trampolining to illustrate the Knack

The Knack: No 1 pelvic floor trick for mums

What is “The Knack”

Need a Quick Win with improving your bladder leakage?

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 to stop urine leakage *

So simple – yet not everyone knows about it

There can be Quick Wins with pelvic floor exercises.  I still clearly remember  when I helped a client stop leaking in just one week by teaching her the Knack – and she was FURIOUS to have waited that long!  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.

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 it and 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.

Then, 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  

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)

how to improve pelvic floor control by simply breathing

How to improve pelvic floor control by simply breathing

Do you wonder what BREATHING has to do with bladder control, prolapse support or vaginal or anal pain??

Physios are not going woo-woo

It’s rather because clinical research & our understanding of the body has deepened, so pelvic floor exercises exercises are evolving. It’s no longer one size fits all.

There’s a good place for the traditional squeezes, lifts and holds, but some mums need to focus their attention more on the “let go”, relaxing and releasing of their muscles.

Pelvic floor relaxation is a thing

Previously exercises were very linear.  Squeeze ON, release/turn off.  Our focus was on what our muscles needed to be able to DO in an emergency situation – when we cough, sneeze, pick up something heavy.  This is not wrong.  If you struggle with stress incontinence (leaks when there is high pressure on the bladder) then the best thing you can learn is The Knack of getting the pelvic floor to co-ordinate with perfect timing.  

However, we now know how our muscles should be doing when we are not thinking about them.  The resting pattern of your muscles has an impact on common problems like urgency, bladder frequency, vaginal heaviness and pelvic pain. 

#1 New thing we know

Firstly, our breathing pattern and our pelvic floor muscle movement pattern are similar and interconnected.   Breathing is easier to understand, feel and control than the hidden away pelvic floor.  So if you want to better connect to your pelvic floor – start by noticing how you breathe.

#2 Weird thing to notice

However, most of the day we don’t think about our breathing AT ALL.  You wouldn’t have been thinking about yours a few minutes ago until I brought the topic up.  Your brain operates your breathing system all day, all night, 24/7 without any conscious input from you.  A gentle in and out, muscles contracting and releasing, a continuum of movement like a swinging pendulum, you are only completely full of air or completely released for a moment in time.

#3 Amazing thing we can do

Yet, you can also have incredible control over this system.  For example, you could take a deep breath right now to blow out an imaginary candle; you could whistle a little tune;  you could shout (or yodel) or pant like a dog.  With training, you could develop sophisticated breath control  as well – as a singer, long distance runner,  athlete, deep sea diver, bird impressionist. Did you know that you need enormous breath control to accurately shoot a pistol or throw a dart?

And then, when you stop panting or wolf-whistling or humming a ditty, your brain just automatically puts you back into gentle breathing mode, no questions asked.  A-MAZ-ING.

a panther demo's pelvic floor relaxation

#4  Pelvic floor muscles should be super-skilled too

We want our pelvic floor muscles to have similar super powers.  When we are NOT thinking about them we want them to gently (gently!) contract and relax, very low key, very little. Just enough to keep blood flowing through them, to nourish their feeder nerves. We want movement to keep the tissues stretchy and flexible. We want to be on standby for whatever we decide to do next. 

Then, when you decide to pick up your toddler or dash up the stairs, we need them to move up a gear or two to help carry that load from below, preventing pelvic organ descent or a sudden urge to wee. 

Similarly, if you want to push shut a heavy door, or hit a tennis serve, or do one of your room shattering sneezes, we want them to go into full tension mode to prevent leaks. And most important of all, if you want to empty your bladder or bowel, or get sexy with your partner you want them to relax and release to allow things out or in.

#5 Best thing to work on

In contrast, if your muscles are always tense they become “crampy” with painful sensations associated with a build up of lactic acid or the soreness to be touched or if stretched. Then if your muscles are always “in gear” you can’t choose to have “more” or “less” for the activity you are doing.

So take moments through the day to tune in to your breathing and from there to your pelvic floor muscles. Find time to reset your background, automatic, movement pattern to line yourself up for a day with super-powers.

