new mums need first aid

First Aid for a sore bottom -RESCue remedy

Just had your baby? How to do first aid for a sore bottom

The pelvic floor needs the same love, care and attention as any other injury. What first aid should you do in the first hours and first days after delivery? How do you get the best healing and recovery?

There are proven first aid methods to encourage optimum healing  and reduce complications after a soft tissue injury. The same methods work for a new mum’s sore bottom as for a footballer’s sprain.

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

Copy the sports teams with my new mums RESCue remedy:

 REST – ELEVATE – SOOTHE – CUE

R IS FOR REST

Relative Rest.  It’s a sad fact that we don’t live in a culture that respects rest. I know you have a newborn – and possibly other children too, as well as a home to clean and visitors to entertain! However, rest is important. It doesn’t need to mean do nothing. However it does mean watching out for signs that you have been literally ‘on your feet’ for too long. This causes blood to pool and congest in the perineum.

What are the warning signs?

  • swelling and puffiness in the perineal area
  • being achy & sore underneath
  • feeling numb
  • being bizzarely irritable

You likely won’t be sore enough to realise why you feel out of sorts and grumpy. But you will find yourself fidgeting and wishing everyone would go home! It’s your body telling you to sit down (or even better lie down) to take the pressure off.

So…..that’s what you NEED TO DO…. and while you do……

E Is FOR ELEVATION

Elevate  Ideally get your bottom higher than your heart so the swelling will be drained back into your lymph system.  Just 10 minutes with the weight off will make you feel like a new person. You don’t have to be unproductive(!):

  • have a luke warm bath (hygiene etc!)
  • lie on your side to cuddle or feed the baby
  • snuggle up to watch telly or read with your toddler
  • lie on your back on the sofa, pillow under your bottom & phone a friend
  • have a power nap to help you cope better with tonight

S IS FOR SOOTHE

Soothe  Cold usually feels wonderful against hot, bruised tissues, and then the cold makes blood flow to the area increase. You will see your skin go pink as the blood vessels dilate. With lovely open blood vessels you can then help drain the swelling by pulsing the pelvic floor muscles. This will push the congested fluids back into your blood stream to be carried away.

How to cool your sore bits? Most purchased cold/gel packs can go directly on your body but if you make a DIY ice pack wrap it in a damp cloth to prevent the pack sticking to your skin. Apply to the sore area for just 5 minutes. You only need the cold for long enough to bring a nice rush of blood flow to the area. This opens the blood vessels up wide to help take the swelling away.

Just cooling will feel nice … and then even better – help the swelling material move back into the blood stream by moving the affected tissues …

CUEYOUR PELVIC FLOOR

PIcture of POGP booklet Fit for the Future with good advice for new mums

Download this free booklet  “Fit for the Future” for clear instructions on pelvic floor exercises, comfortable positions, & early days exercises.

POGP booklet

Cue the pelvic floor.  In the early days of healing don’t be overwhelmed by the idea of having to do hundreds of pelvic floor exercises.  ‘Training’ your pelvic floor comes later. In these first few weeks the priority is MOVEMENT and CONNECTION. Aim to move the muscles to get the swelling down, to make you feel comfortable and to remind the muscles how to work.

Who’s looking after the Chicken?

Mama Chickens, you can’t love & care for your eggs if you are sore and uncomfortable. Use this First Aid for a sore bottom process regularly. Especially in the early days – to help you love and nurse your bottom back to health quickly.

Share the love & most importantly The knowledge. Please let your mum friends know what to do to feel more comfortable.

New Mum’s RESCue Remedy  Rest – Elevate – Soothe – Cue

www.supportedmums.com/firstaid
10 tips to make the first postnatal poos more comfortable

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 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.

There are super pictures and descriptions in the booklet “Improving your Bowel Function” which is free to download from my professional organisation www.pogp.csp.org.uk

  • 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). See the picture above and more detail in the booklet “Improving Bowel Function” available to download free from www.pogp.csp.org.uk

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.  

the best position to sit to have a poo

Best way to start tummy exercises – lie on your side!

Are you starting out on your post-baby journey – the place where you are not sure you have necessarily even got any abdominal muscles left? Or did you find them again but now you are having one of those days where you feel heavy and bloated and like you can’t hold them in? In this post you can discover the best way to start tummy exercises.

