It is the very OPPOSITE of selfish to keep yourself fit and well.
Who is going to look after the egg(s) properly, if the Chicken is tired, weak, undernourished and demoralised? Do you need to focus on gaining energy? 10 Rest Tips today – essential reading for Mums (and their physiotherapists!)
Lessons learned (already) in 2020!
I was invited to go to a 3 hour workshop last weekend called NOURISH! – a lovely word-play on the combined skills of the leaders, Lavinia Brown (a life coach @bobmama_net) and Zoe Kirby (a nutritionist & yoga teacher @zoekirbynutrition). Both inspiring local Cambridge women.
The first step, was taking time to reflect (again) that the need to care for ourselves – mind and body – has to co-exist with all the demands that come with being a Mama Chicken (or Papa Cockerel, of course). And eggs don’t just come disguised as newly hatched chicks. There are career eggs, elderly parent eggs & partner eggs, not forgetting house, garden, friends, & pet-type eggs too.
Lavinia focused on the need for REST. Not mindfulness. Not sleep. Something a bit different. Something I hadn’t realised was different, or missing. REST.
Do we need it?
Lavinia led a brainstorm of ways to recognise that we need REST.
Together, we reflected on the familiar, but often ignored, Physical, Mental and Emotional signs & signals, that tell us that our body & mind are struggling to perform. They are different and combine uniquely for each of us. Think headache, loss of attention, and tearfulness as examples in each category. You may not know yet what yours are – but I bet you have an inkling of a few?
Signs & signals that rest is needed
Since the workshop, I have further simplified how to recognise my own need for rest. The analogy that is working for me is visualising myself as a Phone Battery. I am on the look out for LOW POWER MODE. If I peer into myself I’m no longer in the green. I’m in yellow. My internal voice is trying to say – girl watch out – you are dangerously close to red where Nothing Functions Well and next stop is burn out (physical = tight neck, mental = scattered + overwhelmed, emotional = short fuse and/or tears depending on hormone-levels!).
It’s when I need to Plug-IN
So REST for me is the analogy of plugging my phone into the wall for a short re-charge. Not that routine long-charging of my phone, to reliably give me the whole of tomorrow. That’s SLEEP. Rest is rather a choice to give up using my phone completely for 10 minutes, in order to benefit by getting sufficiently back into the green. Getting enough battery power for a proper 2 hours of full-function ahead. Delayed gratification in it’s most difficult manifestation?
We DO have choices
Since I started to think of Rest like this, it’s been fascinating to have noticed the choices I make regularly, subconciously (and mostly correctly) for my phone. I’m habitually on it. My phone rarely catches me out. So why should my body battery? REST now feels like a positive CHOICE that I make for myself. And a pleasantly guiltless no-brainer too.
Now, it doesn’t seem selfish or indulgent to ask myself “Do I want to get through my afternoon clinic offering my patients the best me, clear thinking, enthusiastic, energetic?” Of course. Then it’s perfectly OK to stop, close my door, eat my lunch, breathe & BE for 10 minutes. Me, plugged in.
Yes, even for naptimes!
Reflecting back to my own baby-days, sometimes, (not often enough), I would make the decision to shut my eyes FIRST as soon as baby was asleep. Even if I only had 20 mins half-nap I was always SO much more productive during the remaining time than if I had not bothered.
My 10 take home Rest Tips
(part inspirational Lavinia, part workshop after-thoughts)
# 1 A rest is as good as a sleep.
One of my mother’s favorite expressions. Meaning just lie there and “be”. This has value. Even (especially) at 2am.
# 2 Activities can be rest-full.
REST doesn’t have to mean Doing Nothing. Rest can be classic activities like walking, reading a book, gardening, baking, or doing some Yoga practice. Lavinia also pointed out activities which don’t appear “restful” at first glance, yet can be enriching and enlivening, such as having coffee with a friend, drinks out with the girls, going to an energetic exercise class, even cleaning (… as long as multi-tasking doesn’t take you longer to get out of the yellow than if you just literally plugged in and didn’t touch your phone for 10). If the intention (and effect) is to recharge your battery, not deplete it, you could have a long list of options.
#3 Rest can be INVIGORATING or SOOTHING.
