Let’s Talk About Toilet Time
Hey girl!!
Are you like me?
When I was a kid, I had the hardest time pooping in a public restroom or anywhere other than my bathroom at my parent’s house.
I remember being away for a basketball camp and sharing a bathroom with 4 close friends and I would have such terrible stomach pains, because I wouldn’t poop the whole time we were there. I would sneak away to find a one toilet restroom where I could cover my ears and try to focus on me and relieving my pain. But it just wouldn’t work.
Fast forward quite a few years, and now I’m a mom and have 3 kids and RARELY do I get a FREE moment to go poop without someone screaming at me, pulling my hair, wanting to nursing etc. My hunky, husband on the other hand, gets like 20 minutes of peace and quiet a few times a day to let if all out.
Anyways, lots of us are dealing with bowel issues: constipation, IBS, hemorrhoids or diverticulitis etc and they can be all be caused from poor toileting techniques.
Girl we are so lucky to have indoor plumbing in this country and since it has been around, we have been sitting on cold toilet seats to have bowel movements. Before that, we would squat to eliminate our feces . In other countries people still continue to squat to have bowel movements and with that they have lower rates of the above bowel issues.
So how can we improve your time on the toilet?
Putting something under your feet while sitting on a toilet, can help "un-kink" your hose, the pelvic floor muscle that wraps around the rectum. This could be a squatty potty ($25) (click here for 1 squatty potty on amazon: https://amzn.to/2MAcEUn or if you need 2 squatty potties, click here ($40): https://amzn.to/2S5f42z), child’s step stool ($10.50) (https://amzn.to/2SbSbKL), old phone books….the list can go on and on. There is a pelvic floor muscle that kinks your rectum when sitting and standing. When you sit with your knees above your hips (feet resting on something), you unkink the hose and the feces can move more smoothly out of your body. Once your feet are resting on something and your knees are slightly above your hips, you can rest your arms on your thighs/ knees and slightly lean forward to create a little more space for stool to exit your body.
Avoid straining. My mom would ask us to hoover over the public toilet seat like Marty McFly from Back to the Future so we wouldn’t touch all it’s grossness. If you are like me, you can remember how challenging it was to pee in a half squatted position. I would hold my breath and push to pee. Now that I am in my speciality, I know this is a no-no. Straining or bearing down, causes increased pressure on the pelvic floor muscles, which can put you at risk for hemorrhoids, diverticulosis, constipation, pelvic organ prolapse and pelvic floor dysfunction. Just breathe while sitting on the toilet in your new "squat" position and things should move out easily. And, layer up that toilet seat with tons of toilet paper so you can sit down. If you are in a public place, or a hotel room, grab the trash can, turn it on it’s side, and use it as a stool to help you.
Give yourself more than 2 minutes to have a bowel movement. I feel like as mom, I am rushed to take care of my business. I need to get in and out as fast as I can, to save my screaming child. I also find it difficult to relax when this is playing out. When we feel stressed like this, it is hard for our muscles to relax and we are prone to straining with bowel movements. Act more like our male friends (sorry men). They take their sweet time in the bathroom and relax and read etc. More like what we should be doing. If you do not have a bowel movement after 9-10 minutes of sitting on the toilet, than you are not ready. Get up and walk around and try again later.
– Amanda Fisher, PT, DPT
Quick Links on Amazon:
Squatty Potty: 1 (https://amzn.to/2MAcEUn ), 2(https://amzn.to/2S5f42z)
*This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you. If you enjoyed this blog, check out our website at www.empoweryourpelvis.com. Follow us on YouTube @AmandaFisher or Instagram @empoweryourpelvis
Try these THREE things to keep your pants dry!
What to try if you are peeing your pants?
Hey lady!
If you are like me, then you MAY or MAY NOT have experienced peeing your pants since you’ve birthed a child?
I mean I laughed, I peed myself.
I coughed, oops, there is a little more pee.
I jumped, and hello, more urine just came out.
I seemed to have very little control of my bladder.
I even had increased urgency where I would turn on water to wash the dishes and all of the sudden I was sprinting to the bathroom.
The first time this happened to me, I was like, why did NO ONE tell me about this? Am I right??
I wished my BFF had mentioned the increased need to pee at least! So that’s why I’m sharing this great information with you.
IF you are or have experienced peeing your pants, you may want to TRY to improve a few things in your life:
1. Posture: Girl, posture changes everything. When you stand and sit, stack your ribs over your pelvis instead of sitting/ standing with poor posture. This allows your pelvic floor to communicate with your diaphragm to correctly fire your pelvic floor when needed.
2. Breath Work: Holding your breath will get you nowhere but cleaning up pee off the ground. And that’s embarrassing. I mean just this weekend, I had a full bladder and held my breathe to pick up my baby and whoops…gravity and increased pressure won over my full bladder and I literally had to change my underwear and pants. My husband, who was standing next to me at the time, was in shock. He says, “why did you not pee in the bathroom before picking him up if you had to go so bad”? Really?! Like I knew I was gonna pee my pants? Ha! So I am sharing with you so you don’t make the same mistake, “blow out” when you are lifting or picking up anything. “Blow as you go” is what I say. This will lessen the pressure on your bladder.
3. Practice the next few exercises and let me know how they are going for you!
Click here to download exercises
Have any questions on the exercises? Send me an email and we can chat more!
Try these modifications out and let me know how your bladder and you are getting along.
Amanda
Flat Butt Posture
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
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:
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) :
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.
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.
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.
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.
Should We See A Pelvic Floor Physical Therapist Postpartum?
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?
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
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
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
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). .