:07:54

Here's MuTu's excellent article on "when can I get back running/planking/what I used to do after the baby"

mutu system. Also has a great reputation

runningLou Tue 04-Feb-14 06:57:07

Gussie, DC are 6 and 2.5 yrs, after each of them had major inco issues but gradually improved slightly though always bad when exercising / lifting / when bladder full. Recently pf has got SO much worse and I don't know why sad Have to wear pads on a daily basis, changing up to 3 x sometimes, especially at work. Why would it suddenly go so bad?

impatienttobemummy Sun 09-Feb-14 17:29:28

Hi all I'm new to this thread been suggested by a kind mnetter I check it out!
I'm 8 weeks pp 2nd baby. Has CS first time, this time a large headed boy needing forceps episiotomy and 2nd degree tear sad had infection is wound so all stitches fell out and only healed 2 weeks ago.. Believe it or not I was quite pleased with the continence 'twas dry 2 weeks ago but obvs not tried Zumba yet wink
However got flu a week ago que coughing fits galore. Been told at drs this week I have a anterior vaginal wall prolapse looks like gussies picture. She said Do my exercises and except it will take a long time to stop being a wind tunnel. She cant tell yet maybe ill need an operation. I'm now damp all the time and wetting myself after I've been to the loo. feels sore and when i cough like its goung to all pop out. when i walk im very aware of the heavy feeling. so am early stages compared to you all Definately not thinking of running wink

Been feeling gutted. Angry etc. GP said no to PT just yet as I'm still healing and says I need to domyblardyexercises for longer yet. So I began Gussies regime last night!

Ill keep checking in for advice and support if that's okay as you all seem a knowledgeable bunch! I'm a nurse so maybe can contribute something useful myself grin maybe

gussiegrips Wed 12-Feb-14 09:53:58

Sorry to take so long to reply, was on a training course and then work went nuts.

A physio lecturer put a ten minute set of me on youtube(!) and it's been really well received by my professional peers. Which is a blessed relief. It's only about kegels, and it's only real purpose is to raise awareness, but, it's a start. If you're interested : pelvic guru link

gussiegrips Wed 12-Feb-14 10:01:17

Lou - is it worse all of a sudden, like in the last week or so? In which case, UTI or similar is usually the cause. Sometimes TOM makes symptoms worse as well, to do with everything becoming a bit more stretchy under the influence of hormones.

Also, as the kids get bigger, the loads you are dealing with increase - that can have a big effect, but, I don't suppose you are lifting the kids much at those ages? (assuming none of them have any SN or disabilities?)

And, I'm assuming you are remembering to #doyerblardyexercises daily?

So, if all those are irrelevant - the most common cause of a sudden and significant worsening of incontinence symptoms is prolapse. Don't panic.

Remember that the USA considers a Grade 2 prolapse (so, nothing hanging out your vag) in a woman who's had 2 vaginal deliveries medically normal. Doesn't mean that you need to put up with it, but, it does mean there's no need for panic. I've got a G2 prolapse and manage it conservatively and am symptom free (unless I've had too many cocktails and am demo-ing my best groovy moves)

Best thing to do is see your GP and let them have a keek up your jacksie.

In the meantime, have a look at the excellent resources on Sherie Palm's site APOPS questionnaire

I don't want to worry you! But, if it was me, and I had to change a pad x3/day, I'd be taking my fanny to a medic.

gussiegrips Wed 12-Feb-14 10:10:17

Impatient - congratulations and commiserations in equal measure.

Firstly - get a referral. There will be a waiting list, and if there's a prolapse that "might" warrant surgery there is NO BENEFIT to waiting any longer than you need to. The waiting list will probably be about 4 weeks anyway - so, you get going with the pf exs meanwhile. Many areas have self referral systems anyway - google your local phsyio department and ask them.

Secondly - flu's a bugger (and, with a NEWBORN? Holy crap. Stuff of nightmares). The coughcoughcough is really tough on the muscles, and, even the very besht pelvic floor is likely to give a bit after that sort of Tough Mudder challenge.

However, once the flu has gone, the strength can come back - #doyerblardyexercises and watch what you are lifting.

Babies and toddlers are heavy - and humphing a pram with shopping and baby whilst also managing a reluctant toddler, well, that's really difficult.

Also, maybe consider looking at an incostress or other internal support. Even try a tampon or mooncup first - sometimes just hoicking everything back up to where it needs to be can really help the muscles re-engage.

What kind of nursing do you do? And, I presume you're on mat leave just now? Jobs that require heavy lifting increase your risk factors for prolapse, (CS will reduce that risk, but, not eliminate it entirely)

So, are you clear on what exercises to do?

Phone your physio department, or, go back to the GP and say that I said I'd be delighted to see someone like you referred onto my list right now.

