Compiled by our Senior and Women's Health Physiotherapist Michelle Gall.
Stress incontinence is probably the most well-known of the pelvic floor disorders; it is defined by the International Continence Society as “involuntary loss of urine on effort or physical exertion, or on sneezing or coughing”. Many women may know it as leakage of urine when you laugh, cough, run, jump or even pick up your kids.
When you do any of these activities above there is an increase in the pressure inside your abdomen causing increased in force pressing on your bladder. To counteract the force on the bladder there needs to be enough ‘closing pressure’ at the urethra which is the exit tube from the bladder. Leakage occurs when the urethral closing pressure cannot stay high enough during increases in intra-abdominal pressure such as when you cough.
The pelvic floor muscles play a significant part in keeping the urethra closed at these times of increased pressure. It does this by providing a lifting action to the bladder and bracing the firm fascia that sits behind the urethra to keep it closed. A strong pelvic floor will cause the front of the urethra to be squeezed shut against the strong wall of pelvic floor behind it when the increased pressure hits. Imagine stepping on a hose and the hose is squeezed closed against the firm ground underneath it and the water stream is stopped. A poor functioning pelvic floor would be like standing on a hose that was sitting on a trampoline…
A full assessment of the pelvic floor can identify not only general muscle weakness (ie can you get a contraction at all), but also the co-ordination and timing ability of the muscles to contract when there is increased pressure (ie. during a cough or laugh). Research has shown that up to 50% of Women perform a pelvic floor contraction incorrectly if they are only given verbal cues. An internal pelvic floor examination is used so the therapist can ensure a correct and effective pelvic floor contraction can be achieved.
Following this assessment, an individualised pelvic floor retraining programme can be commenced. In the case of stress incontinence learning a technique called ‘The Knack’ is also an important component of the treatment; this is the ability to hold the contraction during times of increased pressure.
A review of relevant research in 2010 concluded that supervised pelvic floor muscle training is recommended as the first-line conservative management for urinary incontinence with many women reporting they were cured or improved and had better quality of life.
So if you have come to accept a bit of a leak when you lift your little one as just ‘one of those things that comes with having children then think again, it is very much one of those things that your physio can help with!
When you consider it takes up to 40 weeks or more to create a tiny human, you would think mothers would relax and give their bodies time to restore. Instead, according to a 2014 survey of 1,500 women in the United Kingdom, 40 per cent of new mums feel pressured into losing weight quickly. A 2015 study by the American journal Obstetrics & Gynecology found that 75 per cent of women don't achieve their pre-baby weight one year post-birth, while UK-based research revealed it takes an average of 19 months to get close to pre-pregnancy weight.
In my experience I see a huge number of women who have returned to exercise too soon, and too intensively - meaning they've come to see me with aches and strains on their pelvic floor function. Mothers must remember that you have just performed one of the most incredible things – developing and giving birth to a tiny human. Time and patience are vital.
Respect for the healing process is key. If you had an uncomplicated, natural delivery, you might feel tender for five weeks or more, and it is advisable to wait until your six-week, post-partum check-up before returning to gentle exercise. A caesarean section can require six to 12 weeks' recovery, depending on your body, and you should always wait for the green light from your doctor before starting any physical activity.
After six weeks for a natural delivery or eight to 10 weeks for caesarean section, you can start gentle low-impact exercise, such as cycling, cross trainer, Pilates, yoga and light weights. Avoid high-impact exercise such as running and aerobics until four to six months after giving birth. Exercise on your hands and knees or in bridge position should also wait until after six weeks.
Consider the first three months after birth as the 'fourth trimester' – a time of rest, recovery and irreplaceable moments with your newborn. Eat to nourish your body rather than trying to lose weight and under no circumstances try diet pills, liquid diets or other weight-loss products, which can be harmful to you and your baby if you are breastfeeding.
Blood lost during and after delivery can also lead to iron deficiency, which exacerbates the chronic fatigue that new mothers often experience. Fill up on iron-rich food such as free-range, grass-fed organic beef, dark green, leafy vegetables and dark beans such as kidney or aduki beans, and avoid too many raw foods (unless in easily digestible green juice or smoothie form) as these require more energy to process.
