incontinence

The Scoop on Poop

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.  

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. 

   

Pelvic Organ Prolapse: 50% of Women Who Have Had Children May Have This

Pelvic Organ Prolapse (POP) is a diagnosis women can get postpartum and after childbirth.  Statistically, 50% of women are at risk for POP after pregnancy, but you can develop POP prior to pregnancy.  I ended up having a little pelvic organ prolapse during my "training for half marathon" days, which then worsened postpartum (with each of my pregnancies).  Know this though, having prolapse does not mean you have to stop exercising. I certainly have not and I am pregnant with my third! :)    

Picture from Google Images

Picture from Google Images

Prolapse can tend to be a scary word, so let's go over what it is.  Pelvic Organ Prolapse (we will discuss female anatomy) is when the pelvic organs are pushing against weakened pelvic floor muscles that are not functioning to support the organs within the pelvis (bladder, uterus, rectum, urethra) and women can begin to feel pressure in vagina (sometimes women feel like an old tampon is coming out) from the organs starting to come down into the vagina.   

3 Most Common Types of POP:

Picture from Google Images

Picture from Google Images

1: Cystocele: bladder prolapse.  Women may complain of feeling pressure in vaginal canal.  Sometimes the pressure is felt when the rectum is filling with stool and pushing in on cystocele.  Other times it is felt after lifting or carrying weight (same with all 3 types), such as babywearing.

2. Uterine: The uterus can lower post pregnancy and delivery.  Sometimes it is difficult to keep a tampon in due to a lower uterus or some women find intercourse uncomfortable because their partner may be hitting their cervix during deep penetration.  Do keep in mind, the uterus does move during our cycles (higher and lower) and this is why some women may feel this during their days 14-21 of their cycle (different for everyone). 

Picture from Google Images

Picture from Google Images

3. Rectocele: Rectum prolapse:  Some women may complain of feeling a bulge in vagina when the rectum is full of stool.  Some women have to "splint" or insert their fingers vaginally to push back on the rectum to void during a bowel movement. 

Prolapses are measured by grades of 0-4.  "0" meaning no degree of prolapse and "4" meaning the prolapse is bulging outside of the vaginal opening.  Your doctor can give you your grade of pelvic organ prolapse in their office.  I like to look at my patients' prolapase in the clinic in a few different positions and let the patients see what they are feeling in their vaginal canal. Remember, 50% or more of women can have some kind of degree of POP after baby and some can be asymptomatic and manageable. Some POPs cause more issues so it's important to seek proper postpartum exercises and the help of a pelvic floor physical therapist to assess what exercises would benefit you and help you get back to certain exercises that interest you.  

With being early postpartum, and/ or if you are experiencing "feeling of pressure in your pelvis" or "pressure down there", it is important to avoid certain activities and exercises:

  • Avoid standing for prolonged periods of time: this could be household work, baby wearing through the grocery store,  carrying toddler, lifting heavy weight (moving furniture) etc 
  • Avoid wide leg squats and lifting from a deep squat, especially while holding your breath may increase your prolapse
  • Avoid abdominal exercises: such as crunches, sit ups, planks and push ups (not saying avoid forever)
  • Avoid running, jumping, HITT workouts, plyometrics and burpees etc ( I like to avoid these until 4-6 months postpartum AT LEAST to help the pelvic floor muscles heal properly after delivery). 

What you can do while exercising in early postpartum:

  • Pay attention to what you are feeling in your vagina while exercising and afterwards.  Increased bulging and pressure are bad.  If you feel this, you may have increased your exercise time or intensity too soon. 
  • Focus on your posture and alignment while exercising.  Remember to keep ribs stacked over pelvis.
  • Watch your breathing with exercises.  EXHALE during exertion and avoid holding your breath with exercises.
  • Focus on core and pelvic floor strengthening and retraining to get the muscles on the right tract to support you and your organs again
  • Do exercises in different positions: lying on your back, back and hips elevated, sidelying, sitting, standing (avoid too much of this one due to gravity)

I like to suggest to new moms to seek the help and guidance of a pelvic floor physical therapist before getting back into running or plyometric exercises to avoid POP and other pelvic floor dysfunctions in the future (especially if they are having signs of pelvic floor dysfunction: urinary incontinence, pelvic pain, feeling of pressure, diastasis recti, low back pain, hip pain etc).   . 

Pregnancy Journal: 27 Weeks!

On the hayride to go find our pumpkins!

On the hayride to go find our pumpkins!

I am closer to 28 weeks than 27 weeks while posting this, but our house was hit with the stomach bug this weekend and life got away from me.  

Landon doesn't like sitting on the hay.  Jackson was so excited to sit by the pumpkins!

Landon doesn't like sitting on the hay.  Jackson was so excited to sit by the pumpkins!

So #27weekspregnant and continuing to feel great!  This is my favorite time of year.  I love the fall, Midwest weather, the clothes, the smells, the food (but really, who doesn't love food while pregnant?!), and the outside activities.  My boys and I went to a local Pumpkin Patch this weekend (prior to getting sick), and had a blast. 