Finabhear Wed 12-Feb-14 10:16:18

Gussie your Edinburgh fringe YouTube clip came up on my fb news feed! Thoroughly enjoyed it grin

Fishandjam Wed 12-Feb-14 13:41:58

Well, I may not be peeing myself when I run any more, but will the PFEs stop me from peeing myself when I get a vomiting bug (like I did Monday night)? sad

meglet Wed 12-Feb-14 21:51:17

I've just watched your fringe clip gussie. Cmdr Hadfield grin.

impatienttobemummy Thu 13-Feb-14 08:56:27

Thanks Gussie I will phone them today thanks so much for all the advice. It's all a bit gaping down there wizards sleeve if you will so not sure anything would stay in at the moment!

My newborn weighs 13lbs already so I need to get my PF in shape sharpish as some lifting is unavoidable and only getting heavier!!

My job is a lot more clinic based my hoiking on the ward days are fortunately behind me but I also have back problems so lifting patients has been out for me for a while.

What bothers me is the GP saying 'slightly prolapsing' I need to know exactly what is going on in there what's the grade etc. also I had thrush when I went to see her which has been treated and since the leaking has stopped dont know if that couldve affected things?

I'm doing my blardy exercises but don't know if they are the right ones?!

I try and lift and hold for 10 can't but go as long as I can.
Then I lift and hold for 5 secs 10 times
Then I do the lift 1-3 levels up and down 10 times
Then I do 20 quick holds

Doing this routine 4 times a day more if I can is that okay??

impatienttobemummy Thu 13-Feb-14 13:53:52

At 9 weeks pp what exercise should I be doing? I'm thinking pilates abs swimming but would the cross trainer be to much at the moment?

learnasyougo Fri 14-Feb-14 13:57:17

Gussie, I know this is a little off-topic (well kinda) but I've never got a satisfactory answer on this and I think it's pelvic floor related, so if you could add some expert thoughts on this:

Whenever I've asked women where they felt pain during labour, it seems to be the lower back or around the belly. I did not. I experienced the most intense pain at my pelvic floor/undercarriage. And interestingly NOT when I was having a contraction. I was stuck in pre-labour for days and the most painful thing for me was peeing. During a wee was fine, it was just as I was finishing I'd get the most INTENSE wall of pain at the pf. I'd literally be writhing on the toilet, squeezing the boost button on the TENS machine. I always made sure not to lock or even close the bathroom door (even at the hospital) because I wasn't sure I'd not pass out.

After about 40 hours of pre-labour they broke my waters and left me to hopefully get into established labour. Three hours of consciousness-altering agony - again not contractions - these pains lasted 7 minutes or so and would then trigger a contraction. It was pain in the pelvic floor area, nowhere near the abdomen. This pain was like a super strong spasm/cramp. Searing pain of the pelvic floor and in those three hours of searing pain I dilated a total of 0cm.

I was then given gas and air which helped me to stay in the room (I lost my sense of space with the pain, especialy the 7+ minute ones). When they said 'syntocinon' I insisted I get an epidural first. I hear inductions hurt me and I couldn't imagine anything hurting more than what I'd been through earlier. The epidural numbed my bottom (and pelvic floor) so took away the searing pain but left me with some abdominal pain at regular intervals (turns out the needle hadn't been sited properly so it was missing where contractions were happening) which I assume was the normal contraction pain most women get (by now I was on gas and air despite having had an epidural). The abdominal pain was a walk in the park compared to the pain lower down of earlier. I was able to breathe through these and not lose my marbles.

After the birth (three hour 2nd stage, forceps and a baby the size of a six week old) I had total urinary incontinence - no sensation or control whatsoever - nerve shock maybe? for about 2 months.

I've done a lot of googling and thinking on this. Hardly anything out there on pelvic floor pain during labour, except a bit on the 'spinning babies' website about pelvic floor release - a mismatched or unevenly tense pelvic floor preventing baby descending (my labour was over 70 hours and would have been longer had they not put me on syntocinon drip and once that ran out during the second stage, my contractions stopped again.)

What struck me was I thought transition would be hardest part of labour. It was a piece of CAKE compared to the pelvic floor pain I had in pre-labour.

Do I have a mismatched/uneven pelvic floor? I'm due to have another baby next month. SHould I stop doing my blardy exercises in case I overstrengthen the pelvic floor and risk a reoccurence of this? I spent a lot of time cycling before having my first baby (and always stopping and starting my bike with the same leg) so I wonder whether that might have caused any unevenness (guessing and clutching at straws here). What do you think?

SkiSchoolRun Fri 14-Feb-14 14:42:23

Thanks for this thread. Marking to read later.

Am having physio as last ditch before tvt.

So many friends accept as normal. I feel quite empowered for having seen gp and got my referral. grin

impatienttobemummy Fri 14-Feb-14 18:13:34

Learn, a close friend of mine has been told she has a pelvic floor of steel and she is a keen cyclist and was told this is why!
Good luck at physio ski, report back x

gussiegrips Wed 19-Feb-14 13:32:03

Sorry to take so long to reply (again)

impatient - yep to swimming, and yep to being careful with the cross trainer. If you've got core weakness (so a separation of your abdominal muscles or a general knackeredness of the "corset" of your abdominals, then, yep, it might be a problem. Or, it might be ok if your core is strong.

