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.
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.
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 or disposable pants (see #3).
#2 Disposable Pants
No one really believes that these look like “normal” knickers. However, their big advantage is the all-around cover, front, back and sideways. For an activity involving lots of changes of direction and position (aerobics, yoga, kids tumbling) they will give the most protection against bigger leaks.
Put your biggest PE pants over the top to hide them at your waist line.
However, if you are getting this wet when you play sport your priority should be to solve the bladder problem further. Talk to your physio about what they recommend for you.
#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.
* 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.
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
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.
#5 Add extra support to your core from the outside
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. Have a look at these if you feel just generally ‘unsupported’ at the moment:
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
……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 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.
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.
Cambridge is a wonderfully small place. I am delighted to host a post specially written for you by Lavina Brown, a local Life Coach. Lavinia came to my antenatal pilates class a few years ago. Now, like many women, she has returned to her work with a change of focus – drawn to helping other mothers be their best selves:
As a life coach for mums who want the most from life – to be the best mama they can be AND to find fulfilment and happiness in the workplace – self-care is one of the most important items in my coaching tool kit.
Why? Because we can’t have it all and do it all, all at the same time, without it.
Ambition is a great thing – especially when, on the whole, we women tend to seriously undersell ourselves – but it needs to be tempered with a reality check:
First, that women are naturally empathetic and often also highly sensitive. If we take on too much, this means we also take on too much of other people’s stuff (emotional and physical) leading only to burnout, depression and disease.
Second, that parenting takes up a huge amount of energy (whether we want it to or not). We simply don’t have the full tanks we used to pre-kids, to expend on what we choose. So we need to be careful about what we commit ourselves to and even more careful about taking time-out to replenish those precious tanks of ‘you juice’.
And that means self-care.
Yes, it’s an overused, slightly wishy-washy umbrella term that could mean lots of different things to different people, but that’s the whole point. Self-care is what makes YOU feel better about yourself, however weird and wacky that activity might seem to others. It could be picking your spots last thing before bed, going for a walk in Nature, indulging your inner neat-freak by colour-coding your wardrobe or learning to fly a plane.
I see self-care as falling into two camps: the nourishing sort (think cups of delicious tea, massage, lying in the sun, reading in bed, chats with your bezzies, steaming hot salt baths) and the revitalising sort (think sports, gardening, dancing etc). It doesn’t matter which camp is your natural self-care go-to, what does matter is incorporating at least one item from either list into your routine, on at least a weekly basis.
And there’s the rub: fitting it in. Actually doing it. Scheduling in time for yourself somewhere near the top of your to-do list rather than at the bottom underneath a myriad of chores.
Why is this so hard to do? Because as a society, we have not been taught to value ourselves over and above what we DO in the world. We have forgotten what it is like to be a human being rather than a human doing and in a world that glorifies the term ‘busy’, we have assumed that to get ahead and achieve our maximum, we should always be switched on.
But is this how we want our kids to grow up? No! So why should we fall in line with this crazy, short-termist attitude to life and health? Why not be pioneers instead?
Let’s see rest as a revolutionary act and start implementing it as though our lives depended on it! (Mama truth bomb: they do).
And if you’re still feeling like self-care is indulgent and
selfish, keep my top four reasons to ditch the mama guilt close to hand:
Just think how many hours you have been ‘on duty’and tally that up against how many you plan to take time ‘off’. There’s bound to be a huge imbalance.
Remember that giving yourself permission to do something that feels good and gives you joy, is also allowing others to do the same. By expressing your needs and asking that these be met (something we all struggle with as remote descendants of Victorian disciplinarians), you are showing your partner how they too are worth investing in
Partaking in some self-care without the kids is showing your children that life doesn’t have to be all work and no play. Hard effort deserves celebration – you would celebrate their achievements, so why not celebrate yours, however small, menial or routine they might seem to you at the time?
Happy Mama = Happy Family (and vice versa) You wouldn’t want to inflict shouty, resentful mama on them, would you?