Breastfeeding mums who are tempted to cut calories to lose weight should also be aware that you need, in general, up to 500 more calories a day to support the process. Lactogenic foods can help with milk supply issues, try consuming things like moringa [add to smoothies to help mask the taste], oatmeal, brewer's yeast, salmon and fenugreek seeds.
I recommend booking in for a Women's Health physio appointment after your six week check-up. At this appointment we can check your pelvic floor function, discuss any developing aches and pains, discuss specific exercises for you to do/avoid, and give you some general piece of mind over your body changes.
We also have a number of specialty pre / post natal pilates classes. These group sessions are tailored for individual abilities and allow you to exercise safely and encourage movement through your body. To join a pregnancy, or mums & bubs class we do require you to have a 1-1 prep session first just to make sure you're not in any pain, and to identify any potential complications.
Our reception team is happy to discuss with you your best options and to assist with booking. 093664480 or [email protected]
If you’re in doubt, it’s probably best to see a physiotherapist first. Massage is a maintenance and self care tool, but it might not get to the reason behind why you feel an area needs some attention. If an area feels stiff or sore, seeing the physio will allow them to assess and diagnose the issue, and figure out if massage is appropriate. Often people can jump into a massage a bit too early, and end up making their issue worse.
Once your issue is stable and safe, then asking your physio if you're ready to see a massage therapist can really help with longer term maintenance. It’s often a nice reward for a job well done after a month of diligent rehab. As with all hands on treatment, remember that the massage is a cherry on the top of your plan, the bulk of your management should be homework!
Absolutely, there’s a reason that they are such a staple in so many different fitness environments. One big reason why massage, manipulation and other types of manual therapy get criticised is that you don’t want to build too much of a dependence on other people to manage your aches and niggles, so foam rollers allow you to take some of that power into your own hands.
Massage in some form or another has been used in sport and exercise at least as far back as the Roman gladiators, and for good reason. Self massage with foam rollers can be used to improve recovery times after workouts, to lengthen restricted muscles and even to copy the “cracking” or “pops” that you get to free up a stiff spine. Similar to other types of exercise kit, if you’re not already comfortable with foam rollers, make sure that you check in with a physiotherapist or good personal trainer to show you a few techniques before you bring them into your weekly routine.
Pilates may sound intimidating, but it's actually the most accessible way to build strength and mobility for better posture, balance and flexibility.
If you’ve wanted to try Pilates but something has been holding you back, now’s your time to sign up. Pilates offers plenty of benefits, no matter your fitness background. The technique cultivates body awareness to support everyday movements that are efficient and easeful.
Pilates is a full-body exercise method that consists of low-impact exercises on a Mat, Reformer, Cadillac or Chair. With equipments system of pulleys and springs, handles and straps - the apparatus can provide either resistance or support depending on your needs. You can do Pilates with or without equipment, but no matter what, expect the moves to involve slow, precise movements and breath control. The method emphasises core strength, proper postural alignment and muscle balance.
Pilates is named after its creator, Joseph Pilates, who developed the method in the 1920s. Joseph Pilates believed mental and physical health were closely connected.
A Pilates routine generally includes low-impact flexibility and muscular strength and endurance movements. Exercises aim to promote proper posture and movement patterns as well as balance, flexibility and strength.
Pilates has something to offer people of all ages from beginners to athletes. There are countless ways to modify and adapt Pilates exercises, depending on your age, physical ability, and level of fitness. The exercises are designed with modifications so that people of all levels and abilities can stay safe while being physically challenged.
We love getting people moving. We offer a variety of Pilates classes morning, noon and night out of our boutique Newmarket clinic. This includes mat, equipment classes, and specialty classes for pregnancy and post-natal. We keep the classes small to make sure everyone is completing the exercises safely and effectively. The classes are suitable for all levels as the instructor will provide variations on the exercises to suit your level.