Have you been checked for a diastasis? Here's a quick guide from Jenny Burrell www.burrelleducation.com/2013/why-diastasis-is-about-much-more-than-the-rectus-muscle/

gussiegrips Wed 19-Feb-14 13:42:58

learn - holy crap, that sounds horrific!

What you are describing doesn't sound like usual labour pain from contractions. It sounds much more neuro - and it's entirely possible that you've had some pudendal nerve entrapment because of positioning of the baby.

It's unusual, but, any nerve entrapment is excrutiating - am glad it settled once the baby was born!

Might be worth having a chat with your MW, and usual advice of trying to avoid the lithotomy position. If it was me, I'd be telling everyone involved with your care, so that you can get as much pain relief as possible - though, it's not necessarily definite that it'll come back with this baby. Here's hoping it was bad luck.

A pelvic floor dysfunction can cause problems with the labour, but, it's usually as a result of a previous significant birth injury, or previous pelvic injuries or conditions. And, the pain tends to be a chronic rather than temporary issue (though, 70 hours of labour, wow, that must have felt fairly permanent)

You didn't have an irritable uterus thing going on? Stop/start labour, very little progression just a whole lot of swearing, if I remember correctly....

Congratulations, too, of course!

gussiegrips Wed 19-Feb-14 13:53:03

ski <applauds>

Hope it went well, and you are quite right, no one needs to put up with this guff. There's ALWAYS something which will help.

gussiegrips Wed 19-Feb-14 13:54:12

impatient - that's interesting. We usuall recommend cycling as an alternative to running because it's low impact.

Might go and fix my puncture, actually...

learnasyougo Thu 20-Feb-14 18:47:18

I'll definitely bring up my labour experience with the MW at my 36 week appointment. No one seems to have had what I had, so it seems to be very much out of the norm (which gives me hope for this next one).

70 hours of labour was exhausting, and none of this getting an epidural and having a little nap business I keep hearing about. The epidural DID take away the pelvic floor pain but I still had contraction pain so I was sucking on gas and air AFTER I'd had the epidural needle put in and re-sited (twice) and a top up of fentanyl into my back - all to no avail. They did offer to completely redo the epi, but I said no thanks. I'd given up hitting the boost button when I realised it only made my feet, knees and half a buttock numb and at this point (about 60 hours into labour) I realised I was coping (so long as no one dared take the gas and air away from me!).

The only reason I even agreed to an epi was because of that searing pain of earlier that gave me no dilation whatsoever making me think "crap, if that wasn't even established labour no WAY can I take more pain that that", but as it turned out, established labour and transition was easy in comparison.

Maybe it was a nerve down there affected by the baby's head, but that doesn't explain why I got it when I went for a wee. It was always at the point just before completely empty that it would start. Does the pelvic floor relax during a wee and then re-engage afterwards?

I was also left with zero urinary continence for several weeks after the birth, which I assume was some kind of nerve shock. Maybe it WAS nerve pain. I had six catheters, which kept leaking and/or falling out, too - balloon still full and intact (but completely painless). The midwives were agog when I showed them, haha.

Hoping for a totally different experience this time - sad to think my pelvic floor exercise progress will be wiped out by the next birth, in all probability. I still do my blardy exercises (because they blardy work!) as I'm assuming you want to go into labour WITH a pelvic floor rather than without. Do these muscles perform a role during labour?

gussiegrips Thu 20-Feb-14 19:45:22

I'm right on the edge of my knowledge base when talking about labour - so, take all of this to your midwife and ask for a second opinion!

The pudendal nerve is an interesting one, in that it has a number of twists and turns as it runs it's course. So, yep, it can get pinched in labour, and, as it supplies your urinary sphincter, then, yep, in theory, you would get pain from a compressed nerve when you pee.

It also supplies some of the muscles of the pelvic floor (the others are supplied from nerves coming from a level up or down) - so, yep, if you had pudendal entrapment that lasted over several days then it wouldn't be unexpected that you had a loss of bladder control.

Oh, and yep, it does exactly what you said - relaxes as you poo or pee. Being able to relax your pf is also important, and a too tight pf can cause pain. It's treatable, of course, but pelvic pain's not pleasant (guess you know that, mind!)

Nerves do heal, but, very slowly. So, if they are injured they take many weeks to get better. Heal at a millimetre a day, and during that time you might experience odd sensations or numbness or pain.

If you've had good function since then we can assume that any theoretical nerve damage has gone. Huzzah.

Yep, a stronger pelvic floor is associated with a shorter pushing stage and improved recovery time with a vaginal delivery. So, yep, it's got a role in labour.

Would be interested in what your MW says, and, I'd be asking her to write it all over your notes and make sure that if you do get the same problem the length of time is noted and so the health of the nerve is monitored.

