How much should you drink in a day?

How much should you drink in a day? and How do you decide when to have a wee?

question mark

Why are some questions so full of angst?

Really, these two questions shouldn’t cause so much trouble – but they do

Other health and hygiene questions are easy:  How often should you clean your teeth?   Wash your body?  Change your pants?     Others  are more debatable but fortunately probably not so important: pyjamas or naked?  Knickers on or off at night (I hear Americans definitely do, Brits more variable)? Deodrant or au natural?

These two bladder questions – How much should you drink? and When should you wee? are full of issues

Frequently asked questions

Does how much you drink cover just water or all your drinks?  Are tea and coffee drinks?  What about the milk in your cereal?  Is it different if you are taller/smaller, fatter/thinner or breastfeeding?  Is it better  to have a few big drinks or sip from a bottle all day?  Should we wee when we first feel it or when we are busting?  Is it ok to hang on……..but how long is hanging on for too long?  Is it normal to wee in the night?   Is it ok to have just a tiny wee before you go out the door?   ………

So this article is a two-parter as one influences the other – first what’s the normal IN and then normal OUT ? Then based on that maths how do you know when to go for a wee?  There will be an extra part 3 to consider what’s different when you are pregnant…..

What should go IN and how much should come OUT – the quick version

If you want to cut to the chase, get The Facts, here is a summary of  government/other guidelines and generally agreed wisdom on the subject:

A Quick Summary of daily IN:

Fluid intake:  normal fluid intake should be 1.5 to 2 litres in a 24 hour period.

This is ALL fluids added up together (tea, coffee, water, juices, alcohol). Don’t count the milk in your cereal but if you have soup for lunch, jelly to follow and smoothies to drink you might want to be aware of their impact on the total volume.   If you are breastfeeding or doing sweaty exercise you may need an extra glass here and there to replace lost fluid but unless you sweat profusely or produce gallons of breast milk – this is not nearly as much as you think. 

MOST IMPORTANT:    It is NOT 2 litres of water on top of all your other drinks

1.5-2 litres equates to 6-8 standard 250ml mugs a day, or 4 x 500ml water bottles.

Drinks should be evenly spaced at approx 2 hour intervals, with the last proper drink 2 hours before bedtime (ideally non-caffeine), just sips thereafter. 

And based on this volume IN

A quick summary of the daily OUT routine

          • One wee in the middle of the night is considered normal 
          • On waking up expect a BIG wee  (400-600ml) – you could possibly fill a pint glass
          • Then through the day expect 5-6 average wees (200-400ml) – each one could fill a big mug
            • You do not need to wait until you are bursting to empty your bladder.
            • Aim to empty when your bladder holds a good mug-full.
            • Little ‘yogurt pot’ wees should be avoided.

How much should you drink?  – the long version

If you read this blog regularly, you will know that I Do Like a Bit of Detail and if you do too, I like you already and am very pleased to have you here.

If we talk through the look of a ‘normal’ day, in an untroubled bladder world,  it will help your brain to understand how it all should work.  If you have been having trouble regulating your bladder, suffering with mad dashes to the loo, uncomfortable and inconvenient urges and even bladder accidents, this will really help.  Experience has shown me that if your brain ‘gets it’, you will instinctively make some useful changes and then often there is very little left to do to sort most of this particular problem out.

It is best to take an ‘organised approach’ to when to fill & empty the bladder

First to think about, normal fluid intake is maximum 2000ml ( = 2 litres = 4pints) per day. If you are not a particularly big person, rather go for 1500ml. 

a cup is 250ml

A standard mug is 250ml

If you work on a standard mug or glass (of tea, coffee, water etc) being 250ml then people are often surprised to realise that this is no more than 8 mugs/glasses in 24 hours.

The bladder prefers regular and spaced filling intervals rather than droughts or floods. Though the bottled­ water companies would like to persuade us differently, it is not normal to be constantly sipping water.  A drink every couple of hours should rather nicely lead to needing a wee every couple of hours. 

  • If you look at your wee when it comes out it should be pale yellow.  If it looks like water you are drinking too much, if it is dark yellow you are not drinking enough.
  • Drink every half an hour ? Guess what…you are going to need to wee every half an hour…
  • If 2 litres IN gives you 5-6 wees out – then if you are drinking 4 litres a day, simple maths says that’s either going to be about 12 wees or 6 very very full bursting ones – highly likely to be accompanied by some unpleasant sensations or not quite making it!  Cut back on the volume (to 2 litres a day) and you could get an instantly happier bladder

Monitor your fluid intake carefully for a few days. Your ‘bladder’ problem could be merely operator error at the filling end.

Not all drinks are equal
a glass of water

water is the best choice

It can seem strange that we say 2 litres of FLUID and don’t distinguish water from other drinks.  Tea and coffee are, however, just water with flavoring.  Think how you pour the water out of the kettle?

So they will hydrate you but…you might want to think how the ‘flavoring’ could affect you.

  • Caffeine is a known bladder irritant but some people notice that they react worse to ‘real’ coffee than instant (or vice versa).  Adding fat (milk or cream or on trend is butter!) slows the absorbtion of caffeine.
  • Tea can be ‘light’ by design (eg Earl or Lady Grey) and/or in the making – a few leaves gently steeped is very different from squashing the teabag to death in a mug.  The ‘builders’ tea’ version has extra caffeine and tannins – that’s what stains the mug.

    cup of tea can be light or strong

    How do you ‘take’ your tea?

  • Alcohol is a diuretic (for every glass in, you will get one and half out…think hangover…dry mouth, dehydration, headache…).   You may notice your bladder reacts to certain types of alcohol (spirits, wine, fizz) differently.  Find your tipple of choice and note what to avoid when there isn’t a handy toilet!
  • Fizzy water and de-caf coffee can also be irritating for some people – it is thought that it is something about the manufacturing process.
  • Watch out for ‘sneaky’ ingredients.  Fruit teas are high in sugar, green tea has caffeine (and is also a diruetic – hence drunk on ‘diets’),  many hot chocolates are high in sugar & can contain caffeine.

Start to notice how long it takes for different drinks to pass through you and make your bladder uncomfortable.  You may find you are not as ‘tolerant’ of your favorite drink as you used to be.  Don’t feel you have to go cold turkey – just cut down a bit on the likely culprits and increase the balance of plain water and you will likely see a quick reduction in bladder urgency and increased capacity to hold.  And pick your moments – it doesn’t mean you can’t drink your favorite double strength cappaccino…but maybe not just before a long car journey or the cinema?

Squeezy App (which also reminds you to do your pelvic floor exercises) has a bladder diary you can use to monitor your fluid intake and trips to the loo.

Sweating? Breastfeeding?  When you might need extra fluid
women stretching

Do you need to replace ‘sweat’ or only ‘glow’

Hot days & exercise.   We don’t just lose fluid from our bodies when we wee.  It also escapes from our body in our breath (think how you can steam up a mirror) and when we sweat.  If it is a hot day, we need extra fluid.  If you are doing an extra sweaty activity, you need prepare with a little extra and be sure to re-hydrate after.  “Guesstimate” the amount that you might have glowed away, as well as the drink you were probably due about then anyway…but don’t over do it.

 

Breastfeeding. 

baby breastfeeding

drink extra to replace the volume given to the baby

It is important to have some extra fluid each time you feed…but again don’t over do the drinking or you will just be weeing more.

To estimate the amount you need to re-hydrate – think about the milk volume that you produce when you express? Probably about  200-400ml?  So an extra glass/mug of fluid is all you  need back again – you don’t need to down a pint of water – your poor bladder will just fill to bursting really quickly and not love you for it.

 

 

How often should you Wee? – the long version

Based on drinking the recommended amount of 2 litres/24 hours (roughly one mug [250ml] roughly every 2 hours)  then…………
The first sensation is usually too early

 After 45 minutes to an hour your bladder would normally hold about 120ml (a yogurt pot) of urine and you would get a ‘I might need a wee‘ sensation as the walls of the bladder (it’s a muscle) stretch for the first time.  

120ml “a yogurt pot wee” is a bit early

Our brains should know to recognise this as an ‘irritating-stretching-message’ not a ‘need-a-wee-now’ message.  Subconsciously we clock the time, do the maths (only an hour since I last had  a wee), we tighten our pelvic floor muscles in a slow steady way, distract ourselves with the job in hand and within 2-3 minutes the feeling of wanting a wee completely disappears – like we never needed one in the first place – we go on with our activities, almost forgetting that we have a bladder.

This is the bladder’s normal first response.

That first annoying signal isn’t particularly useful, just a very early warning signal, like your petrol gauge alerting you when you still have 60 miles in the tank.   You don’t need a wee when there is only a yogurt pot worth in the bladder, even if the bladder feels a bit scratchy about it.  Just ignore it and it will go away.

campervan long journeys

safety or just-in-case wees are for long car journeys – ONLY

 If circumstances are justified,  it’s ok to have a “just-in-case” or “safety wee”.  Say you’re  about to go on a a long car journey, or about to have a swim or a shower, or go to bed,  then it makes sense to get rid of even the 120ml so that you have a long run ahead of you.  But you need to justify to yourself why you didn’t just ignore the feeling,  otherwise it can quickly become a habit to have a wee every time you get a bit of sensation and that can be very disabling.

