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?

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!

pf not of!

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

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?!!

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

also if I get a cold it all cones flooding back

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?

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.

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.

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.

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.

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

I feel your pain.

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.

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.

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.

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.

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.

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.

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.

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?

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.

Gussie you are fab!

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

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.

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

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?