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?

Laura yep - here's my recommendation by Jane Appleyard, who's a smasher.

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.

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.

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.

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.

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.

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

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

"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.

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

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.

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

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.

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.

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")

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?

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?

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.

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

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.

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

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.

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

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.

1. 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

1. 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.

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.