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)

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.

 

 

First Aid for sore bottoms – use my RESCue remedy

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

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

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

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

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

RESCUE  REST – SOOTHE – ELEVATE – CUE

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

R IS FOR REST

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

E Is FOR ELEVATION

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

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

S IS FOR SOOTHE

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

CUEYOUR PELVIC FLOOR

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

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

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

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

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

A NASTY ANKLE SPRAIN AND THEN RUN HOME………

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

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

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

WE NEED TO CARE FOR BRUISED SORE VAGINAS TOO

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

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

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

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

Who’s looking after the chicken?

KEEPING THE MOTHER CHICKEN HEALTHY IS IMPORTANT

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

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

CHICKEN-CARE #1

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

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

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

Sore bottom? Try a hard chair

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

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

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

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

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

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

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

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

10 tips to make those first postnatal poos feel more comfortable by specialist physiotherapist

10 Tips to make those first postnatal poos more comfortable

When you are feeling sore after giving birth, the first wees really sting and it is hard to even contemplate how you are going to manage to open your bowels without pain. Postnatal poos need a bit of encouragment.

Here are some tried and tested simple tips to help you have a more comfortable time.

TIP #1   PATTERN

Bowels love a routine and you can train a “bowel habit”.   Try to establish a ritual that your body can get used to and lets you empty your bowel regularly before you become constipated. 

In the near future you will be so much happier if you can relax in the knowledge that you will have had a poo in the privacy of your own home before you have the earliest visitors or want to get out for the day. 

It is very rare to need to open your bowels at night.  But as we get up gravity gets the gut started with some movement (peristalsis) as does movement. Best of all though is the gastro-colic reflex – which means that the sight, smell or taste of food gets the gut going and the bowels moving. 

So have a drink as soon as you can (hot water with lemon used to be served on gynaecology wards) and try to have a small breakfast even if you don’t feel like it.  Clean your teeth and as you clean your teeth start thinking to yourself…next I am going to……….…    

TIP #2  BE PREPARED

Listen out for the alert signal that there is a stool ready to come out.  You absolutely don’t want to miss this.

  The bladder alerts you when it is being stretched so that you can’t overfill it  – but not the bowel – it can get very full and distended without us feeling a thing.  The signal you are looking for is the feeling of pressure and irritation low down on the back passage (the anal sphincter).  This is the stool pushing against the nerve endings at the anal sphincter opening.  You could be a bit numb straight after delivery, and certainly after an epidural, so you may have to really look out for this feeling.

You could be half-way through your breakfast or middle of changing a nappy……if you possibly can, stop what you are doing and get yourself off to the loo.  Even mid-nappy change – just take the baby with  you – they can lie on the changing mat outside the door and get some bottom air!

Don’t put this feeling off.  It is the sign that the body is ready to go and the best poos are the ones the body does naturally.  If you put it off (I’ll just change a nappy…. I’ll just phone my mother……..) you accidentally squeeze it back up inside you where you can’t feel it and then it sits there getting drier and drier making you constipated.

TIP # 3   PRIVACY

Having your bowels open is an intensely private activity.  Make sure that you feel safe and relaxed.  If you are in hospital this might be walking a bit further to find a more tucked away toilet where you don’t feel you will be rushed.  At home, if there are people about ask them to watch the baby (so you can relax about that), excuse yourself,  take yourself off upstairs or as far away as possible, close the door properly.  If you are on your own at home and will worry about the baby – take them with you – leave them on the floor outside with the door ajar.   Ask a toddler to read the baby a story.

TIP # 4   POSITION

They have actually done lots of research about the best way to sit on a toilet.  Yes really.  In Australia.

Nature did not intend us to sit lady like on a ceramic toilet.  We are supposed

the best position to sit to have a poo

picture from POGP booklet Pelvic Organ Prolapse – a Physiotherapy guide for women

to squat down behind a tree.   The key thing is knees higher than your hips.  This un-kinks the bowel and relaxes the pelvic floor muscles.

