And other misconceptions about Women's Health.
First of all I don’t love the terms “normal” or “abnormal” when referring to a woman’s body, but it just sounded better for a title than, “Leak Pee is Permanent and Inevitable and other Misconceptions about the Core and Pelvic Floor”, so I went with “Normal”. And just to clarify, leak pee is never “normal”. This is a misconception that can have both short and long term implications for a woman’s health and well being, effecting their overall quality of life. When it comes to core and pelvic health there are many misconceptions, all of which can have negative consequences for women’s health, and sometimes even the health of men (but as a women’s health practitioner I will be mostly focusing on women). Below I have listed a few of these misconceptions. It is time to set the record straight!
Leak Pee is Normal
When we leak urine, even just a little bit, it is a symptom that there is dysfunction within our core system and our poor pelvic floor is struggling to function optimally. This is something that can happen to anyone; men, women and children. Yes, men have pelvic floors and it is not just women or mother's who experience incontinence.
Our pelvic floor is responsible for many important functions within our body, including sexual health, organ support, stability, elimination and continence. A well functioning body is highly dependent on the function of the core and pelvic floor. Therefore, if we are experiencing symptoms of pelvic floor dysfunction, such as leak pee, it is possible and maybe even likely that without appropriate treatment we may start to experience not only an increase in urinary leakage, but a whole host of other symptoms within the body, such as hip pain, prolapse, diastasis recti, fecal incontinence or even foot or jaw pain.
THE GOOD NEWS?
Leak pee is not inevitable or permanent. It is treatable and can even be prevented.
The reason we are leaking urine can sometimes be hard to pinpoint, as it is often multi factorial. However, by realizing that it is not normal, making small changes and seeing a qualified health/fitness professional you can improve the function of the entire body, including the core and pelvic floor, relieving unpleasant experiences within the body, including incontinence. It is the normalization of incontinence, pain and other “women’s issues”, especially when it comes to mother’s, and the misconception that little can be done to correct or prevent these ailments that creates a barrier to accessing treatment or taking proactive measures. I mean, if it is “normal”, “inevitable” and “out of our control”, then what’s the point in looking for solutions? It is these messages that disempower women, leaving them less confident, afraid and sometimes soaked in urine. These messages are just messages, they are not truth. Please, if you are experiencing any core or pelvic health concerns, take action. You are powerful and deserving of better. There are solutions. Pelvic Health Physiotherapy and Occupational Therapy, Osteopathy, Counselling, and Qualified Fitness Programs, like Corefidence Pilates, can all be great options for helping you improve core strength and pelvic health. Pelvic pain, leakage and worry do not have to be a part of your everyday life. They do not have to stop you from doing things you love to do, need to do or want to do. YOU ARE IN CONTROL!
For more information on urinary incontinence, please check out my blog – Leak Pee is no Laughing Matter. https://www.corefidence.com/post/leak-pee-is-no-laughing-matter
At Six Weeks Postpartum the Body Magically "Bounces Back"and we can Return to all Activities as if we Never Grew and Birthed a Human Being.
For decades women have be told that there is some magic associated with the 6 week postpartum mark, that allows us to start interacting with the world as if we never gave birth. We have been advised to attend a ten minute appointment with a medical professional to discuss birth control and bleeding. We are made to believe that by attending this appointment it will somehow make it safe to return to any activity we choose, integrating the newly postpartum body with the rest of society, as if during those 6 weeks of little sleep, major changes in hormones, changes in diet, breastfeeding and a whole new level of stress and anxiety, some magical healing occurred allowing us to just “bounce back”. And this doesn’t even take into consideration the pregnancy and birth. Now of course, there will be the occasional case where doctors will advise a longer period of caution, but this is rarely due to protecting the integrity of the core or pelvic floor, or any other non life threatening concern.
Women who bring up concerns such as urinary incontinence are often instructed to Kegel, and that will make everything better. This advice in my opinion can make matters worse as over-Kegeling can create further dysfunction. There is so much more to pelvic floor function than Kegels. Unfortunately, the health and function of the core and pelvic floor are areas of the body that are often ignored or misunderstood by doctors. However, as pelvic floor awareness is growing, I believe more medical professionals are discussing the option of Pelvic Health Physiotherapy and rehabilitation with their patients. HOORAY DOCTORS! There are in fact several countries in the world that do take a much more holistic and proactive approach to postpartum care and recovery.