Lavinia highlighted that we need each of these at different times. And that a single activity might be used for either gain (eg Pilates can be energising or relaxing depending what you choose to do) or going for a run might equally fire you up for your day ahead or allow your mind to clear from the one you just had.
#4 QRT – QUALITY REST TIME
QRT is a similar concept I have heard of in the past. We identify our QRT options by taking time to notice the activities that feel like quality time even though you are busy – they are the ones that put you in “the zone” where time goes by without you noticing and/or feeling depleted by the task.
#5 Put the BIG rocks in first.
That old chestnut. REST FIRST, there is always space to DO more. Particular relevant to naptimes?!?
#6 Make a go-to list for yellow moments
When you are in LOW POWER MODE it is likely that your thought processes are slower, so it is harder to think what would get you out of the mode. Keep your list handy.
#7 Why don’t we rest?
How do we self-sabotage our intentions? WHY do we do this? This part of the workshop was incredibly valuable but personal. Not prepared to share! But do a tiny bit of thinking and you will know that we all do this. Multiple reasons!
#8 ACCEPT low power mode
Sometimes you truly CAN’T actually plug in. But I’ve noticed there is another potential choice – if I don’t want to go red I might have to accept that some functions need to switch off, or are just not an option anymore. I have to choose wisely how to use my last bit of power.
For example when I find it’s impossible to make brainy decisions, I can still get some banking done, or answer some low-key emails . Or I persuade myself & The Child into a simple card game, as less effort than arguing over homework. I’ve even been known to curl up for some TV-time. I need to Power Right Down until I can find a proper socket time-slot to re-charge.
#9 Don’t be the Victim
Lavinia’s harshest truth (put very kindly of course). Am I waiting for someone to give me permission to rest? Or offer me the rest on a plate – “ooh you look tired, here sit down, I’ll cook dinner….”. Sure that would be nice but she points out that we disempower our Self by waiting for a Shining Knight , with the risk of becoming bitter and resentful when one doesn’t turn up. Do I go around plugging other people’s phones in for them? No. Do I even remind other people to charge their phones? No! It is MY responsibility to keep my phone charged.
#10 Anticipate: spot patterns
Why am I overwhelmed by friends for supper tonight? Why did I say let’s meet up but now wish I could go to bed? I want to ENJOY the social stuff like I planned, not resent that I overcommitted? This is definitely one of my regular patterns. How to refresh a work-depleted Friday night battery? Get a proper boost to see me through a fun & fulfilling late night? I’m experimenting with a) knowing I need to do this and b) methods – Long soak or quick shower? Read for 10 mins? Sort the socks with a podcast?!
What are your triggers/patterns?
Have you noticed that with Small Ones, 4pm is no longer the end of the day? It is merely the lull – before the real work begins! Teatime, bathtime & bedtime are physically and mentally Hard Work. Could you re-charge/re-boost just before it all kicks off? Or get baby to bed, then have 20 mins “time-out” so that you can re-focus on your relationship with your partner and your own personal to-do list – rather than an antisocial crash-out from exhaustion?
# Bonus . And one for you – Reframe?
Do you want to go to your regular postnatal class, Pilates (spinning, run, swim ….) but feel that your power mode is too low to even get you out the door? Perhaps Re-frame? Going to your class could be the equivalent of plugging yourself in for an hour, giving you a couple of day’s worth of power, in exchange for that short weary drive (in practically red-mode) to get you to the hall/studio/pool?
Does this concept of Rest vs sleep resonate with you?? Which of the Rest Tips had your name on it? What do you do to stay out of the yellow zone? How to you re-charge?
Cambridge is a wonderfully small place. I am delighted to host a post specially written for you by Lavina Brown, a local Life Coach. Lavinia came to my antenatal pilates class a few years ago. Now, like many women, she has returned to her work with a change of focus – drawn to helping other mothers be their best selves:
As a life coach for mums who want the most from life – to be the best mama they can be AND to find fulfilment and happiness in the workplace – self-care is one of the most important items in my coaching tool kit.
Why? Because we can’t have it all and do it all, all at the same time, without it.