Standing up is the hardest place to hold your tummy in

When you have just had your baby, standing up is the hardest place to connect to your lower abdominals. You will look down and see them sagging out in front of you. This is because gravity is relentlessly pulling you both down and out. Now there is no baby filling the internal space the skin and stretched muscles droop down. It is such a strong force that when you try to pull your tummy in it is easy to accidentally hold your breath and “hitch” your muscles up rather than what you really want which is to pull the lower belly in to make it look and feel flatter.

When the tummy muscles are strong enough to stay flatter they will also be strong enough to support your back and your pelvis as you do all the lifting and carrying that motherhood requires. Happy body – happy Mummy!

Best way to start tummy exercises..

My magic tip for you? The best way to start tummy exercises – Lie on your side! Nowhere fancy – roll on your side in bed, or the sofa will do.

Lying on your side is a magic position for working out where on earth your lower belly is

Notice how when you lie on your side you can SEE your belly and you can TOUCH it. Both these things help your brain to focus on where to send the exercise messages.

Feel your tummy with your hand

Let your tummy really really sag out against your own hand. Have your hand quite low, below the belly button. Not under your ribs (those are your “upper” abs). Do your worst. Only you are looking. It will be very stretched – it just did the equally magic trick of carrying a baby to full size. This is a joyous thing, don’t be too hard on what it looks like now.

Notice how your breathing and abdominals connect

Become aware of yourself breathing. Your lungs filling up and emptying air. Notice your abdominals do a very similar thing. It is weird when you notice that as you breathe in your abdominal wall will swell up, then as you breathe out it shrinks in a bit. Make this happen on purpose. First take a breath in and let the belly swell up as much as it can. Then as you breathe out (as if blowing out a candle) you will find the belly muscles want to draw in. Help them along with your brain power and with your inside muscles. These are the abdominals below the belly button which wrap around you like a wide belt.

The abdominals move similar to the lungs. And the pelvic floor moves similar to the abdominals! They are all connected! We have lots of videos to help you understand this – have a look in the Pelvic Floor School.

in this video I use that colourful toy to show how the breathing, abdominals and pelvic floor work and how to co-ordinate your breathing to make them work even better

Think M&S knickers!

Think of trying to shrink wrap ourself a size smaller – or of putting on an excellet pair of M&S tummy support pants.

Then HOLD your shrunk position and BREATHE. If you can’t breathe you are pulled in too tight. Just breathe in and out a few times, just normal everyday breaths (great video of how to do the breathing here). After a minute or so you may begin to even wonder if you are doing anything at all? – but you are – you can prove it to yourself by letting go…..watch how the tummy suddenly reappears in front of you!

Now try same trick sitting up

Practice this focused drawing in sequence for a few minutes in side-lying. Then try it sitting in a chair – again hand on your lower belly (like where a seat belt goes over your lap). It will be trickier here not to hitch up the upper abs again.

Once you have repeated it a few times in these less gravity-demanding positions it should be easier to find them when standing up. If it doesn’t work standing up yet – don’t even worry. Rather use any opportunity to be sitting or lying down.

The party trick to practice practice practice…

  • If you are adept at feeding on your side, this is the ideal time to get two jobs done at the same time. Or after a seated feed snuggle up on the sofa for a cuddle on your side. Take an extra 2 minutes to connect to your belly.
  • Lie on your side to watch TV or make a phone call?
  • Sitting opportunties? Again – feeding! it comes around over and over. And anytime you are the passenger in the car! Nothing else to do and the seat belt is the perfect position to pull your belly away from and drop it back against. See how many lamp-posts you could hold in for?

It will make a difference

In short – don’t be disheartened by what your belly looks like and/or fails to do when you are standing up at the moment. Put your efforts into re-finding the belly muscles. The best way to start tummy exercises is lying on your side but quickly moving on to sitting. Then very soon you will be surprised to find yourself naturally holding them in standing too.

Do let me know in the comments below if this advice was useful? Do you have any questions?

bladder leaks when running

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? Or at the gym, your exercise class, or playing with your children ?? Mums I meet in clinic tell me that they are avoiding events that require them to look “sporty”.  They worry about a VPL if they wear 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.  Heaven forbid a party or wedding?

I’m an experienced women’s physio so I know pads aren’t (and don’t need to be) the solution but they could be a vital part of your journey out of the Miserable Place.⁠

Tips to manage bladder leaks when running or active:

full disclosure: this article contains some affiliate links marked*. As an amazon associate I earn from qualifying purchases. If you make a purchase by clicking through from an affiliate link I receive a small commission  at no further cost to you. Thank you, this helps to support this blog.

