Many of my clients fear prolapse or think that they are destined for surgery if they are diagnosed with prolapse, but the truth is that there is a LOT of variance in how prolapse can impact a woman’s quality of life. Many women have a small amount of prolapse and have no symptoms. As the prolapse progresses, women often have many life changing symptoms. There are a few things to know about prolapse including: 1. What does prolapse actually refer to 2. What are the symptoms of prolapse 3. What can contribute to prolapse and 4. How can you minimize the risk of developing organ prolapse. This blog will discuss what is organ prolapse and some myths about prolapse. Next week you will learn how to do a self check, prevent prolapse and what to do if you have organ prolapse!
What is organ prolapse?
Organ prolapse refers to the descent the anterior or posterior vaginal wall, cervix or the apex of the vagina (only after hysterectomy). This impacts the either your bladder or urethra if the anterior wall is impacted and the rectum/colon if the posterior wall is impacted. This can happen in one area or multiple areas and can impact bladder and bowel function. There are stages to organ prolapse where 0 refers to no prolapse and 4 refers to when the organ shifts or is evident on the outside of the vaginal opening. Stages 0-3 are can be treated successfully with PT and supportive devices as needed.
What are the symptoms of organ prolapse?
Symptoms of prolapse include pelvic heaviness that worsens as the day progresses, leaking of urine or difficulty emptying bladder, difficulty emptying bowels, vaginal bulging or heaviness or low back pain that worsens at the end of the day. Often there are no symptoms of prolapse until the severity increases. Many women feel the need to splint or hold their perineum during bowel movements.
What causes prolapse?
There is not one cause of organ prolapse. Often women have several of the following in their history: Pregnancy, delivery (especially with vacuum or forcep use or extensive time pushing), scar tissue from perineal scars or c section scars that cause imbalance in the pelvic floor, chronic constipation, improper pressure management when lifting, straining or exercising. Many women who have connective tissue disorders like Ehler’s Danlos Syndrome may be more susceptible to prolapse. A recent study compared 1379 women who either participated in Cross Fit or were runners and reported that the runners reported a higher incidence of pelvic organ prolapse and anal incontinence.
There are several myths that circulate with regards to prolapse. Many women and practitioners think that doing kegels is the # 1 thing to do to reduce your prolapse. Nothing could be further from the truth. Yes, we want a strong pelvic floor but strong means able to lengthen and shorten. If you only think about contracting you may not be actually strengthening the full range of the pelvic floor and this will set you back. Just like your bicep works when lengthened and shortened, your pelvic floor needs to do the same. Additionally, lots of videos float around with women doing exercises with their butts elevated to”put back” the prolapsed organ. However, doing that set of exercises even daily will not combat the other 12-15 hours you are sitting, standing or moving that may be leading to over pressure of your pelvic floor. Learning about how you use your body to support or detract from your pelvic floor is key! Can those exercises be part of your plan, yes, but they should not and cannot be the only approach.
Next week we will talk about what you can do to reduce the risk of prolapse. If you've got immediate questions, reach out!
Fatigue in pregnancy is most common in the first and third trimester. Though contrary to popular belief, fatigue is not par for the course in pregnancy. Fortunately, there are some very effective strategies, foods and tools that pregnant women can use to boost their energy and vibrancy in pregnancy. Interested in knowing what three women’s health specialists (a nutritionist, acupuncturist & physical therapist) help women to tackle fatigue during pregnancy? Then read on! After you’re done, you can get more amazing holistic health support from these specialists
by joining their private FB group.
The three main things I do for pregnant women who are feeling exhausted are:
Fatigue can be a debilitating factor in pregnancy for many women. I know how hard it can be and that’s why I tackle fatigue from a variety of angles when working with pregnant women. Three of the most common factors, that I assess and support include:
Darcie Pervier, MSPT, PES Women’s Health Physical Therapist and Pelvic Pain Coach
Once fatigue sets in, it can start a never-ending cycle. That’s why it is so important to be proactive in your self care regime and have a few go to action steps for when fatigue sets in. I have yet to meet a pregnant woman who hasn’t experienced fatigue. Developing a few habits during pregnancy is a critical first step to thriving during pregnancy and preparing for the fourth trimester.
For more guidance on pregnancy and using holistic tools and strategies to create a vibrant pregnancy that extends into motherhood. Join the private FB group run by Zoe, Darcie and Danielle.
