Tips for After a Caesarian Section

Those of you that have been through or will be going through a C-section rather than a vaginal delivery might notice a difference in recovery after the birth. You might not go through the pains of labour, you might be unlucky enough to have to do both but you will definitely realise that your body will need to recover once the baby is out. Your body will be sore in many different places and recovery time will be longer in comparison to vaginal delivery.

Rest whenever you get the opportunity in the first 4-6 weeks. A good form of general exercise is walking, starting with as little as 5-10 minutes daily and gradually building the time up to 30-40 minutes over the first 2 months. It is also important to do specific exercises to strengthen and stabilise the lower trunk. This includes pelvic floor muscle exercises, transverse abdominal exercises and pelvic tilts. I will go into more detail on these specific exercises next week.

It is also important to move in and out of bed correctly. Pretend you are still pregnant (yay). Move slowly and try to avoid using the abdominal muscles in the first 4-6 weeks. To get in: sit on the edge of the bed, lean down onto your elbow towards the pillow, bend your knees and lift your legs onto the bed, then roll onto your back. Reverse this action to get up.

When coughing and sneezing support your lower abdominals by placing your hands or forearms over the caesarean wound. Contract the pelvic floor muscles before the cough or sneeze. To clear your chest take three slow deep breathes in and out, then huff (as if to steam up a mirror), then support your cough as above.

Avoid all unnecessary lifting (so lots of excuses can be made to the hubby about housework.) Avoid lifting heavy objects (anything bigger than the baby) for the first 4-6 weeks. To lift, keep your back flat, draw your tummy in, squeeze your pelvic floor muscles and bend your knees. Keep the object close to you as you lift it up. Use your legs to take the weight of the lift and not your back. So avoid strenuous housework - this definitely includes but is not limited to the laundry basket and the bucket of water to wash the floor.

Driving should be avoided for 6 weeks but you will need to contact your insurance company for individual policies. You must be able to do an emergency stop without hesitation or pain before you can drive again.

You must also speak to your own doctor about pain relief, especially if you are breast feeding.

If you are suffering from pain would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

SPD After Labour

Symphysis pubis dysfunction (SPD) is a common condition found during pregnancy, presenting as pain around the pubic joint area. It is a separation by this joint that leads to pain, caused by the hormone relaxin that is produced in your body during pregnancy. Once the baby is born, the level of the hormone decreases (but is mimicked if you are breast feeding), and the pain will start to go away.

Well this is the scenario in most cases, however for some people this pain can linger or even start after labour itself. Due to the hormone relaxin, your ligaments are more soft and stretchy to enable your baby to be born. Due to this, labour itself (especially if it is a traumatic birth or you delivered in stirrups) can cause a separation at the symphysis pubic joint.

SPD after labour will get better but in some cases it can take time. The good news is there are things that can be done to speed this healing process along, one of those being physiotherapy. After your physiotherapist has assessed you they will give you lots of advice on movement techniques such as keeping your legs closer together during activities that you need to carry on with your daily living. They will help you find comfortable positions to carry out tasks that are important to you. They may also decide to give you crutches if they feel you will benefit from them, along with a specially designed SPD belt (this is different from a back support belt). They will also guide you on specific exercises and design you a personal home program exercise session. Of course this program will also include pelvic floor exercises that every woman should include into her daily routine.

If you feel you need to, you can also take pain killers and over the counter anti-inflammatories. It is important to remember that you can only take anti- inflammatories after labour once the baby is out and NOT if you are still pregnant and suffering from SPD. This is true even if you are breast feeding. If you are pregnant and suffering from SPD, you can only take over the counter pain killers such as Acamol and must go to your doctor if you need something stronger.

.

If you are suffering from SPD and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Cold Weather and Joint Pain

First of all I hope everyone enjoyed the snow and stayed warm. I am also very sorry for rescheduling some of your appointments this week due to the snow. I also had a number of patients contacting me this week about increased pain, so that is the inspiration behind this week's blog.

Yes, the cold can increase your joint pain, however there is some conflicting evidence.

Studies have found a strong relationship between cold damp days and increased joint pain. One suggested reason is that changes in barometric pressure can cause this. Another suggestion is the colder temperatures can cause changes in the viscosity of joint fluid. Other studies suggest there is no link between pain and cold weather at all. However what I do know for sure is many of my patients complain of more pain in the colder weather.

