What I Practice Each Day

Hi Friend! Me again! This crazy pelvic-health-loving momma of 3 high-energy boys.

To try to keep my sanity in my house, I have added two things back into my practice as I am starting to get more sleep at night (which means I am only waking up 2-3 times right now…any other mommas out there??). After having this last kiddo, I found myself stuck in a negative rut/ mindset. I NEED to exercise at least 20-30 minutes AND write in my gratitude journal to keep a more positive outlook for the day and with my boys.

The human body fascinates me and how it heals and continues to change is mind blowing.

Incase any of you out there in cyber world are feeling anxious or the added stress from the holidays, I thought I would share my practice with you. Click here for the download.

I hope the daily practice of gratitude has a positive impact on your day to day life, like it has on my family!

Shake Your Pelvis Like Elvis this Holiday Season!

Xoxo-Amanda

What I Learned About Myself During Our Stay in the NICU

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A year ago TODAY, I took my last pregnancy picture.  I had an OBGYN appt that morning.  By 10:45am, I was told to call my husband and it was time to have this baby via cesarean.  

I remember calling my hubby that day and not being able to get a hold of him on his cell.  He was in a presentation at Burns and McDonnell and I was determined to not have our last baby without him present.  I remember standing in the parking lot of Saint Luke's East hospital chatted with the lovely receptionist at his work and explaining I needed to to get a hold of him ASAP and it was urgent.  "Mam....I'm having a baby in approximately 20 minutes!"  I could hear her voice on the intercom while on the phone with her...so calm..."Brett Fisher...you have a call from your wife on line 3...Brett Fisher". No answer.  I sat myself outside the elevator to go up to the maternity ward.  I was suppose to go straight up stairs BUT I was not having this baby alone. (Looking back, I should have gone straight up stairs and listened to my OBGYN)  

I FINALLY got him on the phone and he was so shocked and left without finishing his presentation.  There is something to be said about having a loved one in the room while you deliver. It is needed!  Especially with a cesarean delivery.  It wasn't my first rodeo, but I still had fears about the "What Ifs".  

With the help of an amazing OBGYN, we delivered our third boy via our third cesarean. Yes, I feel like I am an expert in cesarean recovery lol. Each one has taken a little longer than the first due to scar tissue from the surgery before.  BUT in the end, this momma gets to snuggle the most precious little boy on the planet. 

When your child is placed on your chest, the world seems to stop.  I had no idea what was going on down below with sewing me up, nor did I seem to care.  I was a mother to this beautiful baby boy who has completed our family.  Nothing else seemed to matter.

On December 13th, I remember waking up and my husband taking pictures of me and Baby Hudson and stating how he thought he looked orange.  Not when you looked at him, but when you looked at pictures of him.  

Soon after, a nurse came in to check his vitals and said the same thing. The hospital ended up checking his blood levels earlier than they normally would. Around 10:30pm on Dec. 13th when we got the labs back, and I received a phone call from our pediatrician (who I adore AND who happened to be on call-praise the Lord!) and we were transferred to the NICU at Saint Luke’s East.

Hudson’s bilirubin was 20 or 21 during the early hours of his life. We found out he was Combs positive and ABO incapable. He was immediately put on the highest level of lights to help decrease his bilirubin levels.

My milk was coming in (yes, earlier than most) and I was recovering from my third cesarean so I took the lovely wheel chair down to the NICU multiple times a day to visit my baby and deliver milk. We were sent home after about a week in the NICU and followed up with our pediatrician’s office the following morning for labs. I received the dreaded phone call a few hours later from our pedicatrian (where I’m pretty sure I bawled) to head back to the NICU. I re-packed my bag and called family over to watch the older boys while we headed back into the NICU. It’s there I stayed in the same room with my baby for the following week. Each day sending prayers, asking a zillion questions to the medical staff while waiting for answers.

I was in a deep-dark place mentally while in the NICU for those two weeks. I am still in awe and so incredibly grateful for the love and support we received while in the NICU. We had friends/ family stop in just to chat (MUCH needed), meals brought to our house for the boys and to the NICU for Brett and I, cards and gifts dropped off as well as a basket of goodies and a little Christmas tree for Hudson’s NICU room.

