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

Nap-time Nookie

Because the third time postpartum was a charm, I thought I would be a good time to open up a little on what has worked for my husband and I as we returned to sex postpartum.

Now, before I get into too many details, I want to be honest and let you in on a little secret. Sex has been COMPLETELY different postpartum after each of my deliveries. Between vaginal dryness, sensitivities, leaky boobs etc, intimacy is not the same as it was prior to children, AND that’s not necessarily a bad thing. I love my husband more than anything, but sleep deprivation and a newborn did not help either of us get in the mood.

Girl, before jumping back in the sack postpartum, it is important for you and your partner to feel ready to attempt intercourse once you are released by your healthcare provider. After my first kiddo, I felt the pressure from society to have sex the moment I was released, but I wasn’t ready. I had an emergency c-section, followed by a difficult recovery and was not comfortable in my own skin. I wanted to be there mentally for my spouse to show him how much I love him, but it was hard to focus with my new body, a crying baby in the room and fear taking over. And lets chat hormones for a moment, they took a toll on my libido and sex drive. And then mix that with lack of sleep and my body was like, ummm…no I am TOO exhausted to mess around but I do love my hubby! I would dread coming to bed after nursing the baby because I was afraid he would roll over and attempt to try “sexy time”. This seemed to improve somewhere around 13-15 months postpartum for me, however, I have friends whose libido came back a lot earlier (lucky them!).

While trying to be intimate after our second baby, it was WAY uncomfortable at my cesarean scar. I did not want to be touched and was super sensitive to touch anywhere below the belt. And the dryness was out of control. No amount of lube could fix my Sahara desert “down there”. The pain was unbearable and I was ultra sensitive, I had to ask him to stop. I was in tears, embarrassed and frustrated with myself. My husband was so sweet and felt terrible for causing the pain. This continued a few times before I asked for a referral for a pelvic floor physical therapy.

After our third baby, due to lack of sleep, we waited until closer to 11 weeks postpartum. Third time postpartum was great. I had no issues with being touched or scar healing from my third cesarean delivery. To help in the intimacy and dryness (thank you hormones and breastfeeding), lube and foreplay are necessities, and still are at 13 months postpartum. I am a huge supporter of comfort while adding in great lube (yes, I have some favorites: SYLK :Use PROMO CODE “EYP”, YES and Good Clean Love). Girl don’t ever feel less of a female for using lube. It’s God’s gift to our postpartum vaginas.

Open communication and patience between your partner and you is KEY. There were times I wanted to keep my shirt on because my swollen belly made me feel insecure. Or times I would keep my bra on (too many too count) because my nipples would leak milk or my left boob was huge and FULL of milk which made me look totally lopsided. My husband on the other hand, could not care less and never seems to notice any of my breast or belly issues. He does respect how I feel, which makes me love him even more and checks in to make sure things are comfortable before proceeding forward.

Girl, during the postpartum period, it is not time to pull out your Karma-Sutra book and get too adventurous. Take it slow, focus on breathing, being comfortable in the moment and the position. If you feel discomfort, ask your partner to slow down, close your eyes, breathe and see if that helps to decrease the pain. If not, try another position that might be more comfortable for the both of you OR it just might not be the right time to proceed forward. If pain continues, I would suggest you ask your provider for a referral to a pelvic floor physical therapist.

At this time in our life, we have to schedule out “Nap-time Nookie”. It’s not as sexy as it use to be when we would just get in the sack whenever we wanted, because, well, we now have three small children to look after. And girl seriously, by the end of a work day and taking care of our small humans, I am exhausted. So we try to get all three little guys down for a nap at the same time. My hunky hubby puts the two older boys down while I nurse the youngest (to help with the leaky boobs) and then we meet in the bedroom. It is wonderful when the boys cooperate and we can have some time for us. As a mom, if I can hear my kiddos in the other room, it is difficult for me to focus on this special time with my spouse. So nap time works well for us to have a pleasurable time. This is also when I am able to feel a stronger orgasm (yes this is where my sex life has improved since childbirth).

Oh, one more thing to remember is that each couple and relationship is SO different. Also, love languages are something to keep in mind. My husband would have sex daily if he could. Me, not so much. Luckily, my supportive spouse goes over the top to help out around the house so I can save my energy for other things like nap time nookie.

What I Learned About Myself During Our Stay in the NICU

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!

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:

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.

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.  

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

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?

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

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).

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

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. 

What You Eat MAY Affect Your Hormones

The talk of how crazy women can be has been going on for centuries.  Did you know a hysterectomy was thought to cure women of "hysteria"? Crazy right?!  The thought was women were going crazy (mood swings) because their uterus was searching for children.  So they must be cured if you remove it. 

I am thankful to be living in times of modern medicine.  We know so much more now days about what can affect our hormones.  There are lots of options out there, but I will be focusing this blog on more food related items. 