#1.  Use a pad designed for bladder leakage not menstruation

Sanitary pads and incontinence pads are not made of the same thing.  

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.

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. They also use fabrics that can wick fluid away from the surface. This keeps damp away from your skin and reduces your worries about odour.

what to look for in the shops
Some of the main UK brands are Tena, Always, Poise  and Boots Staydry range. All will send you free samples from their websites.  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. 

but if you need more than a light pad

If you suffer with more severe leakage and could potentially 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, which rustle and sweat. The modern waterproof knicker is a far more sophisticated item!

Discreet panel to protect from bladder leaks when you run

Pretty Clever Pants

from stressnomore.co.uk * (use SUPPORTEDMUMS at checkout for a 15% discount)    or * amazon.co.uk

Annabel Croft, the tennis player and TV presenter Carole Smillie (Strictly 2013!) invented these knickers. She originally thought of the concept for her teenage daughters coping with their periods. Now they are marketed for periods, postnatal and pelvic floor. 

They look exactly like the classic cotton “girls pants” we’ve all worn in our day. Complete with little middle bow! But with a discreet waterproof panel back and front, which just 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 or to reduce your anxiety that your pad might overfill.

Available in a selection of colours including nude, spots, grey marl and black lace.

#3  Knickers with inbuilt protection

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. 

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. 

Disadvantage – once they are wet you need to change the whole knicker.  However, ideal for things like the gym – if you get bladder leaks when running on the treadmill or other higher impact classes. Strip off in the changing room and no worry to dispose of a pad. 

Note: a couple of clients who have tried this option swear they will never wear pads again, certain that the pad itself  was irritating their vulva and making their incontinence worse.

black knickers absorbent for incontinence

Pro TechDry panties and maxie panties  

  www.stressnomore.co.uk    * use SUPPORTEDMUMS at checkout for a 15% discount

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.

SPEAX (previously Icon Undies)

shethinx.com

These are made by the same manufacturers as the Thinx range of period pants.  A forward thinking company with their open-ness about the need for products to empower women to be active.  And addressing sustainability and waste. They have a rather quirky style of presentation and some bold adverts. 

Five different styles: from Hip Hugger, through classic bikini to thong.  Varying prices depending on style £16 – £24 .  They sent through some samples lately for me to show in clinic.  The colours are fun: deep orange, blue, nude, grey and black.  They are made from a silky rather than cotton fabric, much more like an ordinary fashion knicker.

NB: they  are  hand wash only which you might miss in the instructions (and then be very cross about!).

#4   A subtle cover-up with skorts and skirts

picture of a skort to hide pads if you get bladder leaks when running

It started with school uniform but now we can all wear skorts!  Perfect for just hiding a good pair of  pants with a pad and getting on with whatever you wanted to do. 

£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.

#5   Add extra support to your core from the outside

If your bladder leaks when you run EVB shorts give extra support to your abdominals and pelvic floor

EVB Sports

EVB Sports range of shorts, leggings and capris

www.evbsport.com  *  £60-£80

Have a look at these if you feel just generally ‘unsupported’ at the moment. 

Maybe not so much worried about leaks?  More that your entire lower half moves about too much? Or that exercise is straining and fatiguing your pelvic floor and core muscles. 

EVB 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. To create more lift and support for the pelvis, abdominals and pelvic floor.

Most of my clients have gone for the shorts style, giving the option of wearing them underneath any of their other leggings.

# 6   Add extra support to your bladder from the inside

The options have recently expanded for devices that aim to give support to your bladder from inside the vagina.   Often called pessaries. The devices/brands you may see advertised include Contam, Contiform (available on prescription) and Uresta.  The devices increase in price, partly reflecting the number of times that they can be used – from single week use only to monthly to reuseable for a year.

These work particularly well where you or your physiotherapist feel that the bladder has dropped only a little bit (prolapse of the anterior wall/cystocele).   Yet everything else inside (particularly the uterus) is still well supported. You both feel you have created a good layer of muscles through exercise but could do with a bit more support when you are trying to be more active?

