What's the difference between pelvic floor biofeedback and stimulation units?

What’s the difference between a pelvic floor biofeedback device and a stimulation machine?

There are two types of units you can use to help improve your internal muscles –  pelvic floor biofeedback devices and muscle stimulation units.

Pelvic floor Muscle Stimulation Units

These units are designed to be used at home to artificially stimulate the pelvic floor muscles to work. Electrical impulses are sent from the machine directly to the pelvic floor to mimic the messages that your brain is supposed to send. These units are ideal for people who really don’t know where their muscles are or what they are supposed to do. They are also good to use for very weak muscles that can only contract a few times before they fatigue or can only muster a very tiny amount of strength.

  • the sensations (a sort of tingly feeling) created by the electrical impulses help your brain to correctly identify the location of your pelvic floor muscles.
  • the machine will stimulate the muscles to work (contract). It is possible to change the settings to favour different parts of the muscle.
  • you can practice joining in with the machine to learn how to contract your muscles without help
  • the machine can help you to ‘hold’ a muscle contraction while you concentrate on learning to breathe and/or move at the same time
  • we usually recommend that you wait until 3 months postnatally before using a stimulation machine.

Examples of stimulation units:

To be professional, I cannot recommend a single specific product or supplier but I have aimed to narrow down the list of options for  you.  Please do read customer reviews to help you make your decision.  Remember that a specialist physiotherapist like myself has units in clinic for you to try out and borrow if you prefer to try before you buy.

  • Neurotrac Continence is a simple classic pelvic floor stimulation unit which we  have used inNeurotrac Continence is easy to use our clinic for many years.  The buttons are large and few!  It has pre-set programmes for both stress and urgency or your physiotherapist can customise it for you.  Available from Physio & Medical .  Stella is really helpful, you can phone her at 01629 735894.  She has arranged free p&p and a discount for readers £89.59 (includes periform probe) – QUOTE AS-2017 for when placing your order on the phone or use coupon code Conti2 for an online order.
  • Neen Pericalm was recently brought in by a customer.  I also found this one very easy to follow Neen Pericalm is discreet and easy to usethe instructions and set the programmes.  It is also very small and discreet.  Available from Physio & Medical .  Stella is really helpful, you can phone her at 01629 735894.  She has arranged free p&p and a discount for readers  £78.38 (includes periform probe) – QUOTE AS-2017 for when placing your order on the phone or use coupon code Neen3 for an online order.
  • Kegel 8 Mother Nuture (even though it is the cheapest one that Kegel8 offer it has all the Kegel8 Mother Nuture is also a TENS machineprogrammes you will need, plus doubles up as a TENS machine if you anticipate another delivery) £79.99. The kegel 8 Tight & Tone Electronic Pelvic Toner £98.99 looks like a re-package of the Neurotrac Continence which I have used in my clinic for many years (see above).
  • Nu-tek Levator mini continence stimulator.   Win-health  supplies our practice.  It is a Nu-tek levator minigood stimulator though the buttons and set up are a little fiddly until you understand how it works. I recommend you select the Periform probe (which has a hole in the middle rather than solid, most clients find it more comfortable).

Pelvic floor Biofeedback devices

Generally we advise that if you can already contract your pelvic floor muscles then you don’t need to do passive stimulation. The majority of women are ready to jump straight in with a biofeedback unit. Muscles develop quicker by doing ‘active’ exercises where the brain initiates the activity. When you use a biofeedback device to enhance your practice your brain is learning the skill-set that your muscles need to perform in every day life even when you are not plugged in to a machine:

  • With these units the action of your muscles contracting is relayed to a machine which “shows” you what you are doing.  There are several different ways this can be done.  Some machines pick up the electrical signal from your muscles while some respond to pressure.  Some give you a visual picture of what you are doing, others vibrate in response to your contraction.
  • These are great to correctly identify your pelvic floor muscles in different positions and ensure you are contracting correctly and also to help you focus on relaxing fully between contractions
  • to see how well your muscles contract and relax and give you targets to aim for to improve strength, endurance and co-ordination.
  • to practice more complicated tasks (mimic real life tasks)
  • to make exercising a bit more fun and interesting to help you to keep up long-term practice and awareness for your PF muscles (rather like a piece of gym-kit for your pelvic floor!)