So, self-care or be square. Your kids/partner/health will thank you for it…
Lavinia Brown (aka BoboMama) is a qualified transition coach for mothers. She supports women to reach their greatest potential – at home and in the workplace – whilst successfully managing the ‘life bomb’ that is kids. See www.bobomama.net for more details or follow her on social media for daily doses of mama medicine: click here for Insta and here forFB
Other health and hygiene questions are easy. How often should you clean your teeth? Wash your hair? Change your pants? But these two bladder questions – How much should you drink? and When should you wee? are full of issues, myths & legends. This article helps you understand the UK guidelines, understand why how much you drink influences when you will wee – and offers tips & tricks to for a happy bladder!
Bladders & drinks FAQs
Does how much you drink cover just water or all your drinks?
Are tea and coffee drinks?
What about the milk in your cereal?
Is it different if you are taller/smaller, fatter/thinner or breastfeeding?
Is it better to have a few big drinks or sip from a bottle all day?
Should we wee when we first feel it or when we are busting?
Is it ok to hang on……..but how long is hanging on for too long?
Am I normal if I wee in the night?
Is it ok to have just a tiny wee before you go out the door? ………
Phew….see what I mean about a tricky subject?!
How much water should you drink: official guidelines
Your body needs water or other fluids to work properly and to avoid dehydration. That’s why it’s important to drink enough fluids. In climates such as the UK’s, we should drink about 1.2 litres (six to eight glasses) of fluid every day to stop us getting dehyrated. In hotter climates, the body needs more than this. We also get some fluid from the food we eat.
Extra (practical & useful) tips & info:
Normal fluid intake should be 1.2 to MAX 2 litres in a 24 hour period.
It is NOT 1.2 litres of water on top of all your other drinks
This is ALL fluids added up together (tea, coffee, water, juices, alcohol).
1.5-2 litres equates to 6-8 standard 250ml mugs a day, or 4 x 500ml water bottles.
Don’t count the milk in your cereal. But if you have soup for lunch, jelly to follow and smoothies to drink you might want to be aware of their impact on the total volume.
If you are breastfeeding or doing sweaty exercise you may need an extra glass here & there to replace lost fluid. But unless you sweat profusely or produce gallons of breast milk – this is not nearly as much as you think.
Drinks should be evenly spaced at approx 2 hour intervals. With the last proper drink 2 hours before bedtime (ideally non-caffeine), just sips thereafter.
How to be nice to your bladder: filling tips
Let’s talk through the look of a ‘normal’ day, in an untroubled happy bladder world. It will help your brain understand how it should all work.
If you have been suffering with mad dashes to the loo, uncomfortable and inconvenient urges and bladder accidents, these habits will really help.
# 1 . Take an ‘organised approach’ to when to fill & empty the bladder
A standard mug or glass (of tea, coffee, water etc) is 250ml. Many people are often surprised to realise that you therefore need no more than 6-8 mugs/glasses in 24 hours.
The bladder prefers regular and spaced filling intervals rather than droughts or floods. Though the bottled water companies would like to persuade us differently, it is not normal to be constantly sipping water. A drink every couple of hours should rather nicely lead to needing a wee every couple of hours.
If you look at your wee when it comes out it should be pale yellow. If it looks like water you are drinking too much, if it is dark yellow you are not drinking enough.
Drink every half an hour ? Guess what…you are going to need to wee every half an hour…
If 1.2 litres IN gives you 5-6 wees out. Then if you are drinking 3 litres a day, simple maths says that’s about 12 standard wees. Or 6 very very full bursting ones. Those bursting wees are highly likely to be accompanied by some unpleasant sensations or not quite making it! Cut back on the volume (to 1.2 litres a day) and you could get an instantly happier bladder.
Monitor your fluid intake carefully for a few days. Your ‘bladder’ problem could be merely operator error at the filling end.
# 2 Not all drinks are equal
It can seem strange that we say 1.2 litres of FLUID and don’t distinguish water from other drinks. Tea and coffee are, however, just water with flavoring. Think how you pour the water out of the kettle?
So they will hydrate you but…you might want to think how the ‘flavoring’ could affect you:
Caffeine is a known bladder irritant. Some people notice that they react worse to ‘real’ coffee than instant (or vice versa). Adding fat (milk or cream or on trend is butter!) slows the absorbtion of caffeine.