This market has recently expanded. I have written a separate post explaining how these products work, the differences between them & where to get them from.  :  Bladder Support Devices to reduce stress urinary incontinence: how do they work?

water lily to illustrate bladder support devices
For more detail, pictures & videos see this in-depth post

Before you go…a promise?

……that you will not use these ideas to make you complacent about a leakage problem.  Nor 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”. 

Incontinence  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.  You may need to consider how pelvic floor friendly your sport is (ummm….trampolining….)??   Or you may need to modify activities to protect yourself from risk of pelvic organ prolapse. 

pelvic floor for runners
and choose your sport wisely…or make modifications…

To summarise! Do use these stop-gap options to get comfy, happier and more active NOW.  But please, please commit to doing something about your pelvic floor muscles.  Book an appointment with you GP to get a referral to a Specialist Physiotherapist for full assessment,  support and advice.  You can be much better than you are right now. 

What are your tried and tested tips?  Please share your experiences with other mums in our comments section below.  Your story will inspire others.

#beyouroptiMUM  #pantsnotpads #NoMoreMiserableMums

woman with a cup of tea for self care

Why self-care is a revolutionary act: advice from a life coach

Guest post by:  Lavinia Brown aka BoboMama

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:

  1. 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.
  2. 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
  3. 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?
  4. 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 

a glass how much should you drink in a day

How much should you drink in a day? and How do you decide when to have a wee?

question mark

Why are some questions so full of angst?

Really, these two questions shouldn’t cause so much trouble – but they do

Other health and hygiene questions are easy:  How often should you clean your teeth?   Wash your hair?  Change your pants?

These two bladder questions – How much should you drink? and When should you wee? are full of issues

Frequently asked questions

Does how much you drink cover just water or all your drinks?  Are tea and coffee drinks?  What about the milk in your cereal?  Is it different if you are taller/smaller, fatter/thinner or breastfeeding?  Is it better  to have a few big drinks or sip from a bottle all day?  Should we wee when we first feel it or when we are busting?  Is it ok to hang on……..but how long is hanging on for too long?  Is it normal to wee in the night?   Is it ok to have just a tiny wee before you go out the door?   ………

So this article is a two-parter as one influences the other – first what’s the normal IN and then normal OUT ? Then based on that maths how do you know when to go for a wee?  There will be an extra part 3 to consider what’s different when you are pregnant…..

What should go IN and how much should come OUT – the quick version

If you want to cut to the chase, get The Facts, here is a summary of  government/other guidelines and generally agreed wisdom on the subject:

A Quick Summary of daily IN:

Fluid intake:  normal fluid intake should be 1.5 to 2 litres in a 24 hour period.

This is ALL fluids added up together (tea, coffee, water, juices, alcohol). Don’t count the milk in your cereal but if you have soup for lunch, jelly to follow and smoothies to drink you might want to be aware of their impact on the total volume.   If you are breastfeeding or doing sweaty exercise you may need an extra glass here and there to replace lost fluid but unless you sweat profusely or produce gallons of breast milk – this is not nearly as much as you think. 

MOST IMPORTANT:    It is NOT 2 litres of water on top of all your other drinks

1.5-2 litres equates to 6-8 standard 250ml mugs a day, or 4 x 500ml water bottles.

Drinks should be evenly spaced at approx 2 hour intervals, with the last proper drink 2 hours before bedtime (ideally non-caffeine), just sips thereafter. 

And based on this volume IN

A quick summary of the daily OUT routine

          • One wee in the middle of the night is considered normal 
          • On waking up expect a BIG wee  (400-600ml) – you could possibly fill a pint glass
          • Then through the day expect 5-6 average wees (200-400ml) – each one could fill a big mug
            • You do not need to wait until you are bursting to empty your bladder.
            • Aim to empty when your bladder holds a good mug-full.
            • Little ‘yogurt pot’ wees should be avoided.

How much should you drink?  – the long version

If you read this blog regularly, you will know that I Do Like a Bit of Detail and if you do too, I like you already and am very pleased to have you here.

If we talk through the look of a ‘normal’ day, in an untroubled bladder world,  it will help your brain to understand how it all should work.  If you have been having trouble regulating your bladder, suffering with mad dashes to the loo, uncomfortable and inconvenient urges and even bladder accidents, this will really help.  Experience has shown me that if your brain ‘gets it’, you will instinctively make some useful changes and then often there is very little left to do to sort most of this particular problem out.