 Examples of pelvic floor biofeedback devices:

To be professional, I cannot recommend a single specific product or supplier but I have aimed to narrow down the list of options for  you.  Please do read customer reviews to help you make your decision.  Remember that a specialist physiotherapist like myself has units in clinic for you to try out and borrow if you prefer to try before you buy.

Electrical biofeedback devices:

  • Peritone EMG biofeedback unit and Simplex EMG biofeedback unit are  the ones we have used in our clinic for many years (same device in different packaging).  They are effectively two parts.  You place a small internal electrode (called a Periform, £20, which is single person use,  into the vagina, put your clothes back on, and then link your internal device by a cable to the handheld Pelvitone or Simplex unit (we can loan one of these to you).  When you contract your pelvic floor muscles their electrical activity registers on the screen making the  lights change from orange to green and giving an audible beep.  You can practice your quick maximum power squeezes seeing how high you can make the lights go, practice keeping the lights green while you cough or try moving your arms or legs and there is also a work/rest function which ‘counts’ the endurance holds for you and tells you your average squeeze score at the end.

These devices are widely available from lots of online sellers +/- £160 (including the Periform).  Our practice is supplied by WinHealth –and  Physio & Medical (use code pelvi5 for a small additional discount) both of whom can offer a VAT exemption if the unit if for personal use for a medical problem.

Peritone Biofeedback unit

Peritone EMG biofeedback unit

Neurotrac Simplex

Neurotrac Simplex Biofeedback unit

 

Periform + is very comfortable

Periform internal device

 

 

 

 

 

  •  ELVIE.   This is a new release last year and updates the design of the traditional units above. It is becoming very popular as it has modern smart phone visuals, easy charting and they are developing a sense of community amongst users.   I have one I can show you in clinic but the internal device (the pebble) is the expensive part, and understandably single use only, so I’m afraid you can’t try before you buy.
Elvie pelvic floor tracker and app

Elvie pelvic floor tracker and app

It is a discreet, attractive, wireless bluetooth pebble
shaped device to go inside the vagina and then an app to turn your phone into the biofeedback monitor/exercise tracker.  No cables between you and the phone but you can’t put knickers back on or the bluetooth can’t connect. It is beautifully packaged and well designed by women. It can be used in the second trimester of pregnancy but is not recommended for the 1st and 3rd trimesters.   Available directly from  Elvie £150 for the pepple device,  the phone app is free.  Enter PHYSIO at the checkout for a 10% discount.

Pressure Biofeedback devices

Kegel8 pressure biofeedback

  • Kegel 8 Biofeedback Pelvic Trainer Kegel8 are not offering an electrical biofeedback unit in their products any more. They have a product  which uses a pressure system where you squeeze on a larger tube which moves a dial on the hand held unit.  Relatively unsophisticated but an inexpensive option at £79.99 including VAT.

 

  • Epi-No Delphine Plus £89.99 This is another non-electrical device, which monitors the amount of squeeze pressure you
Epi-no Delphine Plus pressure biofeedback can be used in pregnancy

Epi-no pressure biofeedback

are creating with your muscle contraction.  Though, as with the Kegel 8 Trainer, this is less sensitive than the electrical one the advantage of the Epi-No is that it is  certified for use through your whole pregnancy. It can also be used in the latter part of pregnancy (after 37 weeks) to help to stretch the vaginal opening.  Though a recent study * did not show evidence of a protective effect of the Epi-No device on birth trauma, anecdotally many women feel it has helped with their confidence to relax the vaginal opening in preparation for birth.