It truly takes a village to raise a baby. My mental state NEEDED that support. I realized with the help and support from everyone around me (and the amazing NICU staff at SLE), I was strong enough to be patient and make it through that difficult chapter in our lives. Childbirth is tough, but then living the first few weeks in the the NICU is hard too. AND then the first few months of colicky baby, food allergies, 4 nights of sleeping through the night in a year...I know…I CAN DO ANYTHING I put my mind too. My gratitude journal has been my daily go to and has changed my life and my mindset. I am one strong mother and I, like my son, am a fighter.

I know my short time in the NICU cannot compare to what other mothers go through, but I do know, I would not be where I am today without the love and generosity of others during our first few weeks with Baby Hudson.

Today my baby turned O N E. As a reflect back on last year and our journey with him, I just want to say thank you. Thank you to all of you who have continued to follow my journey and who have supported my business. If you ever need anything, please reach out! Have a blessed day!

How To Manage Pelvic Pain Over The Holidays

Hi friend. I’m gonna get straight up personal with you and if you don’t know me yet, allow me to introduce myself. I am Amanda Fisher, pelvic floor physical therapist with a history of pelvic floor issues from peeing my pants to pelvic organ prolapse to pelvic pain to postpartum issues from 3 cesarean deliveries.

Yes, I have experienced my fair share of pelvic floor dysfunction. Now I know it was God’s Plan for me to go through those times to help people like you.

Pelvic pain is a real thing and I can tell you first hand, I have HAD it and still HAVE IT from time to time.

After 10 years of having pelvic pain, I know what to start doing when I feel it creep back in (because let’s face it, we all get busy and fall off the bandwagon of habits we SHOULD continue because it is good for us…but I'm human too) and this time of year is the perfect time for it to come a knockin’. Who isn’t a tad bit stressed around the holidays?! Um…I think we are all raising our hands here.

So, how do I get a handle on my pelvic pain over the holidays?

First thing to do is find a pelvic floor physical therapist in person or virtually. Having a coach or a professional to chat with about your symptoms and give you support/ advice when you need it most is a MUST!! This also creates accountability for me to stay on top of my exercise regimen to kick pelvic floor symptoms.

Second, I schedule or plan out my week and month. I tend to do this on Sundays. I look at my week and plan out what days I can go to the gym (with or without my kiddos), what mornings/ evenings I can walk, and when I can do my pelvic stretches/exercises (I try daily). Writing it down in a notebook or planner makes my brain think that this is happening today and I almost never miss it IF I write it down.

Third, I get a journal and spend a few minutes EACH morning while sipping my coffee (before my kids wake up) writing five things I’m grateful for and 1-2 things I can do today for someone in my family/ friend circle and for a complete stranger. This helps re-wire the brain for positive thoughts. And we could all use a little more of this in our lives, am I right?!

Fourth, motion is lotion. The days I sit on the couch and binge watch Netflix are the days I feel worse. This could be because I am not staying hydrated, or eating more junk food, BUT mostly, it’s because I am sitting in one posture (bad) and not getting blood flow to the tissue. I have to move to feel better and you have to move to create energy and get the blood flowing. I feel so much better after working out, walking etc and then following it up with 1-3 quick pelvic floor stretches to lengthen tissue. So bundle up and get out! OR set a timer in your home and don’t stop moving until it goes off. Follow up with a happy baby stretch or a deep squat to stretch out the pelvic floor muscles.

Fifth, don’t cancel on myself!! This time of year is hectic with all the holiday parties and childhood gatherings, BUT I still make time for myself so I can continue to feel better. And you should too! It is easier to continue a habit I am doing consistently because if I stop it one day, it is much harder for me to get back on the horse and start again.

If you want more information on this or what else I am doing for pelvic floor issues, please email me amanda@empoweryourpelvis.com.

Great exercise while cooking dinner!

As a busy mom, it is great when I can multitask.  This tends to be one exercise I will do while sautéing vegetables or browning ground turkey.  

I find my doorway in the kitchen that has been over taken by my baby's jumperoo.  I start with my feet in the middle of the door frame and then move them closer to whatever side I will be doing the exercise on.  I hold on to the door frame and exhale and tighten may lower abs as I go out and come back in. 

I may do 5-10 reps, 1-2 sets while cooking dinner. 

Why might my Diastasis Recti (Abdominal Separation) not be healing?

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If you think about it, our bodies do a great job at healing diastasis recti (abdominal separation of the linea alba, or fascia), between the rectus abdominus muscle in some women.  Our female figures were made to have this wonderful fascia in our abdomen (line alba) to stretch to accommodate a growing baby and uterus.  Pretty amazing stuff!!

