Category: Mums

#2 What to do when postnatal sex is painful

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Getting your Mojo back: #2 When POSTNATAL sex is PAINFUL

If postnatal sex is painful, it’s not your fault. And it can be sorted.

The problem is that a pain-avoidance cycle can develop quickly.  If you experience pain when you have sex, your body recoils from the idea of sex again.    Your partner doesn’t want to hurt you either.  Before you know it there is an elephant in the room, the PJ’s are looking defensive and you’re both studiously looking tired or more interested in a book.   

But feelings of rejection, disappointment, fear and anxiety only add to the vicious cycle.

Here are some of the most likely issues:

1. Do you have enough lubrication?

Painful sex can be caused by a lack of vaginal lubrication.  The hormone changes of pregnancy, delivery and breastfeeding can change our natural production of essential body fluids in the vagina area.  Couple this with lower libido and rushed foreplay and then sex feels sore as body parts struggle to slide and glide past each other.

personal lubricant is helpful for painful sex

Forget KY Jelly.  There are now some beautifully packaged, organic, pH balanced personal lubricants which can enhance your love life and help keep you moisturised and comfortable.  At Supported Mums we think the inventors of personal lubricant should win Nobel prizes – read more about their magic properties and especially the difference between water-based and oil-based lubricants here. 

2. Are the pelvic floor muscles too tight?

Many women do not realise that pain can also arise during sex because the pelvic floor muscles both at the vaginal entrance and deeper inside the vagina have become tight or tense.  Like any muscle in the body there can have been strains and sprains which have healed tighter than the original tissues, or your body might be subconciously  guarding the area since your delivery. Or you may even know that you had a scar that was slow to heal? Or a scar that is still uncomfortable and you are still fearful of stretching it?

Clues that too much pelvic floor tension might be a problem for you are:

  • penetration is difficult, feeling painful and/or blocked
  • you feel yourself tensing up down below (or notice that you are gripping your teeth or clenching your body)
  • or you notice that you sit with your buttocks clenched, often tense around the pelvis
  • tampons won’t go in
  • you feel achy, painful or heavy in the vulva and vaginal area

Try this:

  • explore the outside (vulva) and inside (vagina) with your fingers.  In the bath is nice as you are naked anyway and it is warm, clean and private.  Can you feel any areas that want to be stretched or massaged?  Are there some focused tension spots?  Amy Stein, a US based physiotherapist has a good guide to perineal massage.
  • Use my BEAM Stretch & Relax sequence to bring your tension levels down in advance of attempting sex.
  • take time with proper foreplay to relax your whole body  as well as time spent enjoying sensations outside and inside the vagina area 
  • ask your GP to refer you to see a specialist pelvic health physiotherapist.  We can examine your pelvic floor muscles and explore with you how to get them working better using natural approaches like exercise (for weak muscles) and manual therapy release (for tight, overworking or scarred muscles).

 Blog Series: Getting your Mojo back:

Please do ask questions or share your story here. Your experience will help others too. #NoMoreMiserableMums

lady in bed

#1 What is GOOD postnatal sex anyway?

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GOOD postnatal sex?  Can you remember sex at all??

 We women can adapt quickly to things not being ‘right’. Patiently accepting a less than good experience as our new normal.   When your body changes slowly, with a process that evolves like pregnancy, childbirth and motherhood, it can be disorientating. Don’t be surprised if you can’t even remember what you felt like before!

Through my work as a specialist pelvic floor physiotherapist,  I have had lots of conversations with women about their bodies and how they find sex after childbirth.  Please be reassured that there are LOTS of women struggling ‘to get their mojo back’ and we will talk about some of the problems in this series:

 Blog Series: Getting your Mojo back:

It’s not all bad – and it will be good again

 I want to reassure you that I do know many women who have found that childbirth improves their experience.  Once the vaginal canal has been stretched sex can be physically more comfortable.  Others enjoy having a more filled out body or seeing  themselves and their partner in their new roles as parents.

Though many women struggle initially,  I have also seen many many mums regain their self-confidence and sexual relationships, by focusing on identifying their specific problems and looking at the solutions. These can be surprising, such as needing to work on pelvic alignment and general pelvic stretching, as well as their pelvic floor strength.

What is good postnatal sex anyway?? 

Let’s explore for a moment what might classify as “good” sex?  (With my convent education and professional physio background, let’s leave ‘hot’ sex to other websites).

  • First you should definitely be able to actually have sex.  All the parts should be able to fit together successfully without feeling there is a block.
  • Sex should be without pain. 
  • And most importantly sex should bring pleasure for you.    

I think of “good sex” as the type of sex that keeps your relationship with your partner connected, bonded and fun.  It keeps you feeling like a woman and lover, not purely a mother.  It keeps you feeling valued and loved and allows you the choice to value and love in return. 