*Kamisan Atan I, et al. BJOG 2016  Does the Epi_No birth trainer prevent vaginal birth-related pelvic floor trauma? A multicentre prospective randomised controlled trial.

 

  • The Vibrance Pelvic Trainer  was released in the UK this January, though it has been available in Asia and USA for several years.  It is a petite internal device which vibrates when you correctly contract your pelvic floor muscles.  The device is  discreet and easy to position correctly. There are no wires and you don’t need a handheld device as the vibration is felt in the device itself.

    Vibrance personal trainer

My instinct is that this device could also be useful as a ‘bridge’ back to penetrative sex  if you were a bit nervous of what things will feel like or having trouble relaxing.  You could practice inserting the trainer at your own pace and might find the vibration element helpful to re-sensitise your tissues.   We have one available to try in our clinic (using a condom cover protocol).  They are available directly from  www.vibrancepelvictrainer.co.uk  £140.83 with VAT exemption.

This links to a digitally annotated instructional video for Vibrance PFT on youtube:https://www.youtube.com/watch?v=n8IoqefRzTU

 

Note about VAT exemption

If you have had a problem for more than 3 months you can declare yourself as having a ‘chronic medical condition’ and do not have to pay VAT. There will be a form to complete. This does not apply to the Elvie which is registered as an exercise tracker not a medical device. Not all the online suppliers can offer this service.

Combined Stim & Biofeedback Machines

You can also buy combined units which do both functions but these are surprisingly expensive (and a bit fiddly) so if you feel you need both systems I usually suggest you buy two separate simpler units and switch between them.

Lubricating gel

You will need a water-based lubricating gel to help the insertion of the devices and it is essential to help the electrical devices to operate correctly. A simple, in-expensive, chemist-own or basic brand name  is all you need unless you  have concerns about ingredients and prefer an organic version.   Do read my posts about the difference between water-based and oil-based lubricating products.

Where to start?  

If you are not too sure how good your muscles are then my role at physiotherapy is to do an internal assessment of your pelvic floor muscles to check how well they are working and teach you how to get the best from them. We can loan you both muscle stimulation and biofeedback units to try out at home to see how well they work for you before you consider buying your own. It is particularly important to consider an individual assessment by a specialist physiotherapist if you are at all worried that your pelvic floor muscles might be too tight rather than too weak.

I can also teach you exercises , which require no equipment at all (!) to get your muscles to the best possible condition. I usually combine pelvic floor exercises with appropriate abdominal muscle work as these two areas need to work well together for best support of our internal organs.

Please don’t hesitate to be in touch if you have further questions.

Pilates spine curl vs traditional bridge – what’s the difference?

Spot the difference?

They look the same – bottom in the air – but the difference is how you get there.  If you are not sure about the difference between a classic bridge and a Pilates spine curl then do read on….

How a traditional bridge works

The traditional ‘bridge’ exercise has been around for years, taught as an exercise for the bottom muscles (officially gluteals, or buttOCKS as my Danish colleague  used to say) .  Most people also give a good push on their hands and feet.  If you tune in you will  feel it is a good  task for a bottom work out.   The usual cheat or incorrect technique for a bridge is to misfire and activate hamstrings, getting back of thigh cramp and missing the gluts workout altogether.

Try one now and notice how your spine behaves during a bridge?  Usually as quite an inflexible rod?  It just goes up and down in either one big piece or two sizeable chunks…bend at the waist – up.  This is because all the down pressure on the hands and feet makes you activate your back muscles, the erector spinae.  These little muscles overlap each other from one spine segment to the next.  This creates the effect of ‘stiffening’ the spine to make it solid and lets it behave as one rod-like piece.