Studies have found 100% of pregnant women will have diastasis recti at 35 weeks gestation and by 6 months postpartum, only 40% of women will continue to have it.  

I am currently 4 months postpartum with my third baby.  I have been consistent with my exercises and stretches in my Body After Birth plan and have noticed an easier closure of my diastasis recti this go around.  

Stretching is just as important as strengthening your muscles.  As a mommy who is carrying baby, stretching is a big part of improving your diastasis.  If you abdominal muscles or low back muscles are tight, they can continue to pull at the linea alba causing your diastasis to stay around. Also, switch up what side you are holding your baby on to make all your muscles work.  And last, try to stand or sit in proper posture when holding your little one (avoid pregnancy stance) to keep your abdominal muscles working for you, instead of stretching out when you are leaning back.  If you find yourself standing in the pregnancy stance, your muscles may not be strong enough to hold baby so make it an exercise.  Practice holding baby in good posture for 5 minutes while doing household activities and see if you are still in proper posture at the end of the 5 minutes (or while baby wearing).  Build your core muscles up to support you and your future self!

 

 

Child's Pose stretch to stretch our low back. Try hands forward, and then to each side, holding off at least 5 breaths. 

Child's Pose stretch to stretch our low back. Try hands forward, and then to each side, holding off at least 5 breaths. 

3 Simple Exercises for Great Sex

Ladies...many of us have experienced sex that wasn't so great, right?!  It's not always rainbows and butterflies.  Sometimes it is uncomfortable.  So why not add some simple exercises to your daily routine to improve it?

If you are dealing with pelvic pain (pain with intercourse, tailbone pain, pain with sitting etc), know that there are many causes for it.  Our initial thought when we are in pain is to go into the fetal ball position.  Go to our "feel safe" position.  This position can tighten up tissue, so it is best to focus on stretches to stretch the lower abdomen and pelvic floor to relieve pain.  

Here are a few of my favorite stretches to try at home:

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Rib/Diaphragmatic Breathing:  Don't underestimate the power of your breath.  Breathing can do a lot to improve tissue mobility, circulation and the nervous system. Place your hands on the side of your body over the ribs.  Focus on breathing into your hands with your hands move away from each other, and then come closer together as your exhale or blow you air out.  Perform 5-10 breaths every hour if you can (can be done lying down, sitting, standing).

 

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Happy Baby Stretch: Lay on your back and grab your feet.  If that is too much of a stretch, you can modify by grabbing the insides of your knees and letting the weight of your hands and gravity stretch while you focus on belly breathing.  Start by holding the stretch for 5 belly breaths.  

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Deep Squat:  Squat down low on your own, or with the help of a wall or while holding on to furniture.  This stretch is great for relieving pelvic pain and constipation, however, some people will feel hip tightness with this stretch and can cause more pain. If that is the case, start by just testing the stretch to see how it feels and maybe hold for one breath and then continue with happy baby stretches to start the relaxation of tissues.  *Avoid this stretch if feeling pubic bone area pain.

Flat Butt Posture

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As you can see, during pregnancy, my pelvis wants to tuck under to balance the weight of the growing baby and uterus (picture on the left).  If I were to move around with this posture throughout pregnancy, it could contribute to the flat booty and pelvic floor issues many mommas experience post-baby.  UNFORTUNATELY, this week I have noticed my butt is, SADLY, looking more flabby than it has in the past.  Time to focus on how this momma is holding herself up during the day!!!  Time to make sure I am practicing what I preach and focus on posture in the right picture. 

I need make a conscious effort now, for the next few weeks, to keep my posture in proper alignment and keep my pelvic untucked.  It is so important for postpartum recovery and what I preach daily! 

With my postpartum women, I am usually discussing how tucked butt posture causes misalignment of the ribs and pelvic floor, which can increase pelvic pain, leaking, pressure in vagina, hip pain and much more.  And this isn't just for women!  For example, my hubby just got a stand up desk at work and has been complaining of hip pain.  When looking at his posture, this is how he is standing during his work day.  Men do it too ladies!  

When tucking our butt under, our initial thought might be that I am clenching my butt so I must be making it stronger, but actually you aren't.  You are making it more weak by turning off the glutes from stabilizing you and you end up clenching more pelvic floor. A weak butt can increase pelvic floor dysfunction and make your postpartum recovery even harder because you don't have a strong butt for picking baby up properly or lugging the car seat around etc. 