When things are really not right

If you are not having sex because there is a deeper problem with your’s or your partner’s libido, or physically something is stopping you even trying (this could be a physical block, some bad healing, an infection, discharge, scarring) then if you are ready to have sex and you feel you just can’t then now is the time to take action. 

You need to book to see your GP for a proper examination, discussion of the issues and investigation of the situation, possibly including referral on to the gynaecology team or to a psychosexual counsellor. 

Many maternity departments have a dedicated clinic for reviewing what will be clinically termed “perineal trauma”. There is also the wonderful MASIC charity with good information about management and recovery of obstetric tears.

Even a while after delivery

Some trauma is missed or masked during delivery.  When the area is swollen, bruised and tender it is not always easy to determine what will heal well in the ‘natural’ way and what will actually cause ongoing problems.   Later or delayed identification of a problem with the perineal area is medically termed ‘occult’ trauma – and by it’s definition may not become apparent until some time after the delivery. So please don’t be embarrassed to speak up about any problems even if you struggle to understand how they have come about or why they didn’t seem to be there at the beginning.

These issues should be getting better:

Common postnatal problems which should be getting better with both time and pelvic floor exercises are:

  • pain in the vaginal or anal area,
  • painful or dissatisfying sex,
  • pelvic organ prolapse (feeling of bulging, gaping or discomfort below)
  • urinary stress incontinence (leaks with cough, sneeze, laugh, run),
  • urgency (struggling to get to the toilet on time),
  • nocturia (needing more than 2 wees in the night) or
  • bowel leakage or constipation

Fortunately, a large percentage of women will find that their post-baby symptoms improve with DIY pelvic floor exercises to improve the strength, endurance and reaction time of the muscles which support the organs and help with continence function. 

When to ask for help?

BUT if after 8-12 weeks of regularly practicing standard pelvic floor exercises,  you find that are still having one or more of these problems it is definitely time to seek further help from your GP and ideally, a specialist pelvic floor physiotherapist.

How to find specialist help

Please don’t delay.  If the exercises you have tried are not helping your symptoms we don’t want you to struggle along alone.

There are several reasons why pelvic floor exercises might not be working  not least because we know that 50% of people find it difficult to do them right by themselves.  But also because there could be problems with scarring, the nerve supply or other things like hormonal imbalances,  an infection , or something completely new, not even necessarily connected with your delivery, like a fibroid, polyp or cyst.

The next step is to get professional assessment of the whole situation, help with the next more advanced stages of muscle training (or perhaps releasing the muscles if they are too tight) and access to further investigations and treatments if needed.

In many areas of the country you can self-refer back to your NHS women’s health physiotherapy team where you gave birth.  Have a look through the booklets and information you were given when you left hospital to see if the pathway is clear.   If it is not clear how to access a specialist physiotherapist or you feel that you need a review at the postnatal clinic,  speak to your GP for guidance.  And if the first GP is not helpful…..book in with another one.  Persistence is sometimes needed.

 Blog Series: Getting your Mojo back:

Please do ask questions or share your story here. Your experience will help others too. #NoMoreMiserableMums

is rest as good as sleep?

Is a Rest as good as a Sleep??

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Selfcare is not selfish or indulgent.

It is the very OPPOSITE of selfish to keep yourself fit and well. ⁠

Who is going to look after the egg(s) properly, if the Chicken is tired, weak, undernourished and demoralised? Do you need to focus on gaining energy? 10 Rest Tips today – essential reading for Mums (and their physiotherapists!)

picture of chicken self care for mums

Lessons learned (already) in 2020!

I was invited to go to a 3 hour workshop last weekend called NOURISH! – a lovely word-play on the combined skills of the leaders, Lavinia Brown (a life coach @bobmama_net) and Zoe Kirby (a nutritionist & yoga teacher @zoekirbynutrition).  Both inspiring local Cambridge women.

The first step, was taking time to reflect (again) that the need to care for ourselves – mind and body –  has to co-exist with all the demands that come with being a Mama Chicken (or Papa Cockerel, of course). And eggs don’t just come disguised as newly hatched chicks.   There are career eggs, elderly parent eggs & partner eggs, not forgetting house, garden, friends, & pet-type eggs too.  ⁠

REST

Lavinia focused on the need for REST.    Not mindfulness.  Not sleep.  Something a bit different.  Something I hadn’t realised was different, or missing.    REST.  

Do we need it?

Lavinia led a brainstorm of ways to recognise that we need REST. 

Together, we reflected on the familiar, but often ignored, Physical, Mental and Emotional signs & signals, that tell us that our body & mind are struggling to perform.  They are different and combine uniquely for each of us. Think headache, loss of attention, and tearfulness as examples in each category.  You may not know yet what yours are – but I bet you have an inkling of a few?