 

 

Ignore the first message and wait for the next one
a big mugful is a perfect wee

A nice big mugfull – 200-400ml – is a perfect comfortable wee

Normally, that first message quickly disappears and  we would forget all about the bladder and be able to fill it further for a second hour (or so) till there is more like 300ml (a large ‘Cath Kidston’ mug) worth. Then you should get a dullish, polite “you need a wee” sensation that sends us off for a comfortable-but-not-urgent wee. 

This is when you should go.  There is still a bit of room in the bladder if you have to stand in a queue, find your front door keys, answer the phone.  There is a bit of give and it is not too heavy if you need a cough or a sneeze.

But not leave it for a third or fourth message…

But do we go when we should go??  Of course not……Many people (and especially busy, distracted mums)  leave it TOO LATE.  

a pint of wee is too much

A pint (500ml) will make your eyes water and could lead to accidents – save for first thing in the morning & emergencies ONLY

If we ignore the middle message, and head into a third or even fourth hour, we can fill to nearly a pint (shift workers, teachers and nurses can often hold even more) BUT filling to your max tends to be accompanied by a sudden, very uncomfortable and “urgent need for a wee” message – the type that makes you sweat, your eyes water and comes with a strong sense of panic that you might not make it (and indeed you might not). 

These maximum capacity wees are intended for first thing in the morning or an emergency.  An emergency being unexpectedly stuck on a motorway, not quite frankly, just putting it off for one more paragraph, chore or advert break.   And not just because you are too busy to remember to go for a wee!

So is there something wrong with your bladder – or is it poor human judgement?
woman working at computer

Concentrating? Distracted? or just too busy?

So many times the problem is really that the  human operator is not listening to the (rather good) system properly.  Guilty???  You already know which way you tend to go… too early (friends and family tease you about always needing a wee) …or too late (lots of sweaty near misses or trouble at the front door)?!

Or, very common, is that you swing between too early and too late – you push your limits…push your limits…leave it…leave it…just one more thing and THEN you very nearly have an accident.  Now you and your bladder are so nervous that you start doing lots of little wees as soon as you feel something, just to be safe…avoiding another experience…but then you think…this is silly… I need to train my bladder… so you start again, filling and filling, past the ‘right’ signal, on up and up …nearly bursting…and there goes the cycle again.

what CAn you do to improve your bladder habits?
WC sign

this week monitor your fluid in and out habits

This week, when you are heading to the toilet for a wee, try to predict the size of the wee you are going to have – simple categories of

  • yogurt pot
  • big mug
  • or pint class

( aka: small, medium and large).

I’m prepared to take a reasonably large bet that as soon as you start taking a bit more notice of what’s going in at the top and what the wees feel like at the different size points, you will quickly  tune in to the bladder sensations and interpret the messages better.

The hardest one to spot and get in tune with is the ‘middle’ one – to be honest it is too polite to be properly useful.  A bit more interesting would mean it wasn’t so easily missed.  But we can’t change nature and once you are familiar with that  “oh this is what a comfortable wee feels like ” you will be able to spot it much better and stop the cycle of under or over-filling.

Exceptions – when to seek more help

If you thought you were going to have an enormous wee but only get a tiny one – or a tiny one but get far more – you may find your body is not well tuned to the sensations.  Sometimes the nerves stay confused after the pressures of pregnancy and childbirth and need retraining.   

use a wrist watch to monitor your wees

Use a watch (simple or fancy) to keep on track

If you do not feel that you get the ‘right’ sensations guiding you towards having a wee at that middle point and you leave it too late before the bladder suddenly decides for you, or you get unexpected leakage, then I would suggest you use the clock as a guide for a while (but all the while trying to tune in to any sensations you are getting).

Start with an hour, then have a wee, noticing how small they are at this stage,  but once you are comfortable with this don’t stick here too long or your bladder will get into an annoying ‘habit’ of thinking this is all you can do. Move up in 15 minute increments as feels comfortable and ‘safe’ to do.   Remember the goal is just 2-3 hours of holding  – no need for more. 

There are also medical conditions of the bladder
  • Overactive Bladder (OAB), often colloquially termed ‘irritable bladder’ is a pathology with symptoms of frequency, urgency and urge incontinence.  Commonly you feel a strong urge to wee and either get only a tiny wee out or you feel the bladder contract and it can just empty itself partially or completely (urge incontinence).  If after organising your fluid intake (as above) you still struggle with bladder control, keep a bladder diary (use Squeezy App)  to monitor the pattern and discuss it with your GP.  There is medication that can help ‘calm’ a bladder and working with a physiotherapist on your pelvic floor muscles will also improve your control.
  • You can have a low grade bladder infection and not necessarily realise this.  Watch for cloudy urine, funny smells, feeling off colour.  The dipstix test at the GP is not that reliable – you may need to send your urine off for testing
  • You may not be making the hormones that suppress night time bladder production (over age 70 this naturally declines). Note if you have massive urine volumes at night even though you are not drinking and discuss this with your GP.
  • Paradoxically – wearing a pad to prevent leakage can irritate the bladder tube and increase urge and leaks.  Try going without a pad or wearing knickers with an inbuilt pad to see if this is the case.

As with all the supported mums advice: if your symptoms aren’t getting better, or you feel you need some individualised help, ask your GP to check you and if appropriate refer you to a specialist physiotherapist.

And weird stuff

Rings and ankles give clues

Ever have one of those  days where you seem to need to wee and wee and wee?  Not necessarily unpleasantly but  you think “where is it all coming from????”

The body constantly re-adjusts our fluid balance – and sometimes does this really dramatically.  You see it best by watching how tight/loose your rings are.  Notice this week how sometimes you can slide your rings about easily and then other times they are stuck on tight.  The body holds fluid when it is hot and dumps it as it gets colder.  We also have circadian rhythms that affect fluid in and out – most people wee more in the mornings and less in the afternoon.

And stress…..

When we are ‘stressed’ (anxious, worried, cross, running late) our system is releasing adrenalin.  Adrenalin triggers our Fight, Flight or Freeze response.  If a tiger walked in your door right now – your hairs would stand on end, your heart would beat faster…and you would wet yourself.  Likely bowels too.  I think it’s supposed to be so that you can run faster.

woman with a tiger

identify your day-to-day “tigers”

Fortunately,  you are unlikely to encounter seriously stressful moments too often but we experience mild ‘stress’  all the time.  When you are feeling anxious, worried, cross, running late , the brain ‘drips’ adrenalin into your system to help you cope.  But with that comes bladder (or bowel) irritation.  Think of standing in a queue to do an exam, or waiting to give a presentation at work…that strong need to wee…and then even to wee again.

So if  you are having a day needing lots of wees, perhaps consider your bladder as a barometer to your stress levels?  Rather than try to ‘fix’ the bladder…can you decrease the source of the stress?

Peaceful sleep
sleeping woman

last proper drink 2 hours before bedtime

It is normal to get up for one wee in the night  (assuming sleeping for 6-8 hours).  Annoying…but perfectly normal. Nicer if you don’t have to but some bodies just do.  Over age of 60 years 1-2 x to wee in the night is normal, as the hormones affecting the kidney processing of your urine change.

  • aim to have your last drink 2 hours before bedtime so that the fluid has plenty of time to go through your system and you can have a good wee before getting into bed. 
  • Best to avoid caffeine late. 
  • Beware, sneaky sources of caffeine like Green Tea & some hot chocolate mixes
  • alcohol is a diuretic ie more volume comes out than went in (just think hangover….dry mouth….)

if you do have a late night drink (party!)) then don’t berate your bladder for needing a 2am wee!

Waking up in the  morning

 Most people wake up with a very full bladder (picture that pint glass!) and need to make getting to the toilet their priority on waking.  

====    Mums go first!   ====

Can I run yet? Advice, videos and checks by specialist physio Amanda Savage

Can I run yet? 10 things to check before you take your post-baby body for a run

 

Can I run yet?  is a popular request from postnatal mums in  physio clinic. Before you dash out that door, use this postnatal checklist to make sure that your body is primed and ready for a successful, rewarding and injury free run.   Download a printable of the 10 checks here.

We all love running

Running is a fabulous free, effective, fun way to exercise which appeals to many new mums .  It’s heart, lungs, legs, bum.  It burns calories quickly.  You don’t need anyone else to do it with (but can if you want to).  It is magic time ALONE.  You can listen to music, your music.   You can go at any time of day for 15 mins or 50, depending how lucky you get with your childcare. It lends itself to an erratic life, no class commitment required .You can even run in the rain.

Where will you start?  Plan to avoid injury and disappointment

  As a specialist physiotherapist I tend to pick up the problems that have developed or show up from mums running too soon, or without realising that their body wasn’t ready.  These are things like sciatica, back or groin pain, recurrence of their antenatal pelvic girdle pain, incontinence and vaginal prolapse. 

Run before?  Often I worry that those who ran pre-baby are  most at risk of injury as it can be difficult to work out where to re-start .  You always remember what you were doing at your peak (!) but it can be tricky to find that “sweet spot” distance/time/pace to start back from.  