So how can our hormones get "imbalanced"?  The most common causes are: 

• excess stress
• lifestyle choices
• aging
• genetics
• lack of nutrients
• pregnancy, miscarriages and abortions 
• environmental exposure to toxins

We have quite a bit of control over the above, especially our genetics.  New studies have shown that we can turn on and off genes in our DNA with external factors (such as diet, sleep and stress). How cool is that?!  The DNA is still passed down to your children and grandchildren, but the choices you make today, can affect your great grandchildren.  Pretty amazing.  

So what choices can we make to make a positive change?

• Start adding dark, leafy greens: most nutrient dense food, yet lacking in a lot of people's diets
  • dark greens clean you blood, improve circulation and improve your immune system by restoring strength and reducing inflammation
  • Start by adding in a 1/2 cup of cooked (lightly sauteed or steamed is best) greens to your day.  Slowly work your way to 3-4 cups of raw and cooked greens
• Add more healthy fats (Fats! Handout)
  • Women's bodies are made up of about 60% fat.  That's almost 50% more than males and it is important for our fertility (that's hormones ladies!). 
  • When we eat a low fat diet, our bodies have a harder time digesting fat-soluble vitamins (Vitamins A, D, E and K) which play an important role in hormone regulation. 
  • Add more Omega 3s to support brain function (deficiencies have been linked to ADD, ADHD etc) 
  • Examples of my faves: coconut butter and avocados

How much fat do I need?  It depends.  Start by keeping a journal and see how you feel after eating good fats. I feel better when eating meals with more healthy fats and I find I am eating more fats now than ever before, somewhere between 30-50% of my daily food, especially while pregnant. Eating more healthy fats has been shown to help some women regulate their hormones to getting their periods/ cycles back on track (while reducing their carbs, not eliminating them).

• Chewing starts your digestion and most of us aren't chewing our food enough.
  • Chewing less makes it harder for food digestion to occur and can cause bloating, gas, abdominal pains, constipation/ diarrhea etc 
  • TRY chewing your bites 20-30 times and see if you notice a difference in how you feel!

So again...

• Take longer to chew your bites (20- 30 times)
• Add 1/2 cup of leafy greens to 1 meal a day, working up to each meal 
• Add good fats to one meal.  It might be avocado slices to your eggs in the morning or to a salad at lunch.  

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).   . 

Pregnancy Journal: 27 Weeks!

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!

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 

Varicose Veins in Pregnancy

My daily attire: full length compression hose, V2 Support and pants

Varicose veins.  Some of you get them in your legs.  Some may get spider veins.  Some of you get them in your pelvis/ labia and some of you get them as hemorrhoids.  I am a proud owner of varicose veins during my pregnancies in my legs AND my pelvis/ labial area.  I am a lucky gal.   With as much swelling as I get in my labial tissue with pregnancies, I grow "balls".  It is a special talent of mine. If you have ever experienced vaginal varicosities, you know what I am talking about.  

This is what the V2 Support looks like.  What I like to call, my "jock strap".

I used to think, why do women not talk about this?  I tried talking about it more with my second pregnancy and the look on everyone's faces when I told them I had "saggy balls" between my thighs made me think, you know maybe I don't need to scare...I mean educate every one about varicose veins.  Or maybe there are other ways to do so.  And that was my cue to write a blog.  Less subtle, right?!

If you are pregnant now and are experiencing "pressure down there" (your don't have to have to the "saggy balls" or varicose veins) or heavy legs, I have some great options for you.  First, let's discuss the pressure in the pelvis.  Now for me, the pressure feeling starts as soon as I roll out of bed in the morning.  Gravity pulls those tissues down and I feel my "balls" growing immediately.  Urinating can be a challenge at times due to the increased swelling.  Remembering to breathe and not strain to urinate is key.  As I always say, just breathe...your pelvic floor will thank you.  Well, peeing is one of those times.  After I wash my hands, I throw on my V2 Support (greatest thing for feeling pressure in the pelvis while pregnant) and head out the door for my morning walk with my dog, Izzie.  Walking is a great exercise for circulating the blood in the pelvis and is great for you and your baby. Also, throughout the day, make sure you are taking frequent breaks from sitting or standing.  Doing either of these too long can cause more discomfort.  Belly breathing is another great exercise for circulating fluids in pelvis/ abdomen.  Also breathing while getting your feet up, can help with the pain in the legs or pressure in the pelvis.  As a mom of two young boys under 4, I find it is challenging to listen to this advice.  I am constantly chasing my children or doing a mom job that I forget to take the time to get my feet up.  BUT when I do, I feel better.  

Besides the V2 Support, I also invested in a good brand of full length compression hose.  If you are pregnant in the summer with these issues, wear maxi skirts/ dresses.  I had to with my last pregnancy and it was worth it.  The compression hose has been a life saver for the leg swelling and pain.  Buy a good brand so they last you longer than 2 weeks.  You can find someone in your area who can measure you so you get the right size.  A local vein clinic in my town will measure people for free!  

If you have any questions on this topic, feel free to email me!  

Remember to breathe...your pelvic floor will love you for it!

Amanda