How a Pilates spine curl is different

A Pilates spine curl uses a completely different technique to raise the body up.  You drive the movement by  drawing up through the pelvic floor and abdominal muscles (on the front of your body), allowing the spine muscles (on the back) to relax, letting the spine become fully flexible  (33 bones connected by elastic).  The spine should roll through its length.  The first movements occurring at the coccyx, then tilting back onto the sacrum, pressing through the back of the pelvic bones, then the movement travels past the waist, onto the lower ribs, aiming to come to a stop with your weight resting through your shoulder blade area (not your neck).  Hold the position for a couple of breaths.   Use the same technique in reverse to come back down.  Have a breath in, then as you breathe out, keep your strength and control through your front abdominal wall to allow yourself to pay out your spine slowly……..take as many breaths as you need….. to let the ribs soften onto the floor,then  roll down towards your waist area.  You may have to really focus to ‘land’ the waist and last few bones of the spine before the pelvis.  Try to land both sides of the pelvis together.  Then make sure you finish the movement properly by allowing the sacrum and coccyx to fully sink to their resting positions and then very last of all release the abdominal and pelvic floor muscles.  Breathe.  Repeat.

Physiotherapy advice

I recommend 6 repetitions on the floor beside the bed before you climb in for the night.  Get into bed with all the tensions and asymmetries of the day corrected.  A flexible body will mould to the mattress beautifully and not keep you awake fidgeting.  If you go to bed straight and aligned you have a much better chance of starting the next day in a good place.

 Let me know, in the comments section below, if this technique check was helpful to you and which other exercises you would like help with?

3 Tips to control abdominal doming in tabletop position

Take care you are not training a pot belly

Do you have a suspicion that each time you bring that second leg up into tabletop position you get  an abdominal bulge or doming?

As tabletop legs is the starting position and foundation for so many of the advanced pilates and core exercises it is absolutely essential to master the art of getting in and out of the position without doming the abdomen.  Otherwise, if each time you move up into position you bulge or dome – what is it that you are actually training?  It could be a  pot belly.

Done well, tabletop legs will help correct a divarification

This is a really important technique to master if you want to correct a divarification and protect your pelvic floor.

It is a hard challenge to get right –  but so satisfying when you do.  You will know when you have got it  because suddenly the whole action feels weightless and even effortless,  the pelvic floor area feels included and the back feels safe and relaxed. And it makes you want to smile!

Tip 1: put your feet on a step.  Practice during the week at home with your feet on a small step (eg child’s step).  This slightly flattens the neutral spine and means  you ‘start’ 1/3 of the way into the leg lift.  This allows you to experience the ‘correct’ feeling over and over again until your brain is happy with the sensation of not needing to ‘flick’.  Then take it down to a phone-book height and last of all back to floor level.

Tip 2:  go onto tip toe first.  Sneaky little manoevre (but a better cheat than ‘the bulge’).  First leg up, then move onto the tip toe of the second leg before you try to lift it.  Your brain will feel the sense of the weight to come and make some subtle core adjustments to half prepare you so that the full lift will be easier.

Tip 3:  you get what you think about!   I say this over and over again because it is so true!  So here is my, as usual bit out the box, visualisation.

 Boats on a beach

Visualisation to help get legs up into tabletop without a bulge

You are on a pebble beach that slopes down to the water.  Think of the first leg coming up as a light-weight rubber dingy which you have to pull by its rope up the beach.  All it takes is a light tug and up it comes.  Now take the rope of the second boat – a big speed boat – much more unwieldy – if you just tug that rope you are not going anywhere  – you will just get a jolt – so rather take up the slack, lean into the rope, let the tension build and build below the surface, until the boat ‘wants’ to come up the beach, then once you have got that initial momentum started – you’re off!

Are you more of a visual learner?  Here is my first ever video, showing the 3 tips.  Even a Playmobil boat (and dog) to help with the visualisation.

Did this post help you?  Please let me know in the comments below if any of these tips worked for you?  Or do you have a trick yourself that would inspire or help others?  Your comments give me ideas what to write about next.  Thank you.