Before you had your baby(ies) were you an erratic jogger, more into 5k fun runs or a half marathon junkie?  What was your peak?  Can you remember how you started out and built up from couch to that first 5k?  You are going to need to take yourself back closer to the beginning  to allow your body time to build the skill-sets of running in the right order – but don’t worry – it will all come together much quicker than the first time you took up running.

Or never at all?  Or are you a complete newbie?  Perhaps running is the only exercise option you are going to have with your post-baby lifestyle and its all new to you?  You can take up running from any level of fitness but it is important to learn more about the process and tried and tested techniques of getting from couch to 5K+ so that you have fun, enjoy the process and don’t get disheartened.  Follow all these steps and you will be out their running with the pros before you know it.

 

Can I run yet?  a Mum’s Pre-run CHECKLIST

#1      Good Shoes     

Will your shoes absorb 80% of the impact?       

Your shoes are your first line of defence against the high impact of running.  

Each step sends a jolt of high pressure, 4 times your body weight, through your ankles, knees, pelvis and spine. When running that can be 800+ steps per mile!   If your foot moves to much on landing this can affect the biomechanics throughout the body and leads to common conditions such as plantarfascitis, ankle/knee strains, sciatica and hip pain.

The softening effect of the pregnancy hormones takes a while to return to normal, taking longer if you are breastfeeding.

TASK 1:  Check your trainers

  • Look at the soles.  If the tread pattern has worn away it is a sign of degrading and loss of cushioning.  The sole should feel squishy not wrinkled and tough!
  • Try them on:  with sports socks and make sure there is a gap of around half a centimetre between your longest toe and the end of the shoe as your feet will expand as you exercise.  Many women’s feet flatten and change shape during pregnancy and rather like your bust you can need to be re-fitted for shoes.
  • Re-lace: Don’t try to secure a gaping shoe by tying the laces too tightly. Laces need to be tied firmly but not so tight that circulation is restricted during exercise. There are lots of different ways to lace shoes for your indivdual foot type.  
  • review your orthotics:  if you needed orthotics before, now with the changes of pregnancy you may need them reviewed or refitted – book an appointment with your podiatrist or physio and let them know you want to run.
  • go shopping with professional advice:  Take your old shoes down to the nearest reputable sports shop for more advice.  Many now have either a treadmill (often with video) or a force plate to create a picture of the pressure points in your foot which may provide useful information.  A trained assistant  will watch you run, give advice and help you try different styles.      In Cambridge we have Up and Running & the sports shop at David Lloyd.

#2        Flexible back & pelvic symmetry      

Can your pelvis transfer your weight from leg to leg?

Running is a sequence of standing on one leg then the other, just speeded up so you don’t see it.

TASK 2:  wobble test

 Try standing on one leg for a few seconds, then the other.  Did they feel the same or different?  Were you markedly more ‘wobbly’ one way, or have to jut your hip out to balance.  Any pain triggered?  Was it easier to move from right to left than left to right (or vice versa).  Did one way just require more ‘thinking’?    

  If this simple test from one leg to the other makes you suspicious that you have a problem shifting your weight evenly, once you hit 3000 running steps this could lead to a back or pelvis problem becoming unmasked. 

 

Check your technique:  With an expert.  If you already have a suspicion that your back or pelvis is not ‘right’     DON’T run yet because it is likely only to get worse.

  • if you had PGP during pregnancy and it is still niggling, go back to your physiotherapy team and ask for a postnatal review and assessment of your spine
  • if you think that your delivery might have triggered a new back or hip problem ask your GP to refer you for a physiotherapy assessment

Focus your training:

 

#3     Glavanised gluts           

Have you got one bottom better than the other?                

The other big load bearing muscles are the gluteals.  As you stride forward each buttock needs to help take your weight and create forward propulsion.  Weak bottom muscles and you will overuse your hamstrings and calves causing cramp or muscle strains. 

TASK 3: the pilates bridge with knee fold test

This task mimics the job the gluts have to do when you run.  Check your gluts are working equally well right and left with this task – you should feel your buttocks not your hamstrings take your weight and your foot should feel that it can just ‘float’ off the floor.

picture of pilates bridge with knee fold to test running technique

Lie on your back with your knees bent, feet flat.  Draw yourself up into a bridge position.  Are you hips level?  Can you feel both gluteals (bottom muscles) working evenly or is one side doing all the work?  Now focus on supporting your body weight with your right leg and let your left knee fold in over your hip.  Feel the work in your right bottom.  Then put your foot down and repeat folding your right knee in.  You should feel your buttocks not your hamstrings take your weight and your foot should feel that it can just ‘float’ off the floor.  You should be able to move smoothly from one side to the other without dipping hips, cramp in feet or hamstrings or rapid fatigue.

Check your technique:  To work on reducing hamstring and foot cramp see my video with 3 top tips   “How to bridge without getting cramp”

Focus your training:    before you go out running and risk an injury, build up your muscle strength and co-ordination by doing a few sessions of my postnatal pilates sequence specifically designed to Galvanise your Gluts.

#4  Abdominal control  

Can your abdominal wall hold strong at peak run?        

A traditional head lift/crunch style abdominal exercise doesn’t reflect the role the abdominals have to play when you move.  In a sit-up/crunch you are keeping your legs still and moving your upper body – but when you run you need to keep your body still and move your legs!  At full sprint both your feet will be off the floor at the same time.

TASK 4:  The Pilates double table top position reflects this action well. 

Can you do 10  leg extensions from table top postion, maintaining neutral spine, a lightly engaged core and while breathing naturally???  Your abdominals should not bulge or dome.  NB:  Start with your arms by your side (arms back, seen in the picture, is the more advanced version).

Can I run yet? tabletop with leg extensions mimics running action

 

 

Check your technique:  If you find your abdominals bulging you are not strong/co-ordinated  enough to run yet.  It may be that you need to improve your technique: see this video   3 Tips to Control Abdominal doming in Tabletop position

 

Focus your training:  Follow my postnatal Pilates sequences Mind the Gap I progressing to Mind the Gap II for a few days –  you will see a great improvement of your ability to control the abdominal wall which will mean you have back and pelvic support when you are running.

#5  Primed Pelvic floor      

Is your pelvic floor ready to take high impact?      

Postnatal pelvic floors can be slow to react and need waking up before you run. No good getting half way down the road before you start to think – ooh all a bit floppy and leaky….. where’s my undercarriage support….???

TASK 5:   35 second  pelvic floor pre-run priming routine:

Turn your toes out, like a ballet dancer.  Tighten your pelvic floor and notice how this position favours the back passage (the anal sphincter) just like you are stopping wind.  Pretend you are having tea with the queen and made the mistake of baked beans for lunch.  You need to effectively close the anus opening without clenching your buttocks more than a smidgen and without it showing on your face.  Do 5 on and off squeezes, not trying to hold, just good squeeze, let go completely.

Then turn your toes in, like a pigeon. Now when you tighten up underneath it should feel different.  Less going on at the back and more focus at the front, around the bladder tube and vagina area.  Let the area be soft, almost a bit saggy,  then lift and tuck the vagina up inside.  Let go – completely.  Then repeat 5 on – off contractions.  Best lift you can do and relax.

Finally turn your toes into your normal standing posture.  Now try to do both the previous actions at the same time.  Most people start with the back tightening and then like a big zip come forward to lift and tuck the front.  When you let go each time now it should feel like there was a bigger ‘up’ and a bigger ‘drop’.  Repeat.  If you are feeling clever add in some side to side tension too!

When you have done 5 squeezes with your toes turned out, 5 with your toes turned in and 5 with everything together you will have done 15 really good pelvic floor muscle contractions.  NOW your muscles will awake and far more ready to cope with the impact as you run.

Check your technique:  If you need to refresh your knowledge of pelvic floor anatomy do watch the videos in our Pelvic Floor School.

 

Focus your training:  Pelvic floor need more attention?  Check out my Pilates for your Pelvic Floor routine.  20 mins everyday for a week and you should already feel an improvement.  If you don’t then organise a proper vaginal assessment of your pelvic floor muscles with a specialist physiotherapist.

#6   Connected core      

Have you warmed up your brain connection to your core?

Runners can be a little guilty about using running to warm up (yes you know you do).   The purpose of the ‘warm up’ is literally to bring your muscles and tissues to a warmer temperature to make them less likely to injure (like bringing eggs to room temp before you bake!).  A brisk walking pace before you break out into a jog is recommended.  Or…because I am a multi-tasking kind of person – you could do some household chores while at home  – hoover, mop a floor, hang out the washing – anything that makes you feel that you want to remove a layer.

TASK 6:  pre-run prep

But I also recommend that you warm up your brain.  5 simple tasks (you will recognise them from the checks above) to focus your neural connections on the muscle actions that you need to run well.  Have your kit on (including shoes), do this right in the hallway before you dash out the door.

  1.  5 spine curls (loosen the connection back to pelvis)
  2. 10 leg stretches (the walking action)
  3. 10 knee folds (the  jogging action)
  4. 10 double table top legs (mimcs legs in full sprint)
  5.  10 bridge with leg changes (primes the gluts)

TIP: or if you only get your run in the evening when your partner comes in from work – do your warm up while the kids are in the bath – even half an hour before you actually go will still be effective – you will be warm and all the right connections switched on – then as soon as you have the requisite childcare …you can be gone!

