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.

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.

Can Pilates strengthen the pelvic floor?

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

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

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

Video: Pilates for your pelvic floor

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

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

SPECIALIST PELVIC FLOOR PHYSIOTHERAPY

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

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

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

morning back stiffness? stretch and relax video by Amanda Savage

More granny than gazelle?

MORNING BACK STIFFNESS?

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

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

WHY DO EXERCISES BEFORE GOING TO BED?

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

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

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

VIDEO: 10 minutes stretch and relax.

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

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