So, start practicing better aligned posture in standing and while carrying/ lifting babies, groceries etc You body will thank you!!  

Sex After Baby

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Sex.  This can be a scary thing for women who have had a cesarean birth, who have torn vaginally, or who have had an episiotomy (or some kind of traumatic birth...or even just birthed a baby).  For one, some women find it hard to look at their cesarean scar, think their vagina appearance has changed or have a difficult time letting their partner look at them postpartum because they have lost muscle tone, have a stretched out belly, stretch marks etc.  

The scar tissue from the cesarean delivery and vaginal delivery (with a 3rd/ 4th degree tear and episiotomy) is still healing at your 6 week check up and will continue to heal for 6-12+ months, even if you are released at your 6 weeks check up and were told your incision was healed.  

Remember, sex should not be painful, but if it is, it would be wise to see a pelvic floor physical therapist to assess your scar tissue (vaginal or abdominal) and see if it might be causing some of your pain.  Most OBGYNs and Midwives recommend waiting until after your 6 week appointment to start engaging in sex again.  If your doctor has cleared you for intercourse, it is fine to start. There are many factors during pregnancy and delivery that can cause pain with sex.  Remember, painful sex is common and not normal.  Speak with your doctor about your pain and see a pelvic floor physical therapist to help improve your symptoms.  A pelvic floor physical therapist can evaluate your pelvic floor muscles for tightness, poor coordination and assess your scar tissue (cesarean or vaginal) to help address your pain.

If you are experiencing pain with sex, here are some things you can try:

  1. Water-based lubricant

    Hormone fluctuations can decrease the amount of lubricant your body produces, especially if you are breastfeeding.  Trying a lubricant that is water based is likely to last longer.  Here are some options (In no particular order) :
    1. Slippery Stuff

    2. SYLK lubricants

    3. Good Clean Love lubricants

    4. YES lubricants

2. Longer foreplay with deep belly breathing

-It may take a little longer to increase your arousal.  Adding in some belly breathing with foreplay can help calm down the tissues and get them ready for the fun!

3. Switch it up!

-A position that used to be comfortable, may not be anymore.  Try a new position out and see if that does the trick.  For example, on your back might be uncomfortable, but on top might cause less discomfort.

If pain continues, please seek the help of a pelvic floor physical therapist and your healthcare provider.

Bladder Chat

Bladder, bladder...what's the matter?  

I once did a community talk with that title (Bladder, Bladder What's the Matter?) and I loved it!  Huge turnout which was eye opening to so many women that they were experiencing similar bladder symptoms to the women sitting next to them-no matter their age!

Urinary incontinence, leaking urine with exertion (coughing, sneezing, laughing, lifting, exercise etc), happens to 1 in 3 women.  If you are in a public place today, look around.  That is quite a few women dealing with some sort of leaking.  Some of those women have been dealing with it since childbirth because maybe they were told it was normal at the age.  Some developed it closer to menopause when tissues and hormones started to change.  And some, well, they have been peeing a little bit with exercise since they were teenagers.  OR, maybe some of you don't leak (yet), but are experiencing the "gotta go pee" feeling BEFORE you leave for exercise class, when you get to the gym, during the class (fear of leaking) and then after the session.  Your bladder is owning you.  You fear of leaking is taking over your day and maybe that's why you are only wearing black workout pants anymore. 

No matter when your leaking or frequent urgency began, know this, it is a COMMON thing that happens BUT it is NOT NORMAL.  

You mean I can be fixed?  Sure thing. 

First, if you are having the urgency and frequency, it is possible your pelvic floor muscles are contracting (tightening) and you will want to see a pelvic floor physical therapist to learn how to control and calm them down to decrease your symptoms and take back your control of your bladder.  Think about all the time your will save from running back and forth to the bathroom.  It's worth it!! 

Same goes for leaking urine.  Not all women with urinary incontinence are dealing with just weakened muscles.  A lot of the time, other things are going on, like an imbalance within the muscle tissues.  I see this a lot in postpartum and menopausal women.  The muscles are not communicating to each other correctly and some develop tightness and some are working how they are suppose to.  With seeing a pelvic floor physical therapist, you are able to bring your awareness to those muscles and learn how to control and coordinate them again.  

So...this holiday season while spending time with people you love, why not ask a group of gals (maybe over some wine :) ) who has bladder issues going on and what they have done to improve them.  Maybe even suggest, you know what, this year, let's take back our health and improve these bothersome symptoms by seeing a pelvic floor PT :).

