water lily to illustrate bladder support devices

Bladder support devices to reduce stress urinary incontinence: how do they work?

Add extra support to your bladder from the inside

[updated August 2019]

Strengthening your pelvic floor is still first prize for bladder leakage problems.  But what if you cannot create enough strength and support for the bladder with your pelvic floor muscles alone? You may benefit from one of the modern devices that tries to give some reinforcement to the bladder neck and bladder tube.

These are devices that you can buy on the internet and then insert and remove yourself.  They are designed to be worn all day but not all the time.  The most popular ones at the moment are Contrelle Activgard, Contam, Contiform and Uresta.  They vary in price chiefly relative to how many times they can be re-used.  Contiform is available on prescription.

If pelvic floor exercises, improving your core, adjusting your exercise regime and better bladder management have not been enough to resolve your bladder leakage then these devices may offer an alternative to surgery. They have a similar mechanism of action  (mechanical support of the urethra) to the TVT and colposuspension procedures.

How will an internal bladder support reduce urinary leakage?

These work particularly well in certain situations.  In particualar if you or your physiotherapist feel that the bladder has dropped only a little bit (prolapse of the anterior wall/cystocele) but that everything else inside (particularly the uterus) is still well supported. You feel you have created a good layer of muscles through exercise but still need a bit more support when you are trying to be active.

These devices work by providing more support for the bladder neck.  When you move fast (jogging, playing tennis) or  there is an increase in abdominal pressure (coughing, sneezing, zumba, aerobics) the pelvic floor muscle is supposed to support the bladder neck so that there is no leakage.  However, if the muscles are weakened and/or untoned that support can be lost. 

Are a visual person?   Imagine a running hose pipe, lying on  soft grass.  When you lay your foot on the pipe you may slow the flow of water but you may not be able to stop it completely.  However, if that under surface is firmer, because you have laid your hosepipe on your garden path (aka a good pelvic floor, and/or a device in position) when you press down on the hosepipe the water flow stops.

hose lying on grass and path

Would it be easier to stop the water by standing on the hose on the grass or on the path?

What type of urinary leakage will they help?

These devices are best for small leaks associated with movement. Or leaks when the bladder is under pressure from coughing, sneezing or laughing (stress urinary incontinence).

They create a mechanical uplift to support the bladder neck the way the pelvic floor is supposed to do.  What these devices can’t do is change symptoms like urgency.  If your bladder is irritated by caffeine, being too full, or you have an overactive bladder, you won’t see any improvement using one of these.  Pelvic floor exercises DO help these symptoms because the pelvic floor contracting activates neurological messages which calm the bladder down.  Unfortunately these devices can’t do that. 

If urgency or frequency symptoms are your bother – then rather practice “endurance/holding” pelvic floor exercises (see more in the Pelvic Floor School) and have a read of the article “How much should you drink in day and when should you have a wee?” for more impact on these problems.

Can I leave it in to wee?  What about during my period?

Yes, they are all designed to be left in when you have a wee.  The pressure of the bladder squeezing is enough to push the urine past the supported area when you need to.

You could still use the Contiform pessary when you had a period (as the menstrual fluid can flow through it) but you couldn’t use a tampon at the same time.  The other designs (Contam, Uresta) act as a block but are not absorbant like a tampon, so shouldn’t be used during your period.

Note: The term pessary can be confusing

Because these devices to reduce bladder leakage sit inside the vagina they are termed a “pessary” but they should not be confused with a  tradional pessary used for supporting Pelvic Organ Prolapse (POP).

The term pessary (plural pessaries) comes from the Latin (pessarium) and Greek (pession) which they referred to a medicated tampon made of lint to go in the vagina.  In the fascinating novel, The Red Tent, by Anita Diamant, set in Old Testament days, a midwife makes a ring pessary out of Beeswax (clever, nice antibacterial properties) and gold pessaries have been found inside female mummies in archeological digs.

