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!   ====

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.

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……

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

Why do tampons go sideways?

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

A BIT OF VAGINA ANATOMY

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

why do tampons go sideways?

the vagina is shaped like a squashed tube

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

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

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

TIPS TO GET TAMPONS IN THE RIGHT PLACE

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

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

What is the difference between water-based and oil-based lubricants? Specialist Physiotherapist Amanda Savage explains

What is the difference between water-based & oil-based lubricants?

If sex is painful, personal lubricant could be life-changing.  It is useful to understand the difference between water-based lubricants and oil-based lubricants.

If you have you have never tried a personal lubricant you might not realise what you have been missing. Those inventors should get Nobel Prizes!  Forget teen movie references to ‘lube and gloves.   And pity our poor grandmothers with probably only vaseline as an option.  Personal lubricants have come an enormously long way in their formulation, effectiveness and packaging.  I hope for the sake of these unsung heroes of our intimate lives that they get a better reputation soon.

IF SEX IS PAINFUL BOTH WATER-BASED Lubricants AND OIL-BASED PERSONAL LUBRICANTS ARE WONDERFUL!

There are some reasons why you might need to use one type over another, such as if you want to use condoms (the lubricant needs to be safe with latex), or you want to use an electricity based pelvic floor gadget (which need a water-based product).  But if you are just experimenting to improve your comfort I would recommend getting some samples of both types from several manufacturers and seeing what suits you and your partner best.

Below I have explained the key differences between water-based and oil-based and there are links to the websites of some of the brands my physiotherapy clients have liked.   

WATER-BASED LUBRICANTS

  • You will probably have come across the water-based lubricants in your ‘medical’ journey.  These are used in gynaecology clinics and smear tests.
  • If you want to use one of the pelvic floor enhancing gadgets (see Gadget Girl!) then you will need to use a water-based lubricant to create a connection between the pelvic floor and the gadget.     Think of how they smeared your belly with gel to do your ultrasounds during your pregnancy. The equipment will need the same kind of contact.
  • A water-based lubricant also works well to help insert a tampon, without interfering with its absorbency.
  • You can use water-based lubricants with condoms and sex toys
  • Many people feel that water-based lubricants feel more natural, “wet”, with a realistic texture and they have no smell or taste.  They leave skin clean and residue free.
  • You can use them for instant topical relief of a dry and itchy feeling vagina and perineal area.  I have known clients keep theirs in the fridge for extra-soothingness!
  • Water-based lubricants can be effective in reducing vaginal dryness over the longer term by rehydrating the tissues (just like a facial moisturiser would do).

THINGS TO CONSIDER?

  • The most well known is the brand KY Jelly but it contains parabens and research1 has shown that the formulation of KY can irritate the sensitive vaginal tissue It can also feel sticky due to the high glycerine content.  Most chemists offer an own-brand version.  These might be well suited to a short examination procedure, or  to use with a pelvic floor exercising gadget, however for intimacy you might find that with the lower quality products can turn a bit ‘sticky’ and you should check the list of ingredients carefully avoiding glycerine, propylene glycol and parabens. 
  • They can be a bit of a devil to get from the tube to the needed body part without dripping. Related post (?!)  “applying personal lubricants without losing your momentum/dignity/sense of humour!

OIL-BASED LUBRICANTS

  • Oil-based lubricants should be formulated with natural plant-oil
  • Products made from mineral oil which is a petroleum bi-product are not suitable for vaginal use
  • Natural plant-oil based lubricants are longer lasting and can nourish dry tissue and make sex much more comfortable
  • They can be used as all-over massage oils as well as personal lubricants so their application to yours, and your partners, important bits can feel more like a natural and enjoyable part of foreplay.
  • Like the cosmetic equivalent face oils, they can protect and feed dry, intimate tissues but they cannot be re-hydrating as they do not contain water.  They can be just as soothing as water-based products and may be more comfortable if you suffer with vulvodynia or other vulval conditions

THINGS TO CONSIDER?

  • All oil based products including Vaseline, Baby Oil and Mineral Oil can affect latex and are not safe to use with condoms
  • They are not the right product to use with pelvic floor gadgets such as stimulation and biofeedback machines (these need a water-based lubricant to conduct electricity between you and the gadget).  When you are using a ‘gadget’ for exercise rather than ‘pleasure’ you may find a cheaper chemist own-brand water-based lubricant perfectly satisfactory for the purpose depending on your personal position about ingredients.
  • Water and oil-based lubricants are suitable for use with silicone toys
  • Silicone is a synthetic product which can offer longer lasting lubrication but doesn’t feel natural and cannot easily be removed with water. Silicone lubricants cannot be used with silicone sex toys but are safe to use with condoms.  They are usually well-tolerated but some people prefer to source a completely non-synthetic product, like the ones made with plant oils.
  • When trying a new lubricant it is always wise to do a patch test on the inside of your arm or wrist.

NOT ALL LUBRICANTS ARE THE SAME

As usual you get what you pay for.   The more expensive products have given attention to the quality of the ingredients and spared a thought for the packaging.  You only need a little bit each time and your intimate relationships are invaluable.  Treat yourself to something made for the purpose, in nice packaging and never run out!   

Please do let our Supported Mums readers know your preferences below and share any advice?  If you have come across a product that you think I should include in this list please let me know your recommendations?