It is best to take an ‘organised approach’ to when to fill & empty the bladder

First to think about, normal fluid intake is maximum 2000ml ( = 2 litres = 4pints) per day. If you are not a particularly big person, rather go for 1500ml. 

a cup is 250ml

A standard mug is 250ml

If you work on a standard mug or glass (of tea, coffee, water etc) being 250ml then people are often surprised to realise that this is no more than 8 mugs/glasses in 24 hours.

The bladder prefers regular and spaced filling intervals rather than droughts or floods. Though the bottled­ water companies would like to persuade us differently, it is not normal to be constantly sipping water.  A drink every couple of hours should rather nicely lead to needing a wee every couple of hours. 

  • If you look at your wee when it comes out it should be pale yellow.  If it looks like water you are drinking too much, if it is dark yellow you are not drinking enough.
  • Drink every half an hour ? Guess what…you are going to need to wee every half an hour…
  • If 2 litres IN gives you 5-6 wees out – then if you are drinking 4 litres a day, simple maths says that’s either going to be about 12 wees or 6 very very full bursting ones – highly likely to be accompanied by some unpleasant sensations or not quite making it!  Cut back on the volume (to 2 litres a day) and you could get an instantly happier bladder

Monitor your fluid intake carefully for a few days. Your ‘bladder’ problem could be merely operator error at the filling end.

Not all drinks are equal

a glass of water

water is the best choice

It can seem strange that we say 2 litres of FLUID and don’t distinguish water from other drinks.  Tea and coffee are, however, just water with flavoring.  Think how you pour the water out of the kettle?

So they will hydrate you but…you might want to think how the ‘flavoring’ could affect you.

  • Caffeine is a known bladder irritant but some people notice that they react worse to ‘real’ coffee than instant (or vice versa).  Adding fat (milk or cream or on trend is butter!) slows the absorbtion of caffeine.
  • Tea can be ‘light’ by design (eg Earl or Lady Grey) and/or in the making – a few leaves gently steeped is very different from squashing the teabag to death in a mug.  The ‘builders’ tea’ version has extra caffeine and tannins – that’s what stains the mug.

    cup of tea can be light or strong

    How do you ‘take’ your tea?

  • Alcohol is a diuretic (for every glass in, you will get one and half out…think hangover…dry mouth, dehydration, headache…).   You may notice your bladder reacts to certain types of alcohol (spirits, wine, fizz) differently.  Find your tipple of choice and note what to avoid when there isn’t a handy toilet!
  • Fizzy water and de-caf coffee can also be irritating for some people – it is thought that it is something about the manufacturing process.
  • Watch out for ‘sneaky’ ingredients.  Fruit teas are high in sugar, green tea has caffeine (and is also a diruetic – hence drunk on ‘diets’),  many hot chocolates are high in sugar & can contain caffeine.

Start to notice how long it takes for different drinks to pass through you and make your bladder uncomfortable.  You may find you are not as ‘tolerant’ of your favorite drink as you used to be.  Don’t feel you have to go cold turkey – just cut down a bit on the likely culprits and increase the balance of plain water and you will likely see a quick reduction in bladder urgency and increased capacity to hold.  And pick your moments – it doesn’t mean you can’t drink your favorite double strength cappaccino…but maybe not just before a long car journey or the cinema?

Squeezy App (which also reminds you to do your pelvic floor exercises) has a bladder diary you can use to monitor your fluid intake and trips to the loo.

Sweating? Breastfeeding?  When you might need extra fluid

women stretching

Do you need to replace ‘sweat’ or only ‘glow’

Hot days & exercise.   We don’t just lose fluid from our bodies when we wee.  It also escapes from our body in our breath (think how you can steam up a mirror) and when we sweat.  If it is a hot day, we need extra fluid.  If you are doing an extra sweaty activity, you need prepare with a little extra and be sure to re-hydrate after.  “Guesstimate” the amount that you might have glowed away, as well as the drink you were probably due about then anyway…but don’t over do it.

Breastfeeding. 

baby breastfeeding

drink extra to replace the volume given to the baby

It is important to have some extra fluid each time you feed…but again don’t over do the drinking or you will just be weeing more.

To estimate the amount you need to re-hydrate – think about the milk volume that you produce when you express? Probably about  200-400ml?  So an extra glass/mug of fluid is all you  need back again – you don’t need to down a pint of water – your poor bladder will just fill to bursting really quickly and not love you for it.