 

What You Need To Know About Pelvic Health

As women, we live in this one body, yet, we still have a difficult time bringing awareness to the pelvic floor muscles and learning how to contract and relax these muscles. This is a topic that surprisingly, not a lot of women are well educated on. I love addressing the pelvic floor muscles, their roles in our health and how they can change with pregnancy and birth.  

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The pelvic floor muscles offer many functions to our bodies: they are supportive to our organs, they help pump/ circulate fluid in as we breathe in and out, they aide in sexual function, they control opening and closing of our openings and stabilize our SI joint, pelvis, hip joints and lumbosacral joints. The muscles run from the front of the pelvis at the pubic bone, to the sits bones and attach to the SI/ tailbone area.  When functioning properly, the pelvic floor muscles should fire prior to movement of lifting children, laundry, jogging, grabbing a glass of water etc. So it is important to continue to focus on your pelvic floor muscles through all phases of life.

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Your "core" is made up of your diaphragm, pelvic floor muscles, transversus abdominus and your mulitidus muscles in your low back.  So, as you can see, doing abdominal exercises for your "6-pack" muscles, will not target the true core. 

With life, we generally create habits.  Even within our bodies, we tend to do things the same way most of the time.  For example, we tend to carry our children or purse on the same side of our body.  This can create compensations to certain tissues and joints, especially during pregnancy and postpartum.  For instance, during pregnancy we may stand with our bum tucked under, our abdominals stretched and tightness in our backs to hold us up with our growing belly/ uterus.  After birth, our bodies stay in a similar posture, with weakened tissue and we start moving throughout the day making new compensations with carrying an infant or a toddler.   Seeing a pelvic floor physical therapist can help you fire and re-train your core the proper way to improve your core support during pregnancy and postpartum. 

One day, I hope it becomes a natural thing for a women to be seen at least once during her pregnancy and then get an automatic referral to a pelvic floor physical therapist postpartum to check on how the pelvic floor is functioning prior to beginning an exercise routine.  I believe many women would benefit on a prenatal visit with a pelvic floor physical therapist, to figure out how to make their pelvic floor muscles function properly and then what posture and body mechanics would be beneficial to avoid to promote a healthy pelvic floor.  Then postpartum, addressing women's pelvic floor strength, endurance, coordination and any areas related to pelvic floor dysfunction, diastasis recti or scarring from cesarean birth or perineal tearing.  I think so many women are doing too much too soon instead of giving their bodies enough time to heal postpartum prior to jumping back on the exercise train.  Remember, it took your body 9 months to grow that baby (ies), so give it grace with healing.  You will be glad your took your time and were smart with your healing and exercise, instead of rushing back into things.  

What Happens During a Cesarean Birth?

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This is an area that as women, even those of us who have HAD a cesarean birth,  we know little about.  Cesarean births can be planned or unplanned.  Planned are scheduled ahead of time and unplanned can happen after pushing for long periods, or when needing to deliver baby quickly, like in my first delivery.  There are lots of different reasons for an unplanned cesarean.  

During the cesarean delivery, the doctor makes an incision into your skin, through your fat cells, connective tissue and into the abdominal cavity.

The abdominal muscles are spread apart and the bladder is moved so the doctor can get to the uterus.  An incision is made into the uterus and the baby is guided out.  After the placenta is removed, then the uterus is stitched up, the bladder is put back, the connective tissue and abdominals, and then the skin is stitched up.  A lot of layers of sutures within the tissues so scar tissue develops as you heal.

Please note, your abdominal muscles are not cut through during a cesarean birth, but your connective tissue is.  This is important to understand why we need recovery programs after birth, not just “sit ups” and running as soon as we feel like it.  

 

"I had a csection, so why do I need to heal my pelvic floor?"

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Google Image

This is a question I seem to get quite often. "I had a csection, so why do I need to heal my pelvic floor?"

During pregnancy, your pelvic floor muscles are compromised and stretched with weight of growing baby and uterus.  This can cause the pelvic floor muscles to be more lax than normal.  Changes in posture during pregnancy, also cause changes to pelvic floor muscles.  For example, standing with your butt tucked under to accommodate growing belly, can cause tightness and change in tone in your pelvic floor muscles.  This can lead to pelvic floor dysfunction (urgency, frequency, leaking of urine, pelvic pain). 