We have experienced Physiotherapists and Pilates Teacher taking the classes so you can find the right class for you. We ask everyone that joins the classes to have a 45 minute 1-1 session prior to starting. Here you will discuss your goals and what you want to achieve. You will be shown how to find your neutral spine, how to engage your pelvic floor and deep abdominals, along with a few basic moves. You will then start a graduated Pilates exercise program that is individualised to your body and needs. Depending on your experience we may advise that you have at least 2-3 one-on-one sessions with a Physiotherapist or Pilates Teacher before proceeding on to a class.
It was once said by the US Chief Medical Officer that if exercise was a pill it would be a billion dollar industry. This is not an understatement, physical activity really is the equivalent of a wonder drug, and without the negative side effects of many of its pharmaceutical counterparts. Exercise has been demonstrated to have positive impacts on multiple body systems including the cardiovascular, gastrointestinal, musculoskeletal and neurological system.
Cardiovascular - Regular physical activity increases the efficiency of the specialised heart muscle allowing it to pump oxygenated blood to all your body tissues easier. Regular physical activity also leads to increased lung capacity, increased number of functioning alveoli in which gas exchange occurs and improved strength of respiratory muscle including the diaphragm and intercostal muscles. All this allows for improved function of the cardiorespiratory system and increased cardiovascular fitness.
Musculoskeletal - Regular physical activity can have positive impacts on various soft tissues including bone, muscle, ligament and tendon. Increased mechanical stress on soft tissue causes cells within these tissues to increase production of collagen leading to increased tensile strength of these tissues. This process is known as mechanotherapy and can be used to explain why tissues increase strength in response to mechanical load and why exercise prescription is such a key part of a rehabilitation program with a physiotherapist. Likewise gradual increase in mechanical loading can increase bone density so long as sufficient opportunity is allowed for rest and bone cell production in between loading cycles. In relation to muscle regular exercise provides a training stimulus which leads to an increase in the ability of the nervous system to recruit more muscle cells to provide a contraction, leading to increased strength. An increase in muscle size (hypertrophy) is due to increase in muscle cell size following repeated bouts of exercise, followed by sufficient rest.
Neurological - Physical activity has been associated with reduced risk of alzheimer's, dementia and improved cognitive function, likely due to improved vascular supply to brain tissue. Regular physical activity is also associated with improved mental health and reduced rates of anxiety and depression. Exercise leads to the release of various endorphins and neurotransmitter chemicals responsible for improving mood and reducing pain. In addition to the likely hormonal and chemical contribution to improved mental health with exercise, it can also improve self-efficacy and provides opportunity for social interaction with others, a factor which is important in managing mental health. Exercise also has been demonstrated to regulate appetite and sleep pattern.
Given the range of body systems on which exercise helps the human body it is not surprising that it has been shown to help in the management of various medical conditions such as obesity, Type II diabetes, stroke, cardiovascular disease, anxiety and depression in addition to a variety of musculoskeletal conditions such as arthritis, spinal pain and tendon issues to name a few.
Recommendations for exercise:
The World Health Organisation (WHO) are the global experts in managing the health of humanity. Given that lack of physical activity and preventable health conditions is seen as a crisis by the WHO, it's not surprising that in 2020 they reviewed their guidelines for physical activity. For adults aged 18-64, at least 150–300 minutes of moderate-intensity aerobic physical activity are recommended weekly or 75–150 minutes of vigorous-intensity aerobic physical activity. In addition to this, adults should also do muscle-strengthening activities that involve all major muscle groups on 2 or more days a week.
Timeframes:
Research shows that it takes on average 66 days to create a new habit forming behaviour, although this number varies widely between individuals (see here). Furthermore, in terms of fitness, after 2-4 weeks people start noticing changes in their strength and fitness when exercising. However, changes in body composition and muscle size more often take 12 weeks on average.
So, if you stick past the first month then your strength and fitness should improve, stick past the 2nd month and the exercise should become a habit. Once things are a habit they become a lot easier to maintain as part of managing our long-term health.
Type of exercise:
There are no suggestions for specific types of exercise. The key is finding something you enjoy and can stick to to make it a habit and part of your life in order to prolong and manage your health throughout your life. Get creative, do what you love! If you don't know where to start or are nervous, get myself or any of the physiotherapists or personal trainers at Auckland physiotherapy to help you. We also offer pilates classes which keep you healthy and moving and are fun at the same time. Win, win!