I am feeling baby move more and more each day.  Especially when Jack and Landon talk to my belly.  They love telling "Baby Fred" (that's what they have named him) all about their days, what they ate and what they did.  I need to record these conversations because they are freaking adorable!  

I was low on iron so I have started taking an iron supplement and eating more iron rich foods (greens, spinach, beans etc) to help improve my levels.  My eyesight has improved with doing so.  My eyesight was getting pretty bad over the last month so I am glad my doctor caught that.  

I am continuing to eat a diet high in good fats and protein.  Lots of good research out there with having a diet high in healthy fats while pregnant and breastfeeding.  I am adding more avocado, coconut MCT oil, and Omegas to my meals and snacks throughout the day.  I definitely feel better when I do, especially when I am staying hydrated, I notice less swelling in my labia and legs.  I mentally feel better too! That's a bonus as a mom of 2 (soon to be 3!).  

Eating a diet high in healthy fats is also great for women of all ages because they help regulate our womanly hormones.  How wonderful is that!!  We could all use a little help with our hormones, am I right?!  hehe

Anyways, I'll be making a post on that soon!

Have a fabulous week!  If you want to chat about anything, remember, I do virtual consults now :)

Amanda 

5 Important Pieces of Information About Diastasis Recti (Abdominal Separation)

Abdominal separation (Diastasis Recti) of your mid line of six-pack muscles is all the chat right now in social media.  So...I want to give you the low down on what the hype is all about.

When I first started my training with pelvic floor physical therapy, I was under the impression that a 2 finger split was considered normal.  With time, more research and growing knowledge about this topic, we now know that not to be true.  

After you read this I hope you feel more comfortable about this topic.  

5 Important Pieces of Information About Diastasis Recti (Abdominal Separation)

Fact 1 :I feel like a see 3 new sponsored posts daily on this topic.  An abdominal separation can happen to the linea alba, the connective tissue within your mid line, due to the laxity that happens from growing uterus and baby.  Try not to stress out about an abdominal separation.  It is very common among pregnant and postpartum women and very possible to heal a diastasis recti (men can have Diastasis Recti too).  A study by Diane Lee, found 100% of women have abdominal separation at 35 weeks gestation (pregnancy).  Your body is smart one and knows what it is doing.  Your belly stretches to accommodate your growing uterus and baby. The study found that by 6 months postpartum, diastasis had decreased to 35-39%.  So it is important to check in with belly every now and then to see if yours has gotten stronger.  

Fact 2: Posture and alignment are important with strengthening the gap.  Pay attention to how you are standing, lifting and carrying baby. Make sure your shoulders and ribs are stacked over pelvis to keep your torso in good alignment, which decreases pressure in your abdomen (less pressure pushing on linea alba-midline of abdomen).  Try to be mindful of how you are lifting/ carrying baby, especially when in the car seat or baby wearing. This is also a great place to start seeing a pelvic floor physical therapist so they can help you with your alignment with activities and assist you on your road to recovery.

Fact 3: Another way you can decrease the pressure in your belly is by breathing out (exhaling) when you are lifting baby.  This is great to remember when lifting baby into car, crib, picking toys up from the ground, lifting holiday decorations etc.  

Fact 4: There is NOT one exercise that will heal your abdominal separation.  There is also NOT one exercise that will ruin your abdomen.  There may be exercises that you need to avoid while you are working on strengthening your separation, but you can get back to those exercises when your body is ready.  For instance, if you are seeing a pelvic floor physical therapist, they may ask you to avoid certain core strengthening exercises, like a plank, but that doesn’t mean you will have to avoid them forever.

Fact 5:  The internet gets us caught up in the separation of our abdomen.  Is it 2 fingers wide, 3 fingers wide or more.  I tend to not get caught up on the separation split width and try to not get my patients too excited on this either.  I am more interested in the tension created between the 6 pack muscles that run from the breast bone to the pubic bone. I want my patients to improve in their “bridge” between their mid line, meaning more “taut” with activities of lifting, carrying, exercise etc.  When your tension improves, you are getting stronger!   

Pregnancy Journal: 25 Weeks

Rocking my sweet compression hose (and V2)

Rocking my sweet compression hose (and V2)

Finding myself full with eating small meals these days. I am working on eating meals higher in healthier fats with this pregnancy and I am feeling better when I do!  A few of my favorites are adding avocados and good oils to meals.  

Over this last week, I have been having more low back spasms after being on my feet for prolonged periods of time.  I continue to walk my dog in the mornings (my reflection time) and have a little round ligament pain occasionally, mostly on hills.  I work on core hugging during the hills to lessen the pain.  I am hoping to try a core belly support here soon to help ease the pain as well.  Baby boy is the size of a cauliflower this week and kicking like crazy!  Jackson, my oldest, has been calling this baby "Fred" for the last couple of months.  So much, that I am having a difficult time coming up with a name for this child, because now we all are referring to my bump as "Baby Fred".  Any name I say, Jackson will reply with, "Fred is a fine name for a baby".  He is too cute!

Continuing to get in some core, arms and legs workouts, along with some prenatal yoga (very relaxing...pretty sure I fell asleep in class), after my morning walks and between patients, biz and mom life.  Life is crazy, busy right now, and I love it!