Fingers crossed you get a much easier time of it this time around.

afussyphase Thu 27-Feb-14 22:19:00

Millions to billions in costs, depending what you include -- and I CANNOT find a body of literature that explores whether moderate exercise - brisk walking/light running - strengthens or weakens the pf. There are very few studies, and those focus on elite athletes such as trampolists. But in terms of lifestyle recommendations, I am not considering whether to become an elite trampolinist, so this information is not particularly helpful.

There are lots of claims from various health services that we shouldn't run / do anything that makes leaks happen because these activities weaken the pf. But there is at least one study reporting that women who do these things have stronger pfs; they acknowledge that it's unclear whether that's mainly selection bias (duh - if it makes you leak you are less likely to do it!) or strengthening of the muscles due to the activity (also some evidence for this). I think it's really, really irresponsible for public health services to discourage women from convenient and otherwise great forms of exercise with no references to research, and minimal (apparently) research beyond a couple of studies in people with very unusual physiologies and activity profiles (elite trampolists! I mean, really - as a basis for general public health advice??).

Anyway - if millions to billions of $ or £ are riding on this, and we still don't know whether light running, brisk walking are bad or beneficial - why don't we know? I realise it's not cure-cancer type of highly-fundable cutting edge research, but why not collect 10,000 volunteers or whatever and do a prospective study? (I'm a researcher in a fairly medical/public health field and I have done a 2hr search of pubmed - not exhaustive, but if there were lots of evidence out there, rather than just completely unsubstantiated leaflet claims, I'd have found it!).
If anyone knows of any, can you link it?

gussiegrips Thu 27-Feb-14 23:17:03

You're right, fussy - there isn't research about moderate exercise.

There hasn't been any real research into what is going on with sub-clinical women. That's because the sub-clinical women are silent about their leaking, I don't think there has been ANY serious investigation into the incidence of incontinence, and, that's partly because women are either too embarrassed to admit to having a problem, or they don't recognise that they have a problem because they "only leak when they've had a glass of wine" and they think that doesn't count. Any leaking is abnormal, but many women think that it's a natural consequence of motherhood or menopause.

I stand by what I've said. There is loads of research saying that if you have a prolapse then impact activities will make it worse. That's categorical, but, the studies aren't saying "don't run, your cervix will fall out". They are saying "be aware of the effect of impact, and weigh that up against your individual risk". And, the evidence is clear, the best way to strengthen your pf is not to run/pilates/yoga, it's to do pelvic floor exercises x3 day for x3 months and then x1 day every day. Other exercise may help, or at least, not harm, but, for efficacy you've just got to do the bloody exercises.

You are right, there is much work to be done. And, the easiest, and best place to gather 10, 000 volunteers to answer a questionnaire about their leaking and their exercise levels is, I'd suggest, is mumsnet.

There's scope to do a really good, anonymous study using this site. And, it could be linked to the studies showing that internet based rehab works, that women are capable of self-diagnosis and that distant reminders to comply with the exercises are effective.

There's a page on Herman and Wallace's site with a comprehensive list of sound studies about anything/everything related to the pelvis. Nothing looking at moderate exercise though... hermanwallace.com/resources-for-pelvic-rehabilitation-practitioners

I do want to make clear, I am NOT saying "don't run". I AM saying, if you leak when you run that is abnormal, and you'd be well advised to establish what the cause of the incontinence is because it is likely to get worse if you don't.

afussyphase Fri 28-Feb-14 09:29:34

Thanks Gussie! Clearly some people also need support in addition to the exercises, as well as support to know exactly how to do them (I know, it sounds simple, but personally I was trying to hold for longer than the muscles could actually hold, so it wasn't very effective, and trying to do the 'flicks' too fast -- according to my NHS physio/b&b specialist). The NHS do a zapper thingy that gets the muscles strong enough to benefit from the exercises...

MN might be a good place to start but ideally you'd get a large cohort eg from pre-natal services and do a prospective study where you could get data from testing the muscles rather than relying on self-reports. Personally I don't have the skills (or the time!) though smile

gussiegrips Fri 28-Feb-14 12:09:27

Yep, zapper thingie is great. You can buy electrical stimulation units online, but, I'd advise anyone to buy a physio assessment rather than just getting a gadget.

They are good for people who are so weak they can't initiate a contraction.

And, yep, a self reporting, broad study would be a starting point. Clarity of incidence, awareness, compliance and activity levels would be handy.

I'll get there - it's slow, but, am getting there!

kentishgirl Fri 28-Feb-14 12:56:28

This thread is brilliant - thank Gussie.

I have these problems and I've never talked to anyone about them.

I have some stress incontinence when jumping about. And if I cough. Not usually too bad but enough that I'll wear a pad if going out dancing.And when I had bronchitis last winter I spent 3 days off work sitting on a pile of towels (as in bath towels, not knickers ones) pishing myself constantly as I was violently coughing. And when I was vomiting at a friends house for a couple of hours I also completely pished myself and all over her bathroom floor (embarrassing).