Tea can be ‘light’ by design (eg Earl or Lady Grey). Or light in the making; a few leaves gently steeped is very different from squashing the teabag to death in a mug. The ‘builders’ tea’ version has extra caffeine and tannins – that’s what stains the mug.
Alcohol is a diuretic (for every glass in, you will get one and half out…think hangover…dry mouth, dehydration, headache…).
You may notice your bladder reacts to certain types of alcohol (spirits, wine, fizz) differently. Find your tipple of choice and note what to avoid when there isn’t a handy toilet!
Fizzy water and de-caf coffee can also be irritating for some people. It is thought that it is something about the manufacturing process.
Watch out for ‘sneaky’ ingredients. Fruit teas are high in sugar. Green tea has caffeine (and is also a diruetic – hence drunk on ‘diets’). Many hot chocolates are high in sugar & can contain caffeine.
#3 Take more notice of how drinks affect you
Start to notice how long it takes for different drinks to pass through you and make your bladder uncomfortable.
Squeezy App (which reminds you to do your pelvic floor exercises) has a bladder diary you can use to monitor your fluid intake and trips to the loo or download a chart here.
You may find you are not as ‘tolerant’ of your favorite drink as you used to be.
Don’t feel you have to go cold turkey. Just cut down a bit on the likely culprits. Then increase the balance of plain water. You will likely see a quick reduction in bladder urgency and increased capacity to hold.
Pick your moments. It doesn’t mean you can’t drink your favorite double strength cappaccino…but maybe not just before a long car journey or the cinema?
#4Sweating? Breastfeeding? When you might need extra fluid
Hot days & exercise: We don’t just lose fluid from our bodies when we wee. It also escapes from our body in our breath (think how you can steam up a mirror). Also when we sweat. If it is a hot day, we need extra fluid. If you are doing an extra sweaty activity, drink a little extra before and be sure to re-hydrate after. “Guesstimate” the amount that you might have glowed away. As well as the drink you were probably due about then anyway. But don’t over do it.
Breastfeeding: It is important to have some extra fluid each time you feed…but again don’t over do the drinking or you will just be weeing more. To estimate the amount you need to re-hydrate – think about the milk volume that you produce when you express? Probably about 200-400ml? So an extra glass/mug of fluid is all you need back again. You don’t need to down a pint of water – your poor bladder will just fill to bursting really quickly and not love you for it.
When should you have a wee?
A quick summary of the daily OUT routine. IF you are drinking 1.2 litres fluids in 24 hours (which is one 250ml mug roughly every 2 hours)
One wee in the middle of the night is considered normal
On waking up expect a BIG wee (400-600ml) – you could possibly fill a pint glass
Then through the day expect 5-6 average wees (200-400ml) – each one could fill a big mug
You do not need to wait until you are bursting to empty your bladder.
Aim to empty when your bladder holds a good mug-full. Little ‘yogurt pot’ wees should be avoided.
How to be nice to your bladder: emptying tips
# 1The first sensation is usually too early
After 45 minutes to an hour your bladder would normally hold about 120ml (a yogurt pot) of urine. Then you would get a ‘I might need a wee‘ sensation. This happens as the walls of the bladder (it’s a muscle) stretch for the first time.
Our brains should know to recognise this as an ‘irritating-stretching-message’ not a ‘need-a-wee-now’ message. Subconsciously we should
clock the time,
do the maths (only an hour since I last had a wee)
tighten our pelvic floor muscles in a slow steady way,
distract ourselves with the job in hand
and within 2-3 minutes the feeling of wanting a wee completely disappears – like we never needed one in the first place – we go on with our activities, almost forgetting that we have a bladder.
This is the bladder’s normal first response.
That first annoying signal isn’t particularly useful. It’s just a very early warning signal. Like your petrol gauge alerting you when you still have 60 miles in the tank. You don’t need a wee when there is only a yogurt pot worth in the bladder, even if the bladder feels a bit scratchy about it. Just ignore it and it will go away.
If circumstances are justified, it’s ok to have a “just-in-case” or “safety wee“. Say you’re about to go on a a long car journey. Or about to have a swim or a shower. Or go to bed. Then it makes sense to get rid of even the 120ml so that you have a long run ahead of you. But you need to justify to yourself why you didn’t just ignore the feeling. Otherwise it can quickly become a habit to have a wee every time you get a bit of sensation. That can be very disabling.