Focus your training:  If you are better disciplined with a voice to keep you attentive and help with breath and timing the  10 minute Pre-run Prep in my postnatal pilates sequence has it all covered. Follow the links for free access to these professionally made videos.

#7   Protected Bust   

Are your post-baby assets protected ?                       

Everyone pays attention to a good bra fitting postnatally. You may need your sports bra re-fitted too.  

Especially if you now have a bigger bust.  Protecting and caring for your delicate breast tissue is  important after the stretching through pregnancy and breast feeding.  An ill fitting bra will press on your trapezius muscles (running along the neck and back) which can cause pain and discomfort.

 

TASK 7:  put your old sports bra on

Wear it for about five minutes to assess comfort and fit. Lift your arms up, bend down and jump to see if the bra and breasts stay in place. If you find spillage over, under or at the sides, reassess!

There are two types of sports bras.  For small to medium busts compression bras press the breast against the chest wall to minimise bounce and enhance support as you move but if you are bigger than a 36B you will find you need an encapsulation bra (who thought that name up?), so that there is support for each breast in a proper cup.

 

#8    Support Pants        

Extra layers in all the right places.

Again, its all about support.  The best pair to reduce joggle.  Of the belly, of the pelvic floor, of your back.  Maybe even wear two pairs?  

  • JoJo Maman have a good pair of postnatal ones that are made of thick lycra. You can wear the tummy panel high up to under the ribs to help hold your tummy, or roll back (like yoga pants) to reinforce the pelvis.  They also have a vest that comes down to give tummy support if you prefer support top down rather than bottom up.
  • Or tight cycling shorts under your running ones to come up higher over your tummy. 
  • If you plan to do a lot of sport invest in the clever design of the  EVBsport.com * range of leggings, shorts and capris.  They have special extra support stitching for the abdominals and pelvic floor areas. Designed from the ground up by a running mum.  

* this is an affiliate link, if you make a purchase by clicking through from here I receive a small commission  at no further cost to you. Thank you, this helps to support this blog.

#9  Bladder and bowel check        

Be prepared for unexpected events

Your Bladder:  Running is going to make the bladder jig up and down. You could get bladder leaks on running, even if you have been fine for normal activities till now.  Running is a higher impact activity than most other things and could unmask a pelvic floor problem.   If it happens, you are not going to panic as on this website we have all the information you need to sort it out.  At the same time it could happen and we don’t want it to spoil your first run because you didn’t expect it. For that first run have a good quality panty liner in place so that anything unexpected doesn’t embarrass you.  Any signs of bladder trouble default to brisk walking, which can be just as effective for fitness and calorie burning, for now.

   If you are already experiencing bladder leaks please don’t run yet  sort it out with advice from us here at Supported Mums or by getting in touch with your local specialist physiotherapist.  And meanwile  there are lots of other ways to get fit which are more pelvic floor friendly.

Your Bowel:  The pelvis is a compact space. If the bowel is full it will feel uncomfortable when you run and could put pressure on the bladder causing unexpected leakage.

TASK 9   wees and poos before you go!

Leave time in your routine to have the option to empty your bladder & bowel before you go out.  You need privacy and TIME for a good poo.  Take a book to read – it helps switch off your thinking brain and let you relax.  

Check your technqiue:  Watch 3 Ps for a Perfect Po  Then enlighten family and friends!

 

Focus your training: The bowel is controlled by the Pelvic floor too?  Check out my Pilates for your Pelvic Floor routine.  20 mins everyday for a week and you will already feel an improvement.

 

#10   Motivation & Pacing?     

Aim to under-achieve!

Humans have a tendency to try to over achieve and then feel disappointed and demotivated when we fail to reach our goals.  You can’t start back running where you left off months ago.  You will just feel unfit and disappointed.  The best advice I ever read for getting back into running was aim to underachieve.  You want to get home thinking – “that was great, I feel fabulous, I could easily have done more, I can’t wait to go again “.

TASK 10:  download a pacing app

There are lots of great couch to 5km programmes that will help you pace your run and lead you safely and effectively from nothing back to your 5 km and beyond. 

I highly recommend the much loved “Laura”  the voice of the Podcast “Couch to 5km” downloadable from the NHS choices website, and now also as a free app. It got me from barely able to run for 1 minute (I know, for a physiotherapist frankly quite shocking!) to a comfortable 20 min just like it said it would.   There are also extension podcasts for C25K graduates.  If you want to be able to listen to your own playlists there are many paid for options you could try.  

Run to enjoy the headspace

  • Half the week I ‘run’ rather than walk my dog.  My runs are my treat to listen to my favorite podcasts.   Now I’ve done the NHS couch to 5km app enough times I can set my phone timer for suitable walk/run intervals in the background to keep to a plan that challenges me but doesn’t over do it.
  • There are lots of books about Running and Mindfulness, or running as mindfulness (quick Amazon search will give you more than 5 recent ones).  Authors explain the benefits on mood, anxiety and sleep patterns.

Or run with friends for motivation and company:

  • if you ran before with a group ask your partner or family to help you with childcare specifically for that time-slot so that you can rejoin  the group you used to belong to.
  • Buggyfit classes and/or baby boot camps have lots of cardiovascular elements and you can take your baby in their pram.   This would be a good place to learn warm up and cool down sequences and find like minded local mums to get out running with.
  • If you are in Bath, Bristol or London you are lucky to have This Mum Runs  networks near you.  This Mum Runs is a community encouraging and supporting real mums into or back into running.  For beginners they run (paid for) courses to take you from new to running for 30 minutes.  You join a once a week group (at a mum friendly time),  led by a TMR trained coach called a “Runmaker” who helps with learning to pace and running technique.  Then you aim to do 2 independent runs on your own or with friends in between.  Graduates or those who can already run comfortably for 30 mins can join in a local, free running group, led my a Run Angel, thoughtfully on an evening or Sunday morning 8am.  Read more on their inspiring website.

Can I run yet?   If you can tick all 10 then Go run girl!

Missing a few?  We can support you

Specialist Physiotherapists help postnatal women build up their bodies to run again.  We work to pre-empt the most common problems that can arise if you run on an under prepared postnatal body.  I hope this  guide is a useful focus on the essential ground work to make your running the fun, useful, effective and safe activity that it should be.  Please don’t hesitate to ask questions in the comments below.

Please let me and other readers know how you have got on and which tips resonated with you?  We can all inspire each other.

Are you a list kind of girl?  – To Download a free printable check list CLICK here:

my favorite standing pelvic floor exercise

My favourite standing pelvic floor exercise, ever

This is absolutely my favourite standing pelvic floor exercise.   I love that it anchors you to the spot with a quick little routine to stop you getting distracted part way through. 

Honestly takes 35 seconds but pings your pelvic floor muscles awake.  Little and often improves muscle memory, reaction times, and encourages quick muscle growth.

  1.  Turn your toes out, like a ballet dancer, 5 squeezes of the back passage

Turn your toes out, like a ballet dancer.  Tighten your pelvic floor and notice how this position favours the back passage (the anal sphincter) just like you are stopping wind.  Pretend you are having tea with the queen and made the mistake of baked beans for lunch.  You need to effectively close the anus opening, without clenching your buttocks more than a smidgen and without it showing on your face!  Do 5 on and off squeezes, not trying to hold, just a good squeeze, then let go completely.

2.  Turn your toes in, like a pigeon, 5 lift and tucks of the vagina/bladder tube area

Then turn your toes in, like a pigeon. Now when you tighten up underneath it should feel different.  Less going on at the back and more focus at the front, around the bladder tube and vagina area.  Let the area be soft, almost a bit saggy,  then lift and tuck the vagina up inside.  Let go – completely.  Then repeat 5 on – off contractions.  Best lift you can do ….and relax. Don’t worry if your abdominal muscles join in a little bit but keep the focus on your pelvic floor.

3.  Turn your toes normal, both areas together as a unit

Finally turn your toes into your normal standing posture.  Now try to do both the previous actions at the same time.  Most people start with the back tightening and then like a big zip come forward to lift and tuck the front.  When you let go each time now it should feel like there was a bigger ‘up’ and a bigger ‘drop’.  Repeat.  If you are feeling clever add in some side to side tension too (yes, the pelvic floor is bowl shaped, see this in my video showing a model pelvis in the pelvic floor school)

When you have done 5 squeezes with your toes turned out, 5 with your toes turned in and 5 with everything together you will have done 15 really good pelvic floor muscle contractions.  NOW your muscles will be thinking – hey she doesn’t normally work us like this – we are going to need to grow!

When to do it?

Perfect exercise to do little and often through an ordinary day.  It tags on really well to cleaning your teeth – or after a wee.  At home, use that quiet moment in the toilet to focus on yourself.  If you are working, linger in the cubicle for an extra 40 seconds – you are getting paid to exercise!