I also get what you've described as urgency incontinence - although I don't go to the loo all that much, I think I just hang about too long and with a full bladder some things act as a 'trigger'. Something to work on there - I can see it is behavioural

I always thought the exercise were a bit of a fobb off and didn't do much but now I've read this thread I'm going to start doing your 3 times a day ones religiously. Thank you.

I'm a bit confused about what a prolapse is and how you know if you've got one - and will doing the exercises help with this? Or at least to try first before seeing a doctor? The reason I wonder about it is actually when I'm doing a poo. My perenium sort of bulges downwards and I have to push it up with my hand to get the poo out.

I can't believe I've just typed all this but it's a relief (ha ha) to get it all out.

kentishgirl Fri 28-Feb-14 12:58:03

Oh and I'm late 40s and had a child in early 20s, if that's relevant.

gussiegrips Fri 28-Feb-14 15:58:45

Kentish - see, that's where I think MN could be really helpful for folk because it can be completely anonymous. Handy if you are shy.

So, a prolapse is essentially a hernia in your vagina. Think of it like a ladder run in your tights - part of the vaginal wall is weak, but intact, so the organs above it will drop into your vaginal vault. They can do that a wee bit, a lot, or "holy crap, WTF is THAT?".

Low grade prolapses can be managed conservatively, in fact, there's a paper to be published in the Lancet tomorrow (how cutting edge am I!) about this very thing - it's a really good paper. lancet prolapse study. The findings are, do your bloody exercises

If you're having problems pooing it's possible that the rectum's sagging forwards slightly. That disrupts the mechanics and a bit of poo can get "stuck" - which is why folk land up using a bit of jiggery pokery to shift it. There is a tool you can get called a femeeze. It looks like a pink shoehorn, but, is handy if you can't quite get the pressure in the right bit. www.mdti.co.uk/Female-Health-Products/View-all-products.html It might be available on prescription, ask your GP. If not, it's made by MDTi, that link's to the shop.

Prolapse is very common. Avoid heavy lifting, straining and becoming constipated. Try very hard not to get the flu, coughing and puking won't help.

Learn to contract your pelvic floor before you go to cough or sneeze or lift, it's very helpful habit!

Take your fanny to a doctor, Kent. Get a referral to a women's health physio. do your exercises, three times a day, and don't panic.

Got one myself. It's alright. Just got to do the exercises and drink plenty water, but, they can worse if not looked after.

Well done for posting too!

cowsarescary Fri 28-Feb-14 16:04:36

I do feel that if Gussie and Piglet John were Put In Charge Of Everything, we would all be grateful.

kentishgirl Mon 03-Mar-14 15:40:13

Thank you for the advice, Gussy

RunRunRuby Mon 03-Mar-14 23:08:33

Wah. I don't leak wee but something made me click on this thread and now I've realised I've probably been doing all the wrong exercise! sad

I haven't had children but just over a year ago I had surgery for bowel cancer. I've had my colon and rectum out, which involved an incision from belly button to just above pubic bone, so right through my stomach muscles. I now have an ileo-anal pouch which is a pouch made from my small bowel, I'm not 100% sure how the muscles work but it relies on pelvic floor more than a normal rectum. The surgery rather weakened my pelvic floor, but I haven't had any leakage possibly because the catheter has done something weird to my bladder.

I have an Aquaflex, but got out of the habit of using it as I've been having nerve pain elsewhere and didn't want to aggravate it. I also find it quite hard to get it into position. I'm pretty sure my um lady bits slope to one side. Is this possible? And is it a problem? It's only since the surgery. I don't think I have a prolapse as I saw a gynae to have my eggs frozen and I think she would've mentioned it if she'd seen one while she was in there. I saw a physio about pelvic floor exercises, she recommended the Aquaflex, but she didn't examine me and I only saw her twice. I was then told by my medical/surgical team to just exercise however I wanted.

So I've been running and also doing the seven minute workout every day including push ups, crunches, star jumps and the plank sad I had been meaning to ask my surgeon about the plank etc. as when I do it my tummy bulges downwards, even when I'm sucking my muscles in really hard it has little effect, whereas I can suck them in quite effectively when I'm standing. It sounds like this is actually a sign that the exercises are not appropriate blush

Cycling and swimming are not currently options for me, so is walking the only exercise? I don't want to do anything to jeopardise my pelvic floor but my oncologist told me the only thing I could do to reduce my risk of recurrence was to exercise so I'm keen to do something smile

On the subject of pelvic floors in labour, for those who have mentioned it, my Pilates instructor has recently changed the instructions in our class when we tighten our cores, now she says not to pull up on the pelvic floor itself as apparently if your pelvic floor is too tight it can make it difficult to give birth as the muscles don't relax enough to let the baby out. I ignore this as I will never be able to give birth naturally and my pelvic floor needs all the help it can get.