  • So sit with your feet up on a toddler step or box
  • Bottom well back on the seat
  • Rest your elbows on your knees
  • Untuck your tail bone keeping your back relatively straight
  • Let all your body muscles relax, especially your pelvic floor and abdominals

TIP #5  DON’T THINK ABOUT IT…..AND BE PATIENT.

Emptying the bowel is a natural thing that the body does best on automatic pilot.  It is not something that ‘we’ do.  Like sneezing.  The best ones come from nowhere.  And just like a juicy sneeze that you can feel coming – if you think about it too hard (and especially if you say “I think I am going to sneeze”) – it will disappear!

An age old trick – read a book/magazine/back of a shampoo bottle….anything to distract your corticol (thinking) brain and let your automatic brain do it’s own thing.  Give your body some time.  You are waiting for something solid to move out – it doesn’t just fall out like liquid.  Your body needs to accept that it is a quiet, private moment.

TIP #6  DON’T PUSH……PANT

A traditional ‘push’ involves a big breath, closes your mouth, hooks in your abdominal muscles and then bares down.  This action draws the pelvic floor muscles UP and closes the hole that we want the stool to travel through.  Exactly the opposite to what you want.

Remember ‘panting’ in antenatal classes?  To let the baby’s head birth gently without getting in the way with our own muscles.  Use exactly the same type of breath as you feel the stool coming, soft and gentle, little sighs and slow out breaths.  Nurse it along.

TIP #7  SUPPORT YOUR PERINEUM AND PELVIC FLOOR

The downward pressure of the poo passing through the rectum and bowel opening is going to stretch the perineum which will be tender, sore and healing from your delivery. 

Take a pad of toilet tissue and press it over the whole of your perineum, just leaving the small anal sphincter free.  Press upwards to support your soft bits as the poo is coming down.  This will also direct the poo backwards to come out the anal passage easily,  rather than the pressure coming forward into the vagina area. (Lots of people carry on doing this for ever because it is so helpful).

TIP#8  PAUSE

Now relax, sit back and just wait a good minute before you dash off.  There could be a bit more.  Sometimes there is a pocket of wind which needs to move through and then there can be a ‘second wave’ of stool that could come out.  Again you might not even be able to tell it is there until you have a sudden new urge.  If you don’t wait for this bit and it gets left behind it can act as a ‘bung’ and become windy or uncomfortable later.  Remember to do this for a few weeks and you will get to know your body better and how it is likely to behave.

TIP #9 PROTECT YOUR SKIN

Treat your own bottom just like you do your baby’s.  Wipe gently from front to back.  Don’t scrub at your skin with dry tissue.  Dampen some cotton wool or use a non-alcoholic wet wipe.  Wait for your skin to dry and then apply a baby-bottom cream for you too.  This helps your skin heal and acts as a thin barrier from rubbing against your underwear.

TIP #10   YOU MIGHT NEED TO GO AGAIN…..

You body can be all over the place for several weeks after a delivery.  All the hormones, broken routines for your eating, sleeping and exercise play havoc.  Your pelvic floor muscles are stretched and weakened so you will feel more vulnerable and less certain of your holding powers.

Once you start applying the tips above, and especially once you start really listening out for the signals to go to the toilet, you can be surprised to find that you need more than one poo in a day.  This is perfectly ok.  Often each time  you eat a big meal you then need a poo.  Traditionally most people go after breakfast – but you may need an after lunch one too!   It is that great mechanism the gastro-colic reflex again, triggering  the gut to work after eating.  Make the most of that and keep alert for opportunities.  It is much more comfortable to poo when the poo is just right and wants to come out naturally.

OR YOU MIGHT NOT……

However, guts can also go into shut down after delivery, leaving you feeling constipated. If you suspect at all that you are constipated ask the midwives for a softener or laxative.  The right kind of stool is firm but soft with a beginning and an end.  Too runny and you will feel that you can’t hold it in or will have an accident, but too hard and it is sore and uncomfortable to pass through the soft delicate opening.  Make sure you are are you drinking enough? 

How are you finding coping with your bowels after having your baby?  If you are feeling up to sharing with other mothers, on this very personal topic,  we would love to hear from you.