Video: How to improve pelvic floor control by simply breathing 

  • Firstly, tune into your breathing pattern.  Feel your rib cage lift and raise as you breathe in, drop and shrink as you breathe out. Play with it.  Breathe deep, blow out an imaginary candle.  Do this a couple of times.  Then stop.  Can you feel your body revert to your base breathing pattern?
  • Then, notice how your BELLY breathes.  Yes it does!!  Drop your hands to abdomen.  Channel your inner frog.  Notice that your belly mimics your breath.  As you breathe in your belly lifts as you breathe out it falls.
  • Finally, lower your consciousness to your pelvic floor.  It is the lowest moving set of muscles.  Can you feel how these move to, in time with your breathing, ever so gently contracting & letting go. Or gathering & releasing, or lifting & lowering – whichever words work best for you.

Have you improved your pelvic floor skills by practicing breathing? Please let me know if this video and explanation was helpful and how you are getting on?

how to look after an episiotomy or tear

How to look after an episiotomy or tear after delivery

How to look after an episiotomy or tear after delivery

Did you have a vaginal delivery with stitches? If you are not sure how to look after an episiotomy or tear I have links to reliable instructions here. Not sure when you can do pelvic floor exericses (and how?). Wondering when you can massage the scar … and how to do it?

Let me guide you through the different things you need to do at each stage.

What are you dealing with?

Many mums have stitches after they deliver their baby. The area of the vulva where the cut or tear will form a scar as it heals is called the perineum. The perineum is thick tissue between the opening of the vagina and the opening of the anus. An area you normally don’t think about.

This picture from St Georges NHS scar tissue management guide shows the different areas where you might have had a line of stitches

diagram to show where episiotomy scars or tears might be

If you are squeamish it is not always good to look! On the other hand it can be helpful to know where your stitches are. You will feel more confident to avoid disturbing them, as well as caring for them to get the best possible healing.

The reason this area bleeds so much is because it has a great blood supply. This means it heals well too. Your stitches are dissolvable and usually gone by a month. However it is common to wait a full “6 weeks” to be sure that the wounds are fully healed. During these first weeks you want to encourage the healing process, and tissue stretchiness. Balancing being careful not to over exert (which will disrupt the scar as it heals), and avoid an infection in the area.

Nature will heal really well, especially with your help

There are 3 stages to think about to look after an episiotomy or tear, with different priorities to consider and different ways to help at each stage:

Early Days (0-6 weeks)

Initial wound healing and formation of a healed scar

Keep the wound clean & prevent infection

  • prevent infection getting into the area
  • quickly recognise if there is an infection and seek treatment
  • manage the bleeding (lochia) without irritating your skin

Your maternity hospital will usually have given you advice and a booklet or resource. If you didn’t get one, Oxford University NHS Hospital Trust has simple advice on how to keep your stitches clean and cared for: https://www.ouh.nhs.uk/patient-guide/leaflets/files/10929Pperineum.pdf

Leeds NHS Trust made this clear video: Physiotherapist, Jenny Watkins

Follow my RESCue process to reduce pain:

  • reduce the discomfort and pain so that you can enjoy being a mum
  • help haemmorrhoids, brusing and swelling to go down
  • use your pelvic floor exercises to promote blood flow and healing
  • keep pressure off your healing bottom
  • ensure you eat well and stay hydrated to have regular bowel movements. Learn how to sit on the toilet properly!
new mums need first aid

REST – ELEVATION – SOOTHE – CUE the pelvic floor muscles. Read the detail here about how to apply ice, sit comfortably, do the gentlest of pelvic floor, promote best healing.

Start Early days exercises to help the scar stretch naturally:

  • introduce Movement to Feel Good
  • prevent your pelvic floor or gluts muscles tightening up in a guarding pattern around the scar
  • encourage the scar to stretch naturally as it heals so that it is comfortable
  • avoid straining and excess pressure on the scar as it heals

This great booklet of specialist physio advice on moving well, emptying your bowels, & very first days exercises is free to download.


explore the Supported Mums YouTube playlist or my Pilates classes on Beam for Early Days exercises which will gently stretch the area, encourage connection to your abdominals & pelvic floor but not over-exert or put pressure on your healing body too early.


Picking up the Pace (6 weeks +)

promote formation of a flexible, comfortable scar.