I do my exercises every day. Is it okay to do all three lots of each in one go or am I meant to do them at three different times during the day? I do bonus ones when I'm bored in lectures or whenever I remember grin

One last thing, for anyone who finds themselves suddenly desperate to go, when I first had my surgery it often felt like I couldn't hold on and I'd end up rushing to the bathroom, which is what prompted me to see a physio. The absolute best advice she gave to me was to breathe out. It's really hard to force yourself to breathe out at the time as you instinctively hold your breath but breathing out reduces the pressure on your pelvic floor and it honestly does help. It also reduces the panicky feeling.

Sorry for a massive rambly post blush

gussiegrips Wed 05-Mar-14 13:19:36

Ruby, first, glad you are well.

Second, glad you're doing your exercises! I've not got loads of experience with post-surgery, mostly they land up with colleague who's a dab hand with chronic pelvic pain. My understanding is that you'll still have your sphincter, but, the pf muscles function will help maintain continence.

Sounds to me that you need to strengthen your core a bit before doing plank etc. Plank and all that you're doing are fantastic exercises, but, if you don't have the core control you'll cheat, and that spikes your intra-abd pressure and that will lead to stress on your pf.

And, yep, exercise for folk like you is medicine. Well, it's medicine for all of us, really. So, I'd advise you to get a referral to a physio, or, if your pilates instructor's good, get her to have a look at your core control. You'll be free to do impact activities, as long as you have good muscular support.

So, you want to be assessed to make sure you are able to engage your TA and multifidus, that you can lift and lower your pf and that you can hold the lot in when you do movement or hold a position.

don't suppose you're near a foofoo fun club? I met Jenny at the weekend, these are really good classes (not an employee or affiliated!)

Do as many exercises as you like. There's no real limit, as long as you're not wearing yourself out! You know that stiff feeling you get in your leg muscles the day after a hard session at the gym? Want that in your fanjo? <shudder> So, no fatigue, but, otherwise, repetition is good.

x

RunRunRuby Wed 05-Mar-14 14:43:19

Brilliant, thank you gussie I will try and get a referral to a physio. Yes I still have my sphincter but much more dependent on my pelvic floor. My previous physio looked horrified when she realised it wasn't wee that I was worried about sad so I think I will ask my specialist nurse if she can recommend one who is more used to bowel surgery patients smile

I've had a bit of a break from running due to nerve pain but it did feel a bit ummm wobbly(?) when I was running so assuming I don't have good muscular support grin I mistakenly thought that the running would help strengthen everything but really I need to be stronger first!

I will be careful to avoid fanny fatigue grin and will look into foofoo fun club!

Thank you again, I'm really grateful to have found this thread and your great advice otherwise I would've carried on doing ineffective stomach exercises and straining my poor pelvic floor smile flowers

gussiegrips Wed 05-Mar-14 19:22:21

Yep, you'll be best off with a specialist continence physio - pee and poo are bread and butter to us. A musculo-skeletal physio will be comfortable dealing with pelvic floors and cores, but, possibly less confident in talking about keech. Besides which, you're usually only separated by a curtain in an outpatients department, and for this stuff you really need a room with actual walls so you don't scare the poor patients listening in.

The nerve pain's worth having investigated too, especially if it's a running related thing. Sometimes the nerves get kind of tethered by scar tissue. It can be easily corrected, but, like all things pelvic, if it's ignored then it can worsen and becomes intractable after years. Again, common after big abdo surgery, and, you don't need to put up with it, particularly if it's going to interfere with your exercise regime.

Totally agree, get your core sorted and then you'll be fine to do whatever exercise you like. PM me where you are, if you like, I'll possibly know someone in your area or which department you're looking for.

I presume you've got access to a continence nurse? They can refer in some areas too.

Happy to help. x

RunRunRuby Wed 05-Mar-14 19:43:49

Thanks gussie no continence nurse as I've not had any issues, it's more that they wanted to check my pelvic floor was alright and teach me the exercises so that it holds up in the future! smile I have a specialist bowel nurse who can advise on things and refer me for stuff etc.

Last physio was attached to GP surgery so walls thankfully but not a specialist. Will ask bowel nurse if she can recommend one.

The nerve pain is in my bum (lovely, I know) it's been investigated a bit but don't think there's anything they can do. I've just started on gabapentin so hopefully that'll do the trick. It's not exactly related to running but running, and walking sometimes, triggers spasms in my pouch and then that sometimes triggers the nerve pain. It happened earlier when I ran to cross a road hmm so definitely going to take a break from running from now! But when I was running three times a week it gradually happened less which is why I thought running might be helping everything, hopefully if I just walk instead it'll have same effects smile

Thank you for all your advice!

gussiegrips Thu 06-Mar-14 12:20:20

Yep, get a specialist. It's common to get trigger points in the muscles (pelvic floor dysfunction) they can cause the pain you describe. Similar to the post-whiplash pain folk get in their neck/shoulder. Works with a bit of prodding, so, finger up the fanjo/jacksie stuff, but, it does work. You can do it yourself, and there's some "interesting" looking gadgets to help that.