How often should you Wee? – the long version

Based on drinking the recommended amount of 2 litres/24 hours (roughly one mug [250ml] roughly every 2 hours)  then…………
The first sensation is usually too early

 After 45 minutes to an hour your bladder would normally hold about 120ml (a yogurt pot) of urine and you would get a ‘I might need a wee‘ sensation as the walls of the bladder (it’s a muscle) stretch for the first time.  

120ml “a yogurt pot wee” is a bit early

Our brains should know to recognise this as an ‘irritating-stretching-message’ not a ‘need-a-wee-now’ message.  Subconsciously we clock the time, do the maths (only an hour since I last had  a wee), we tighten our pelvic floor muscles in a slow steady way, distract ourselves with the job in hand and within 2-3 minutes the feeling of wanting a wee completely disappears – like we never needed one in the first place – we go on with our activities, almost forgetting that we have a bladder.

This is the bladder’s normal first response.

That first annoying signal isn’t particularly useful, just a very early warning signal, like your petrol gauge alerting you when you still have 60 miles in the tank.   You don’t need a wee when there is only a yogurt pot worth in the bladder, even if the bladder feels a bit scratchy about it.  Just ignore it and it will go away.

campervan long journeys

safety or just-in-case wees are for long car journeys – ONLY

 If circumstances are justified,  it’s ok to have a “just-in-case” or “safety wee”.  Say you’re  about to go on a a long car journey, or about to have a swim or a shower, or go to bed,  then it makes sense to get rid of even the 120ml so that you have a long run ahead of you.  But you need to justify to yourself why you didn’t just ignore the feeling,  otherwise it can quickly become a habit to have a wee every time you get a bit of sensation and that can be very disabling.

Ignore the first message and wait for the next one

a big mugful is a perfect wee

A nice big mugfull – 200-400ml – is a perfect comfortable wee

Normally, that first message quickly disappears and  we would forget all about the bladder and be able to fill it further for a second hour (or so) till there is more like 300ml (a large ‘Cath Kidston’ mug) worth. Then you should get a dullish, polite “you need a wee” sensation that sends us off for a comfortable-but-not-urgent wee. 

This is when you should go.  There is still a bit of room in the bladder if you have to stand in a queue, find your front door keys, answer the phone.  There is a bit of give and it is not too heavy if you need a cough or a sneeze.

But not leave it for a third or fourth message…

But do we go when we should go??  Of course not……Many people (and especially busy, distracted mums)  leave it TOO LATE.  

a pint of wee is too much

A pint (500ml) will make your eyes water and could lead to accidents – save for first thing in the morning & emergencies ONLY

If we ignore the middle message, and head into a third or even fourth hour, we can fill to nearly a pint (shift workers, teachers and nurses can often hold even more) BUT filling to your max tends to be accompanied by a sudden, very uncomfortable and “urgent need for a wee” message – the type that makes you sweat, your eyes water and comes with a strong sense of panic that you might not make it (and indeed you might not). 

These maximum capacity wees are intended for first thing in the morning or an emergency.  An emergency being unexpectedly stuck on a motorway, not quite frankly, just putting it off for one more paragraph, chore or advert break.   And not just because you are too busy to remember to go for a wee!

So is there something wrong with your bladder – or is it poor human judgement?

woman working at computer

Concentrating? Distracted? or just too busy?

So many times the problem is really that the  human operator is not listening to the (rather good) system properly.  Guilty???  You already know which way you tend to go… too early (friends and family tease you about always needing a wee) …or too late (lots of sweaty near misses or trouble at the front door)?!

Or, very common, is that you swing between too early and too late – you push your limits…push your limits…leave it…leave it…just one more thing and THEN you very nearly have an accident.  Now you and your bladder are so nervous that you start doing lots of little wees as soon as you feel something, just to be safe…avoiding another experience…but then you think…this is silly… I need to train my bladder… so you start again, filling and filling, past the ‘right’ signal, on up and up …nearly bursting…and there goes the cycle again.

what CAn you do to improve your bladder habits?

WC sign

this week monitor your fluid in and out habits

This week, when you are heading to the toilet for a wee, try to predict the size of the wee you are going to have – simple categories of

  • yogurt pot
  • big mug
  • or pint class

( aka: small, medium and large).