After 6 weeks the scar should be fully healed, the scab is gone. Now you can look after an episiotomy or tear further by helping the body form flexible, collagen rich scar tissue. This type of tissue will comfortably move with you whatever you want to do! And you will soon be able to forget all about it!

This is when you can start scar massage

  • use scar massage to encourage the formation of a flexible, comfortable, well formed scar. This leaflet from St Georges NHS Trust is a good starting point. For more depth American Physical Therapist Amy Stein adds detail. In the video, below, my colleague, Clare Bourne explains how to massage your scar from 6 weeks.
  • you can use a natural oil like olive, almond or coconut or there are several commercial ones available with blends of essential oils included. Be sure to check for allergies & I would recommend keeping the oil only for this massage of this area.
  • return to sex. See our Getting back your Mojo series
  • seek help if you are not happy with the way you are feeling
  • do pelvic floor exercises with the intention of improving your strength, endurance and co-ordination. This will prevent leaks, support your pelvic organs. Vital preparation before you return to your hobbies and sports around 3 months. See our Pelvic Floor School for ways to progress from the basics. Including how to relax the pelvic floor & stretch it out to prevent pain. Join me for Postnatal Pilates online?

Finding your new normal (12 weeks – 12 years!)

Life and your body are not the same after a baby, and may change again with baby number two or three. What is normal? Perhaps don’t focus on getting “back” to normal as life is a forward journey? Where will your body and your family take you next?

In this phase be sure to sort out any niggly problems

  • check in on your scar 1-2 x month to make sure it is happy and to maintain it’s stretchiness
  • if you didn’t start scar massage earlier definitely give the scar some love and attention now
  • Persistent pain needs assessing further. Definitely seek help from a specialist physiotherapist. If the scar is painful or tugging as you move or during sex. Or you suspect it might be causing a problem like back pain, difficulty working your abdominals or pelvic floor.
  • give your love-life the time and attention it deserves. Check in with these suggestions if sex is painful or feels a bit flat.

If you can’t access a physiotherapist or want to learn more yourself first I highly recommend these books:

Please let me know if this post was helpful. Don’t hesitate to be in touch if you have questions.

how to look after a caesarean scar

How to look after a Caesarean scar

How to look after a Caesarean Scar

Did you have a Caesarean delivery? Wondering how to look after the Caesarean scar? How to massage the caesarean scar?

This post focuses on looking after the Caesarean scar itself. For general advice about how to get comfortable, moving well, when to start abdominal exercises and why you still need to think about your pelvic floor see this other post:

lady doing exercises after a caesarean

Let me guide you through the different things you need to do to look after your Caesarean scar at each stage.

What are you dealing with?

It is easy to take a Caesarean section scar lightly because we can only see the surface of it. Surgery and surgeons are so good at this operation, modern stitches are dissolvable, so that you will likely only see a neat 10-15cm thin line on your skin. This starts raised and red but over a few months settles to eventually be a thin silvery line.

However, underneath the surface several layers of tissues, such as fat & fascia were also cut and stitched. Fortunately, the abdominal muscles themselves are not cut – they can be pushed apart side to side to let the baby through.

Nature will heal really well, especially with your help

There are 3 stages to think about to look after a Caesarean scar with different priorities to consider and different ways for you to help at each stage:

Early Days (0-6 weeks)

Initial wound healing and formation of a healed scar

Keep the wound clean & prevent infection

  • prevent infection getting into the area by keeping the wound clean & dry
  • quickly recognise if there is an infection and seek treatment
  • avoid straining the scar which might cause it to breakdown as it is trying to heal – this is why you need to get lots of help with caring for the baby & housework and stick to the simple exercises, which make you Feel Good but don’t make the abdominal muscles pull on the scar

Your maternity hospital will usually have given you advice and a booklet or resource. If you didn’t get one, this NHS article has simple advice on how to keep your stitches clean and cared for in the first 6 weeks.

Start Early days exercises to help the scar stretch naturally:

  • introduce Movement to Feel Good
  • prevent your body tightening up in a guarding pattern
  • walk daily (start with just 10 mins then build up) to encourage your circulation, improve posture, boost your mood & move naturally
  • encourage the scar to stretch naturally as it heals so that it is comfortable with simple arm & leg movements
  • avoid straining and excess pressure on the belly as the scar heals

This great booklet of specialist physio advice on moving well, emptying your bowels, & very first days exercises is free to download.


explore the Supported Mums 0-6 weeks YouTube playlist or my Pilates classes on Beam for Early Days exercises which will gently stretch the area, encourage connection to your abdominals & pelvic floor but not over-exert or put pressure on your healing body too early.