Speak to specialist bowel nurse, tell her you've chatted to a random stranger about your sore arse, show her the posts, and ask her to refer you to a continence physio. The problems you describe don't sound insurmountable.

Am really pleased you're so motivated. In fact, I'm considering making badges a la Blue Peter to distribute to people who earn them. Getting one earns you free entry to your own vag.

RunRunRuby Tue 11-Mar-14 08:58:45

Ooh a badge. That's almost as good as stickers.

I may have ahem overexercised the other day, I now understand what you meant. Will be more careful in future! I was on a long car journey (as a passenger) and bored so thought I'd use the time productively.

I've started walking every morning. It's a nice way to start the day anyway and easier to motivate myself to get out of bed for a walk than for a run!

Will ask bowel nurse about specialist physio, she must be fed up of me requesting things I've read about on the Internet grin

Will the continence physio be okay seeing me given that I haven't had any continence issues? Presumably they're still the best person as have extensive knowledge of that area and hopefully experience of this op. I feel like a bit of a fraud but I don't want issues when I'm older. Especially as my medical team are planning for me to have twins which I'm sure will test my pelvic floor strength grin I had to wear those big Tena pants in hospital after my first surgery as I was bleeding and they wouldn't give me sanitary pads instead angry it was absolutely the most humiliating experience of my life and I never want to wear one again!

I've been promoting pelvic floor exercises to everyone, including several strangers in Aldi who may have overheard me instructing my sister on the techniques and their benefits blush

Thank you, you are fabulous grin

CorrieDale Sat 15-Mar-14 20:44:47

So glad to have stumbled across this thread (obviously leaking a bit as I fell!)

I had a uterine prolapse after acquiring a bout of bronchitis 3 weeks after giving birth 6 years ago . I saw a physiotherapist and she gave me some exercises and info, and scared the dickens out of me about how doing the exercises wrong was worse than not doing them at all! Anyway, I did them and things improved. The coil has helped because it was worse when I had my period. Losing 3 stone really helped too. Obviously, once everything was pretty much back where it belonged, I let the exercises slide (not that I go on the slide myself of course because I dribble wee as I pick up speed.)

I now do Taekwondo and the white suits coordinate very poorly with my weak pelvic floor - otoh, you can hide a hammock under the baggy trousers so it isn't all bad! But it's hard to kick effectively around a hammock! This thread has made me believe there is a better way... Giving up Tkd isn't an option so I started with 10, 10, 3 yesterday and have even set phone reminders so I don't let things slide once my PF improves a bit.

I did check out iPhone apps. There's an NHS one that looks good but I am allergic to paying for apps! And they seem obsessed with discreet reminders - I am pretty open about my saggy pelvic floor and if doing the exercises brings about any improvement I shall be even more open!

Bollard Sat 15-Mar-14 21:01:19

This thread is great smile. I have a problem with stress incontinence. I had specialist physio which improved the strength and tone, but didn't translate into solving the problem. I was booked in for a TVT a couple of years ago but chickened out at the last minute. In the past 6 months I've tried other ways of dealing with it. I find that if I drink virtually no caffeine I'm much better. I also did the C25K plan and was pleasantly surprised to find that, so long as I was careful, the problem because much better. I still need pads but it's a huge improvement and I'm now running 5K (quite slowly) a few times a week.

However, there are times in my cycle when the problem gets loads worse, usually mid-cycle. I went out for a run on Friday and had to walk home as I was so pissy sad. I've been eating more sugary food than I should (cutting down on sugar seems to help) but even so, it was really bad.

I don't think I'm prepared to accept the risks of a TVT. For an op that isn't life-saving, the risks seemed too high and too scary. I'm really trying to listen to my body about what exercise works for me, and was prepared to not pursue the running, but now love it and would hate to give it up, and apart from Friday I generally feel as though it's fine. It's been v bad today as well, much worse than usual. Loads of peeing, loads of leaking...

CorrieDale Sun 16-Mar-14 19:03:26

Ah yes. Caffeine. I love coffee but avoid it on taekwondo days. The GP i saw about my prolapse told me to drink plenty of fluids but not tea or coffee because 'they make you wee differently'. Not sure what she meant but coffee does make me leak more. I have my tea very weak so my PF tolerates it better.