Signs & signals that rest is needed

Since the workshop, I have further simplified how to recognise my own need for rest.  The analogy that is working for me is visualising myself as a Phone Battery. I am on the look out for LOW POWER MODE.  If I peer into myself I’m no longer in the green. I’m in yellow.  My internal voice is trying to say –  girl watch out – you are dangerously close to red where Nothing Functions Well and next stop is burn out (physical = tight neck, mental = scattered + overwhelmed, emotional = short fuse and/or tears depending on hormone-levels!). 

It’s when I need to Plug-IN

So REST for me is the analogy of plugging my phone into the wall for a short re-charge.  Not that routine long-charging of my phone, to reliably give me the whole of tomorrow.  That’s SLEEP.  Rest is rather a choice to give up using my phone completely for 10 minutes, in order to benefit by getting sufficiently back into the green. Getting enough battery power for a proper 2 hours of full-function ahead.  Delayed gratification in it’s most difficult manifestation?

We DO have choices

Since I started to think of Rest like this, it’s been fascinating to have noticed the choices I make regularly, subconciously (and mostly correctly) for my phone. I’m habitually on it. My phone rarely catches me out. So why should my body battery? REST now feels like a positive CHOICE that I make for myself.  And a pleasantly guiltless no-brainer too.

Now, it doesn’t seem selfish or indulgent to ask myself “Do I want to get through my afternoon clinic offering my patients the best me, clear thinking, enthusiastic, energetic?”  Of course.  Then it’s perfectly OK to stop, close my door, eat my lunch, breathe & BE for 10 minutes.  Me, plugged in.

Yes, even for naptimes!

Reflecting back to my own baby-days, sometimes, (not often enough), I would make the decision to shut my eyes FIRST as soon as baby was asleep. Even if I only had 20 mins half-nap I was always SO much more productive during the remaining time than if I had not bothered.

Rest Tips: keep a list of restful activities in a journal

My 10 take home Rest Tips

(part inspirational Lavinia, part workshop after-thoughts)

# 1   A rest is as good as a sleep.

One of my mother’s favorite expressions.  Meaning just lie there and “be”.  This has value.  Even (especially) at 2am.
# 2   Activities can be rest-full. 

REST doesn’t have to mean Doing Nothing.  Rest can be classic activities like walking, reading a book, gardening, baking, or doing some Yoga practice. Lavinia also pointed out activities which don’t appear “restful” at first glance, yet can be enriching and enlivening, such as having coffee with a friend, drinks out with the girls, going to an energetic exercise class, even cleaning (… as long as multi-tasking doesn’t take you longer to get out of the yellow than if you just literally plugged in and didn’t touch your phone for 10). If the intention (and effect) is to recharge your battery, not deplete it, you could have a long list of options.
#3  Rest can be INVIGORATING or SOOTHING. 

Lavinia highlighted that we need each of these at different times.  And that a single activity might be used for either gain (eg Pilates can be energising or relaxing depending what you choose to do) or going for a run might equally fire you up for your day ahead or allow your mind to clear from the one you just had.
#4 QRT – QUALITY REST TIME

QRT is a similar concept I have heard of in the past.  We identify our QRT options by taking time to notice the activities that feel like quality time even though you are busy – they are the ones that put you in “the zone” where time goes by without you noticing and/or feeling depleted by the task.
#5  Put the BIG rocks in first. 

That old chestnut.  REST FIRST, there is always space to DO more. Particular relevant to naptimes?!?


#6 Make a go-to list for yellow moments 

When you are in LOW POWER MODE it is likely that your thought processes are slower, so it is harder to think what would get you out of the mode.  Keep your list handy.
#7 Why don’t we rest? 

How do we self-sabotage our intentions?  WHY do we do this?  This part of the workshop was incredibly valuable but personal. Not prepared to share!  But do a tiny bit of thinking and you will know that we all do this. Multiple reasons!
#8  ACCEPT low power mode

Sometimes you truly CAN’T actually plug in.  But I’ve noticed there is another potential choice –  if I don’t want to go red I might have to accept that  some functions need to switch off, or are just not an option anymore.  I have to  choose wisely how to use my last bit of power. 