#2 . Ignore the first message and wait for the next one
Normally, that first message quickly disappears. We forget all about the bladder. We can fill it for a second hour (or so) till there is more like 300ml. Think a large ‘Cath Kidston’ mug-worth. Then you should get a dullish, polite “you need a wee” sensation that sends us off for a comfortable-but-not-urgent wee.
This is when you should go. There is still a bit of room in the bladder. If you have to stand in a queue, find your front door keys, answer the phone. There is a bit of give and it is not too heavy if you need a cough or a sneeze.
# 3. But do not leave it for a third or fourth message…
But do we go when we should go?? Of course not……Many people (and especially busy, distracted mums) leave it TOO LATE.
You can ignore the middle message, and head into a third or even fourth hour. You can fill to nearly a pint (shift workers, teachers and nurses can often hold even more). BUT filling to your max tends to be accompanied by a sudden, very uncomfortable and urgent “need for a wee” message. The type that makes you sweat, your eyes water and comes with a strong sense of panic. Panic that you might not make it (and indeed you might not).
These maximum capacity wees are intended for first thing in the morning or an emergency. BTW an emergency is being unexpectedly stuck on a motorway. NOT just putting it off for …one more paragraph, one more chore or an advert break. And not just because you are too busy to remember to go for a wee!
#4 . Is there really something wrong with your bladder – or is it poor human judgement?
So many times the problem is really operator error. The human operator is not listening to the (rather good) system properly. Guilty??? Which are you? Tend to go too early (friends and family tease you about always needing a wee)? Or tend to leave it too late (lots of sweaty near misses or trouble at the front door)?!
Or, not uncommon are you swinging between too early and too late? Do you push your limits…push your limits…leave it…leave it…just one more thing and THEN you very nearly have an accident?! The problem is this makes your bladder very nervous. You start doing lots of little wees as soon as you feel something, just to be safe. You keep weeing early to avoid another bad experience? But then you think…this is silly… I need to train my bladder. So you start again, filling and filling, past the ‘right’ signal, on up and up …nearly bursting.. having an accident. And then you get nervous and go early again….a real viscious cycle.
What can you do to improve your bladder habits?
Homework this week. When you are heading to the toilet for a wee, try to predict the size of the wee you are going to have. Use the simple categories of:
or pint class
( aka: small, medium and large).
I’m prepared to take a reasonably large bet that as soon as you start taking a bit more notice of what’s going in at the top and what the wees feel like at the different size points, you will quickly tune in to the bladder sensations and interpret the messages better.
The hardest one to spot and get in tune with is the ‘middle’ one. It can almost be too polite to be properly useful. A bit more interesting would mean it wasn’t so easily missed! But we can’t change nature. Once you are familiar with the feeling of a “comfortable-size wee” you will be able to spot when to have a wee more easily. This will help stop the cycle of under or over-filling.
Exceptions – when to seek more help
If you thought you were going to have an enormous wee but only get a tiny one – or a tiny one but get far more – you may find your body is not well tuned to the sensations. Sometimes the nerves stay confused after the pressures of pregnancy and childbirth and need retraining.
If you do not feel that you get the ‘right’ sensations guiding you towards having a wee at that middle point and you leave it too late before the bladder suddenly decides for you, or you get unexpected leakage, then I would suggest you use the clock as a guide for a while (but all the while trying to tune in to any sensations you are getting).
Start with an hour, then have a wee, noticing how small they are at this stage. Then, once you are comfortable with this, don’t stick here too long or your bladder will get into an annoying ‘habit’ of thinking this is all you can do. Move up in 15 minute increments as feels comfortable and ‘safe’ to do. Remember the goal is just 2-3 hours of holding – no need for more.
There are also medical conditions of the bladder
Overactive Bladder (OAB), often colloquially termed ‘irritable bladder’ is a pathology with symptoms of frequency, urgency and urge incontinence. Commonly you feel a strong urge to wee but only a small wee comes out. Or you feel the bladder suddenly contract and leak, partially or completely (called urge incontinence). If you have tried the tips above, but you still struggle with bladder control, keep a bladder diary to discuss the pattern with your GP. There is medication that can help ‘calm’ a bladder. Or working with a physiotherapist on your pelvic floor muscles will also improve your control.
