Improving pelvic floor - what did you do?

[PelvicFlaws]

OK, name changed for this!

Disgracefully, first born DD's 2.6 now and I haven't done anything about it but I know my pelvic floor is weak and I'm worried I'm going to have trouble in the future. In my defence, I tore horifically and then my stitches tore again and I had to go around with an open wound (TMI alert - and yes, they couldn't do anything) for ages while it healed. It was so bloody depressing. Gah!

What can I do now? Anyone used any of those devices? The kegel excercising things? And would you recommend?

Thanks!

[gussiegrips]

Sawraight, Andy. Not sarky, and it is a horribly wearing problem - I do understand.

Good luck today.

Now, all of you - go and #doyerblardyexercises!

[BlueChampagne]

Interesting gussiegrips - I found a mooncup had the same effect, but without the drying.

[AndyMurraysBalls]

Gussie - I'm being facetious too, because I'm so annoyed with this problem. Sorry for being a sarcy mare.

OP - how are you getting on?

[gussiegrips]

Ach, I was being a bit facetious, Andy. But, about 30% of female track athletes who haven't had kids report themselves as having experienced stress incontinence regularly.

Athletes have a surprisingly high incidence - and very few of them seek help. It depends on the sport, but trampolining/long jump/gymnastics - about 80% incidence. I find that really shocking.

Tampon works because it sits in your vagina and the neck of your bladder sits on the other side of your vaginal wall - so it's a bit like a splint wodging everything in place. So, when you run the neck of your bladder is supported by the tampon pushing up from inside your vagina, therefore the downward pressure is less. These women notice they leak less when using a tampon, so use it even if not menstruating. It does work - but, obviously, can be a little drying which isn't awfully comfortable, and, potentially, could cause thrush etc. even mentioned on NHS website

[AndyMurraysBalls]

All the women I run with wear running knickers or proper running shorts. No-one ties anything round their waist. Surely that would slow you down and make you faff about.

I don't quite get the tampon idea. Surely a tampon goes up your fanjo but the wee comes from another bit?

[puffylovett]

I had really bad stress incontinence after my 2 dss were born... Going back to dancing helped a bit, but I've recently started cycling and that seems to have helped tremendously. I managed to actually jump on the kids trampoline the other day..

I'm going to try what gussie recommends though, I deffo don't do enough kegels.

[gussiegrips]

Janek - there's not actually one agreed "prescription" for exercises. As long as you are doing fast and slow twitches you'll improve. and, yep, what you wrote is what I meant.

10, 10 3 works because it's easy to remember and covers all the muscles. "We won't pee with a 10, 10, 3"

Am working on my book...

[gussiegrips]

Bertha - yep, using the muscles that make your thighs clench will in itself also make your pelvic floor muscles contract. Clever you!

If you get inot the habit of clenching your bits every time you sneeze it cuts down on the leaking.

[gussiegrips]

Pantone - yep, definitely! There's no difference, from a physiological point of view, between using Adult Thingies and Medical Thingies. Some folk find it less embarrassing buying something from Anne Summers than from Boots - who cares? Just as long as it makes you #doyerblardyexercises.

[Janek]

Yes, thanks for the response gussie, i always thought you had to do ten 10-second clenches which is very difficult/boring/i lose count/i forget what i'm meant to be doing. One ten second clench is much less onerous.

So to confirm - one ten-second-clench, ten one-second clenches and one lift going up and down three floors. I think i can manage this .

[BigBoobiedBertha]

Thanks for the reply gussiegrips - love your name btw, now that I get it

I definitely got the 'bulging' when I was coughing so badly with my chest infection. Don't get it so often now I will remember the awfulness time of that to spur me on with my exercises.

Interestingly (to me anyway) after reading this thread on Saturday, I notice that if I am about to sneeze or cough when I am walking around I stop and clench my thighs together - not quite crossing my legs but the same effect. I hadn't noticed I felt the need to do that before. I remember my mum doing that when I was younger and wondering what the hell she was doing but now I know!

[Pantone363]

Ben wa balls

[gussiegrips]

Andy - yep, hormonal changes can affect continence and could, potentially, give you a sudden pishy episode when you are otherwise fine.

Certainly, the menopause is when many people (who have previously never had a problem) will present.

Running differently isn't going to get you a PB. I'm looking at doing some research into runners using silicone pessaries - //www.incostress.com It's got good science behind it, and it works (ask me how I know, gets me through a zumba class) - but, it's not commonly used, mainly, I think, because we don't talk about it.

Many, many female runners use tampons as internal support - incostress is better.

Hospital should screen you for UTI (most common cause of sudden pishieness), so take a sample with you. No leaking at any other time?

Do your exercises, and don't panic - there's loads and loads that can be helpful. Certainly, the worst thing to do now is start piddling more often just incase.

Remember, there's 3x your body weight rattling into your pelvic floor with every single running step. So, it doesn't take a genius to figure out that's quite a lot of impact over the course of an hour's run. THis is why every single lady runner you see has a wee sweatshirt tied round her waist...

