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POP: Getting Those Pesky Organs to Stay Put!

This past weekend I received several messages related to pelvic floor dysfunctions that are not being taken at face value. “Well you’ve had kids”, “it’s all in your head”, “this is a psychosocial problem not  a physical problem”. I have said it before and I will say it again, women need to be listened to, trusted, and most importantly, respected when they bring problems to healthcare providers, family, and friends. Although it may seem helpful to say that “this is something that happens when you have had kids”, it can be less than helpful AND is often not the case.

Pelvic Organ Prolapse (POP), is becoming a more well known topic of discussion in various mom groups, and in particular postpartum fitness groups. A large part of the impression I get as I am tagged, mentioned, and participating in these various forums is there seems to be significant panic associated with POP. People become paralyzed, hyper vigilant, and fearful of movement (also known as Kinesiophobia). So let’s break it down to dispel some of the hysteria that seeps into many pelvic health related issues.

Your top three organs that prolapse are (typically) your bladder (cystocele), your rectum (rectocele), and your uterus (uterine prolapse). Although most commonly occurring after child-birth, even those without children can have POP. Let’s focus on pregnancy and post-partum phase.

During pregnancy your uterus grows from approximately 5cm in size (which would hang out below your pubic bone), to what seems impossibly large to house the tiny little growing miracle (all the way up to the rib cage). This feat in and of itself does a few things, but thinking of organs specifically – they get moved, pushed and pressed all over the place because there just isn’t room.

How is this possible? Imagine your organs are like little boats at the dock. The boats (organs) wouldn’t do well in inclement weather (movement) if they were tied tightly or cemented to the dock; instead they have ropes (ligaments) to attach and hold them in a relatively stable position relative to the dock (abdominal wall/pelvis/ribs), and the other boats. Your organs aren’t cemented in place either, they essentially float being guided by ligaments, general positioning and support from other organs and the pelvic floor, as well as all the other connective tissue. So, when you are pregnant and the uterus is forging its way through the pelvic and abdominal cavity, everything else is able to move into new positions to compensate.

 

Once baby is born (vaginal or C-section), the organs suddenly have a lot more space to move around in – their ligaments and fascia have stretched, and there is no longer a tiny human occupying the extra space. As everything settles into a ‘new normal’, if everything is coordinating well, the organs will be situated in a similar position to pre-pregnancy with some slight variance. If the pelvic floor isn’t able to support, or other muscles around the rib cage are having difficulty relaxing, we can get changes in pressure that contribute to pushing these organs down and create POP and various symptoms.

What do we watch for? Feeling of heaviness, falling down or falling out, pressure, discomfort, or bulging, difficulty inserting a tampon, or keeping a tampon in, are all common complaints of POP.

There is much that Pelvic Floor Physio can do to assist with POP, and in many instances resolution of symptoms is possible.

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2016 WMBEXA and ABEX Awards, is a WMBEXA award recipient of 2017, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.
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What YOU want to know about the Pelvic Floor: Part 1

Q: How do I know if I should see someone?

A: There are many different signs or symptoms that children, women and men can watch for to know if they should be seeing a pelvic floor therapist. Some of the big things to think about include:

  • leaking (urine or feces)
  • urgency and frequency (many trips to the bathroom, or getting to the bathroom and voiding small amounts)
  • pain with intercourse
  • pressure in the pelvic floor
  • feeling like things are falling down or falling out
  • needing to ‘lift’ the pelvic floor or ‘help down there’ to void the bladder or evacuate the bowel
  • inability to increase activity due to any symptoms
  • low back, pubic symphysis, hip or SIJ pain
  • recurring tightness of the hips and pelvis
  • you have been pregnant
  • you have delivered a baby (vaginally or via c-section)

… and this isn’t necessarily an exhaustive list, just the first things that come to mind for clientele that frequent the clinic. Essentially if you feel there is something that is ‘off’ or ‘wrong’ within the pelvic floor, abdomen or pelvis, seeing a pelvic floor therapist may be of benefit.

