Running with poor pelvic floor- what is your solution

[Runlikeareindeer]

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?

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

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 :( Have to wear pads on a daily basis, changing up to 3 x sometimes, especially at work. Why would it suddenly go so bad?

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 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
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

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 maybe

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

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.

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.

Gussie your Edinburgh fringe YouTube clip came up on my fb news feed! Thoroughly enjoyed it

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)?

I've just watched your fringe clip gussie. Cmdr Hadfield .

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??

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?

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?

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.

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

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/

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!

ski

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.

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...

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?

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.

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?

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.

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 :)

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!

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.