Let me know how you get on, I'm interested in whether they'd offer you urodynamic testing on the history of one episode.

[BlueChampagne]

Got my exercises from www.patient.co.uk/ and so far am in Gussiegrips' 70%.

[AndyMurraysBalls]

I should add, I am definitely not overweight (9 stone at 5 foot 4) and otherwise extremely healthy. Crap eyesight doesn't count.

[AndyMurraysBalls]

Hi Gussie.
Apologies to the OP because I feel like I'm hijacking.

I'm confident I don't have a prolapse. I have been doing the exercises and the running problem occurs around the first day of my period (which are erratic and unpredictable). Is it a menopause thing?

Since my last post I have sustained a bad injury because I am not running normally because I am constantly worrying about pissing. Someone at the club actually asked me why I am running differently and well ...... What can you say to a 25 year old man who is trying to help you get a PB? I don't want him to think I am that old woman on Little Britain.

I have the hospital appointment tomorrow and I want results and solutions. Am I expecting too much?

[gussiegrips]

www.gussetgrippers.weebly.com (hope it's ok to post it, I'm not really advertising!)

The basic exercises I use are:

1. one single squeeze for a count of 10 seconds
   

1. one lot of ten quick flicks in a row
   
2. lift to the first, second and third floors and then lower back down.
   

Yep, you need to relax inbetween each exercise - that's really important. You should feel a "drop" down into your knickers as you relax - and if you can feel your buttocks working stop at that point and build it up. It's really common for your PF to get weary when you start, it'll get there with practice. If you can't do it properly, stop and rest. Do the flicks at a "on for a second, off for a second" pace - and you're better doing 5 good ones than 10 guff ones. And, it's ten contractions in a row.

Remember that 1:3 women have SI, it's really common - and not running to the loo is good, but you dont' want to wait until your bladder is absolutely full either. Peeing about 250 - 300ml is great, waiting until it's a 500ml job isn't. Should you feel like getting technical about it and getting a measuring jug out, feel free...

Prolapse symptoms:
a bulge
leaking pee
difficulty pooing
a dragging sensation "down below"
painful sex/using a tampon
tends to be worse as the day goes on/your monthy cycle changes

Easiest thing to do is get a mirror, stand up and have a look. If you can see anything in the vaginal opening then, yep, you've probably got a bit of a prolapse. Of course, that depends on you knowing what your bits look like int he first place, and most some of us have never had a good peer down there. If you do have a prolapse it's important to get good information about managing it becaue you can manage a minor one conservatively.

IT really bothers me that this information is given out in a vague fashion. the research is solid - if you do 10, 10, 3 for 3 months, you'll get better. If you do it once a day, you'll prevent prolapse. I'm kind of on my high horse and going to do some research into trying to bust the taboo and get the information out into the public domain - it's so common, and so easily fixed, and yet, not really properly addressed by anyone.

You'll forget though - so, either set your phone to ring, or follow me on twitter. I'm quite a good nag.

Do ask questions. I'm a fanjo evangelist and have bored everyone in earshot of me...

[Janek]

Good questions, i too am awaiting the answers!

[BigBoobiedBertha]

Thank you gussiegrips. That was really useful. I just thought the Kegels were the hold for 10 secs one and maybe the flicky ones but I suppose I have come unstuck in the number of times you are supposed to do it, how regularly and how long you are supposed to keep it up for to get results. When I was pregnant I was told or read that you should do Kegels regularly but it was all a bit vague.

I have a couple of things I want to clarify if you don't mind.

1. Are you saying you need to do 10 of the 10 sec ones per session? (I am assuming that is what the 10,10 and 3 x3 bit means but it is Sunday afternoon and my brain is mushy).
   

1. When I do the flicky ones, it feels like I never properly relax on the relax bit. Does that matter? Am I perhaps going to fast? Oh and when you say 10 of those is that 10 contractions and 10 relaxations which I think I might struggle with at the moment or 5 of each which I can just about do without ending up bobbing up down in my seat rather than actually contracting and relaxing my undercarriage. I think my buttocks take over at about 6 of each when my pelvic floor gets tired.
   

I have been thinking about my post and yours and I definitely have stress incontinence not helped by the fact that I sometimes don't go to the loo often enough. I leave it and leave it, sometimes for hours and then wonder why my knickers are damp.

And one final question, how do you know if you have a prolapse?

[Roshbegosh]

Gussie I can't find the link to your website on your profile. Struggling with the 'lift' one but thanks for the great advice x

[PelvicFlaws]

Gussiegrips I love you. Thank you SO much for your post. And yes, great idea for MN to make a campaign out of this!

Luckily, the only leaky accident I ever had was when DD was about five days old and I saw a rat (!) but what you say about the 'just-in-case' wees training your bladder to hold less has hit home - I do that. Damn!

I am doing the exercises as I type.