Ambition is a great thing – especially when, on the whole, we women tend to seriously undersell ourselves – but it needs to be tempered with a reality check:
First, that women are naturally empathetic and often also highly sensitive. If we take on too much, this means we also take on too much of other people’s stuff (emotional and physical) leading only to burnout, depression and disease.
Second, that parenting takes up a huge amount of energy (whether we want it to or not). We simply don’t have the full tanks we used to pre-kids, to expend on what we choose. So we need to be careful about what we commit ourselves to and even more careful about taking time-out to replenish those precious tanks of ‘you juice’.
And that means self-care.
Yes, it’s an overused, slightly wishy-washy umbrella term that could mean lots of different things to different people, but that’s the whole point. Self-care is what makes YOU feel better about yourself, however weird and wacky that activity might seem to others. It could be picking your spots last thing before bed, going for a walk in Nature, indulging your inner neat-freak by colour-coding your wardrobe or learning to fly a plane.
I see self-care as falling into two camps: the nourishing sort (think cups of delicious tea, massage, lying in the sun, reading in bed, chats with your bezzies, steaming hot salt baths) and the revitalising sort (think sports, gardening, dancing etc). It doesn’t matter which camp is your natural self-care go-to, what does matter is incorporating at least one item from either list into your routine, on at least a weekly basis.
And there’s the rub: fitting it in. Actually doing it. Scheduling in time for yourself somewhere near the top of your to-do list rather than at the bottom underneath a myriad of chores.
Why is this so hard to do? Because as a society, we have not been taught to value ourselves over and above what we DO in the world. We have forgotten what it is like to be a human being rather than a human doing and in a world that glorifies the term ‘busy’, we have assumed that to get ahead and achieve our maximum, we should always be switched on.
But is this how we want our kids to grow up? No! So why should we fall in line with this crazy, short-termist attitude to life and health? Why not be pioneers instead?
Let’s see rest as a revolutionary act and start implementing it as though our lives depended on it! (Mama truth bomb: they do).
And if you’re still feeling like self-care is indulgent and
selfish, keep my top four reasons to ditch the mama guilt close to hand:
Just think how many hours you have been ‘on duty’and tally that up against how many you plan to take time ‘off’. There’s bound to be a huge imbalance.
Remember that giving yourself permission to do something that feels good and gives you joy, is also allowing others to do the same. By expressing your needs and asking that these be met (something we all struggle with as remote descendants of Victorian disciplinarians), you are showing your partner how they too are worth investing in
Partaking in some self-care without the kids is showing your children that life doesn’t have to be all work and no play. Hard effort deserves celebration – you would celebrate their achievements, so why not celebrate yours, however small, menial or routine they might seem to you at the time?
Happy Mama = Happy Family (and vice versa) You wouldn’t want to inflict shouty, resentful mama on them, would you?
So, self-care or be square. Your kids/partner/health will thank you for it…
Lavinia Brown (aka BoboMama) is a qualified transition coach for mothers. She supports women to reach their greatest potential – at home and in the workplace – whilst successfully managing the ‘life bomb’ that is kids. See www.bobomama.net for more details or follow her on social media for daily doses of mama medicine: click here for Insta and here forFB
Other health and hygiene questions are easy. How often should you clean your teeth? Wash your hair? Change your pants? But these two bladder questions – How much should you drink? and When should you wee? are full of issues, myths & legends. This article helps you understand the UK guidelines, understand why how much you drink influences when you will wee – and offers tips & tricks to for a happy bladder!
Bladders & drinks FAQs
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?
Am I normal if I wee in the night?
Is it ok to have just a tiny wee before you go out the door? ………
Phew….see what I mean about a tricky subject?!
How much water should you drink: official guidelines
Your body needs water or other fluids to work properly and to avoid dehydration. That’s why it’s important to drink enough fluids. In climates such as the UK’s, we should drink about 1.2 litres (six to eight glasses) of fluid every day to stop us getting dehyrated. In hotter climates, the body needs more than this. We also get some fluid from the food we eat.
Extra (practical & useful) tips & info:
Normal fluid intake should be 1.2 to MAX 2 litres in a 24 hour period.
It is NOT 1.2 litres of water on top of all your other drinks
This is ALL fluids added up together (tea, coffee, water, juices, alcohol).