There are two meanings in modern medicine:

  • a pessary as a vehicle for giving medication via the vagina (or if via the anus more often called a suppository).  You might have used a Canestan pessary for treating thrush?  Several hormone replacement medications are given this way (Vagifem and Ovestin for example) and some types of contraception
  • more commonly when we talk about someone having a pessary fitted we mean the more structured type such as a ring pessary, Gehrung, Gellhorn, shelf (Falk) or a cube.    These are designed to structurally hold the uterus right to the back of the vagina tube.  Or to give uplift to the anterior wall of the vagina (which supports the bladder). Or to reinforce the posterior wall of the vagina (which acts as a boundary for the bowel).  These are sound alternatives to surgical repair of prolapse.

    These structured pessaries are usually fitted by your GP or your gynaecologist after a full examination of the prolapse problem (with lights and a speculum).  Getting a good fit is important, as is how often you have them changed.  Usually only the ring style of pessary might be the type you are able to take in and out yourself (after training). 

    There are some new over the counter disposable pessaries which you can buy online, such as  Contam.  It is marketed for use both as a stress incontinence device as well as a bladder wall support (depending where you position it). It is early days to see how well women finds these newer products work as more DIY options for vaginal wall support.

A guide to devices to reduce stress urinary incontinence

[last updated August 2019]

Each company markets their own product and may use more than one distributor.  Here is my personal “quick guide” to what’s out there at the moment, apologies if it has already changed again by the time you read this!  Please do let me know if I have missed something out, you find a new supplier, have comments or you would like to share your experiences with other readers?:

Contrelle Activgard   (single use only)  currently unavailable in UK 

Contam pessary  (reusable for a week)

£26.99 for a normal vaginal pessary starter set from www.stressnomore.com   [use promotion code SUPPORTEDMUMS at checkout for a 15% discount].

These are quite new on the market.  There are no clinical trials listed.

Contam is a brand offering a variety of shapes and sizes of washable resuseable (for a week) vaginal pessaries.

picture of contam

It is the tampon shaped ones that are suitable for supporting the bladder neck (and can also be used to support the uterus).

The cube shaped ones are for going much further back in the vagina to support a more severe uterus prolapse.

It is suggested that you position them differently according to the problem:

  • For incontinence: insert the pessary deep into your vagina, then pull it back slightly so that it’s within reach of your fingerscontam

Contam pessaries can be used for up to a week by washing them after each removal. The manufacturers suggest that to clean your pessary, either boil it for 3-10 minutes or place it into the washing machine at 60 degrees. Then either leave it to dry naturally or store it in a bowl of water ready for the next insertion.

Though these are only reusable a few times and a more expensive option than pads, they would suits a mums who is generally not experiencing day to day stress incontinence but knows when she is going to leak.  For example if you do a longer run, or go to a Zumba class.  You might only use them only once or twice a week. You can put one of these in before they go and not need to worry with other protection (or maybe use with a pair of Pretty Clever  Pants “just in case”).  

Contiform Pessary    (re-usable up to 30 times)

£79.99 starter pack of 3 (different sizes), or £52.99 for an individual size  from www.stressnomore.co.uk    [promotion code SUPPORTEDMUMS for 15% discount) or amazon.co.uk or the distributor www.pioneermedical.com or  available on NHS prescription from your GP [starter pack: NHS order code   SKU184 , PIP code 375-5808 ]

The principle of the Contiform and its position in the vagina is to create uplift and support for the neck of the bladder.  These are re-usable up to 30 times so if you felt you needed support daily rather than ad hoc this is likely a more economical option in the longer term.

Contiform starter pack

The Contiform Pessary looks like a plastic hollow tampon.    The smaller circle supports the bladder tube (the urethra), the larger surface lies against the floor of the vagina, giving support to the bowel wall.  They are made of a firm but flexible non-latex plastic and can be reused, with the guarantee  up to 30 times (there is a “slit” that develops with wear to show you when the device needs changing),  longer if not worn all day.

You can buy these online or they are now available on NHS prescription.  You would need to tell  your GP about your symptoms, and ask him to prescribe a starter pack for you.  While you are there ask for a referral to specialist physiotherapy too if you haven’t already got your own pelvic floor coach(!).  Especially if using a Contiform works for you – it suggests that a stronger pelvic floor could do this job naturally for you too!

This video available on the distributors facebook page explains well.

