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”.  It 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.

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.

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 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

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.   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.  I like that there is attention to detail on the packaging, a range of colours including grey marl, and that their website promotes pelvic floor exercises too.

iconundies.com

These don’t appear to be stocked in the UK at present but I found their website when searching and 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.  Browsing their website and blog will, I hope, help you feel emboldened and determined to not limit yourself from taking part in sport.

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.

Protect Dry panties and maxie panties £19.80 (VAT exemption available*) www.imedicare.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).

Hi Line Thong £16.80 free p&p  respond.co.uk

The only thong style about.  I knew they existed as we have a pair in clinic but it took me absolutely ages to find them on the web.   I could only  find them from a company that specialises in continence underwear for severe problems.  Don’t be put off by the surrounding unglamorous options.  Our link takes you straight to the right page! They look just like a ‘sloggi’ style knicker but have a thickened gusset which can hold up to 120 ml (1/2  a mug ) without leaking through.  The gusset is a more traditional thick cotton material unlike the more modern technology of the Protech Dry (above).  There is a waterproof liner but it doesn’t rustle.   Only in white but I had a customer who dyed a pair black to wear under a party dress.    They can be washed up to 200 times so you can just just strip off with the rest of your gym kit and stick through the wash. 

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 solid 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!   https://www.gearforgirls.co.uk/running-skirts-dresses/

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

Contrelle Activgard  £10.50 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.  You can still wee or have your bowels open as normal.

They work through the principle of 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.  Below is an informative video tutorial by a physiotherapy colleague Jane Appleyard. 

As these are a more expensive option than pads, these 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 Diary Doll 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!

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.  Book an appointment with you GP to get a referral to a Specialist Physiotherapist for support and advice.  You can be much better than you are right now.  #beyouroptiMUM

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 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 free access to Pactster for a month.

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.

 

 

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?

*denotes an affiliate link

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.   * affiliate link    The Elvie 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.