The Pelvic Floor Questionnaire

I have written a number of blogs now on the pelvic floor area. Many of you might be asking yourselves whether it is this really that important, or thinking “this may apply to others but I am fine now and therefore I do not need to do my pelvic floor exercises”. However, yes this does apply to you; even if you suffer no problems at the moment, it can prevent future problems, so start exercising today. I have made a pelvic floor questionnaire that will help you determine whether you are a high risk or lower risk for future problems developing. If you find yourself in the higher risk category, which applies if you answer yes to any of the following questions, then you might find it worthwhile spending a session with a physio to ensure you are doing the exercises correctly. So here we go.

1. Do you suffer with your waterworks i.e. do you leak urine when you cough, sneeze or do exercise (stress urinary incontinence) or get a desperate urge to go and not make it to the toilet in time (urge incontinence)?

Facts

Up to 1 in 3 women will leak urine during their lifetime. Women under the age of 50-55 tend to suffer from stress urinary incontinence while post menopausal women tend to suffer from urge incontinence. However you can suffer from both regardless of your age.

2. Do you have a pelvic organ prolapse? (a bladder prolapse, cystocele, uterine prolapse, the womb, or bowel, rectocele, or a combination of any of these.)

Facts

1 in 2 women will develop a pelvic organ prolapse and women with a prolapse are 3 times more likely to suffer from urinary incontinence.

3. Have you had a normal vaginal delivery?

Facts

10% of women will have damage to their pelvic floor muscles after a vaginal delivery. After a normal vaginal delivery you are at double the risk of developing a prolapse. The risk increase if you have a big baby (over 4kg) or twins.

4. Did you have an instrumental delivery, either ventouse or forceps?

Facts

25% of women whose babies are delivered by ventouse will sustain pelvic floor damage, 65% for forceps.

5. Did you have a prolonged second stage of labour?

Facts

This is associated with neuromuscular damage to the pelvic floor.

If you are suffering from incontinence or not sure if you are doing your pelvic floor exercises correctly 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.

Prolapse: Don't Let It Be Your Downfall

One in two women will develop a prolapse, but again this is one of those secrets that is never spoken about and therefore often never dealt with. Strengthening your pelvic floor muscles and making some lifestyle changes can reduce or resolve symptoms of a pelvic organ prolapse.

A pelvic organ prolapse is when either the bladder, bowel or womb bulges into the walls of the vagina which have often been weakened through various stages of life, such as pregnancy, birth and menopause, as well as chronic constipation and jobs involving heavy lifting. This may or may not be accompanied by symptoms. However, if you feel a lump, or a bulge in the vagina, or as if something is there or something has come down, or you get an aching, dragging feeling if you have been on your feet all day, then it can really affect the quality of your life. It can also cause urinary and bowel symptoms or make you feel uncomfortable during sex.

The pelvic floor muscle has two roles. One is to help with toileting and the other is to support your bladder, bowel and uterus. With a prolapse, the muscle fibres that need to be strengthened are the endurance ones. Therefore they are constantly working. If you brace your pelvic floor muscles every time you are lifting this can help strengthen them. Ideally if you have been diagnosed with a prolapse then you should avoid lifting heavy objects.

One way of dealing with a prolapse is surgery, but it is not always the best option and you should always first try a more conservative approach - which often produce very good results and avoid the need for surgery entirely. Your women's health physiotherapist can show you suitable exercises and other treatments, and suggest appropriate lifestyle changes.

If you have a prolapse 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.

Exercise After a C-Section

Getting the right balance after a C-section is extremely important. Your body needs to recover and rest is very much needed. Rest whenever you get the opportunity in the first 4-6 weeks. Whenever the baby is sleeping, forget the housework and take a nap too (and anyone who knows me personally will know that me saying forget the house work is not something to be taken lightly.)

Eventually your body will start to feel like yours again and exercise can help the healing process along. 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.

Your lower trunk will also need to be strengthened and stabilised. This includes pelvic floor muscle exercises - which should not be forgotten by any women, not just those who are post c-section. Pelvic floor exercise should be carried out at least 3 times a day. Holding a contraction for 10 seconds and doing 10 reps of these, and also doing a quick contraction with a quick release also doing 10 reps of these.

Transversus abdominal exercises are another main area to focus on, (which includes pelvic tilts).

Lie on your back with your knees bent and feet flat on the bed. Pull in your tummy and tilt your pelvis up, flattening out the lower back. Hold this position for 2-3 seconds and then slowly relax half way. Continue tilting your pelvis up and relaxing to the half way position. Aim for the movement to be slow and smooth.

If you are suffering from any 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.

Labouring with SPD: The Birth Plan

Making a birth plan is important in my opinion (even if you don't stick to it) and this is even more true if you suffer from SPD. In a midwife's ideal world there would be no pregnancy complications and everyone would deliver on their backs in stirrups, so that the midwife could maintain a good posture and control the baby easily. In many patients' ideal world they would deliver in a more upright position so gravity could help the labour and delivery along. By making a birth plan, you can consider all the different options and factors and work our what your preferred labour would look like.

If you suffer from SPD it is important before labour begins to measure how far you can open your legs in a pain free range. If your are very prepared you can buy a long piece of rope and tie it around your knees so you have the measurements of how far you are going to allow your legs to be open during the delivery, on hand. This is even more vital if you plan on having an epidural. This is because you will not feel pain while the epidural is in but will feel the pain afterwards if you have opened your legs into your pain range. With this in mind, a position that should definitely be avoided is a delivery in stirrups.

In the first stage of labour, movement and gravity play an important role. Most commonly, at this stage you are still at home, and timing your contractions. If you suffer from SPD it is still good to be walking around but not to be constantly climbing the stairs, which can often speed things along. Using the gym ball can also be good, by sitting on it and rolling your pelvis, but do ensure that your legs are not straddled too far open.

It is important to support your body in positions that are comfortable for you but to avoid straddling your legs, for example do not straddle a chair, however you can lean onto a chair or any other equipment.

In the final pushing stages there are many good options for positions. Being on your side is very good because the midwife can have good control and you can too. You can also be in a squatting position (as long as you are in pain free range). Any position where your legs are in your control and cannot be pushed open by someone else is a good position.

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.

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.

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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.

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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.