 

Q: Do you recommend that all women see a pelvic floor physio? Or just if they are “leaking”?

A: There are a great many symptoms that can be indicating factors for pelvic floor dysfunction that doesn’t have anything to do with leaking in particular. To answer this question in short: yes. In long, I would say that many women would benefit from a pelvic floor assessment regardless of their “leaking” status, especially for women who have had children, or anyone who experiences pain with intercourse.

A big reason for the general answer of “yes” is the fact that what we know about pelvic floor is not necessarily functional working knowledge. Rather, most women ‘know’ they are supposed to do ‘kegels’, and yet no one has taken the time to explain or ensure that they are being done correctly. What we know about kegels is that they are meant to strengthen the pelvic floor, and most women describe that they imagine SQUEEZING the pelvic floor. As my clients know, the pelvic floor to work functionally needs to LIFT UP and IN, not squeeze, as well as RELAX down and out.

Just because you aren’t leaking, doesn’t necessarily mean that the pelvic floor is functioning well. Just the same as even though many people do not have knee pain, they often have weakness or tightness that could be addressed to prevent issues arising in the future.

 

Q: When do you recommend women be seen? During pregnancy? Post-partum?

A: Women can and should be seen whenever they are having issues. Issues are bound to arise during pregnancy and post-partum. So long as there aren’t any contraindications to a pelvic floor exam by the treating physician or OB, assessment during pregnancy is possible as well (after the first trimester). During pregnancy some women will choose to attend an assessment for labor and delivery preparation after 32 weeks gestation to help get a better handle on relaxing the pelvic floor; we do want a baby to come down and out after all!

Post-partum we are able to see women that are painful as soon as they feel up for leaving the house, and specific for pelvic floor assessment approximately 6-8 weeks post-partum. Pelvic Floor Therapy is able to address c-section healing and recovery, as well as perineal healing and recovery. Tearing, surgical incisions, other birth traumas can all be addressed in the post-partum phase.

Q: What if I haven’t had children in a few years but am experiencing problems? Can physio still help?

A: YES YES YES! The absolute best thing about the body is it’s propensity to change. It is never too late to see a pelvic floor physio, 8 weeks, 8 months, 8 years or longer we can always see what changes can be made to help resolve any complaint

Q: What are some signs of a weak pelvic floor?

A: The simple answer for this one is leaking or incontinence. The long answer is – it depends on whether it is loose and weak (not very common) or tight and weak (much more common). Often we equate something being tight or taught with being strong, but this is definitely not the case with the pelvic floor. A tight but weak pelvic floor often progresses through one or a combination of: discomfort or pain with intercourse, constipation or difficulty completely emptying the bowels, discomfort or bruised feeling through the perineum or tail bone, hip tightness and restricted movement, low back pain… and more. One client had neck pain (right by the shoulders) that she had had since her second was born (5 years previous) and nothing seemed to help. Ultimately this client had pelvic floor weakness that was driving her neck pain!

Do you know someone having issues with this area? Maybe they have some of the complaints listed above – share with them! Are YOU someone suffering with these symptoms? Contact us today to get started your path to resolution!

Do you have some BURNING questions you want answered that wasn’t covered? Send them our way and we will get them going in Part 2!

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2016 WMBEXA and ABEX Awards, is a WMBEXA award recipient of 2017, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.
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Diastasis Recti: The “Splitting” Abdominal Muscles

It seems the topic of “Diastasis” is picking up speed in a variety of forums. Particularly on social media in mom groups and exercise discussions. There also appears to be a wide array of misinformation that continues to be spread around. I had one client tell me “I have been doing some research and one place I went to online said that if I have a diastasis I will ALWAYS look a minimum of 3 months pregnant.” This, for the vast majority, doesn’t necessarily need to be true; especially when you know what to do. I have been asked to write a few key things in regards to diastasis from a physiotherapy rehabilitation perspective.