You can have a low gradebladder infection and not necessarily realise this. Watch for cloudy urine, funny smells, feeling off colour. The dipstix test at the GP is not that reliable – you may need to send your urine off for testing
You may not be making the hormones that suppress night time bladder production. If you have massive urine volumes at night, even though you are not drinking, discuss this with your GP.
Paradoxically – wearing a pad to prevent leakage can irritate the bladder tube and increase urge and leaks. Try going without a pad or wearing knickers with an inbuilt pad to see if this is the case.
a CHANGE in bladder habits can also be an indicator of several other medical conditions.
Ever have one of those days where you seem to need to wee and wee and wee? Not necessarily unpleasantly but you think “where is it all coming from????”
The body constantly re-adjusts our fluid balance – and sometimes does this really dramatically. You see it best by watching how tight/loose your rings are. Notice this week how sometimes you can slide your rings about easily but other times they are stuck on tight. The body holds fluid when it is hot and dumps it as it gets colder. We also have circadian rhythms that affect fluid in and out. Most people wee more in the mornings and less in the afternoon.
Stress affects bladders
When we are ‘stressed’ (anxious, worried, cross, running late) our system is releasing adrenalin. Adrenalin triggers our Fight, Flight or Freeze response. If a tiger walked in your door right now – your hairs would stand on end, your heart would beat faster…and you would wet yourself. Likely bowels too. I think it’s supposed to be so that you can run faster.
Fortunately, you are unlikely to encounter seriously stressful moments too often but we experience mild ‘stress’ all the time. When you are feeling anxious, worried, cross, running late , the brain ‘drips’ adrenalin into your system to help you cope. But with that comes bladder (or bowel) irritation. Think of standing in a queue to do an exam, or waiting to give a presentation at work…that strong need to wee…and then even to wee again.
So if you are having a day needing lots of wees, ask if you are stressed? Your bladder could be used as a barometer to your stress levels? Rather than try to ‘fix’ the bladder…can you decrease the source of the stress?
Peaceful sleep & your bladder
It is normal to get up for one wee in the night (assuming sleeping for 6-8 hours). Annoying…but perfectly normal. Nicer if you don’t have to but some bodies just do.
But don’t be hard on the grandparents. Over the age of 60 it is normal to wee once or twice in the night. Hormone changes of aging affect the way the kidneys process urine.
aim to have your last drink 2 hours before bedtime. Then the fluid has plenty of time to go through your system with a good wee before getting into bed.
Best to avoid caffeine late.
Beware, sneaky sources of caffeine like Green Tea & some hot chocolate mixes
alcohol is a diuretic ie more volume comes out than went in (just think hangover….dry mouth….)
if you do have a late night drink (party!)) then don’t berate your bladder for needing a 2am wee!
That first morning wee…
If you don’t wake in the night most people wake up with a very full bladder. You will need to make getting to the toilet your priority on waking.
==== Mums go first! ====
I appreciate that this was a LONG blog post – but I couldn’t leave anything out. I hope it has been helpful. Do let me know if this has helped you?
This is absolutely my favourite standing pelvic floor exercise. I love that it anchors you to the spot with a quick little routine to stop you getting distracted part way through.
Honestly takes 35 seconds but pings your pelvic floor muscles awake.Little and often improves muscle memory, reaction times, and encourages quick muscle growth.
Turn your toes out, like a ballet dancer, 5 squeezes of the back passage
Turn your toes out, like a ballet dancer.Tighten your pelvic floor and notice how this position favours the back passage (the anal sphincter) just like you are stopping wind.Pretend you are having tea with the queen and made the mistake of baked beans for lunch.You need to effectively close the anus opening, without clenching your buttocks more than a smidgen and without it showing on your face!Do 5 on and off squeezes, not trying to hold, just a good squeeze, then let go completely.
2. Turn your toes in, like a pigeon, 5 lift and tucks of the vagina/bladder tube area
Then turn your toes in, like a pigeon. Now when you tighten up underneath it should feel different.Less going on at the back and more focus at the front, around the bladder tube and vagina area.Let the area be soft, almost a bit saggy,then lift and tuck the vagina up inside.Let go – completely.Then repeat 5 on – off contractions.Best lift you can do ….and relax. Don’t worry if your abdominal muscles join in a little bit but keep the focus on your pelvic floor.
