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?

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

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.

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).

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.

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!

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

.

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?

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'....

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?

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!

"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.

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.

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.

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.

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)

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.

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)

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.

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

And my humble informed-layman instincts 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.

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.

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.