1.5-2 litres equates to 6-8 standard 250ml mugs a day, or 4 x 500ml water bottles.
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 & 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.
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.
How to be nice to your bladder: filling tips
Let’s talk through the look of a ‘normal’ day, in an untroubled happy bladder world. It will help your brain understand how it should all work.
If you have been suffering with mad dashes to the loo, uncomfortable and inconvenient urges and bladder accidents, these habits will really help.
# 1 . Take an ‘organised approach’ to when to fill & empty the bladder
A standard mug or glass (of tea, coffee, water etc) is 250ml. Many people are often surprised to realise that you therefore need no more than 6-8 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 1.2 litres IN gives you 5-6 wees out. Then if you are drinking 3 litres a day, simple maths says that’s about 12 standard wees. Or 6 very very full bursting ones. Those bursting wees are highly likely to be accompanied by some unpleasant sensations or not quite making it! Cut back on the volume (to 1.2 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.
# 2 Not all drinks are equal
It can seem strange that we say 1.2 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. 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). Or light 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.
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.
#3 Take more notice of how drinks affect you
Start to notice how long it takes for different drinks to pass through you and make your bladder uncomfortable.
Squeezy App (which 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 or download a chart here.
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. Then increase the balance of plain water. You will likely see a quick reduction in bladder urgency and increased capacity to hold.
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?
#4Sweating? Breastfeeding? When you might need extra fluid
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). Also when we sweat. If it is a hot day, we need extra fluid. If you are doing an extra sweaty activity, drink a little extra before 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: 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.
When should you have a wee?
A quick summary of the daily OUT routine. IF you are drinking 1.2 litres fluids in 24 hours (which is one 250ml mug roughly every 2 hours)
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 to be nice to your bladder: emptying tips
# 1The first sensation is usually too early
After 45 minutes to an hour your bladder would normally hold about 120ml (a yogurt pot) of urine. Then you would get a ‘I might need a wee‘ sensation. This happens as the walls of the bladder (it’s a muscle) stretch for the first time.
Our brains should know to recognise this as an ‘irritating-stretching-message’ not a ‘need-a-wee-now’ message. Subconsciously we should
clock the time,
do the maths (only an hour since I last had a wee)
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. It’s 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.
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. That can be very disabling.
#2 . Ignore the first message and wait for the next one
Normally, that first message quickly disappears. We forget all about the bladder. We can fill it for a second hour (or so) till there is more like 300ml. Think 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.
# 3. But do 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.
You can ignore the middle message, and head into a third or even fourth hour. You 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. 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. BTW an emergency is being unexpectedly stuck on a motorway. NOT just putting it off for …one more paragraph, one more chore or an advert break. And not just because you are too busy to remember to go for a wee!
#4 . Is there really something wrong with your bladder – or is it poor human judgement?
So many times the problem is really operator error. The human operator is not listening to the (rather good) system properly. Guilty??? Which are you? Tend to go too early (friends and family tease you about always needing a wee)? Or tend to leave it too late (lots of sweaty near misses or trouble at the front door)?!
Or, not uncommon are you swinging between too early and too late? Do you push your limits…push your limits…leave it…leave it…just one more thing and THEN you very nearly have an accident?! The problem is this makes your bladder very nervous. You start doing lots of little wees as soon as you feel something, just to be safe. You keep weeing early to avoid another bad 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.. having an accident. And then you get nervous and go early again….a real viscious cycle.
What can you do to improve your bladder habits?
Homework 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. Use the simple categories of:
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. It can almost be too polite to be properly useful. A bit more interesting would mean it wasn’t so easily missed! But we can’t change nature. Once you are familiar with the feeling of a “comfortable-size wee” you will be able to spot when to have a wee more easily. This will help 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.
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. Then, 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 but only a small wee comes out. Or you feel the bladder suddenly contract and leak, partially or completely (called urge incontinence). If you have tried the tips above, but you still struggle with bladder control, keep a bladder diary to discuss the pattern with your GP. There is medication that can help ‘calm’ a bladder. Or working with a physiotherapist on your pelvic floor muscles will also improve your control.
You can have a low gradebladder 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. If you have massive urine volumes at night, even though you are not drinking, 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.
a CHANGE in bladder habits can also be an indicator of several other medical conditions.