[gussiegrips]

Swooping in with my superhero cape made out of tena pads on...

I'm a women's health physio, got some stats for you:

84% of simple stress incontinence can be cured in 5 physio sessions

70% cure with doing exercises on your own for three months.

a third of women aged 35-55 wet themselves. Most never seek help. That's a shame, you don't have to put up with this guff.

Do 3 exercises, 3 times a day for 3 months and then once a day, every day, until you die, or they stop working.

There's a difference between leaking when you cough/sneeze/jump and a frank loss of control when you run - that's an urgency problem. It can be helped by doing your exercises, but you might need to add in some behavioural stuff (like when you pee yourself because you've put the key in the door, long before you get near the loo).

there's some good evidence now showing that if you are wearing a sports bra you should have some internal support too. Things like www.incostress.com, a silicone tampon. When you run there's 3x your body weight rattling through your pelvic floor - no wonder you pish yourself after a while.

Frequency is when you go "just incase" and land up training your bladder to hold less volume than it should. Peeing more than 8x a day or once at night is not normal.

Any sort of pishing yourself during activities or sex is not normal (unless your partner asks you very, very nicely, I suppose)

Yep, there are some people who shouldn't do kegels - a too tight pelvic floor can mimic a weak one. If you have pain during sex/can't use a tampon/get pelvic pain and wet yourself, you should get an assessment and, naturally, if doing the exercises hurt then you should stop and get an assessment.

There are a number of articles with huge hit rates on the web saying that kegels are guff and squats are good. This is not evidence based and should be ignored Kegels are awesome, see the stats above. Science, see?

Prolapse can be a nasty old thing. but, it's very common, why, I have a grade 2 prolapse myself . Exercises can help, pessaries can help, not getting constipated etc helps - but, you should see a medic to grade it as there is a point of no return when you just need to get the whole thing wheeched back up in place. Get a referral.

I teach 3 basic exercises:

hold 10 secs
10 quick flicks
up 3 floors and back down

So, imagine you are going to let rip a huge, stinky fart - and, you are on a date with someone you really fancy and you don't want to horrify them. THat squeezing round your bumhole is you working your pelvic floor. Hold 10 secs.

If you can't feel it, lie on your tummy (takes the effect of gravity away)

If you still can't feel it, bung something into your fanjo and squeeze it (nothing wooden incase of splinters. Usually we recommend a finger, but it doesn't need to be your finger...)

If you still can't feel it - get a referral.

10 quick flicks - contract/relax/contract/relax etc

3 floors - imagine you've got a lift in your vagina, take it to the first, second and third floors and then back down again. It is a bit odd, but it makes you use the muscles at the front instead of just the ones round your bumhole, and that's important. Try to control the "lift" on the way back down, or you'll kill the Borrowers who are going up for reasons unclear.

10, 10, 3, 3x a day, 3 months.

follow me on twitter - @gussiegrips, when I tweet, you twitch your twinkle. Otherwise, you'll forget.

I've got a very amateurish website (linkie on my profile, don't want to fall foul of advertising, though, i'm not selling anything...yet, but I do need to turn this into some sort of job!) with further info.

I'd like MN to run this as a campaign - it's shockingly common, easily fixed and yet we don't talk about it. I've just turned this stuff into a comedy show and run it at the Edinburgh Fringe, went well and i'm hoping to use that to break down the taboos surrounding it.

Essentially - try the exercises. They are boring. But, they bloody well work and, being in control of your bladder will change your life.

PM me if you have questions, I'm happy to help. And, we should get MN to run this as a campaign, seriously, it makes people so utterly miserable. (a third of people with incontinence are also clinically depressed - obviously, it doesn't make you feel very good about yourself)

Oh, and I've not seen the dvd on foofoo funbox (keep asking her for a sample, I'm not bloody buying it if I'm going to be recommending it to patients!) but it does look sound. She's not a physio, but the exercises look ok from what I've seen on the web. However, if you do the 10,10,3 you will get better - science, see? Free, too.

Don't put up with it. You really, truly, don't have to.

right, go and #doyerblardyexercises. Right now. Go on.

[FloraFoxley]

Make sure you're your ideal weight. As soon as I reduced my weight to a normal weight all the issues I had had vanished
So it's worth bearing in mind if that's something you could address.

[PelvicFlaws]

Sorry - I should say, perineum sewn up too (natural tear) but not very er, tightly!

[PelvicFlaws]

Wow, thanks for advice. all. Will look into everything mentioned. Very helpful! I did pilates for 10 years before DD came along, so no stranger to it, but haven't since. Maybe it's time to go back.

gybegirl - it's frigging awful isn't it. I was so depressed about it. (although - TMI - mine was mainly at the top, so not so much of an issue re the perineum, but hey, why would a doctor be concerned about a split clitoris - that's just "cosmetic", FFS)

I'm not sure what'll happen if I have another DC and tear again. Maybe I'll get them to do a repair job!

Thanks again all. Much appreciated.