Important note

If you think this exercise is mad and you couldn’t feel a thing when you tried to do it – try it  lying down, not so much the feet positions but focusing first on the back passage and then on the front.  This positon  takes the weight of your organs off the pelvic floor and gives you more chance to ‘feel’ the muscles working.  If that still leaves you cold – then I would recommend you have a chat to your GP and ask for a referral to a specialist pelvic floor physiotherapist for a full assessment and examination.  There are lots of things we can teach you in clinic 1:1 to help you find and improve your muscle function.

vaginal cones and weights explained by a physiotherapist

Vaginal cones: a modern girl’s guide to the ancient art of pelvic floor weights

Vaginal cones and weights; relatively cheap and a good way to progress your pelvic floor training

Vaginal cones and weights are a very different concept to electronic devices, cheaper and more accessible for most people.  There is a bit of a knack to using them correctly.   They are particularly good for building the endurance qualities of the pelvic floor – which we need for holding babies, carrying shopping and going for a run.

 Did you know that vaginal cones are modern versions  of Chinese Ming Balls?  Once only available in sex shops and more associated with ancient “boudoir” skills than bladder control.  But good things last the test of time and vaginal cones are now even available on NHS prescription!   

The electronic devices monitor whether you are squeezing correctly and give  you feedback on that action as well as ‘games’ to keep you occupied.  However, because they are technically advanced, they are clever and also expensive.  Cones are a much cheaper, non-electric alternative (£25 – £30 with one type available on prescription).  

There are several choices on the market: –

the Neen Aquaflex Cones  Pelvic Floor Exercises System (boots.com, stressnomore.com), you put little weights inside a plastic cone and add more inside the plastic shell as you progress.  

Aquaflext vaginal cones have stood the test of time

Aquaflex vaginal cones

With the Kegel8 Vaginal Cones (www.stressnomore.com) you have 3 different cones of lighter to heavier weight.  

Kegel8 vaginal cones are available on prescription now

Kegel8 Vaginal Cones

There are also several others such as the Lelo Luna Beads which are more obviously modern takes on the original Ming Ball concept (www.stressnomore.com carry a comprehensive range)

Lelo luna balls vaginal weights based on Ming Balls

Lelo Luna Balls

 

 

Aquaflex vs Kegel8?

I have had many clients use both the Aquaflex or Kegel8  system – they do exactly the same job – Kegel8 a bit prettier and more touchy-feely with a nice pointer to help you see how far in to put it in (and now available on prescription) .  The Aquaflex cones have a finer retrieval cord, which appears from online reviews to make some people nervous  (though I’ve never had anyone have any trouble) but this does let you put your knickers back on giving you more options of where you might use them!   Have a look at them both online and read the customer reviews – but I would say it is just a personal preference thing.

Cones and weights are a progression from the basic exercise

You do need to have a good foundation pelvic floor contraction first or they are just going to fall straight out the minute you stand up, which is most disheartening.  If this happens to you, I would recommend you get your pelvic floor technique checked by a specialist physiotherapist first.    It is not uncommon for people to think they are squeezing quite perfectly only to find on proper vaginal examination that there is really not much going on at all.  Don’t panic if this is you – it is all sortable but cones are not for you (yet!). 

It’s like adding hand weights to your pilates routine

Good ol’ basic pelvic floor exercises come first (see the Pelvic Floor School videos).  The vaginal cones are to your pelvic floor exercises, as adding handweights would be to your yoga or pilates routine.  It takes the normal unloaded task and makes it more challenging by adding a resistance to work against.  Adding “load” to a muscle encourages it to work harder and grow more.    In the gym you can hold handweights for your arm exercises or push against a piece of gym equipment for more resistance challenge for your legs.  The cones allow you to add some weight directly onto the pelvic floor. 

How to use them

Though I said earlier it is like adding hand weights to arm exercises – it’s not quite like you might think.  When you are exercising with the vaginal weights you are not trying to squeeze and contract, on and off like with traditional pelvic floor/kegel exercises. Now you are rather trying to hold the weight of the cone in place while you do another activity.   You really are holding it to stop it falling out.  This style of holding exercise promotes the development of the slow twitch/endurance qualities of the muscle – think of channelling Mo Farah (for 2 hours on your feet at playgroup) rather than Hussein Bolt (though we need his power for The Knack when we cough or sneeze).    We need to develop this endurance muscle skill for when we are lugging shopping or carrying toddlers or trying to enjoy prolonged exercise.

First find the right weight

 If the vaginal weight is too heavy you will feel the cone slip out of position within 30 seconds.  If it is too light you might find you have completely forgotten all about it and practically gone out shopping with it.  It will have just been sitting in the vagina like a plastic tampon.  The right weight should feel like you are not doing anything terribly exciting for a minute or so and then you start to feel that it is slipping towards the vagina opening and needs a little push to reposition it.  This means that your muscles were holding it well, in an endurance hold, but as you started to fatigue, the muscles loosened and it started to move down the vagina with gravity.

 When inserting the cone it can help to use a tiny dab of personal lubricant on the end to help entry to the vagina but beware anything more than a dab or you will never hold it in.  Think more cork fully in a bottle than tampon position.  The Kegel8 has a marker on the “tail” to guide position, or with the Aquaflex you should have to reach inside about a knuckles depth to feel the base of the cone.

Then choose your venue

I don’t recommend wearing them out of the house as some adverts suggest. That just seems like asking for trouble to me.  I suggest that you stay securely at home and start by putting the cone in for a relatively still activity and then increasing the challenge. 

A customer favorite is to use the cones when you are going to wash your hair in the shower – based on the principle that this is about every second or third day and you don’t forget to wash your hair.   I also like that you are going to be naked anyway and its a naturally clean environment.   You can keep the cone you are using hidden discreetly in the bathroom, ideally somewhere close enough to the shower that you can reach it even if you’ve already got in and got wet before you remember the cone.

First skill – just stand still!

First goal is to just stand still and wash your hair as normal.  You will find yourself more conscious of your underneaths (!) and if it’s the right weight you will feel the need to reposition it a couple of times as soon as your muscles tire.  About the 4th time you come to wash your hair you should be noticing that it slips less easily and then very soon it doesn’t feel like a challenge at all. 

Progress to complex activities…

Now put your shampoo & toiletries on the floor while you shower to make yourself have to bend up and down a few times mid-hair wash.  When this is easy, progress by extending the showering session to include standing on the bath mat and over-dramatically rubbing dry, add in a little jog on the spot and then the ultimate tests are a bit of jumping up and down – and a pretend cough. The thought that you could shoot the cone across the bathroom if you don’t hold on will certainly activate the right muscles.    Once you can do all these things with your first weight time to progress.  If you are using the Kegel8 cones move to the next weight up, if you are using Aquaflex, unscrew the cone to add another weight inside.  Now, with your heavier weight in place go back to standing still and just hairwashing, progressing through the stages as before.

And maintain weekly….

Once you feel you have improved your muscle strength, endurance and co-ordination vaginal cones are neat to establish a “maintenance drill”  Pick one of your hair washes a week (say the weekend wash) to be the “cones-wash” and as long as week on week you are still as masterful at your washing, jumping and coughing routine you know the muscles are keeping strong.

Other popular activities

ironing – progress from simple tea-towels to complex men’s shirts and put the basket of laundry on the floor so you have to bend more

emptying the dishwasher – takes longer if you are multi-tasking with the cones but a nice bit of bending/stretching and few steps about the kitchen required

childcare – my sister’s mantra was never doing anything when you child is asleep that you could have done when they were awake.  Under 5’s are not going to remotely notice what you are up to.  Put some music on!  Start with some  sedate wafting about  to gentle nursery rhymes and build up to a good stomping rendition of the Grand Old Duke of York or a bit of Justin Bieber (no judgements here).

Let’s grow this list.  Have you tried vaginal cones or weights?  When (Where???!)  do you do yours?  Do share (photos optional).

bladder leaks when running? 6 physio tips for discreet ways to stay dry and avoid a VPL

Bladder leaks when running? 6 discreet ways to keep dry and avoid a VPL

What do you do if you worry about bladder leaks when running, at the gym, your exercise class, or playing with your children ? Mums I meet in clinic tell me that they avoid events that require them to look “sporty”.  They worry about a VPL if they wear the normal figure hugging  gym kit.  They don’t want to stand out in a baggy tracksuit trying to hide a  pair of substantive knickers with a pad.  

There are  6 discreet work-arounds that I recommend to my physiotherapy clients

…….But first you have to promise that you will not use these ideas to make you complacent about a leakage problem or as an excuse to avoid the issue of your bladder for another 3 months.

Incontinence might be “common” (45% of women report bladder leakage at 3 months after birth, even 10% of those after Caesarean) …. but it is never “normal”. 

pelvic floor for runners

choose your sport wisely

Incontinence  is a sign of pelvic floor (or bladder) dysfunction. Something that needs addressing and that can be greatly improved or completely resolved with the right exercise and help.

Incontinence is also a sign of lack of pelvic floor support so you need to consider how pelvic floor friendly your sport is and may need to modify or lower the impact activities to protect yourself from risk of prolapse which is movement of the internal organs downward.

So, without endorsing pads and knickers as a solution, rather as a temporary, pragmatic stop-gap while you sort your pelvic floor out:

6 Tips to manage bladder leaks When running or with your sport:

 

#1.  A pad designed for bladder leakage not menstruation

Sanitary pads and incontinence pads are not made of the same thing.  The right pads for the task are worth the little bit of extra cost.   With the advent of new technology you will be amazed how slim a proper bladder leakage pad can be to hold a large amount of liquid.