I’m prepared to take a reasonably large bet that as soon as you start taking a bit more notice of what’s going in at the top and what the wees feel like at the different size points, you will quickly  tune in to the bladder sensations and interpret the messages better.

The hardest one to spot and get in tune with is the ‘middle’ one – to be honest it is too polite to be properly useful.  A bit more interesting would mean it wasn’t so easily missed.  But we can’t change nature and once you are familiar with that  “oh this is what a comfortable wee feels like ” you will be able to spot it much better and stop the cycle of under or over-filling.

Exceptions – when to seek more help

If you thought you were going to have an enormous wee but only get a tiny one – or a tiny one but get far more – you may find your body is not well tuned to the sensations.  Sometimes the nerves stay confused after the pressures of pregnancy and childbirth and need retraining.   

use a wrist watch to monitor your wees

Use a watch (simple or fancy) to keep on track

If you do not feel that you get the ‘right’ sensations guiding you towards having a wee at that middle point and you leave it too late before the bladder suddenly decides for you, or you get unexpected leakage, then I would suggest you use the clock as a guide for a while (but all the while trying to tune in to any sensations you are getting).

Start with an hour, then have a wee, noticing how small they are at this stage,  but once you are comfortable with this don’t stick here too long or your bladder will get into an annoying ‘habit’ of thinking this is all you can do. Move up in 15 minute increments as feels comfortable and ‘safe’ to do.   Remember the goal is just 2-3 hours of holding  – no need for more. 

There are also medical conditions of the bladder
  • Overactive Bladder (OAB), often colloquially termed ‘irritable bladder’ is a pathology with symptoms of frequency, urgency and urge incontinence.  Commonly you feel a strong urge to wee and either get only a tiny wee out or you feel the bladder contract and it can just empty itself partially or completely (urge incontinence).  If after organising your fluid intake (as above) you still struggle with bladder control, keep a bladder diary (use Squeezy App)  to monitor the pattern and discuss it with your GP.  There is medication that can help ‘calm’ a bladder and working with a physiotherapist on your pelvic floor muscles will also improve your control.
  • You can have a low grade bladder infection and not necessarily realise this.  Watch for cloudy urine, funny smells, feeling off colour.  The dipstix test at the GP is not that reliable – you may need to send your urine off for testing
  • You may not be making the hormones that suppress night time bladder production (over age 70 this naturally declines). Note if you have massive urine volumes at night even though you are not drinking and discuss this with your GP.
  • Paradoxically – wearing a pad to prevent leakage can irritate the bladder tube and increase urge and leaks.  Try going without a pad or wearing knickers with an inbuilt pad to see if this is the case.

As with all the supported mums advice: if your symptoms aren’t getting better, or you feel you need some individualised help, ask your GP to check you and if appropriate refer you to a specialist physiotherapist.

And weird stuff

Rings and ankles give clues

Ever have one of those  days where you seem to need to wee and wee and wee?  Not necessarily unpleasantly but  you think “where is it all coming from????”

The body constantly re-adjusts our fluid balance – and sometimes does this really dramatically.  You see it best by watching how tight/loose your rings are.  Notice this week how sometimes you can slide your rings about easily and then other times they are stuck on tight.  The body holds fluid when it is hot and dumps it as it gets colder.  We also have circadian rhythms that affect fluid in and out – most people wee more in the mornings and less in the afternoon.

And stress…..

When we are ‘stressed’ (anxious, worried, cross, running late) our system is releasing adrenalin.  Adrenalin triggers our Fight, Flight or Freeze response.  If a tiger walked in your door right now – your hairs would stand on end, your heart would beat faster…and you would wet yourself.  Likely bowels too.  I think it’s supposed to be so that you can run faster.

woman with a tiger

identify your day-to-day “tigers”

Fortunately,  you are unlikely to encounter seriously stressful moments too often but we experience mild ‘stress’  all the time.  When you are feeling anxious, worried, cross, running late , the brain ‘drips’ adrenalin into your system to help you cope.  But with that comes bladder (or bowel) irritation.  Think of standing in a queue to do an exam, or waiting to give a presentation at work…that strong need to wee…and then even to wee again.

So if  you are having a day needing lots of wees, perhaps consider your bladder as a barometer to your stress levels?  Rather than try to ‘fix’ the bladder…can you decrease the source of the stress?