Pelvic floor muscles are also involved if you pushed prior to cesarean birth.  Also, cesarean scars can cause issues with nerve function to the pelvic floor, where you might develop pelvic pain with sex, urethral burning, or feeling of needing to pee all the time.  It is important to get the pelvic floor muscles to function properly with your “core” after birth.  See a pelvic floor physical therapist to re-train your pelvic floor muscles and core to function properly again as you care for your family at home or during an exercise routine.  

Seeing a pelvic floor physical therapist postpartum is ideal.  If you are looking for someone in your area and would like a recommendation, just let me know!!  

Should We See A Pelvic Floor Physical Therapist Postpartum?

Image from Google Images 

Image from Google Images 

Just a little food for thought.  Delivering a baby, vaginally or cesarean, is a difficult job for our body.  I hate to say it, but birth is traumatic to our tissues.  The muscles are stretched during childbirth, some are torn or even cut through, in order to do what is best to get baby out safely.  As a pelvic floor physical therapist, I have often wondered, why are these women missing out on opportunities to improve the function of their pelvic floor and abdominal muscles after delivering a child?  In all other areas of muscle injury (strain) or rupture/ tearing, patients are usually advised to seek the help of a physical therapist for regaining muscle control, range of motion, strength, flexibility, stability and overall function.  For instance, someone might have a whiplash injury (similar to a childbirth with minimal or no tearing), they would see a physical therapist to stretch tight muscles and strengthen weak muscles.  If someone tore their Rotator Cuff, they may have surgery to fix the muscles (similar to repairing pelvic floor muscles or abdominal muscles after delivering a baby(ies)), then they would seek the help of a physical therapist to stretch the tight muscles, regain coordination of the muscles, teach the brain how to connect with the muscles again, and go through a program of improving range of motion and strength/ endurance of the muscles.  

I think we are missing this with our new moms.  Think about it.  Women are pregnant for approximately 9 months (posture changes, back muscles tighten, abdominal muscles weaken etc) and then they go thru delivery (with tearing or not) and their body's are expected to bounce right back while taking care of a rapidly growing new born.

What I see with my patients are poor postural stances of weakened and stretched abdominal muscles, tight and short low back muscles, sometimes tucked bums or ribs thrusts with carrying and lifting baby/ children/ car seat etc.  I think it would benefit so many new moms to be referred to a pelvic floor physical therapist postpartum.  Every new mom could come in for a screen to see if they are having any issues and if there are any things a new mom should be working on in the first couple of months.  I personally think, it would be beneficial to see a pelvic floor physical therapist for a screen PRIOR to getting back into an exercise program.  A pelvic floor physical therapist can evaluate women for diastasis recti, pelvic pain, pelvic organ prolapse, urinary incontinence and proper postural and body mechanics.  Hopefully with seeing  pelvic floor physical therapist, this would prevent more pelvic floor risks and issues in the future. 

So...see a pelvic floor physical therapist today, even for a screen, to see if you would benefit from starting a pelvic floor home exercise program.  Why not support your tissues for a stronger future?  

The Scoop on Poop

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Everyone poops.  This is a discussion I had with my 4 year old recently.  He was avoiding going "number 2", until we were getting home at the end of the day. 

We discussed how everyone poops.  Mommy poops.  Daddy poops.  Grandmas and Grandpas poop. His teachers at school poop.  His daycare lady poops.  All the kids he is around all day poop etc.  We talked about the different places people go too.  He seemed shocked that people would poop outside of their house.  I tried to explain, when your body is telling you it needs to get something out, aka for him a belly ache, then you need to listen and go to the bathroom instead of waiting all day and being miserable.  (As this can cause some pelvic problems down the road)

This is often a similar discussion with my patients.  Bowel movements are often a topic with pelvic patients, as the organs are supported by the pelvic floor muscles.  Constipation and frequent bowel movements can both cause pelvic floor issues so it is best to address them when treating pelvic floor symptoms.

Poop kind of has a bad reputation, which is sad, because it can tell you a lot about your health.  So before you flush after your next BM (bowel movement), be sure to take a glance inside the toilet and just see what your poop is telling.  Yes, I said check out your poop!  