URESTA      (lasts a year)

£179 (+VAT ) + £8 P&P  for a starter kit containing 3 sizes  from iMEDicare on 01923 237795 or via uresta.uk

picture of uresta
Uresta is reusable for a year

VAT zero rated for user self purchase if suffering from chronic stress urinary incontinence only

Uresta, designed and manufactured in Canada, joins this family of internal support devices with the unique selling point that it is fully reuseable with the manufacturers suggesting replacement after one year.

So if you have had good success with one of the devices above this would be a natural progression to a potentially more environmentally friendly and overall less expensive option.

A clinical trial of 32 women found that of those still using it at 2 weeks (21 women out of the original 32), 76% of them (16) were still using it at their 12 month visit.   Farrell SA, Baydock S, Amir B, et al.  Effectiveness of a new self-positioning pessary for the management of urinary incontinence in women.  Am J  Obst  Gynaecol 2007:196:474e.1-474.e8

There is a helpful video from their website below. If you are worried about the high initial cost Uresta offer (and I know honour) a full money back guarantee if the product doesn’t work for you and also give good advice about how to find the right size for you.

this video is from uresta.co.uk

Beware misleading marketing

Some of the marketing blurbs list “strengthen your pelvic floor” as a benefit of using their device.  This is only true in the loosest meaning – while they are in place, by artificially re-inforcing the vagina wall  I suppose you could claim that is “strengthening” the pelvic floor action – but they are in no way making any change to the muscle.  Only exercise can change the composition and activity of the muscles or surgery the non-muscular elements.  When you take the device out the structural situation remains the same.   However, these devices definitely offer an alternative to surgery with a similar mechanism of action, mechanical suppport of the urethra to the TVT and colposuspension procedures.

Living life to the full

To conclude – I would suggest that these devices are part of your package of things you are doing/using to change the way that bladder leakage limits your lifestyle with your goal to cure your leakage problem rather than simply manage it, if possible.

However, if you are feeling more confident to exercise because you are not worrying about leaking,  then this will be a Good Thing for your overall health, wellbeing and mood.   

Do contact your local specialist physiotherapist to help support you with finding the right products, exercises and sports for your needs

Have you tried an internal bladder support device? What did you think? Any tips for other mums?

a glass how much should you drink in a day

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

question mark

Why are some questions so full of angst?

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

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

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

Frequently asked questions

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

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

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

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

A Quick Summary of daily IN:

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

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

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

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

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

And based on this volume IN

A quick summary of the daily OUT routine

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

How much should you drink?  – the long version

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

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

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

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

a cup is 250ml

A standard mug is 250ml

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

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

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

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

Not all drinks are equal

a glass of water

water is the best choice

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

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

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

    cup of tea can be light or strong

    How do you ‘take’ your tea?

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

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

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

Sweating? Breastfeeding?  When you might need extra fluid

women stretching

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

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

Breastfeeding. 

baby breastfeeding

drink extra to replace the volume given to the baby

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

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

How often should you Wee? – the long version

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

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

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

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

This is the bladder’s normal first response.

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

campervan long journeys

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

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

Ignore the first message and wait for the next one

a big mugful is a perfect wee

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

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

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

But not leave it for a third or fourth message…

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

a pint of wee is too much

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

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

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

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

woman working at computer

Concentrating? Distracted? or just too busy?

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

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

what CAn you do to improve your bladder habits?

WC sign

this week monitor your fluid in and out habits

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

  • yogurt pot
  • big mug
  • or pint class

( aka: small, medium and large).

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

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

Exceptions – when to seek more help

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

use a wrist watch to monitor your wees

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

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

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

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

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

And weird stuff

Rings and ankles give clues

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

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

And stress…..

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

woman with a tiger

identify your day-to-day “tigers”

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

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

Peaceful sleep

sleeping woman

last proper drink 2 hours before bedtime

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

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

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

Waking up in the  morning

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

====    Mums go first!   ====

Can I run yet? Advice, videos and checks by specialist physio Amanda Savage

Can I run yet? 10 things to check before you take your post-baby body for a run

 

Can I run yet?  is a popular request from postnatal mums in  physio clinic. Before you dash out that door, use this postnatal checklist to make sure that your body is primed and ready for a successful, rewarding and injury free run.   Download a printable of the 10 checks here.

