Compiled by our Senior and Women's Health Physiotherapist Michelle Gall.


What is Stress Incontinence?

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.  

What causes Stress Incontinence?

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…

How can physiotherapy help?

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 admin@aucklandphysiotherapy.co.nz

Do foam rollers work?

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.

Intro To The Pilates Method

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.

What is Pilates?

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.

What are the Benefits?

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.

Who is Pilates for?

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.

Pilates at Auckland Physiotherapy

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.

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