First Aid for sore bottoms – use my RESCue remedy

GIVING BIRTH CREATES A SOFT TISSUE INJURY –  TO THE PELVIC FLOOR

football-619243_1920

Look after your stretched pelvic floor tissues just like a football injury

The pelvic floor needs the same love, care and attention in the first hours, days and weeks after delivery as any other injury would.  As the first aider rushes to the side of the pitch with bags of ice, everyone knows there are proven first aid methods to encourage optimum healing  and reduce complications.  And pitch-side alone is not enough, be sure that a footballer has good instructions and support for the next few weeks to get back to normal walking again before progressive rehab to full on training. Bet everyone is really nice to him as he hops around on his crutches!

FIRST AID FOR SPORTS INJURIES – COPY AND REPEAT FOR PELVIC FLOOR

In sport there is  a snappy acronym to help  remember the routine RICE: Rest-Ice-Compression-Elevation. I have coined my own:

RESCUE  REST – SOOTHE – ELEVATE – CUE

Keep this process in mind in the early days postnatally ’RESCue  Rest-Soothe-Elevate-Cue to help you love and nurse your bottom back to health quickly:

R IS FOR REST

Rest.  This means watching out for the way that if you are on your feet too long  swelling and congestion will pool in the perineal area making you feel achy, sore and bizarrely irritable.  It won’t be sore enough (unfortunately) to make you realise why you feel out of sorts and grumpy but you will find yourself fidgeting and wishing everyone would go home so that you can sit down and take the pressure off.

E Is FOR ELEVATION

Elevate   If you can get your bottom higher than your heart the swelling will be drained back into your lymph system.  Just 10 minutes with the weight off and elevation can make you feel like a new person.

Lie on your back on the sofa with a pillow under your bottom and your feet up on the arm rest while you have a baby (or toddler) cuddle or phone a friend.

S IS FOR SOOTHE

Soothe  cold  usually feels wonderful against hot, bruised tissues.  The principle is that cooling the area increases blood flow (skin will go pink as the blood vessels dilate).  The cold is soothing but the opening of the blood vessels is then best used to help drain the swelling with pulsing of the pelvic floor. 

CUEYOUR PELVIC FLOOR

Cue the pelvic floor.  In the early days of healing don’t be frightened off by the idea of having to do hundreds of pelvic floor exercises every day.  ‘Training’ your pelvic floor comes later (and I am a great believer in quality over quantity anyway).  In these first few weeks the priority is to get the swelling down to make you feel comfortable and to cue the muscles to remind them what to do and how to work.  Imagine a cut in your hand.  After a few hours of being still and guarding the hand your fingers will close in and the palm become stiff with swelling.  You would need to concentrate on gently flexing and opening the palm to ease the stiffness – the first few times it would be a bit sore and and you would be nervous but with a few repetitions it would start to feel better for the exercise.  Exactly the same with your pelvic floor.

Download the free booklet  “Fit for the Future” published by the Professional Network of Pelvic, Obstetric and Gynaecological Physiotherapists for clear instructions on pelvic floor exercises.

Let me know if you have success with this approach – and any other tips you might have to share with other new mums?

Can Pilates strengthen the pelvic floor?

If you already know how to work your pelvic floor effectively, then yes, definitely, Pilates can help strengthen the pelvic floor.   As both a specialist pelvic floor physiotherapist and an experienced Pilates Instructor this is my area of expertise and I have made a video of my favorite pelvic floor friendly pilates exercises (see below)..

BUT, if your pelvic floor muscles are weak, or ‘switched off’ when you are doing pilates (so they could be perfectly good muscles but your brain is not telling them to work) then you could happily do an entire Pilates class with relatively little impact on the muscles at all. 

Without a proper pelvic floor contraction, challenging Pilates exercises (or aerobics or gym work) might be working you hard, but you will not be getting the proper benefit, and you could even risk making your problems worse by stretching the pelvic floor rather than strengthening it.    So if you have any worries that your pelvic floor is not quite what it should be, do make sure you get your GP to refer you to a Specialist Physiotherapist to get your technique checked before you do too much more with an unprotected pelvic floor.