We all love running

Running is a fabulous free, effective, fun way to exercise which appeals to many new mums .  It’s heart, lungs, legs, bum.  It burns calories quickly.  You don’t need anyone else to do it with (but can if you want to).  It is magic time ALONE.  You can listen to music, your music.   You can go at any time of day for 15 mins or 50, depending how lucky you get with your childcare. It lends itself to an erratic life, no class commitment required .You can even run in the rain.

Where will you start?  Plan to avoid injury and disappointment

  As a specialist physiotherapist I tend to pick up the problems that have developed or show up from mums running too soon, or without realising that their body wasn’t ready.  These are things like sciatica, back or groin pain, recurrence of their antenatal pelvic girdle pain, incontinence and vaginal prolapse. 

Run before?  Often I worry that those who ran pre-baby are  most at risk of injury as it can be difficult to work out where to re-start .  You always remember what you were doing at your peak (!) but it can be tricky to find that “sweet spot” distance/time/pace to start back from.  

Before you had your baby(ies) were you an erratic jogger, more into 5k fun runs or a half marathon junkie?  What was your peak?  Can you remember how you started out and built up from couch to that first 5k?  You are going to need to take yourself back closer to the beginning  to allow your body time to build the skill-sets of running in the right order – but don’t worry – it will all come together much quicker than the first time you took up running.

Or never at all?  Or are you a complete newbie?  Perhaps running is the only exercise option you are going to have with your post-baby lifestyle and its all new to you?  You can take up running from any level of fitness but it is important to learn more about the process and tried and tested techniques of getting from couch to 5K+ so that you have fun, enjoy the process and don’t get disheartened.  Follow all these steps and you will be out their running with the pros before you know it.

 

Can I run yet?  a Mum’s Pre-run CHECKLIST

#1      Good Shoes     

Will your shoes absorb 80% of the impact?       

Your shoes are your first line of defence against the high impact of running.  

Each step sends a jolt of high pressure, 4 times your body weight, through your ankles, knees, pelvis and spine. When running that can be 800+ steps per mile!   If your foot moves to much on landing this can affect the biomechanics throughout the body and leads to common conditions such as plantarfascitis, ankle/knee strains, sciatica and hip pain.

The softening effect of the pregnancy hormones takes a while to return to normal, taking longer if you are breastfeeding.

TASK 1:  Check your trainers

  • Look at the soles.  If the tread pattern has worn away it is a sign of degrading and loss of cushioning.  The sole should feel squishy not wrinkled and tough!
  • Try them on:  with sports socks and make sure there is a gap of around half a centimetre between your longest toe and the end of the shoe as your feet will expand as you exercise.  Many women’s feet flatten and change shape during pregnancy and rather like your bust you can need to be re-fitted for shoes.
  • Re-lace: Don’t try to secure a gaping shoe by tying the laces too tightly. Laces need to be tied firmly but not so tight that circulation is restricted during exercise. There are lots of different ways to lace shoes for your indivdual foot type.  
  • review your orthotics:  if you needed orthotics before, now with the changes of pregnancy you may need them reviewed or refitted – book an appointment with your podiatrist or physio and let them know you want to run.
  • go shopping with professional advice:  Take your old shoes down to the nearest reputable sports shop for more advice.  Many now have either a treadmill (often with video) or a force plate to create a picture of the pressure points in your foot which may provide useful information.  A trained assistant  will watch you run, give advice and help you try different styles.      In Cambridge we have Up and Running & the sports shop at David Lloyd.

#2        Flexible back & pelvic symmetry      

Can your pelvis transfer your weight from leg to leg?

Running is a sequence of standing on one leg then the other, just speeded up so you don’t see it.

TASK 2:  wobble test

 Try standing on one leg for a few seconds, then the other.  Did they feel the same or different?  Were you markedly more ‘wobbly’ one way, or have to jut your hip out to balance.  Any pain triggered?  Was it easier to move from right to left than left to right (or vice versa).  Did one way just require more ‘thinking’?    