Your poop has gone on quite a trip to end up in the toilet.  Remember, at one point, that poop was food.  The salad you ate last night went into your mouth and started the digestion process with chewing (side note: try chewing 20-30 times with each bite to help with digestion).  When you swallowed, it ended up in your stomach where it continued to break down with acids and other organs helped with this process.  The nutrients of your dinner are absorbed in the small intestine. Then your salad became waste product as it reached the colon to begin it's journey of leaving the body.  When stool reaches your rectum, you get a signal from your brain that something is about to exit and make an appearance.  It is best not to hold back your poop, but to take the time to sit down on the toilet, with your knees slightly above your hips (squatty pottys), to have a nice relaxing bowel movement (breathing and "shhhhh-ing" are great tips to help with the relaxation).

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So what does healthy poop look like?  I get this question a lot and most people are surprised there are many types of poop, 7 according to the Bristol Stool Scale :). You want to strive for a Type 3 or 4. If you are more type 1 or 2 it is a sign of constipation, and adding water and/ or fiber can improve this.  If you are a type 5, 6 or 7 regularly, you may have an issue with absorption or have an infection. 

Color of poop is another thing to pay attention to as it can tell you what is going on with your organs.  Poop also gets it's color from your food so don't be too alarmed it if changes red when you eat too many beets or cranberries! Poop should be a nice milk chocolate type of color.  If it is a black, tar like color it can be a sign of bleeding so consulting a physician to rule things out is a good idea.  Stools green/ yellow in color can mean you are eating a good amount of green things or a sign of gallbladder issues.  If you are starting a diet, don't be shocked to have a variety of colors when you glance in the toilet. 

Last one, should your poop float or sink like the Titanic?  Floating poop can be a sign you have too much fat (bad fat) in your diet or issues with your liver or gallbladder.  Cutting back on pizza and fast food may give you a successful poop sink in the toilet.  

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Running Postpartum

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Your 4th Trimester is your recovery phase.  A time to restore your strength and endurance.  Think of your postpartum recovery more like a marathon vs a sprint.  If it were a sprint, you would see your OB at your 6th week check up and get released to resume exercise AND you would head home to go for a jog.  If this sounds like you, you will likely increase your risk for pelvic floor dysfunction (leaking urine, pelvic organ prolapse, low back pain, hip pain, pelvic pain...I could go on and on and on...). 

Retraining your pelvic floor and core muscles how to work for you is very important and should take time to get them back functioning properly.  I mean, the pelvic floor and abdominal muscles have been stretched for 9+ months and forgot how to work properly.   It is our job, as smart moms, to make sure they are functioning before running/ jumping with 10-12 times our body weight thru those muscles.  That's a lot of stress on those muscles.  Think about your life down the road with your pelvic floor, abdominal muscles and your organs...you want them working in the correct way when you are in your 60s, 70s and so on, right?!  I do!

For my friends and patients who love running, I advise waiting 4-6 months postpartum to begin running.  I really think closer to the 6 months would be best for our lovely pelvic floors.  4 months seems to be early when you think about life as a mom of 1, 2 or more children.  It is a challenge to train your muscles prior to that time consistently.  AND then we throw in breastfeeding (hormones), lack of sleep (increased cortisol-stress hormone-effects how our body heals and recovers) and then 6 months sounds a little early.  Especially with the hormones that are still heightened in our bodies.  If my patients are breastfeeding, we may push back running past 6 months, depending on how the body is functioning with movement and what the pelvic floor strength, endurance and tone is looking like.  

Before my patients are advised to begin running, they have completed certain pelvic floor/ core strengthening exercises and home exercise programs for a period of 8-12 weeks to set them up for good outcome when they go out for their run for the first time. 

Things to think about prior to going out for a run at 4-6 months postpartum:

1. Have you had an evaluation with a pelvic floor physical therapist to assess your pelvic floor function? core strength? function with posture and alignment?  You should!  All of us should postpartum!

2. If you pee your pants with coughing, sneezing, laughing, lifting, bending over etc you are not ready to run yet. 

3. Feeling of pressure or heaviness in the vagina? Worse after lifting? Or while on your cycle?  If you answered "yes", you are not ready to run yet. 

4. Do you have an abdominal separation in your midline that is weak (Diastasis Recti)?  If so, I would wait to go out and run. 

"So...what can I do instead?"

I love having patients find hills in their neighborhoods to walk up and down.  Prior to doing this, patients have been walking on a flat surface (for a long time) with no increased symptoms from above.   Patients are to practice proper alignment while walking to promote proper core recruitment.  I cue patients to rotate their upper body arm swing while ascending and descending hills.