Peaceful sleep

sleeping woman

last proper drink 2 hours before bedtime

It is normal to get up for one wee in the night  (assuming sleeping for 6-8 hours).  Annoying…but perfectly normal. Nicer if you don’t have to but some bodies just do.  Over age of 60 years 1-2 x to wee in the night is normal, as the hormones affecting the kidney processing of your urine change.

  • aim to have your last drink 2 hours before bedtime so that the fluid has plenty of time to go through your system and you can have a good wee before getting into bed. 
  • Best to avoid caffeine late. 
  • Beware, sneaky sources of caffeine like Green Tea & some hot chocolate mixes
  • alcohol is a diuretic ie more volume comes out than went in (just think hangover….dry mouth….)

if you do have a late night drink (party!)) then don’t berate your bladder for needing a 2am wee!

Waking up in the  morning

 Most people wake up with a very full bladder (picture that pint glass!) and need to make getting to the toilet their priority on waking.  

====    Mums go first!   ====

standing pelvic floor exercises

My favourite standing pelvic floor exercise, ever

This is absolutely my favourite standing pelvic floor exercise.   I love that it anchors you to the spot with a quick little routine to stop you getting distracted part way through. 

Honestly takes 35 seconds but pings your pelvic floor muscles awake.  Little and often improves muscle memory, reaction times, and encourages quick muscle growth.

  1.  Turn your toes out, like a ballet dancer, 5 squeezes of the back passage

Turn your toes out, like a ballet dancer.  Tighten your pelvic floor and notice how this position favours the back passage (the anal sphincter) just like you are stopping wind.  Pretend you are having tea with the queen and made the mistake of baked beans for lunch.  You need to effectively close the anus opening, without clenching your buttocks more than a smidgen and without it showing on your face!  Do 5 on and off squeezes, not trying to hold, just a good squeeze, then let go completely.

2.  Turn your toes in, like a pigeon, 5 lift and tucks of the vagina/bladder tube area

Then turn your toes in, like a pigeon. Now when you tighten up underneath it should feel different.  Less going on at the back and more focus at the front, around the bladder tube and vagina area.  Let the area be soft, almost a bit saggy,  then lift and tuck the vagina up inside.  Let go – completely.  Then repeat 5 on – off contractions.  Best lift you can do ….and relax. Don’t worry if your abdominal muscles join in a little bit but keep the focus on your pelvic floor.

3.  Turn your toes normal, both areas together as a unit

Finally turn your toes into your normal standing posture.  Now try to do both the previous actions at the same time.  Most people start with the back tightening and then like a big zip come forward to lift and tuck the front.  When you let go each time now it should feel like there was a bigger ‘up’ and a bigger ‘drop’.  Repeat.  If you are feeling clever add in some side to side tension too (yes, the pelvic floor is bowl shaped, see this in my video showing a model pelvis in the pelvic floor school)

When you have done 5 squeezes with your toes turned out, 5 with your toes turned in and 5 with everything together you will have done 15 really good pelvic floor muscle contractions.  NOW your muscles will be thinking – hey she doesn’t normally work us like this – we are going to need to grow!

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!

Important note

If you think this exercise is mad and you couldn’t feel a thing when you tried to do it – try it  lying down, not so much the feet positions but focusing first on the back passage and then on the front.  This positon  takes the weight of your organs off the pelvic floor and gives you more chance to ‘feel’ the muscles working.  If that still leaves you cold – then I would recommend you have a chat to your GP and ask for a referral to a specialist pelvic floor physiotherapist for a full assessment and examination.  There are lots of things we can teach you in clinic 1:1 to help you find and improve your muscle function.

trampolining to illustrate the Knack

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)

baby sitting on potty 3 Ps of a perfect poo

3 Ps of a perfect poo: are you sitting comfortably?

There are 3 Ps of a perfect poo which you should keep in mind during your ablutions!

Are you 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.

Rather open your mouth (which helps relax your pelvic floor) and let out pants or sighs, just as the midwives teach you to pant to deliver your babies head.  This allows the poo to come out as one full tube with just a nudge and light pressure from you.

Now you really know everything!  Do go share!

About to have a baby or just delivered??  Do see the post 10 tips for the first postnatal poos for more ways to help you have comfortable bowel movements.

PS  It was a great Public Speaking course – I highly recommend the team at Ginger

**  My original title was The Life Changing Magic of Sitting Comfortably.. but it now seems to be known as the 3 Ps talk……

exercises for the early days

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 extended 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.