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 but 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.
Stress affects bladders
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.
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, ask if you are stressed? Your bladder could be used as a barometer to your stress levels? Rather than try to ‘fix’ the bladder…can you decrease the source of the stress?
Peaceful sleep & your bladder
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.
But don’t be hard on the grandparents. Over the age of 60 it is normal to wee once or twice in the night. Hormone changes of aging affect the way the kidneys process urine.
aim to have your last drink 2 hours before bedtime. Then the fluid has plenty of time to go through your system with 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!
That first morning wee…
If you don’t wake in the night most people wake up with a very full bladder. You will need to make getting to the toilet your priority on waking.
==== Mums go first! ====
I appreciate that this was a LONG blog post – but I couldn’t leave anything out. I hope it has been helpful. Do let me know if this has helped you?
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.
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!
In this video I go through the exercise with Stephanie from Kegel8 and The Knack too.
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!
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.
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 angrythat 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 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 stretchelastic 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 to 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
If 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
Practicethe 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)
There are 3 Ps of a perfect poo which you should keep in mind during your ablutions!
Are you or family 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!
[Before you watch – to explain the context – this was an adventure on to a public speaking course a while back. There was a Gala Finale with the brief to give a ten minute inspirational speech… well with a challenge like that it’s hard to hold a physio back….Apologies, a bit squeaky at the beginning – I was very nervous!! ]
P for 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 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.
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
P for Patience
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.
P for don’t Push – rather Pant!
[This last P got a bit lost in the talk ( I got a bit flustered when they showed me the 2 minute warning notice!). I got to fill in the gap to the audience in the awards bit – they voted it the “peoples choice” which was 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.
Ratheropen 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.
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?
Why do tampons go sideways? There are few reasons:
1. There’s more space inside than you might think
The vagina is surprisingly wide and stretchy. Essential for babies heads to come out but leaving plenty of room for things to move about – especially for tampons to go sideways.
I think we mentally picture the vagina as a narrow tube – rather like a hosepipe. However, though you can’t see much at the opening, inside the vagina there is quite a decent space. The vagina is a tube, but not an evenly shaped one – more like a squashed tube, wider side to side than top to bottom.
This clever shape helps to let a babies head out without damage to the vagina itself.
The pelvic floor muscles should support the tube from below and from the sides. However, pregnancy, childbirth, straining for constipation, pressure from chronic coughing or lots of lifting can all stretch and weaken the pelvic floor muscles. As a result the vagina tube can feel more “gapey” or spacey – and it’s easier for tampons to drift off centre or tilt to one side.
2. the cervix deflects the tampon sideways
If the end of the tampon comes up against the cervix it can tilt off sideways into the ‘cheek’ area giving you inadequate protection and that ‘half used’ look when you remove it.
The cervix is the opening to the uterus (womb). It sits right at the back of the vagina tube, dangling down from the top of the tube (similar to the way your epiglottis sits right at the back of your mouth). The cervix is the size and shape of a nose. You can put your finger inside and find it.
The cervix is pretty solid and though it pushes up out of the way during sex, it is quite easy to accidentally knock into it by accident when inserting a tampon.
3. The tampon touches the cervix and annoys it
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?
This is because the cervix is the only bit inside with decent nerve endings (if you knock it during sex it you might get a short sharp mild pain and find yourself shifting position.) If a tampon is relentlessly pressing on the cervix you get this strong urge to bear down and feel that the tampon is pushing out or that you need to take it out. Have you ever had this sensation?
A video to show the anatomy of the vagina & cervix:
Are you a visual person? I use a 3D model (and a piece of paper!) in this video to explain to Stephanie Taylor from Kegel8 how our internal organs are supported by our pelvic floor:
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). * use SUPPORTEDMUMS at checkout for a 15% discount
make time for your pelvic floor exercises with particular emphasis on the sides. Follow the videos in our Pelvic Floor School.
How have you got on with returning to having periods and using tampons and sanitary pads? Any questions?
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.
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 tissue2 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, orto 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 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?
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
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.
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!
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)
HACKUse 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
The Elvie is a discreet vaginal device which tracks your pelvic floor exercises on your smartphone
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
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?!