So, what is it about the six week mark that all of a sudden makes it appropriate for women to return to bootcamp, CrossFit or running marathons? NOTHING! It is in general not appropriate or safe for women to be returning to high impact activities at six weeks. I believe that this idea of returning to sex, running, weight lifting etc. at six weeks, is based on the fact that it is at approximately six to eight weeks postpartum that the uterus returns to its pre-pregnancy size and the wound where the placenta was attached has healed. However, there is so much more to postpartum healing than uterine health and by advising women to “jump back in” we may be endangering their physical and mental/emotional well being.
There are many things to consider when returning to exercise and other activities postpartum. Firstly; we have to respect how the mom is feeling in all aspects of her life.
We have to understand that every woman’s pregnancy, birth and postpartum situation is different and we should not all be grouped together, being expected and sometimes pressured, directly or indirectly to “get our bodies back”, get back to usual activities and become a super mom. It is also important to respect that the body of a postpartum woman has undergone an entire pregnancy and birth experience which can be incredibly taxing on the body. And although it is absolutely beautiful, pregnancy and birth can create an amount of injury, stress and/or trauma within the body that requires time for optimal healing. With a knee injury or hip surgery we are advised to rest, heal and rehabilitate. The postpartum body should be given the same respect and attention.
It is approximately within the first eight weeks postpartum that a large amount of spontaneous healing takes place. However it can take six to twelve months or longer for the body to be considered completely healed. The early postpartum period is the first eighteen months after giving birth. Does this mean that we should be lying in bed for twelve to eighteen months postpartum? Of course not. But we should allow our bodies time to heal and slowing and progressively return to higher impact or strenuous activities. It is important for us to listen to our bodies and respect our emotions, never feeling like we should be doing more, weighing less or feeling stronger. Every woman’s prenatal and postpartum journey is unique, and although every women requires time to heal, rest and adjust (which I believe for everyone should be at least the first eight weeks postpartum), every women’s postpartum experiences and how quickly they arrive at a place of being truly ready to do more will look a little differently and for many it may involve two steps forward and one step back, which is perfectly ok.
In my opinion every woman deserves better postnatal care that involves medical doctors, Pelvic Health Physiotherapists, qualified postnatal fitness trainers and mental health practitioners. Women should be encouraged and supported to undergo core and pelvic floor retraining and rehabilitation in a manner that is slow and free of pressures. It is with the support, assistance and advice from these professionals that a woman should slowly and progressively return to exercises and certain activities or begin new activities safely.
And remember, a woman can never get her pre - pregnancy body back, as once postpartum always postpartum. This is not a bad thing. Our postpartum body can be just as, if not stronger and more beautiful than it was before.
Pregnancy causes core dysfunctions
Pregnancy gets a bad rap when it comes to things such as back pain, incontinence and prolapse. It is often blamed for all of these and more, viewed as the sole cause to these discomforts within the body. And although, pregnancy can definitely play a big role in the development of core/pelvic floor dysfunction, in my opinion it is rarely the only factor, but instead the “straw that broke the camel’s back”.
Core and Pelvic Floor dysfunction, in my opinion is multi-factorial in most cases. Often times, women go into pregnancy with a compromised core and pelvic floor. I don’t say this in an attempt to criticize or lay blame, the fact is, that in our society of stress, shoes, desk jobs and “gym culture”, among other things, it is difficult to have a “perfectly functioning core” going into pregnancy. Genetics, body shape and previous surgeries and injuries can also all play a role. We also have to look at the experiences of the body throughout the pregnancy and birth as well as immediately postpartum and everything after. Is core dysfunction more common in postpartum women than women who have never given birth? Yes, I believe so, however it is not the pregnancy in isolation that results in this outcome. We also have to remember that many people who have never given birth, including men and children can have dysfunction or weakness within their core and pelvic floor, for various reasons, non of which are pregnancy related. The good news is there are many things that we can do, before, during and after pregnancy to support our bodies and minimize the risk of negative symptoms often associated with being a mom. And yes, these same tools, supports, and strategies can also be used for men, children and women who have never given birth. We are all capable of having bodies that allow us to feel strong and functional. Pelvic Floor Physiotherapists, Osteopaths, Qualified Fitness Instructors/Movement Professionals and Naturopaths can all be great options for helping us achieve confidence in our bodies.
Pregnancy is Three trimesters long
Ok, so this one is partially true. Pregnancy from the time a woman gets pregnant to when she delivers, usually sometime around forty weeks, is broken down into three trimesters. However, it is important to account for at least one other time period that is extremely significant to both the mom and baby. This can also be an important time for the other parent and siblings.