Video: Pilates for your pelvic floor

In this video I have chosen pilates exercises that my clients find help them particularly focus on the pelvic floor.  I give you lots of extra cues to keep you thinking about the muscles even while you think about your breathing, your abdominals and which way to move your arms and legs!  Pilates done well is a real ‘brain exercise’ too!

Below you can view a (silent!) trailer, then CLICK HERE  to view the full video at pactster.com.  Use my code AmandaPostnatal to view any Pactster video for free for a month.

SPECIALIST PELVIC FLOOR PHYSIOTHERAPY

There is so much that a specialist pelvic floor physiotherapist can teach you to improve internal muscle strength, endurance and co-ordination.  Through post-graduate training we have the skill to properly assess and examine the pelvic floor muscles with a vaginal examination.  We do this in a kind and gentle way putting you as much at ease as we can and aiming to help you understand how they work.  Once, together, we have a better understanding of where your muscles are at presently, we can then show you how to help them to grow and improve your skill at using them to prevent incontinence and improve internal organ support.  It’s not just up/down squeezes!  We have lots of different ways to the standard exercises you may have already tried! To encourage proper muscle activation we have tricks & tips, more advanced and interesting exercises, even great gadgets that can show you what you are doing and help your muscles work.  

Specialist physiotherapists have passed exams to become full members of the Professional Network of Pelvic, Obstetric and Gynaecological Physiotherapy (POGP).    Ask your GP to refer you to the local NHS services (if you are Cambridge-based you can self-refer) or do come to see me at my practice (South Cambridge Physiotherapy).  

Was this post helpful to you?  Please do let me know in the comments section below.  Your feedback inspires me and others, and helps me to think about what to write next.

morning back stiffness? stretch and relax video by Amanda Savage

More granny than gazelle?

MORNING BACK STIFFNESS?

Do you wake with back stiffness, feeling rather like an old lady; starting the day with contorting stretches just to feel normal? Do you find that you struggle to get comfortable in bed at night?

The natural instinct is to try morning stretches to loosen and get going.  If this is working for you please don’t stop – but if it seems rather laborious and more like patching the problem each day rather than solving it – try for the week ahead doing some Pilates spine curls and streches before you go to bed.

WHY DO EXERCISES BEFORE GOING TO BED?

This has been a successful tactic for lots of my patients in clinic with niggly morning back stiffness. 

My theory is that by the end of a normal day of lifting, carrying, sitting, driving, and walking, the majority of people have lost pelvic alignment and their spines have resorted to stiffening the back muscles to keep us upright.  If you go to bed with a rigid lower back and asymmetrical pelvis then you are going to find a soft mattress uncomfortable as it distorts your shape further.  Furthermore,  you will eventually fall asleep but on a poorly arranged spine.  It won’t hurt when you are sleeping but it will complain as you start to move again next day.    

Mini-experiment:  You can feel this effect right now.  Try leaning your hand on the table or chair beside you so that your palm is flat with your wrist at 90 degrees.  It won’t hurt while you lean on it.  If you were distracted chatting to someone you could lean like this for a couple of minutes and not even think about it.  But when you release the pressure off your hand it will ache across the wrist joint and feel uncomfortable for a good minute or two before it wears off.  A night’s sleep on a stiff or crooked spinal column is a magnified version of this.

VIDEO: 10 minutes stretch and relax.

Below is a (silent!) trailer, to watch the video in full CLICK HERE.  Use my code ASpostnatal to access all the videos on Pactster free for a month.

Even if you don’t do the video try 6 Pilates spine curls, on the floor (the mattress will be too soft), before you go to bed this week and let me know how you get on?  And if you have any other tips for  waking with the suppleness of a young gazelle please do share below.