runningLou Mon 07-Apr-14 08:21:16

I hope people don't mind me resurrecting this thread? After some urgent advice!
Had an absolutely horrific and disgusting experience yesterday running a 10k race. I was wearing a Tena lady extra, which I do need as I leak A LOT when running. Am 34, have had 2 normal deliveries, PF has been awful after each one then with physio has got back to the stage where it's not so much of an issue day-to-day, but is still disastrous when exercising.
Yesterday (and I really hope this isn't TMI for anyone), I was running hard (really wanted to be sub-50 and it's a difficult course, first half all hilly and on muddy gravel trails not roads), and basically the pad got unstuck, and started drifting, first out of my knicks, then down one thigh (at this point I was totally freaking out about what the runners behind me might have been seeing!!), then came to rest just above my right knee!!!!! I was wearing knee-length leggings - luckily with a short running skirt over so the initial lumps and bumps weren't visible. Anyway I ran with this for a while then thought - sod it - as I could feel it was preoccupying me and I knew I couldn't run properly and also I was so worried it would just fall out!!! So I stopped for a sec, yanked at it, and all those little gel crystals, like in a disposable nappy, just went everywhere!!! Managed to salvage most of it, chucked it in the hedge (sorry, course marshalls!), and ran on. Didn't notice until the end of the race but throughout I still had a bulge over my right knee which resulted in a shower of gel crystals again when I took my leggings off. Mortifying.
I was still sub-50 - squeaked in at 49:58!! But, I am just sooooo depressed by this.
Anyway later today I have an appointment with urology at the hospital as the state of my PF has been getting me down so much that GP referred me. Just wondering if anyone has any advice as to what help / intervention I should ask for?
I have been assessed for TVT before but consultant said things weren't bad enough and also I was too young at 34 as the op needs to be repeated every 10-15 years and that would be a lot of repetitions in my lifetime.
Reading the message above I'm thinking I probably need to cut out caffeine entirely - am on de-caff tea and coffee and only have 1 cup of either per day, otherwise herbal tea and rooibos - but maybe this is still too much?
Any help or advice appreciated!

runningLou Wed 09-Apr-14 10:07:20

just bumping blush

How did you get on with the urologist? There's a lot of advice up thread about the different exercises and also wearing a mooncup. Never tried personally but are the weights worth thinking about? Also yoga is great for general core strength which I think helps too. Running must one of the toughest things for your pf to cope with but if you love it and I assume you're good at it with a sub-50min 10k!!! then it's got to be worth trying everything above! Sorry I don't have personal experience, I've had two quite big babies but been religious with my exercises and I do quite a bit of lifting and pushing with my job which I think helps.

runningLou Thu 10-Apr-14 14:54:51

Have weights, wear mooncup, and have started Pilates to build core strength ... no joy so far sad
Urologist said I need to come back for urodynamics test where basically they get to you wear a catheter whilst jogging on the spot to see how bad the loss really is. Not looking forward to that!! That'll be in a month's time.
They also said in terms of surgery options it's really a question of whether I want any more kids (have DD and DS) as I wouldn't have the possibility after the op ...

That's positive though that they are going to do something about it! Tough decision to make in the mean time sad

fivecupsoftea Thu 17-Apr-14 11:58:08

I've just discovered this thread and have skim read all 13 pages. I am hypermobile, is there any hope for me in recovering my pelvic floor? I love running and tennis. I'm working hard at my pelvic floor exercises, but getting nowhere. Do I need to stop running for a bit - will that help? I'm seeing a specialist physio in a couple of weeks time, and am dreading hearing advice telling me to stop running, but I will do it if that what it takes. Is there any specific advice for people who are hypermobile?

Thanks for this thread. Just read the whole thing! was supposed to be cooking dinner
I think I have a slight prolapse after (bravely) looking at the images Gussie posted, except mine is the other way around i.e. the bulge is from the back. Does it make a difference if you have the prolapse from the front or the back?
I am 42 and have had 3 children, all vaginal deliveries.
After my 2nd baby I did go to the doctor as I was worried things didn't seem normal down there, but she reassured me it was just how my vaginal opening had stretched & torn, so it looked different. But now after my third I am worried again it's not 'right'.

It doesn't cause me much discomfort generally - its not painful, and sex is fine - but I do find tampons work their way out which is annoying, and I occasionally leak. Not daily, but occasionally e.g if I exercise without going for a wee first, or sometimes when I cough. And after going on a friend's trampoline the other day, I now understand what people mean!!

This has been a very interesting thread to read. A little disheartening is the bit about not doing impact exercise, as I really need to drop a dress size and tighten up my saggy tummy, so had been doing some exercise DVDs and feeling rather proud of myself, but now wonder if I should carry on sad. Cycling is not an option as I live in a city with lots of busy roads so don't feel confident going out on my bike. Swimming I could do once a week, but the advantage of the DVDs is that I can do them every day at home without needing to find childcare so I can fit them in easily. I wonder if I do the pelvic floor exercises if I can do the aerobic exercises too?

I am going to domyblardyexercises regularly and see if that helps.

A couple of my friends had the operation, but I know it took them a while to recover and if it only has a life of 10-15 years that's not so great, so don't want to follow that route just yet.

stephanienikkigomez Tue 20-May-14 09:43:36

I am a french women and was looking everywhere in London to find a good physiotherapist for my pelvic floor. In France it s normal to have a prescription after each pregnancy. I was looking everywhere to find this service in london.
Now i just finished my rehab with mummy's physio, they are specialist in all pelvic / women related issue and i advice anyone to use their services they are amazing . I am now back to running, no more incontinence , no more back pain. you can check them out www.mummysphysio.com

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