So what can be done? Stay warm. Apart from wearing an extra jumper exercise can also help. Warm ups are called warm ups for a reason and it is imperative to warm up extra vigilantly in the cold weather. It is easy to get lazy in the cold weather but important not to. Just make sure your chosen sport is not down hill skiing, snowboarding or sledging; keep it safe if you are pregnant.

Keeping a healthy diet can also help as can a hot water bottle, as long as it is not lying over your bump. Baths can also be relaxing but if you are pregnant make sure the water is not too hot as it can make you dizzy when it comes to standing up, and saunas should be avoided. This is because the heat makes your blood vessels wider and this can cause light headedness and fainting.

Your body will do a brilliant job in keeping your unborn baby warm so it is just yourself you need to worry abut here. It is you that becomes susceptible to the cold during pregnancy. As your bump gets bigger and there is more surface area for heat to be lost through the colder you may feel, so make sure you dress properly for these cold wintery days.

.

If you are suffering from pain and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Diary with a Capital Pee: Keeping a Bladder Diary

When trying to improve any area of your life you will only know if you have done so by recording the figures and measuring the change. This is the reason I ask my patients who come to me for pelvic floor rehabilitation to keep a diary. In the diary I ask them to jot down the following activities:

• Date / time of day
• Type and amount of fluid intake
• Type and amount of food eaten
• Amount of urine excreted (small, medium, large)
• Amount of leakage (small, medium, large)
• Activity engaged in when leakage occurred
• Was an urge present? (Yes or No)
• Change of pad required?

It is very important for all women to be doing their pelvic floor exercises every day. The reason being that we have so many factors against us that we need to be one step ahead of the game. Pelvic floor muscles get weakened with every pregnancy. 65% of pregnancies come with incontinence. Although lots of women then have no incontinence problems once the baby is out, it is important to remember that the muscles have been weakened so exercise is still crucial.

If you are lucky enough not to fall in the above 65% you are still not home free because the actual delivery can also cause weakness. 60% of women who have had 4 or more babies complain of incontinence.

I am very pro breastfeeding, it has many advantages and I do it myself, but unfortunately it is also a contributing factor, due to hormones. As mentioned in previous blogs, relaxin weakens joints and ligaments, and it takes 3 months for this hormone to leave our bodies after birth - but while we are breastfeeding, this hormone is mimicked. It is more important for breastfeeding mums to do their exercises and they often see little improvement for there efforts – but it would be far worse if they don't.

Another contributing factor is the neurological one. It is important to remember your pelvic floor contracts reflexively before we cough or sneeze. Reflex inhibition is the brain’s way of protecting a part of the body that is damaged. Unless these reflexes are re-established, chronic injury can be a result. You are probably more familiar with ankle sprain, and probably know that if the ankle is sprained badly there is a tendency for that ankle to twist and give way again. When treating sports injuries the physio concentrates on retraining the protective reflex action of the muscles around the ankle. There is no point in treating the joint without re training the reflex. So to it is the same with pelvic floor after childbirth. The protective reflex contraction of the pelvic floor when you cough or sneeze is lost, but this protective reflex can be re-learnt. You can teach yourself to actively squeeze and lift before each cough or sneeze.

Even if you do not suffer incontinence post-birth, the muscles have gone through a real beating and exercise to regain strength should start no later than 24 hours post delivery.

The pelvic floor muscles fatigue like all other muscles do. It is important to realise that fatigue is also a contributing factor to the fall of the pelvic floor. Therefore rest is also important, especially just after giving birth.

Quite often if you have recurrent cystitis/urine infections it can lead to bladder instability. It is the inflammation in these cases that is the cause of your incontinence.

Now let's mention menopause. Many women sail through life blissfully unaware of the time bomb ticking away between their legs. Quite often they are totally unaware of the stresses and strains that have weakened their pelvic floor until they reach menopause and this is the final straw. During menopause the oestrogen level drops. Oestrogen factor is also responsible for the thinning effect that can occur within the vagina and urethra. Meaning the pelvic floor needs to be stronger.

Ageing can also take a toll on your pelvic floor like it does with all your muscles, so too with constipation, chronic cough and being overweight.

As you can see the odds are against us women, but the dairy helps monitor all aspects of the bladder routine and can hopefully help show the effects of exercise and work out what needs to be changed.

If you are suffering from incontinence and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.