3. Turn your toes normal, both areas together as a unit
Finally turn your toes into your normal standing posture.Now try to do both the previous actions at the same time.Most people start with the back tightening and then like a big zip come forward to lift and tuck the front.When you let go each time now it should feel like there was a bigger ‘up’ and a bigger ‘drop’.Repeat.If you are feeling clever add in some side to side tension too (yes, the pelvic floor is bowl shaped, see this in my video showing a model pelvis in the pelvic floor school)
When you have done 5 squeezes with your toes turned out, 5 with your toes turned in and 5 with everything together you will have done 15 really good pelvic floor muscle contractions.NOW your muscles will be thinking – hey she doesn’t normally work us like this – we are going to need to grow!
In this video I go through the exercise with Stephanie from Kegel8 and The Knack too.
When to do it?
Perfect exercise to do little and often through an ordinary day.It tags on really well to cleaning your teeth – or after a wee.At home, use that quiet moment in the toilet to focus on yourself.If you are working, linger in the cubicle for an extra 40 seconds – you are getting paid to exercise!
If you think this exercise is mad and you couldn’t feel a thing when you tried to do it – try it lying down, not so much the feet positions but focusing first on the back passage and then on the front. This positon takes the weight of your organs off the pelvic floor and gives you more chance to ‘feel’ the muscles working.If that still leaves you cold – then I would recommend you have a chat to your GP and ask for a referral to a specialist pelvic floor physiotherapist for a full assessment and examination.There are lots of things we can teach you in clinic 1:1 to help you find and improve your muscle function.
There are 3 Ps of a perfect poo which you should keep in mind during your ablutions!
Are you or family doing any naturally??
How do you sit?
Do some people in your family take a LONG time in the toilet?
Who reads the paper? (Should you keep books in the loo?)
Might you be helping too much?
Do see the video below to learn more about good bowel habits and promote some healthy/unusual/hilarious family discussions!
[Before you watch – to explain the context – this was an adventure on to a public speaking course a while back. There was a Gala Finale with the brief to give a ten minute inspirational speech… well with a challenge like that it’s hard to hold a physio back….Apologies, a bit squeaky at the beginning – I was very nervous!! ]
P for Position
They have actually done lots of research about the best way to sit on a toilet.Yes really.In Australia.
Nature did not intend us to sit lady like on a ceramic toilet.We are supposed to squat down behind a tree. The key thing is knees higher than your hips.This un-kinks the bowel and relaxes the pelvic floor muscles.
sit with your feet up on a toddler step or box
Bottom well back on the seat
Rest your elbows on your knees
Untuck your tail bone keeping your back relatively straight
Let all your body muscles relax, especially your pelvic floor and abdominals
P for Patience
Emptying the bowel is a natural thing that the body does best on automatic pilot.It is not something that ‘we’ do.Like sneezing.The best ones come from nowhere.And just like a juicy sneeze that you can feel coming – if you think about it too hard (and especially if you say “I think I am going to sneeze”) – it will disappear!
An age old trick – READ – a book/magazine/back of a shampoo bottle….anything to distract your corticol (thinking) brain and let your automatic brain do it’s own thing.Give your body some time.You are waiting for something solid to move out – it doesn’t just fall out like liquid.Your body needs to accept that it is a quiet, private moment.
P for don’t Push – rather Pant!
[This last P got a bit lost in the talk ( I got a bit flustered when they showed me the 2 minute warning notice!). I got to fill in the gap to the audience in the awards bit – they voted it the “peoples choice” which was encouraging.]
The danger of a traditional “hold-your-breath” push is that you can accidentally tighten your pelvic floor just as the stool is trying to come out. This can cause it to be pinched off midway so you get some out but lots gets left behind in the rectum. You might not be able to feel it there but it goes on giving off gas, making you windy, pressing on the rectum walls, making you uncomfortable, and drying out into small pebbles.