…if I have a diastasis I will ALWAYS look 3 months pregnant

Let’s discuss what a diastasis is. The short version is it is the ‘splitting of the abdominal muscles’. A more specific answer is that in response to pregnancy, the abdominal muscles and associated tissue (fascia) stretch to allow room for a growing fetus. The muscles that are most affected by this is the rectus abdominis (the 6-pack ab muscles that sit in the front). This is not ‘bad’, cannot be prevented, and is in fact necessary during pregnancy. From a clinical perspective, I would say 100% of women who are pregnant, that look pregnant at the time of delivery, will have developed some diastasis during pregnancy. (Side note: diastasis  can also occur outside of pregnancy, but that is another discussion.)

In theory, after labor and delivery, the diastasis will ‘snap’ back together and the core muscles will work in perfect unison… Sometimes this coordination comes naturally to women post-partum. However, often women require some help in getting all the pieces working well together in a functional and coordinated fashion.

…after labor and delivery, the diastasis will ‘snap’ back together 

This is where people profit off our post-partum mommas  “Get your body BACK after baby”, “Post-partum BOOTCAMP”, “Get rid of MUMMY TUMMY in 1 simple exercise”. Unless someone is checking for diastasis recti, do so on a regular (weekly, daily) basis, and can ensure that you are coordinating those muscles well… claiming to be a Post-Partum Specialist is likely an over statement. Often times I see that someone has “healed” their own diastasis and want to “show you how” with their main credential being that they went through the same thing, and they are fine after starting back into heavy exercise at “6” weeks post-partum.

Simply asking people if they have a diastasis is not enough. Knowledge of the issue without being able to assist in modifying exercises to appropriately return to function is where many people stand. Are you wanting to start a class? Ask the instructor what they know about diastasis. If you don’t know if you have one, will they check? How many people have they checked? Not all postpartum fitness classes are created equal.

A diastasis is not necessarily a ‘quick fix’, and often people don’t realize they have it since it typically isn’t painful. What we do “know” is that a diastasis present at 8 weeks post-partum is likely to continue to be present (read dysfunctional) at a year post-partum. But what does ‘problematic’ mean if it’s not painful?

The tissue (fascia) of the diastasis doesn’t need to close in the sense of getting back to how it was, but it does need to be able to generate tension. If it can generate tension well and it is separated 2.5cm that person is going to have better function than if it is separated 1.5cm and not generating tension. (Think of tension as whether you have a firm uncooked noodle versus a soft, cooked noodle between the muscles. The cooked noodle will give away under pressure of the muscles on either side, and the uncooked noodle will hold and transfer force). Problematic could also be the contribution of diastasis to back pain, diaphragm dysfunction, and pelvic floor issues. Diastasis doesn’t cause these things, but it may contribute.

Focusing on the diastasis alone is a simplification of a complex situation, and each person will require slightly different treatment approaches.

What do I recommend? Contact your local pelvic floor physiotherapist, there is no time limit on when to go, but within the first 8-12 weeks will give time to get into a routine with baby and be early enough to have minimal “bad habits” or compensations to combat; or before you start back into exercise. It  is never too late to address anything that has developed during pregnancy and post-partum.

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Staying Fluid and Injury Free in Dance and Choreography

I am a UK based physio working in Exeter and Totnes. My focus is in helping people to develop a positive relationship with their body allowing them to become injury free, taking control of their own health and enjoying an active life.

When learning new choreography there is often a pressure to get the moves right quickly. This can energise us and enables us to focus our effort but it can also increase stress and tension. By focusing on what we’re trying to achieve it’s easy to forget our bodies, the very thing we need to be tuned in to. In my experience as a physiotherapist, tension is the major risk factor in triggering an injury.

How can I stay relaxed when learning choreography?