For example when I find it’s impossible to make brainy decisions, I can still get some banking done, or answer some low-key emails .  Or I persuade myself & The Child into a simple card game, as less effort than arguing over homework. I’ve even been known to curl up for some TV-time.  I need to Power Right Down until I can find a proper socket time-slot to re-charge.
#9  Don’t be the Victim

Lavinia’s harshest truth (put very kindly of course).  Am I waiting for someone to give me permission to rest?   Or offer me the rest on a plate – “ooh you look tired, here sit down, I’ll cook dinner….”.  Sure that would be nice but she points out that we disempower our Self by waiting for a Shining Knight , with the risk of becoming bitter and resentful when one doesn’t turn up.  Do I go around plugging other people’s phones in for them?  No.  Do I even remind other people to charge their phones?  No!  It is MY responsibility to keep my phone charged.  
#10 Anticipate: spot patterns

Why am I overwhelmed by friends for supper tonight? Why did I say let’s meet up but now wish I could go to bed?    I want to ENJOY the social stuff like I planned, not resent that I overcommitted?  This is definitely one of my regular patterns.  How  to refresh a work-depleted Friday night battery?  Get a proper  boost to see me through a fun & fulfilling late night? I’m experimenting with a) knowing I need to do this and b) methods –  Long soak or quick shower?  Read for 10 mins? Sort the socks with a podcast?!

What are your triggers/patterns?

Have you noticed that with Small Ones, 4pm is no longer the end of the day? It is merely the lull – before the real work begins! Teatime, bathtime & bedtime are physically and mentally Hard Work. Could you re-charge/re-boost just before it all kicks off? Or get baby to bed, then have 20 mins “time-out” so that you can re-focus on your relationship with your partner and your own personal to-do list – rather than an antisocial crash-out from exhaustion?

#  Bonus .    And one for you – Reframe? 

Do you want to go to your regular postnatal class, Pilates (spinning, run, swim ….) but feel that your power mode is too low to even get you out the door?  Perhaps Re-frame?  Going to your class could be the equivalent of plugging yourself in for an hour, giving you a couple of day’s worth of power, in exchange for that short weary drive (in practically red-mode) to get you to the hall/studio/pool?

Does this concept of Rest vs sleep resonate with you?? Which of the Rest Tips had your name on it? What do you do to stay out of the yellow zone? How to you re-charge?

advice and exercises after delivery

Essential advice and exercises after delivery

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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

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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 …

CUE – YOUR 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

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  • 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.

  • MInd the Gap I & II for non-crunch abs work

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!

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10 tips to make the first postnatal poos more comfortable

10 Tips to make those first postnatal poos more comfortable

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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?

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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.

  • Exercises for after a Caesarean led by a specialist physiotherapist
    Birth to 6 weeks or Caesarean to 6 weeks help you move and connect straight away

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!

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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.

 

https://youtu.be/yaK0RqbU-Jw
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

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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?

Tips to manage bladder leaks when running or active:

this article contains some affiliate links marked*. 

#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.

disposable incontinence pads

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

Comforts light pads

Smaller brands Natracare and Cottons aim to use environmentally friendly materials and avoid the use of parabens and bleaching processes.

 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.

Tip: 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.

Sainsbury's Love Luna for bladder leaks
Sainsbury’s Love Luna
Giggle Knickers for bladder leakage
Giggle Knickers
Speax by Thinx underwear for leaks
Speax by Thinx
Wearever washable incontinence pants knickers
Wearever
Jude incontinence underwear range
Jude
Modibodi underwear for leaks
Modibodi

#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. No one will even notice if you are wearing a pad or have a bladder leak when you’re running.

£20-£80. Offered by sports brands Decathalon, Salomon, Reebok and fashion brands too:

Skort from Sherpa Adventure Gear
Sherpa Adventure Gear
Gym + Coffee smart black skort
Gym + Coffee
Shein skort
Shein

 

#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 EVB Sports Shorts* if you feel just generally ‘unsupported’ at the moment. Specially designed to add effective uplift to both the pelvic floor and abdomen. Full detail in the blog post: Are EVB Sports Shorts an active Mum’s best friend?

these shorts support your abdomen and pelvic floor for running
Engineered by an Irish Mum/runner
EVB Sports shorts help bladder leaks when running
EVB Sports Shorts

# 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. Can be an ideal strategy to stop bladder leaks when running.   Often called pessaries. The devices/brands you may see advertised include Contrelle, Efemia, Contiform (all available on prescription) and Uresta.  The devices increase in price, partly reflecting the number of times that they can be re-used. From single day use only, to monthly, to reuseable for a year.

picture of Contrelle Activgard - back on the market - great single use to stop bladder leaks when running
Contrelle
efemia bladder support device is soft and effective at stopping bladder leaks when running
Efemia
picture of Contiform to remove bladder leaks when running
Contiform
picture of uresta to reduce bladder leaks when running
Uresta

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 you do with a bit more support when you are trying to be more active?

More detail about their similarities and differences in the post: Bladder Support Pessaires for Stress Urinary Incontinence: how do they work?

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 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 to reduce bladder leaks when running?  Please share your experiences with other mums in our comments section below.  Your story will inspire others.

#beyouroptiMUM  #pantsnotpads #NoMoreMiserableMums