  If this simple test from one leg to the other makes you suspicious that you have a problem shifting your weight evenly, once you hit 3000 running steps this could lead to a back or pelvis problem becoming unmasked. 

 

Check your technique:  With an expert.  If you already have a suspicion that your back or pelvis is not ‘right’     DON’T run yet because it is likely only to get worse.

  • if you had PGP during pregnancy and it is still niggling, go back to your physiotherapy team and ask for a postnatal review and assessment of your spine
  • if you think that your delivery might have triggered a new back or hip problem ask your GP to refer you for a physiotherapy assessment

Focus your training:

 


       Are you a list kind of girl?– To Download a free printable check list CLICK here

 


#3     Glavanised gluts           

Have you got one bottom better than the other?                

The other big load bearing muscles are the gluteals.  As you stride forward each buttock needs to help take your weight and create forward propulsion.  Weak bottom muscles and you will overuse your hamstrings and calves causing cramp or muscle strains. 

TASK 3: the pilates bridge with knee fold test

This task mimics the job the gluts have to do when you run.  Check your gluts are working equally well right and left with this task – you should feel your buttocks not your hamstrings take your weight and your foot should feel that it can just ‘float’ off the floor.

picture of pilates bridge with knee fold to test running technique

Lie on your back with your knees bent, feet flat.  Draw yourself up into a bridge position.  Are you hips level?  Can you feel both gluteals (bottom muscles) working evenly or is one side doing all the work?  Now focus on supporting your body weight with your right leg and let your left knee fold in over your hip.  Feel the work in your right bottom.  Then put your foot down and repeat folding your right knee in.  You should feel your buttocks not your hamstrings take your weight and your foot should feel that it can just ‘float’ off the floor.  You should be able to move smoothly from one side to the other without dipping hips, cramp in feet or hamstrings or rapid fatigue.

Check your technique:  To work on reducing hamstring and foot cramp see my video with 3 top tips   “How to bridge without getting cramp”

Focus your training:    before you go out running and risk an injury, build up your muscle strength and co-ordination by doing a few sessions of my postnatal pilates sequence specifically designed to Galvanise your Gluts.

#4  Abdominal control  

Can your abdominal wall hold strong at peak run?        

A traditional head lift/crunch style abdominal exercise doesn’t reflect the role the abdominals have to play when you move.  In a sit-up/crunch you are keeping your legs still and moving your upper body – but when you run you need to keep your body still and move your legs!  At full sprint both your feet will be off the floor at the same time.

TASK 4:  The Pilates double table top position reflects this action well. 

Can you do 10  leg extensions from table top postion, maintaining neutral spine, a lightly engaged core and while breathing naturally???  Your abdominals should not bulge or dome.  NB:  Start with your arms by your side (arms back, seen in the picture, is the more advanced version).

Can I run yet? tabletop with leg extensions mimics running action

 

 

Check your technique:  If you find your abdominals bulging you are not strong/co-ordinated  enough to run yet.  It may be that you need to improve your technique: see this video   3 Tips to Control Abdominal doming in Tabletop position

 

Focus your training:  Follow my postnatal Pilates sequences Mind the Gap I progressing to Mind the Gap II for a few days –  you will see a great improvement of your ability to control the abdominal wall which will mean you have back and pelvic support when you are running.

#5  Primed Pelvic floor      

Is your pelvic floor ready to take high impact?      

Postnatal pelvic floors can be slow to react and need waking up before you run. No good getting half way down the road before you start to think – ooh all a bit floppy and leaky….. where’s my undercarriage support….???

TASK 5:   35 second  pelvic floor pre-run priming routine:

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 good squeeze, let go completely.

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.

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!

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 awake and far more ready to cope with the impact as you run.

Check your technique:  If you need to refresh your knowledge of pelvic floor anatomy do watch the videos in our Pelvic Floor School.

 

Focus your training:  Pelvic floor need more attention?  Check out my Pilates for your Pelvic Floor routine.  20 mins everyday for a week and you should already feel an improvement.  If you don’t then organise a proper vaginal assessment of your pelvic floor muscles with a specialist physiotherapist.

#6   Connected core      

Have you warmed up your brain connection to your core?