YES®  www.yesyesyes.org

SYLK   www.sylk.co.uk

Boots own brand lubricating jelly    www.boots.com   

References:

11D. Edwards & N. Panay (2015): Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition? Climacteric, DOI: 10.3109/13697137.2015.1124259

2World Health Organization. Use and procurement of additional lubricants for male and female condoms: WHO/UNFPA/FHI360 advisory note 2012 [7 July 2015]. Available from: http://apps.who.int/iris/bitstream/10665/76580/1/WHO_RHR_12.33_eng.pdf

3 Great Pelvic Floor Exercise Apps

If you have a smart phone you may enjoy one of the new pelvic floor exercise apps.  These are great innovations.  This week I have  tried out a couple of  reminder apps (Squeezy & my pff), a tracking app (Elvie) and an exercise workout to watch on your phone (Pelvic Floor First)

Road-testing has had entertaining moments with  my phone  beeping and buzzing.    I have done a LOT of pelvic floor exercises this week.  Perk of the job.

TIP (obvious, to everyone else I’m sure, but I did it by accident):  When you are looking at them the first time and organising your settings you might find it easier to view the app on your iPad/tablet so all the buttons and instructions are bigger.

Sadly there is no app that actually does the exercises for you.    Though they all have similar sounding descriptions on the app stores,  I would categorise them into ‘reminder’ apps, ‘ exercise tracking’ apps (with wearable device) and ‘portable exercise workouts’ to follow on your smart device.

REMINDER APPS

Pelvic floor exercise apps - Squeezy NHS

Squeezy NHS app gives regular reminders and lovely visual prompts to follow

  Squeezy – the NHS Physiotherapy App for Pelvic Floor Muscle Exercises, Propagator Ltd £2.99.  Also offers the Apple Watch App for iphone. 

This has been designed by one of my specialist physiotherapy colleagues, Myra Robson, using all her NHS experience and hundreds of clients feedback to develop an informative, easy to use, clear and visually pleasing app.  You can change settings easily yourself to chose how many times a day you want to be reminded to do your exercises.  It sends you a (silent!) text message to remind you to do your exercises.   Then you tap on the screen to start a balloon/type bubble moving – you can’t but help start squeezing in response!  Its a great visual prompt (with optional ‘boing’ noises).  There are drills to practice fast contractions or slower ‘holding’ contractions.  You can change the settings to make the exercises a comfortable speed for your ability.  You can record your sessions, as well as how much you have been drinking.   

If you are working with a physiotherapist they can help you set up your programme to fit with their training and check up on your efforts!  

pelvic floor exercise apps - My pff

My pff by tena

My pff – an app sponsored by Lights by TENA.  Free.

This free app is a similar exercise concept, with a screen changing colour up and down to show you how long to hold and relax for, but lacks the helpful information and bespoke settings options of Squeezy.     It was very simple to chose your level (in the settings bar at the base) and then get started.   I liked the very simple interface of this app but similar to the reviewers I had problems with it crashing when trying to set the reminders.  Once I had set them (2 or 3 crashes but it restarted easily each time) it worked fine.  I like that there was a simple button to turn the reminder off (if you finally get a daytime nap you would be hideously cross if it’s an app that wakes you up)

HACK  Use your phone clock function!   Free.

Set your phone’s ordinary timer to alert you every 4 hours through the day to do your exercises

Exercise tracker device with smart phone app

Pelvic floor exercise apps - Elvie

The Elvie is a discreet vaginal device which tracks your pelvic floor exercises on your smartphone

Elvie  feedback/tracker device with free app   £169     www.elvie.com  

Tracking apps  communicate with a wearable device.  You may already have a FitBit worn on your wrist to communicate with your phone?  The Elvie is, as they say, ‘the most intimate’ tracker – a small, pebble shaped unit which you put inside the vagina.  Then it communicates via blue tooth to a phone app.  When you practice your pelvic floor contractions a patented force and motion sensor system detects the strength of the muscle activity and shows up on your phone screen, giving you real time information about how well you are contracting.  There are clever ‘games’ to play by contracting your muscles – think pacman controlled by your pelvic floor? It records your exercise sessions – great for motivation.

Important note – designed for discreet home exercise, unlike a FitBit, not for going out & about!

WORK OUT APPS WITH PELVIC FLOOR FRIENDLY EXERCISES

pelvic floor first app has good workouts

The Pelvic Floor First app has great pelvic floor friendly workouts

Pelvic Floor First – by the Continence Foundation of Australia . Free.

This app is not a ‘reminder-type app’, rather a portable workout regime to copy.  If you like your pelvic floor exercises disguised amongst your other body part exercises then this app may be just right for you.  The app is based on the Continence Foundation of Australia’s Pelvic Floor First website with the workouts designed by a physiotherapist and fitness professional to be ‘pelvic floor safe’.

There are 3 levels of workouts, using light hand weights and a gymball as props.  The exercises are very clearly presented as just stills, audio or audio & video together.  It has a nice feature to count down a daily workout but you do have to keep starting each new exercise by pressing the arrow on the screen.

 Have you tried a pelvic floor exercise app?  Did you like it?  Please share your recommendations in the comments below and let me know which one I should road-test next?!