Blood is thicker than water.  The products designed to be used for menstruation are great for that purpose but do not to cope well with liquid.  As they are predominantly cottonwool based, if they get wet, they just go soggy and mis-shapen. If you are moving about they can get scrunched up, rub and leave your skin in contact with urine causing chafing and soreness.

be active to improve your strength and wellbeing

If you suffer with stress incontinence (leakage when coughing, sneezing, running or similar) or urge incontinence (leaking before you can get to the toilet on time) it is much better to use a pad designed for the purpose of catching & containing liquid.  Pads for bladder leakage are now using the technology developed for babies nappies, such as little gel beads that  swell with liquid, and fabrics that can wick fluid away from the surface.  This means pads can be much slimmer than they used to be, keep dampness away from your skin and have good odour control too.

Some of the main uk brands are Tena, Always, Poise  and Boots Staydry range.  Unfortunately, the organic brands (Natracare and Cottons) don’t have a specific incontinence product (yet).  The products are usually in the same ‘feminine hygiene’ aisle (or website section of an online store) but separated into one column of shelves for products for periods and one for bladder leakage.   The most common indicator is a row of variously filled ‘drip’ or circle symbols to indicate the level of leakage you wish to contain. 

In general pads for ‘lighter’ bladder leakage look and feel like pantyliners and come in boxes to keep them flat and compact.   This makes a good starting point if you are looking for something to keep you confident and safe against a small leak. 

If you suffer with more severe leakage and could potentially empty half your bladder, or would risk getting wet clothes then look at the pads in bags which will be more absorbent.  However, if you are getting that wet when you play sport your priority should be to solve the bladder problem further.  Talk to your physio about what they recommend.

2. MODERN waterproof knickers

Forget dated images of plastic pants,  the modern waterproof knicker is a far more sophisticated item than you could have ever imagined.

Pretty Clever Pants (previously called Diary Doll Pants)  

 £9.95 from  boots.com and amazon.co.uk  

Two pairs for £16.99 from Highstreettv.com  and £19.99 for 2 pairs of the new lace panel style.

Annabel Croft, the tennis player and TV presenter Carole Smillie (Strictly 2013!) invented these knickers to work with a protective pad – to give an extra leak-proof layer.   She originally thought of the concept for her teenage daughters coping with their periods but now they are marketed for periods, postnatal and pelvic floor.  One of those products you wish you had thought of yourself.

They look exactly like the classic cotton “girls pants” we’ve all worn in our day, complete with little middle bow but have a discreet waterproof panel back and front.   The panel feels like thicker cotton and importantly doesn’t rustle. 

They are designed to be worn with a pad but should give you the confidence to keep a pad thinner and lighter or to reduce your anxiety that your pad might overfill.

I like that there is attention to detail on the packaging, a range of colours including grey marl, an.

Shopping can be a little confusing as they were called “Diary Doll” pants for a a while but changed their name when they started being distributed by  High Street TV.

iconundies.com

When I first published this post last year these weren’t stocked in the UK  but I included their  website  as I liked their open-ness about the need for products to empower women to be active.  They have a rather quirky style of presentation and some bold adverts.  

Good news now available in the UK  through their website.

Five different styles too – from Hip Hugger, through classic bikini to thong.  Varying prices depending on style £16 – £24 (in this weeks 33.3% off sale to mark World Continence Week)icon u

 

3.  Knickers with inbuilt protection

Good for the environment.  Great if you are usually fine but like to know you have back up.  Possibly more discreet if you need a thicker pad than a liner.  Strip off in the changing room and no worry to dispose of a pad.  Disadvantage, once they are wet you need to change the whole knicker.  A couple of clients who have tried these swear they will never wear pads again, certain that the pad itself  was irritating their vulva and making their incontinence worse.

Protect Dry panties and maxie panties

£19.80 (VAT exemption available*) per pair or  www.imedicare.co.uk 

Protech panties have an inbuilt waterproof gusset yet are slim and discreet

pantie style white or black from www.imedicare.com

 or  www.stressnomore.co.uk

We are so lucky to be in the era of textile research and design and I am delighted to see this being applied to underwear.  The gusset in these  Protech knickers is hardly thicker than your normal good robust cotton “pants” but is made of 3 layers, an absorbent fibre (holding up to 40ml = 2+ tablespoons), an odour retention layer and wick away surface.  Like some of the best quality pads but fixed in place with sealed seams.  Quite a lot of bottom coverage here so you might like a skort or skirt on top to avoid a VPL (see below).

high waist black women's pants for incontinence
Black highwaist from www.stressnomore.co.uk

4. A subtle cover-up with skorts and skirts

It started with school uniform but now we can all wear skorts!  Skirts over shorts is now an on-trend look. Perfect for just hiding a good pair of  pants with a pad and getting on with whatever you wanted to enjoy doing. 

A quick google shopping search for running skirts and running shorts shows a range in price from £20-£80 offered by brands Decathalon, Salomon, Reebok and many others.

prettyfit.co.uk are stockists of the US brand runningskirts with a limited range but fun unusual prints £62  and I got rather side-tracked look at ALL the nice kit at gear4girls!  

5. Add extra support to your core from the outside

EVB shorts, leggings and capris

  www.evbsport.com    £60-£80

EVB capris may help support your pelvic floor when runningHave a look at these if you feel just generally ‘unsupported’ at the moment. 

Maybe not so much worried about leaks, but more that your entire lower half moves about too much and that exercise is straining and fatiguing your pelvic floor and core muscles. 

Company founder, Yvonne Brady tells her story of returning to running after her third baby and struggling with muscle strength.  Women’s health physiotherapists like myself are recommending these as an ‘extra’ layer creating more lift and support for the pelvis, abdominals and pelvic floor.

6. Add extra support to your bladder from the inside

The options have recently expanded for devices that aim to give support to the bladder from inside the vagina.  The three brands below increase in price, chiefly reflecting the number of times that they can be used:

Contrelle Activgard   (single use only)

£14.99 starter pack of 3,  £76 for a pack of 35  available www.desmitmedical.com (with VAT exemption*) or www.stressnomore.co.uk

Contrelle Activgard is a flexible foam plastic which you soak (to prevent drying the vagina), fold

double and then insert with an applicator into the vagina (not dissimilar to a tampon, but positioned nearer to the opening) to create uplift and support for the neck of the bladder.  They are disposable, single use only, but you can wear one up to 16 hours without removing it. 

Contrelle Activgard starter pack has 3 different sizes to try

You can still wee or have your bowels open as normal.

They work by providing more support for the bladder neck.  When you move fast (jogging, playing tennis) or  there is an increase in abdominal pressure (coughing, sneezing, zumba, aerobics) the pelvic floor muscle is supposed to support the bladder neck so that there is no leakage.  However, if the muscles are weakened and untoned that support can be lost.  Imagine a running hose pipe, lying on  soft grass.  When you lay your foot on the pipe you may slow the flow of water but you may not be able to stop it completely.  However, if that under surface is firmer, because you have laid your hosepipe on your garden path (aka a good pelvic floor, and/or the foam Contrelle Activgard in position) when you press down on the hosepipe the water flow stops. 

These work particularly well where you or your physiotherapist feel that the bladder has dropped a bit (prolapse of the anterior wall/cystocele).  Below is an informative video tutorial by a physiotherapy colleague Jane Appleyard. 

As these are a more expensive option than pads, they are most popular with mums who are generally not experiencing day to day stress incontinence but know when they are going to leak.  For example if they do a longer run, or go to a Zumba class.  They use them only once of twice a week. They can put one of these in before they go and not need to worry with other protection (or maybe just a pair of Pretty Clever  Pants “just in case”).  

Do buy a starter pack first, as like tampons they come in different sizes.  You will be able to use all 3 but there will be one size that feels best for you. Thereafter they come in big boxes of 35 at a time!

Contiform   Pessary    (re-usable up to 30 times)

£79.99 starter pack of 3, or £52.99 for an individual size  from www.stressnomore.co.uk or available on NHS prescription from your GP [code     ]

The principle of the Contiform and its position in the vagina is the same as the Contrelle Activgard but these are re-usable.

Contiform starter pack

The Contiform Pessary looks like a hollow tampon.   The smaller circle supports the bladder tube (the urethra), the larger surface lies against the floor of the vagina, giving support to the bowel wall.  They are made of a firm but flexible non-latex plastic and can be reused, with the guarantee  up to 30 times,  longer if not warn all day.

You can buy online or they are now available on NHS prescription.  You would need to tell  your GP about your symptoms, and ask him to prescribe a starter pack for you.  While you are there ask for a referral to physiotherapy too if you haven’t already got your own pelvic floor coach.

 

URESTA      (lasts a year)

 

And remember that promise….

Incontinence might be “common” (45% of women report bladder leakage at 3 months after birth, even 10% of those after Caesarean) …. but it is never “normal”.  It is a sign of pelvic floor (or bladder) dysfunction. Something that needs assessing and addressing.  Commit to doing something about your pelvic floor muscles.  Book an appointment with you GP to get a referral to a Specialist Physiotherapist for full assessment,  support and advice.  You can be much better than you are right now.  #beyouroptiMUM  #pantsnotpads

What are your tried and tested tips?  Please share your experiences with other mums in our comments section below.  Your story will inspire others.

the knack: your pelvic floor is for preventing urine leaks when you cough or sneeze

The Knack: my No 1 piece of physio advice for new mums

I still clearly remember  when I helped a client stop leaking in just one week by teaching her the Knack – and she was FURIOUS.