Your perineum after brith needs the same care as an ankle strain - advice from specialist physiotherapist Amanda Savage

Your perineum after birth – the same as a bad ankle strain….without the sympathy

A NASTY ANKLE SPRAIN AND THEN RUN HOME………

Imagine the state of your ankle if you fell on an uneven pavement, gave it a nasty twist and then still had to run home – you wouldn’t be at all surprised to be looking at a hot, red, swollen, bruised and very tender foot and ankle?  Add a cut and some stitches and you would feel very sorry for it.

Because everyone can see the damage you would be lavished with care and attention: crutches to keep the weight off; leg up when you sit down to reduce swelling; tubigrip; icepacks; exercises to keep it stiffening up and plenty of willing helpers to let you take it easy for a good few days.

Everyone knows that you have to nurse and care for an injury to help healing to take place successfully, to avoid complications and to get back to normal walking again as quickly as possible.

WE NEED TO CARE FOR BRUISED SORE VAGINAS TOO

During birth the perineum (the skin and tissues surrounding the opening of the vagina) experiences a traumatic stretch and strain.  Clinically this is termed a soft tissue injury.  It would be great to care for the perineum in the first weeks of motherhood with a similar respect for the healing process.

Unfortunately, things are stacked against the love and attention needed, apart from the obvious distraction of a beautiful, demanding newborn:

  • you are high on the  birth experience so your own bottom is low on your agenda
  • nobody can see your sore bits and you don’t limp so there is no outside sign that you are injured
  • you can’t (wouldn’t?!) exactly discuss your sore bits with many people
  • most of the time you are sitting on the sore part to feed which makes it go numb
  • mothers are incredibly stoic people and don’t complain
  • it’s hard to know what’s ‘normal’ so there is a tendency to just battle on

In these posts I have pulled together  tips and tricks to guide you how to care for your perineum from day one until it is all feeling better again.  Don’t hesitate to ask if you want clarification or think of something that I have left out that would be useful for other new mums to  know?

Who’s looking after the chicken?

KEEPING THE MOTHER CHICKEN HEALTHY IS IMPORTANT

In the early days of a newborn baby there is an awful lot to think about for the newly hatched egg.  However, don’t forget,  every day, to stop and think about the chicken.   Who is going to look after the egg properly if the chicken is tired, weak, undernourished and sore?

For a truly happy family, new mothers, and especially their recently wonderfully used bodies need some love and attention too.

CHICKEN-CARE #1

Take the baby out in the pram for a pacy 20 minute walk.  Breathe deeply, stand tall and hold your tummy in.  Walk so that you hear your heels clicking (this makes your bottom muscles pert), and go fast enough that you couldn’t talk.   Baby exposed to sunlight to help regulate their sleep cycles – tick.  Posture and core muscles woken up – tick.  Cardio-vascular exercise – tick!

Do you respect your body and your own needs?  What did you do today for yourself?  What could you do to feel stronger and fitter?  

Sore bottom? Try a hard chair. Professional physio advice after birth

Sore bottom? Try a hard chair

HARD CHAIR?  HAVE YOU SEEN MY STITCHES!?!@##%

If you are nursing a tender bruised perineum after your childbirth heroics that doesn’t seem the kindest option does it?  But actually soft cushions or the sofa may press up against the sore area more than you would think, as they mould in around you. This can restrict the blood and lymphatic flow to the tissues.  It will all feel a bit numb after a while as you sit there but can feel very sore and achey when you stand up again.  Definitely NOT a ring cushion – an old fashioned solution – as they pull all your weight and pressure down into the centre just where you hurt the most.

My midwife was insistent that I sat on a kitchen chair to breastfeed to improve my posture.  I was still spectacularly unsuccessful at breastfeeding  but the positive outcome was that I noticed I didn’t ache so much in my undercarriage when my marathon feeding stint finished.

A harder surface and more upright chair works because you  take more weight through your feet and ‘sitting bones’ keeping pressure off the perineum and coccyx.  This stops the soft tissues and their blood supply from being squashed and lets air flow under.