This “trimester” is the first three months after the birth of the baby and is referred to as the fourth trimester. This trimester will look a little differently for everyone and for some, especially for those who may spend the first few weeks or months within the hospital it will last longer.
This is the time period of adjustment and connection for mom, baby and the rest of the family. For mom, this is a time of healing and restoring, both physically and emotionally. This time which often involves little sleep, can be an extremely trying time. This is a time of major hormonal shifts, bleeding, cramping and other aches and pains. Mom may be experiencing postpartum blues and possibly the beginnings of postpartum depression or anxiety. For mom and baby, they are getting to know each other outside of pregnancy. They are seeing each other for the first time and learning so very much. This is also the time that feeding, whether breast, bottle or both is established. This can be a very trying and frustrating time. Mom may be experiencing engorged breast, and may even be dealing with inverted nipples, thrush or mastitis. If using formula this may be a period of trial and error, looking for the formula and bottle that best work for baby.
For baby, this is their first few months outside of the womb. They must adjust from their interuterine life to a new extrauterine life. To baby they are still a part of their mom, who they need for comfort, to assist with emotional and physiological regulation and possibly feeding, among other things. Consequently, baby may be very demanding of mom’s attention, who herself is trying to heal and adjust.
For other family members, this can also be a time of adjusting. The non birthing partner may need to pick up some new responsibilities, while mom recovers. They may also experience a whole host of emotions such as anxiety, doubts and joy. They will likely experience some fatigue and may grieve a loss of closeness with the new mom as she gives most of her attention to the new baby. If there are other children in the home, they may be feeling a host of emotions and may even start to show some signs of developmental regression as they fight for attention and learn to cope and adjust to life with their new sibling.
It is important for this time period to be honoured and respected. There should be no pressures on the new mom to get out and about, lose the baby weight or return to her “old self”. This is a time of rest recovery and bonding. It is during this trimester where the help of friends, family or outside help such as a Postpartum Doula can be very beneficial.
Diastasis Recti is a Women’s Problem and Always Indicates a Weak Core.
Diastasis Recti is a term often used to describe widening between the two rectus abdominis muscles. It is a condition often associated with pregnant and postpartum women. However, Diastasis Recti doesn’t only happen to moms, it can be found in children, men and women who have never given birth. The literal translation of the term “Diastatis Recti” means, distance or separation of the two rectus abdominis or six pack muscles. It we take this translation literally, than technically we all have a Diastasis Recti as we all have a space between our six pack muscles.
This gap can become wider throughout our life time due to many factors, including; posture, injury, surgery, breathing mechanics, abdominal tension and pregnancy. However, a widened gap doesn’t always indicate a weakened core. When assessing core strength, we want to assess breathing and movement patterns as well as how the abdominal wall and entire core respond to load. This means that someone with a widened gap can still have a strong and functional core. For example; all women will experience an increased abdominal separation by their third trimester of pregnancy. This is to create space for the baby, while protecting the body of the mother. The tissue that connects the right and left halves of the rectus abdominis muscles will thin and lengthen, allowing this process to occur. It can take several weeks for this tissue to heal and return to “normal”. However, for many women the distance may never return to its pre-pregnancy width, but this does not indicate a weakness in the core. Again, it is about the integrity of the core, not the size of the gap. A smaller gap, does not guarantee strength and function and a larger gap doesn’t guarantee a dysfunction. Gap size is separate from core function.
I believe it is very important for all women to see a Pelvic Health Physiotherapist or other qualified practitioner between six and eight weeks postpartum to assess healing of the abdominal wall. Ideally women will have seen someone during pregnancy to prepare their bodies for optimal recovery. Generally, spontaneous healing occurs in the first eight weeks postpartum, however for some women it may take longer and in either case with the right strategies and support, many men and women who have lost some core strength can definitely restore function and even be stronger than ever!
If you are a woman looking to optimize the function of your core and pelvic floor, Corefidence Pilates for Women’s Health can help. Corefidence offers classes, personal training and educational workshops that are designed to help women feel stronger, empowered and confident within their bodies through all stages of life. Using both a proactive and restorative care approach based on elements of Pilates, Yoga, Barefoot Training and the Body Ready Method, Corefidence training uses evidence based strategies to help women reawaken, connect to and strengthen their entire body with a special emphasis on core strength and pelvic health.
Prenatal Training Postnatal Retraining Core Strength Pelvic Health