Sarah came to physio with the problem of urinary stress incontinence, leaking urine when she coughed and sneezed. It had been happening since her second son was born……….17 years before.

She had diligently practiced pelvic floor muscle exercises as everyone had told her to. When we checked them properly, with a vaginal examination, her muscles were firm, with an excellent strong contraction.  But, no one had ever explained the connection between practising strong muscle squeezes and WHEN TO USE THE SKILL IN REAL LIFE

I taught her about the Knack.  The next time she came back she was CROSS!  It worked – no leaks when she coughed – and quite rightly she was angry that no one had taught her something so easy, so simple and so effective sooner. It was humbling.  And my priority ever since to make sure I spread the word about this technique.  I don’t want today’s new mums to wait even 17 hours to figure this one out.

What is “The Knack”

The Knack is the magical art of drawing up your pelvic floor muscles just before you cough, sneeze, laugh or pick up something heavy.  Research has confirmed it works *

Your pelvic floor is like a trampette

You probably didn’t have to do this pre-contraction of the pelvic floor before you were pregnant, because a pre-pregnancy pelvic floor has a lot of the Knack: your healthy pelvic floor bounces pressure away like a new trampette natural tone and tension in it.  Like a trampette, straight out of the box from Argos, you can bounce up and down on itand your body weight barely makes a dent in the springy surface.  Pre-pregnancy, most of the down pressure when you cough or jump is deflected straight back up towards your head by the pelvic floor muscles.  Your bladder barely feels a bump.

However, you don’t need me to tell you that pregnancy and delivery have a notable affect on our soft tissues.  The abdominal wall is a clear indicator of what happens when you stretch  elastic slowly and steadily for 9 months.  Some are more lucky than others in the natural ‘spring back’ department.  Most women know that they are going to have to work the Knack: after a pregnancy the pelvic floor is stretched like a used trampetteto restore abdominal muscle tone and strength.   The pelvic floor has carried the same baby-burden and if you had a vaginal delivery (or pushed a long time before eventually needing a caesarean) there will have also been some micro tears to the muscle fibres and their connective tissue attachments.  Now, at least temporarily, the pelvic floor behaves like the well-used trampette – a sense that if you jump too hard your feet might touch the floor!

The Knack creates supportive tension

the knack: what your friends and your pelvic floor are forIf you tighten your pelvic floor muscles, in the exact moment before you cough, it is like two friends pulling your trampette tight for you just for that moment that you want to jump.  Yes, I admit its not ‘natural’, it’s not ideal, it requires thinking, you didn’t have to do it before……but it can make the difference between a bladder leak or not. 

Practice makes perfect

Practice  the Knack with a ‘pretend’ cough after you have had a wee. Your bladder is empty so you are unlikely to come unstuck. Challenge the system gently.  Hold your pelvic floor muscles firmly – cough lightly.  After a few days of practice, when that is feeling safe and secure, challenge the skill by coughing a bit harder.  Then increase your confidence by allowing an hour to pass so that your bladder is fuller when you cough (but start with the lighter coughs again!). 

With practice you will train a “learned-reflex”, a habit.  Your brain gets so used to the sequence of prepare, protect, cough that you do it on auto-pilot.

Sneezes are harder (and coughing fits, choking, vomiting….)

Sneezes are harder to resist with your pelvic floor than coughs, because you have less warning that they are coming and generally they create more downward abdominal pressure. Especially if you are one of those people who make everyone in the room jump out of their skin when you sneeze or are prone to 6 in a row?   A hacking cough with a head cold, or an allergy induced coughing fit are jolly tricky too.  Work on getting the anticipated, lighter coughs sorted first and then the rest can follow as your muscles strengthen.

Allow yourself some slack

Beware multi-tasking – I remember having a full bladder, baby in one hand, the folded Maclaren in the other, one foot on the escalator, and I sneezed – NOPE – the Knack did not work!!!  But hey, I could live with that – it seemed fair – it was a lot to ask of my pelvic floor system. 

If you can successfully use the Knack 9/10 times and only the occasional leak gets through that is excellent. 

Know when to ask for help

The Knack alone might not be enough for you.   Your pelvic floor muscles can be so weak that you need help to get them working again.  And it is possible to have muscles that have repaired too tight or are constantly overworking and becoming easily fatigued or sore.    Remember there are specialist physiotherapists attached to every UK maternity department who can give you an individual assessment, training and support.   Don’t hesitate to ask your GP to refer you to a specialist physiotherapist (full members of pogp.csp.org.uk have extensive post-graduate training).   

Does the Knack work for you? Any questions?  Please do ask, I am very happy to help.

*  Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence.   Miller, J.M., Sampselle, C., Ashton-Miller, J. et al. Int Urogynecol J (2008) 19: 773. doi:10.1007/s00192-007-0525-3).

Drawings copyright of A M Savage  (Proudly using stickmen since 1991)

3 Ps of a perfect poo: are you sitting comfortably? Amanda Savage specialist physiotherapist gives sound and hilarious advice

3 Ps of a perfect poo: are you sitting comfortably?

There are 3 Ps of a perfect poo which you should keep in mind during your ablutions!  Are you doing any naturally?  How do you sit?  Do some people in your family take a LONG time in the toilet? Who reads the paper? Should you keep books in the loo? Might you be helping too much?

Do see the video below to learn more about good bowel habits and promote some healthy/unusual/hilarious family discussions!

P for Position

P for Patience

P for don’t Push – rather Pant!  

NOTE:  This last P got a bit lost in the talk (this was my first talk to a public audience and I got a bit muddled when they showed me the 2 minute warning!).  I got to fill in the gap to the audience in the awards bit (they voted it the “peoples choice” which was very encouraging).   The danger of a traditional hold-your-breath-push is that you can accidentally tighten your pelvic floor just as the stool is trying to come out.  This can cause it to be pinched off midway so you get some out but lots gets left behind in the rectum. You might not be able to feel it there but it goes on giving off gas, making  you windy, pressing on the rectum walls, making you uncomfortable, and drying out into small pebbles.   Rather open your mouth (which helps relax your pelvic floor) and let out pants or sighs, just as the midwives teach you to pant to deliver your babies head.  This allows the poo to come out as one full tube with just a nudge and light pressure from you.  Now you really know everything!  Do go share!

About to have a baby or just delivered??  Do see the post 10 tips for the first postnatal poos for more ways to help you have comfortable bowel movements.

PS  It was a great Public Speaking course – I highly recommend the team at Ginger

**  My original title was The Life Changing Magic of Sitting Comfortably.. but it now seems to be known as the 3 Ps talk……

Postnatal sex giving you Valentine's blues?

Postnatal sex giving you Valentine’s blues?

When you are busy with a newborn baby, sex can drop quite low on your ‘to do’ list.  If it isn’t even comfortable when you do find the moment, it is all too easy to lose the intimacy in your adult relationship.  There are some simple but effective things you can do yourself, straight away, to improve your comfort and enjoyment.

Pelvic floor exercises improve sexual health too

First, commit to a couple of weeks of daily pelvic floor exercises to bring about proper change in these muscles.  The pelvic floor muscles play an important role in giving you a sense of closure around your partner as well as support and friction to create your own pleasurable sensations.  Taking time out to deliberately exercise the pelvic floor muscles will bring blood flow to the area, tone and tighten the muscles and improve your ability to feel the walls of the vagina during sex.  Many women report they are able to reach orgasm more easily, and that their orgasms are more powerful, after focusing on pelvic floor muscle exercises

There is an excellent booklet “Pelvic Floor Exercises (for women)” published by the POGP, my professional physiotherapy network, giving clear guidance.  Download a free pdf booklet here.

Pelvic Floor Muscle training TIPS for busy mums

Pelvic floor exercises while you brush your teethMulti-task your morning rituals.   A great time to remember to do pelvic floor exercises is when you clean your teeth.  Even busy new mothers, who might not have brushed their hair or had a shower, remember to clean their teeth! 

Stand still and focus on the pelvic floor muscles.  These are the soft muscular tissues around the opening of the bladder, bowel and vagina.  A pelvic floor squeeze is when you pull up around the back passage (like stopping wind) as well as the vaginal/bladder opening (like stopping a wee). First concentrate on 10 really good strong squeezes of the pelvic floor muscles in a row, focusing on making every squeeze a good one.  Remember to RELAX the pelvic floor properly between each contraction.  It is possible to overwork the muscles causing tension and tightness in the pelvic floor.  Some people experience pain and discomfort during sex because they find it difficult to relax their muscles. Make sure you notice what both a contraction and a relaxation feel like.   

Then try to sustain a medium hold of your pelvic floor muscles while you are cleaning your teeth Perfect mum-multitasking!  You will find you can only hold the pelvic floor contraction for a few seconds to start but with practice you might manage to clean the whole  top row of teeth before you fatigue!