Ratheropen your mouth (which helps relax your pelvic floor) and let out pants or sighs, just as the midwives teach you to pant to deliver your babies head. This allows the poo to come out as one full tube with just a nudge and light pressure from you.
Imagine the state of your ankle if you fell on an uneven pavement, gave it a nasty twist and then still had to run home – you wouldn’t be at all surprised to be looking at a hot, red, swollen, bruised and very tender foot and ankle? Add a cut and some stitches and you would feel very sorry for it.
Because everyone can see the damage you would be lavished with care and attention: crutches to keep the weight off; leg up when you sit down to reduce swelling; tubigrip; icepacks; exercises to keep it stiffening up and plenty of willing helpers to let you take it easy for a good few days.
Everyone knows that you have to nurse and care for an injury to help healing to take place successfully, to avoid complications and to get back to normal walking again as quickly as possible.
WE NEED TO CARE FOR BRUISED SORE VAGINAS TOO
During birth the perineum (the skin and tissues surrounding the opening of the vagina) experiences a traumatic stretch and strain. Clinically this is termed a soft tissue injury. It would be great to care for the perineum in the first weeks of motherhood with a similar respect for the healing process.
Unfortunately, things are stacked against the love and attention needed, apart from the obvious distraction of a beautiful, demanding newborn:
you are high on the birth experience so your own bottom is low on your agenda
nobody can see your sore bits and you don’t limp so there is no outside sign that you are injured
you can’t (wouldn’t?!) exactly discuss your sore bits with many people
most of the time you are sitting on the sore part to feed which makes it go numb
mothers are incredibly stoic people and don’t complain
it’s hard to know what’s ‘normal’ so there is a tendency to just battle on
In these posts I have pulled together tips and tricks to guide you how to care for your perineum from day one until it is all feeling better again. Don’t hesitate to ask if you want clarification or think of something that I have left out that would be useful for other new mums to know?
In the early days of a newborn baby there is an awful lot to think about for the newly hatched egg. However, don’t forget, every day, to stop and think about the chicken. Who is going to look after the egg properly if the chicken is tired, weak, undernourished and sore?
For a truly happy family, new mothers, and especially their recently wonderfully used bodies need some love and attention too.
Take the baby out in the pram for a pacy 20 minute walk. Breathe deeply, stand tall and hold your tummy in. Walk so that you hear your heels clicking (this makes your bottom muscles pert), and go fast enough that you couldn’t talk. Baby exposed to sunlight to help regulate their sleep cycles – tick. Posture and core muscles woken up – tick. Cardio-vascular exercise – tick!
Do you respect your body and your own needs? What did you do today for yourself? What could you do to feel stronger and fitter?
If you are nursing a tender bruised perineum after your childbirth heroics that doesn’t seem the kindest option does it? But actually soft cushions or the sofa may press up against the sore area more than you would think, as they mould in around you. This can restrict the blood and lymphatic flow to the tissues. It will all feel a bit numb after a while as you sit there but can feel very sore and achey when you stand up again. Definitely NOT a ring cushion – an old fashioned solution – as they pull all your weight and pressure down into the centre just where you hurt the most.
My midwife was insistent that I sat on a kitchen chair to breastfeed to improve my posture. I was still spectacularly unsuccessful at breastfeeding but the positive outcome was that I noticed I didn’t ache so much in my undercarriage when my marathon feeding stint finished.
A harder surface and more upright chair works because you take more weight through your feet and ‘sitting bones’ keeping pressure off the perineum and coccyx. This stops the soft tissues and their blood supply from being squashed and lets air flow under.
When I worked in the hospital there were these fabulous “valley” cushions but they don’t seem to be available anymore (unless you want to splash £199 on amazon!). Luckily I would suggest a cheaper alternative which we used to use if we ran out of the real deal: for an immediate DIY, or a subtle ‘out and about’ solution fold two matching hand towels into square blocks. Put one under each bottom cheek leaving the perineum a few centimetres blissfully airborne in the middle. Try it and smile as you find pressure relief!
If you have a long slow feeder or suffered with a good deal of stitches to the vagina or anal area, or are coping with piles, you will be grateful for improved comfort for several weeks ahead. Mother hens, be kind to your body.
How did you cope with a sore bottom and feeding? If you have any tips to help other mums, please comment below.