As a physiotherapist I work closely with breath. When we are stressed it is easy to lose our natural breathing pattern. This results in breathing into the chest rather than using our full abdomen, increasing tension and reducing performance.

Instead, take opportunities to breathe in softly through the nose feeling the lower abdomen gently expand. Avoid pulling in or tensing the stomach muscles. If you sense tension or discomfort you can take a long, slow and gentle out breath exhaling through the nose. Feel the muscle tension melting away, you can focus relaxation on specific parts of your body.

Dancing is fun and it is important to not be hard on yourself but to treat your body with patience. Often my clients put a lot of pressure on themselves and find that their performance improves when they just relax into their practice. Trust that you’re doing your best and your body will follow. If you have an injury it can be both stressful and frustrating, you may feel unable to train and this stress is likely to slow down recovery. I encourage clients to use imagery in their recovery process, softening breath and imagining yourself doing the choreography. Imagery has been shown to improve sports performance and helps connect the body and mind.

Michael Otto BSc MCSP  Holistic Physio in the UK.

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Do YOU have TMJ?

Have you heard of your temporomandibular joint (TMJ)? It’s one of the most used joints in your body. Did you know physiotherapy can help with TMJ problems?

Your TMJ, also known as your jaw joint, is used for eating, talking, expressing emotion (both consciously and unconsciously) and breathing.

Pain associated with dysfunction in this area may be felt in the jaw line, cheek, ear, temporal region (side of head) and commonly associated with headaches and neck pain. TMJ problems, or TMJ dysfunction (TMD) can also present as inability to fully open your mouth, pain with chewing, popping/cracking with opening and closing your mouth, and/or grinding/clenching of teeth.

Some of the causes of TMJ problems can be derangement or displacement of a disc between your mandible (jaw bone) and skull, muscle dysfunction, habitual clenching/grinding (bruxism), or trauma to the face and jaw. Common contributing factors to TMD can be stress, anxiety, prolonged opening of the mouth (e.g. during dental procedures), mandibular malalignment or orthodontic work to name a few.

A physiotherapist will assess the TMJ by asking a detailed history, taking observations of jaw alignment, posture, and neck position. They will observe how the individual opens and closes their mouth, looking for abnormal movements patterns, and observe for clicking from the TMJ. The therapist will palpate externally for muscle tone, and to assess the movement of the TMJ. Using gloves an intra-oral assessment will be completed as well to determine how the joint is functioning, and to further assess the myofascial system. The neck is generally assessed as it can commonly contribute to dysfunction in the TMJ.

Following an assessment, a treatment plan and home program will be developed.

Ms. W comes in with complaints of pain through the right greater than left temporal region of her jaw, inner ear on right, frequent headaches and stiffness in the jaw that is often worse in the morning. Recently she has begun to noticing a clicking from her right jaw, especially when she yawns or eats chewier items. Her dentist advised her she likely has TMJ problems and recommended that physiotherapy may help.

The physiotherapist may ask a few of the following questions: How long have you been dealing with this problem? Do you ever find yourself clenching your jaw in times of stress or have you been told you grind your teeth overnight? Any recent dental procedures? Any history of trauma to the face or neck?

As mentioned above the TMJ is one of the most frequently used joints in the body. Most clients who receive treatment for their jaws have been experiencing symptoms for some time, and often did not know that physiotherapy can help. Commonly they have seen their doctor or dentist prior to seeking treatment.

In the case above the individual likely has a longer standing history of clenching, also known as bruxism. Commonly people can do this subconsciously during their sleep, or in times of stress. When frequently clenching the muscles of the face and jaw can become fatigued and become sources of pain. When muscle are held tight for long enough they can start to alter the way the jaw moves, and lead to problems with a disc located between the jaw and the skull.

The physiotherapist will develop a treatment plan specific to Ms. W’s presentation completing treatment specific to the muscles surrounding the TMJ and the joint itself.

 

If any of the symptoms described sound familiar, book in for an assessment today!

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