Picking up the Pace (6 weeks +)

promote formation of a flexible, comfortable scar.

After 6 weeks the scar should be fully healed, the scab is gone. Now you can look after a Caesarean scar further by helping the body form flexible, collagen rich scar tissue. This type of tissue will comfortably move with you whatever you want to do! And you will soon be able to forget all about it!

This is when you can start Caesarean scar massage

  • use scar massage to encourage the formation of a flexible, comfortable, well formed scar. In the video, below, my colleague, Clare Bourne explains how to massage your scar from 6 weeks.
  • you can use a natural oil like olive, almond or coconut or there are several commercial ones available with blends of essential oils included. Be sure to check for allergies & I would recommend keeping the oil only for this massage of this area.

Finding your new normal (12 weeks – 12 years!)

Life and your body are not the same after a baby, and may change again with baby number two or three. What is normal? Perhaps don’t focus on getting “back” to normal as life is a forward journey? Where will your body and your family take you next?

In this phase be sure to sort out any niggly problems

  • check in on your scar 1-2 x month to make sure it is happy and to maintain it’s stretchiness. My colleague Clare Bourne demonstrates in the video below how to do a firmer massage from 12 weeks.
  • if you didn’t start scar massage earlier definitely give the scar some love and attention now

If you can’t access a physiotherapist or want to learn more to help yourself first I highly recommend these books:

Please do let me know if this post is helpful?

advice and exercises after delivery

Essential advice and exercises after delivery

Not sure what exercises you should do after your birth? Lost your information from the hospital or midwife? Need advice? Follow the link below to the best sound medical information put together for you by a team of specialist physiotherapists.

I believe that if your body is in a good place you will cope better with the physical & emotional demands of motherhood.  

Early postnatal exercises have lots of benefits

Even though you are busy with your delicious newborn baby, taking time out to do some early postnatal exercises will help your recovery:   

Physiotherapists promote MOVEMENT as soon as possible after delivery.

  • moving your spine & stretching your muscles will help prevent back pain.
  • you will also sort out niggles before they build up. 
  • your abdominal muscles need your attention to strengthen and tone.
  • Exercise will give you back your shape and strength to support your back when lifting and carrying your baby
  • Gentle pelvic floor exercises promote blood flow, reduce swelling and get the healing process off to a great start.

FREE INFORMATION BOOKLET

My professional organisation POGP has developed a fabulous information booklet with the essential advice & exercises after delivery:

POGP booklet Fit for the Future

This free booklet has clear guidance and advice for the early days after your birth.  You can download a free pdf of “Fit for the Future” here.


You will find pictures of rest, changing & feeding positions, getting in & out of bed, and bowel emptying. Specific advice for after a caesarean.  Also detailed pelvic floor exercises, as well as starting and progressing your abdominal exercises.

And do join me for calm, safe, clearly led Postnatal Pilates classes suitable Birth to 6 weeks, or 6 weeks +. Professionally made videos which you can access for free. More details here.

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
exercises for the early days

Postnatal exercises for the early days

  • Are you overwhelmed by which postnatal pilates exercises are best for you and when you should start them?
  • Would you like to get going but not sure what you can do safely in the first few weeks?
  • Want to tone your abdominals without creating a pot-belly or putting too much pressure on your pelvic floor?
  • Are you looking for guidance about when to progress on to more challenging exercises?

I have developed a complete sequence of progressing postnatal Pilates classes for you to do at home. They are hosted on BEAM, an online platform specialising in providing friendly on demand and live exercise to mums.

Click through to BEAMfeelgood.com and use my affiliate code BEAM-WITH-SUPPORTED-MUMS for 30 days free Gold Membership. This gives you full access to my on-demand and LIVE classes as well as others on the site such as HIIT, Babysleek Barre and yoga.