Runners can be a little guilty about using running to warm up (yes you know you do).   The purpose of the ‘warm up’ is literally to bring your muscles and tissues to a warmer temperature to make them less likely to injure (like bringing eggs to room temp before you bake!).  A brisk walking pace before you break out into a jog is recommended.  Or…because I am a multi-tasking kind of person – you could do some household chores while at home  – hoover, mop a floor, hang out the washing – anything that makes you feel that you want to remove a layer.

TASK 6:  pre-run prep

But I also recommend that you warm up your brain.  5 simple tasks (you will recognise them from the checks above) to focus your neural connections on the muscle actions that you need to run well.  Have your kit on (including shoes), do this right in the hallway before you dash out the door.

  1.  5 spine curls (loosen the connection back to pelvis)
  2. 10 leg stretches (the walking action)
  3. 10 knee folds (the  jogging action)
  4. 10 double table top legs (mimcs legs in full sprint)
  5.  10 bridge with leg changes (primes the gluts)

TIP: or if you only get your run in the evening when your partner comes in from work – do your warm up while the kids are in the bath – even half an hour before you actually go will still be effective – you will be warm and all the right connections switched on – then as soon as you have the requisite childcare …you can be gone!

Focus your training:  If you are better disciplined with a voice to keep you attentive and help with breath and timing the  10 minute Pre-run Prep in my postnatal pilates sequence has it all covered. Follow the links for free access to these professionally made videos.

#7   Protected Bust   

Are your post-baby assets protected ?                       

Everyone pays attention to a good bra fitting postnatally. You may need your sports bra re-fitted too.  

Especially if you now have a bigger bust.  Protecting and caring for your delicate breast tissue is  important after the stretching through pregnancy and breast feeding.  An ill fitting bra will press on your trapezius muscles (running along the neck and back) which can cause pain and discomfort.

 

TASK 7:  put your old sports bra on

Wear it for about five minutes to assess comfort and fit. Lift your arms up, bend down and jump to see if the bra and breasts stay in place. If you find spillage over, under or at the sides, reassess!

There are two types of sports bras.  For small to medium busts compression bras press the breast against the chest wall to minimise bounce and enhance support as you move but if you are bigger than a 36B you will find you need an encapsulation bra (who thought that name up?), so that there is support for each breast in a proper cup.


       

Are you a list kind of girl?- To Download a free printable check list CLICK here


#8    Support Pants        

Extra layers in all the right places.

Again, its all about support.  The best pair to reduce joggle.  Of the belly, of the pelvic floor, of your back.  Maybe even wear two pairs?  

  • JoJo Maman have a good pair of postnatal ones that are made of thick lycra. You can wear the tummy panel high up to under the ribs to help hold your tummy, or roll back (like yoga pants) to reinforce the pelvis.  They also have a vest that comes down to give tummy support if you prefer support top down rather than bottom up.
  • Or tight cycling shorts under your running ones to come up higher over your tummy. 
  • If you plan to do a lot of sport invest in the clever design of the  EVBsport.com * range of leggings, shorts and capris.  They have special extra support stitching for the abdominals and pelvic floor areas. Designed from the ground up by a running mum.  

* this is an affiliate link, if you make a purchase by clicking through from here I receive a small commission  at no further cost to you. Thank you, this helps to support this blog.

#9  Bladder and bowel check        

Be prepared for unexpected events

Your Bladder:  Running is going to make the bladder jig up and down. You could get bladder leaks on running, even if you have been fine for normal activities till now.  Running is a higher impact activity than most other things and could unmask a pelvic floor problem.   If it happens, you are not going to panic as on this website we have all the information you need to sort it out.  At the same time it could happen and we don’t want it to spoil your first run because you didn’t expect it. For that first run have a good quality panty liner in place so that anything unexpected doesn’t embarrass you.  Any signs of bladder trouble default to brisk walking, which can be just as effective for fitness and calorie burning, for now.

   If you are already experiencing bladder leaks please don’t run yet  sort it out with advice from us here at Supported Mums or by getting in touch with your local specialist physiotherapist.  And meanwile  there are lots of other ways to get fit which are more pelvic floor friendly.