Exercises after a Caesarean led by a specialist physiotherapistFollow a video.  Do you keep meaning to do your pelvic floor exercises but get distracted?  Are you better with supervision?  – join me for an exercise session straight from your computer. I will keep reminding you to focus on your pelvic floor throughout!  You can follow the  “Pilates for your pelvic floor” sequence through online exercise host pactster.com  Use the code PhysioPostnatal to access all their videos free for a month (try HIIT workouts from the team at & Breathe Postnatal too) .

pelvic floor reminder apps, exercise & tracker devices can be really usefulTap into tech.  If you are a gadget kind of girl, you might enjoy working with a  reminder app on your phone, or a pelvic floor exerciser or tracker device.   The Squeezy app is a simple reminder device with lovely visuals to help you focus when you practice.   Biofeedback, stimulation and tracker devices typically include a probe that goes in the vagina then attach to a handheld device which monitors your squeezes before your eyes.  Great for stopping you getting distracted from the task in hand, keeping track of your exercise sessions and boosting your confidence as you see yourself improving at the tasks you can read more about gadgets for pelvic floor here

Pelvic floor exercises not working for you?

If you feel that you are not making progress with your pelvic floor exercises by yourself, do ask your GP to refer you for a full assessment, examination and guidance with a specialist pelvic floor physiotherapist.  She will help you establish whether pelvic floor weakness or tightness is your main concern, as well as explore other factors like pelvic alignment and joint issues which could be making achieving the positions needed for sex difficult.   Read more about how to find a specialist physiotherapist on our resources page.

Personal Lubricant can be essential too

Do also consider adding a personal lubricant to your bedside table drawer. The inventors deserve Nobel Prizes!  The hormone changes of pregnancy and breastfeeding can leave your body surprisingly dry at the vaginal opening and deeper inside.  When you are trying to grab a quick sexy moment, with maybe less time than usual to get in the mood, your body may not produce enough natural lubrication.  This can make penetration painful or  the movement of your partner inside you can feel like a friction burn.  Using a personal lubricant during your foreplay (it works best if you put it on both of you) can make a magical transformation to your comfort and enjoyment.

Personal lubricants sometimes require a sense of humour in their application but there are now many nicer options than the medical stuff you come across at a smear test.   Look for a product with natural and organic ingredients, like Sylk or Yes.  It is important to ensure that they are pH balanced to the normal vaginal pH of between 3.8pH and 4.5pH.  Lubricants with a higher pH are too alkaline and can lead to UTIs, Thrush and Bacterial Vaginosis.  Lubricants can be water-based or oil-based (read more here) . You might try a sample of each to see which you and your partner enjoy the feel of best, though do be aware that only water-based lubricants can be used with condoms.  Online shopping means you don’t need to be embarrassed to ask for them in a chemist, try Boots online or trusted online pharmacy White Pharmacy.

If you are still experiencing discomfort after boosting your pelvic floor muscles and trying a personal lubricant don’t hesitate to talk to your GP.  They will be sympathetic and impressed that you have already tried these first steps.  Your GP  can organise referral to a specialist physiotherapist to give you personal 1:1 assessment and guidance,  and they will be able to move on to other investigations of the possible causes of your pain. You can and will enjoy comfortable sex again – but you must be brave to let them know that you are suffering.    

early postnatal exercises have many benefits

Postnatal exercises for the early days

Early postnatal exercises have lots of benefits

Get a free Exercise booklet & exercise video.

I believe that if your body is a good place you will cope better with the physical and emotional demands of motherhood.  Even though you are busy with your delicious newborn baby, taking time out to do some early postnatal exercises will help your recovery:   

  • moving your spine and stretching your muscles will help prevent back pain and sort out niggles before they build up you can see that your abdominal muscles have been stretched from your pregnancy.
  • Your muscles need your attention to strengthen and tone them to give you back your shape and give you a strong wall at the front to support your back when you are lifting and carrying your baby
  • Just carrying a baby for 9 months stretches and weakens the pelvic floor muscles underneath.  A vaginal delivery further strains the muscles and you may have had cuts or tears in the muscle too.  Gentle pelvic floor exercises promote blood flow, reduce swelling and get the healing process off to a great start.

FREE INFORMATION BOOKLET:  Physiotherapists promote MOVEMENT as soon as possible after delivery to help your circulation, stretch out your abdominal wall, regain your posture, engage your pelvic floor and support your back. There is an excellent booklet, “Fit for the Future”, published by the POGP, my professional physiotherapy network, full of clear guidance and advice for the early days after your birth.  You can download a free pdf of “Fit for the Future” here.

VIDEO: Early postnatal exercises, safe & effective for Birth to 6 weeks

These exercises are  for the first stage of your postnatal recovery, from coming home  to 6 weeks.  You can follow me through a sequence of  gentle but effective Pilates movements which actually mimic all the things  you are already doing, walking around, climbing stairs, stretching – but with cues to show you how to use your abdominal muscles and pelvic floor to support you and help you feel more comfortable.

If you had a caesarean delivery I have made a special video for you to follow. Read  more in this post.

If you have exercised through your pregnancy you will LOVE to be using your body safely and effectively again.  If you are new to exercise, welcome to a wonderful fitness journey!

Below is a (silent!) trailer, to view the video in full CLICK HERE, use my promotional code AmandaPostnatal for extended one month free access to all the videos on Pactster.

Did you find this video helpful?  Please help us let other mums know about our safe, pelvic floor friendly exercises.  Please write a review at Pactster (or below) or share the video with a friend.

Can I do exercises after a Caesarean? Expert physio advice from Amanda Savage

Can I do exercises after a Caesarean?

Free safe exercise booklet & video

Many women are worried about doing any exercises after a Caesarean section and find themselves becoming very stiff, hunched over and uncomfortable.

Physiotherapists promote MOVEMENT as soon as possible after a Caesarean to help your circulation, stretch out your abdominal wall, regain your posture, engage your pelvic floor and support your back. There is an excellent booklet, “Fit for the Future”, published by the POGP, my professional physiotherapy network, full of clear guidance and advice for the early days after your birth, with a special section for after Caesarean.  You can download a free pdf of “Fit for the Future” here.

I have made a video with online platform Pactster of safe and effective exercises after a caesarean Section 

These exercises are  for the first stage of your post-op recovery, from coming home after Caesarean section to 6 weeks.  You can follow me through a sequence of  gentle but effective Pilates movements which actually mimic all the things  you are already doing, walking around, climbing stairs, stretching – but with cues to show you how to use your abdominal muscles and pelvic floor to support you and help you feel more comfortable.

BEFORE you Follow THE VIDEO  >>>>>>   Sensible   CHECK!

A caesarean section is a surgical procedure and the post-op period needs to be approached with sensible caution. Before you start the video take a moment to ask yourself the following 3 questions:

  1. Why did you need a Caesarean section?
  2. Was the Caesarean operation straightforward, and have you had any post-op complications?
  3. Do you have any other medical issues?

30% of women deliver routinely by Caesarean section, for many reasons such as breech presentation, prolonged second stage or foetal distress.  But if you needed a Caesarean section for an unusually complicated reason and/or you could write a small essay in answer to No’s 2 or 3 then you are better served by a 1:1 personal assessment of your situation and needs, rather than an online video.  Do see the page about how to find a local women’s health physiotherapist.

HAPPY ALL WELL, THEN LET’s CoNTINUE…

Though you will feel fragile and sore initially, you will still soon be moving around comfortably, enjoying the magic of looking after your newborn(s).  If after pondering these questions, you feel that you are  progressing as well as expected after C-section, then remember that MOVEMENT is good for you and will help you feel more flexible, stronger and in tune with your body.

  • Take a little time each day to focus on some proper exercise for you.
  • Do read the special guidance in “Fit for the Future” (download the free booklet here)
  • Wait to start the “Caesarean to 6 week” sequence until you return home from hospital as the midwives will have checked that your wound is ready for you to move about freely.  

At any time If you have any concerns at all about your caesarean scar oozing or bleeding, or feeling anything but mildly sore as you exercise or after, then it is very important that you stop straight away and ask your GP or midwife for advice before you continue.

Women recover at different rates from a caesarean section.  It is ok to just try 2 or 3 of the exercises at first and then each couple of days add another one until you feel you enjoy doing the whole sequence. 

Below is a trailer of the exercise session designed to be suitable for after a caesarean

It’s not your computer – the trailer is silent!  It gives a glimpse of the exercise session.

To watch the Caesarean to 6 week video in full click here to go to Pactster.com  Do Use my promotional code, “AmandaPostnatal” for extended free access to Pactster for a month (free trial is usually only 14 days).

How long should I follow this exercise programme?

When you are doing exercises after a Caesarean section you should feel that they leave you feeling more comfortable and energised, not at all sore.  Any worries at all do speak to your GP or midwife or contact your local women’s health physiotherapy department.

These exercises can complement regular walking (gradually building your distance each few days) and slowly picking up more domestic tasks (stall as long as you can on the hoovering!).

Though you will be feeling much more active after even 2-3 weeks post-op remember that time is needed for the internal stitches to fully heal and be robust enough to cope with more vigorous exercises.  Don’t try to progress beyond these or similar level exercises until your 6 week check-up.

Please do let me know  if you have found this video sequence helpful and how you find exercising using the Pactster.com website?   – your feedback is really valued.