Many mums are worried about exercising after their delivery. These exercises are for the first stage of your postnatal recovery. That tricky time from after delivery  to 6 weeks – full of myths & scare stories! Specialist physiotherapists like myself can guide you at this stage.

 Follow me through a sequence of  gentle but effective Pilates movements. The exercises safely mimic everyday activities like walking , climbing stairs & stretching. But I add clear cues about how to use your abdominal & pelvic floor muscles correctly at the same time. You will quickly feel stronger, more supported and comfortable again.

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!

Can you help other mums?

Please help us let other mums know about our safe, pelvic floor friendly exercises & resources.  Many mums are worried and nervous about exercising. We want Supported Mums & BEAM to be friendly, safe places to get sound information and support on your postnatal journey. Please write a review at BEAM, and share the videos with a friend!

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
lady doing exercises after a caesarean

Can I do exercises after a Caesarean?

Many women are worried about doing any exercises after a Caesarean section. But then they find themselves becoming very stiff, hunched over and uncomfortable.

You can do exercises after a Caesarean! Specialist physiotherapists like myself can guide you which ones to choose.

Physiotherapists promote MOVEMENT as soon as possible after a Caesarean. It helps your circulation, stretches out your abdominal wall, regains your posture, engages your pelvic floor and supports your back.

POGP booklet Fit for the Future

There is an excellent booklet, “Fit for the Future”, published by the POGP, my professional physiotherapy network, full of clear guidance and advice for the early days after your birth, with a special section for after Caesarean.  You can download a free pdf of “Fit for the Future” here.


Caesarean to 6 weeks postnatal exercise video

I have made a video of safe & effective exercises suitable for mums after a Caesarean Section. It is hosted by online platform BEAM

These exercises are for the first stage of your post-op recovery. From coming home from hospital to your 6 week check up.  You can follow me through a sequence of  gentle but effective Pilates movements.  These mimic daily activities you are already doing like walking around, climbing stairs, stretching. I will add lots of cues to show you how to use your abdominal & pelvic floor muscles correctly. You will quickly feel more supported and comfortable.

Click through to BEAMfeelgood.com and use my affiliate code BEAM-WITH-SUPPORTED-MUMS for 30 days free Gold Membership. This gives you full access to my on-demand and LIVE classes.

BEFORE you follow the video  >>>>>>

A caesarean section is a surgical procedure and the post-op period needs to be approached with sensible caution. Before you start the video take a moment to ask yourself the following 3 questions:

  1. Why did you need a Caesarean section?
  2. Was the Caesarean operation straightforward, and have you had any post-op complications?
  3. Do you have any other medical issues?

30% of women deliver routinely by Caesarean section. There are many reasons such as breech presentation, prolonged second stage or foetal distress. Recovery is usually straightforward & this exercise programme will be lovely for you.

 However if you needed a Caesarean section for an unusually complicated reason? Or you could write a small essay in answer to No’s 2 or 3 (!) this video might not be suitable. You may be better served by a 1:1 personal assessment of your situation and needs, rather than an online video.  Do see the page about how to find a local women’s health physiotherapist.

Straight forward recovery?

 If after pondering these questions, you feel that you are  progressing as well as expected after C-section, please come and join in! Remember that MOVEMENT is good for you! Exercise will help you feel more flexible, stronger and in tune with your body.

  • Take a little time each day to focus on some proper exercise for you.
  • Do read the special guidance in “Fit for the Future” (download the free booklet here)
  • Wait to start the “Caesarean to 6 week” sequence until you return home from hospital as the midwives will have checked that your wound is ready for you to move about freely.  

At any time you have any concerns at all about your caesarean scar oozing or bleeding, or feeling anything but mildly sore as you exercise or after, then it is very important that you stop straight away and ask your GP or midwife for advice before you continue.

Women recover at different rates from a caesarean section.  It is ok to just try 2 or 3 of the exercises at first. Then each couple of days add another one until you feel you enjoy doing the whole sequence. 

CAN YOU HELP OTHER MUMS?

Please help us let other mums know about our safe, pelvic floor friendly exercises & resources.  

Many mums are worried and nervous about exercising after a Caesarean. We want Supported Mums & BEAM to be friendly, safe places to get sound information and support on your postnatal journey. 

Please write a review at BEAM, and share the videos with a friend!

Best way to start abs 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?