Your Bowel:  The pelvis is a compact space. If the bowel is full it will feel uncomfortable when you run and could put pressure on the bladder causing unexpected leakage.

TASK 9   wees and poos before you go!

Leave time in your routine to have the option to empty your bladder & bowel before you go out.  You need privacy and TIME for a good poo.  Take a book to read – it helps switch off your thinking brain and let you relax.  

Check your technqiue:  Watch 3 Ps for a Perfect Po  Then enlighten family and friends!

 

Focus your training: The bowel is controlled by the Pelvic floor too?  Check out my Pilates for your Pelvic Floor routine.  20 mins everyday for a week and you will already feel an improvement.

 

#10   Motivation & Pacing?     

Aim to under-achieve!

Humans have a tendency to try to over achieve and then feel disappointed and demotivated when we fail to reach our goals.  You can’t start back running where you left off months ago.  You will just feel unfit and disappointed.  The best advice I ever read for getting back into running was aim to underachieve.  You want to get home thinking – “that was great, I feel fabulous, I could easily have done more, I can’t wait to go again “.

TASK 10:  download a pacing app

There are lots of great couch to 5km programmes that will help you pace your run and lead you safely and effectively from nothing back to your 5 km and beyond. 

I highly recommend the much loved “Laura”  the voice of the Podcast “Couch to 5km” downloadable from the NHS choices website, and now also as a free app. It got me from barely able to run for 1 minute (I know, for a physiotherapist frankly quite shocking!) to a comfortable 20 min just like it said it would.   There are also extension podcasts for C25K graduates.  If you want to be able to listen to your own playlists there are many paid for options you could try.  

Run to enjoy the headspace

  • Half the week I ‘run’ rather than walk my dog.  My runs are my treat to listen to my favorite podcasts.   Now I’ve done the NHS couch to 5km app enough times I can set my phone timer for suitable walk/run intervals in the background to keep to a plan that challenges me but doesn’t over do it.
  • There are lots of books about Running and Mindfulness, or running as mindfulness (quick Amazon search will give you more than 5 recent ones).  Authors explain the benefits on mood, anxiety and sleep patterns.

Or run with friends for motivation and company:

  • if you ran before with a group ask your partner or family to help you with childcare specifically for that time-slot so that you can rejoin  the group you used to belong to.
  • Buggyfit classes and/or baby boot camps have lots of cardiovascular elements and you can take your baby in their pram.   This would be a good place to learn warm up and cool down sequences and find like minded local mums to get out running with.
  • If you are in Bath, Bristol or London you are lucky to have This Mum Runs  networks near you.  This Mum Runs is a community encouraging and supporting real mums into or back into running.  For beginners they run (paid for) courses to take you from new to running for 30 minutes.  You join a once a week group (at a mum friendly time),  led by a TMR trained coach called a “Runmaker” who helps with learning to pace and running technique.  Then you aim to do 2 independent runs on your own or with friends in between.  Graduates or those who can already run comfortably for 30 mins can join in a local, free running group, led my a Run Angel, thoughtfully on an evening or Sunday morning 8am.  Read more on their inspiring website.

Can I run yet?   If you can tick all 10 then Go run girl!

Missing a few?  We can support you

Specialist Physiotherapists help postnatal women build up their bodies to run again.  We work to pre-empt the most common problems that can arise if you run on an under prepared postnatal body.  I hope this  guide is a useful focus on the essential ground work to make your running the fun, useful, effective and safe activity that it should be.  Please don’t hesitate to ask questions in the comments below.

Please let me and other readers know how you have got on and which tips resonated with you?  We can all inspire each other.

Are you a list kind of girl?  – To Download a free printable check list CLICK here:

standing pelvic floor exercises

My favourite standing pelvic floor exercise, ever

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

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

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

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

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

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

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

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

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

In this video I go through the exercise with Stephanie from Kegel8 and The Knack too.

When to do it?

Perfect exercise to do little and often through an ordinary day.  It tags on really well to cleaning your teeth – or after a wee.  At home, use that quiet moment in the toilet to focus on yourself.  If you are working, linger in the cubicle for an extra 40 seconds – you are getting paid to exercise!

Important note

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