For something in-between squishy sofa and hard kitchen chair you can hire or buy a Valley Cushion.  These are cleverly designed with an adjustable inflatable cushion on each side with a ‘valley’ down the middle.

When I worked in the hospital the valley cushions were always in hot demand.  If we ran out we had a rather ingenious hack: for an immediate DIY, or a subtle ‘out and about’ solution fold two matching hand towels into square blocks.  Put one under each bottom cheek leaving the perineum a few centimetres blissfully airborne in the middle.  Try it and smile as you find pressure relief!

If you have a long slow feeder or suffered with a good deal of stitches to the vagina or anal area, or are coping with piles,  you will be grateful for improved comfort for several weeks ahead.  Mother hens, be kind to your body & treat yourself to the real deal.  You can buy or hire a VALLEY® cushion direct from the manufacturer but also through contact your local NCT branch to hire a VALLEY cushion, ensuring fundraising for that excellent charity in the process.

How did you cope with a sore bottom and feeding?  If you have any tips to help other mums, please comment below.

Why do tampons go sideways? Amanda Savage, specialist physio, explains

Why do tampons go sideways?

Have you ever had the experience of an uncomfortable tampon or one that looks as though only the side half of it has absorbed anything? So annoying.  Why do tampons go sideways?

A BIT OF VAGINA ANATOMY

The vagina inside is surprisingly wide and stretchy, leaving plenty of room for things to move about.  In our heads I think we picture it as a narrow tube rather like a hosepipe but actually, though narrow at the opening, inside it is quite a decent tubular space – it has to be to let a babies head out without damage to the vagina itself. 

why do tampons go sideways?

the vagina is shaped like a squashed tube

Imagine a  tube that has been squashed. This shape means that we are narrow top to bottom (termed anterior to posterior in medical terms) but have plenty of room side to side.  This is just like the shape of a mouth.  Even open wide the mouth has a surprisingly small opening top to bottom but plenty of room side to side, in the cheeks.

Keeping with the mouth analogy, at the back of your mouth you have an epiglottis dangling down, at the back of the vagina tunnel the cervix dangles down; more like the size and shape of a nose. The cervix is pretty solid and though it pushes up out of the way during sex, it is quite easy to end up with a tampon nudging against it.

You will recognise this sensation, though you might not have realised what it was.  Have you ever put a tampon in and then barely 5 minutes later you have an overwhelming desire to pull it back out ?  It is just not right, or downright uncomfortable, almost as if your body is rejecting it?  The cervix is the only bit inside with decent nerve endings  (so if you knock it during sex it you might get a short sharp mild pain) but if a tampon is pressing on it relentlessly you get this strong urge to bear down and feel that the tampon is pushing out.  Or alternatively the tampon itself comes up against the cervix as you insert it and as you keep pushing it tilts off sideways into the ‘cheek’ area giving you inadequate protection and that ‘half used’ look when you remove it.

TIPS TO GET TAMPONS IN THE RIGHT PLACE

  • Don’t rush the process (mums!   you know you do)
  • Visualise what you are doing.  Keep contact with the back wall of the vagina (the bowel side) as you are putting the tampon in and it will end up underneath the cervix rather than on it.  Aim for your back passage.
  • Not all tampons are the same – some types expand widthways but others expand lengthways so they can effectively push themselves out as they become elongated when full. If you can’t picture what yours do, drop one  in water and see what shape it becomes.
  • Applicator tampons give you a bit more option to position the tampon before you let go – nice to use for the beginnings and ends of periods when the vagina is a bit drier and less easy to slide tampons in
  • Pop a dab of lubricant (water-based) on the end of the tampon to help it slide in more easily
  • If you feel your cervix is sitting very low since your baby try using a menstrual cup (like a MoonCup) instead of tampons – these are designed to sit closer to the opening of the vagina rather than deep inside (more like the position of a cork in a bottle).

How have you got on with returning to having periods and using tampons and sanitary pads?  Any questions?