Turn inward and listen quietly to what your body needs for nourishment of mind and body.
It is so common to follow the steps we have been told to do. We follow trends for workouts, fad diets, fashion, and oh so much more. Do you ever stop to think of what you would do if you had zero influence from social media or the outside world. What life would you create to build ultimate health and joy?
Let's start simple... Do you go to high impact classes even though you pee when you do them or your back is sore for 4 days afterwards? Why? What is your body really asking for to create health and strength? What if you could harness all of the potential of your body while supporting the areas that are weakened or offline. Your body works as a whole, so when you have even the tiniest of symptoms you should know it is a sign that there is a compensatory strategy in the works that may or may not be working for you.
Do you cut yourself down and beat yourself up because you aren't living up to the expectations you have set as goals? Are those really your goals or one's you have adopted from our society? For example, I have back pain because I sit too much and don't exercise. It is common to convince ourselves we are undeserving of wellness because we can't do it all.
Create a plan to nourish yourself, even if it is just small daily steps.
It is easy to make fitness and wellness a checkbox item. When we do that it becomes a to do not a full desire and conscious decision to be in the moment of self nurturing. If you eat leftovers from your kids plates as dinner, or squeeze in workouts amongst the chaos of kids and work, try setting aside one day to slowly enjoy your meal or workout with mindfulness and intention.
3. BE REAL... Is doing what you are doing REALLY getting you closer to where you want to be?
Is it really going to bring you full happiness to look a certain way or achieve a certain promotion? This goes back to #1 but think more globally. What is your true goal? Is it to achieve and acquire more or have more moments of joy, complete happiness and a sense of fullness within your life? Do you really think life will be perfect if you look perfect but pee your pants? Ha! NO! It's easy to get into the grind of working for more and giving selflessly to every community event, but make sure you are making time to feed your own soul.
4. Where do you ultimately want to be? Who do you need by your side to get there?
Build your web of support. You have a universe of support hoping and helping you to become your most authentic self. It wants you to find success. Who do you need for support, education, encouragement and mentorship? Here at Newburyport Wellness I am driven to educate and empower you as part of your web of support.
5. Tackle small goals daily and have ultimate compassion for yourself when life may not cooperate with your progression.
Tomorrow is a new day and what seems like a lack of progress is truly a hidden lesson. To be honest, this is the most difficult thing to do. when my first daughter was born, I repeated, "the plan is not to have a plan" over and over and over. I have a moving plan now with sticky notes on a clipboard so I can visually see the small successes that contribute to the larger goal. There is no point in wasting time feeling badly about what didn't get done. A well thought out small step is far better than fast steps taken without thought and consideration or endless contemplation with no forward momentum.
Perfect Posture Is Like The Perfect Breeze....
Ever Changing And Yet So Powerful
Yet another patient this week asked me if they are supposed to squeeze their shoulder blades and stand up straighter to have better posture. It happens weekly that a client perceives good posture as ONE good position to hold throughout the day. Nothing could be further from the truth. Good posture is ever changing.
Think of GOOD POSTURE like a state of being not a one size fits all position. Infact, maybe we just need to obliterate the term “good posture” from our mindset. The singularity in the idea of “good posture” is toxic and defeating.
“Good posture” is really the body’s ability to create a stable platform for movement throughout all of your movements in a day. Maybe we should consider good posture an “activated state of being.” Think of moving easily and freely and more importantly with strength and stability. That is good posture. Good posture is essentially the ability to move easily off of a stable platform.
The key to good posture is engaging your best breath in each position so that your deep core muscles and pelvic floor can work unitedly to support your system.. Yes, slouching is not the best- it puts a ton of pressure on your low back and pelvic floor and can translate shifts all the way to your head causing upper back pain and headaches. But, that being said, neither is sitting up so straight that your chest is pointing to the sun and your ribs angle out in front of your pelvis. In this position you can’t actually connect your diaphragm with your pelvic floor to create a connected breath that unites the back, abdominals and pelvic floor with the diaphragm to create stability.
Good posture is a bit different for us all and it really can be summed up as the place where you can connect your breath from your diaphragm to your pelvic floor. It is where your body can work at its best and most efficiently for whatever task you take on.
Signs of Subtle Postural Dysfunction or Postural Weakness
Postural control begins when we are babies learning to sit. When babies develop they must develop the ability to hold a body part steady against gravity before they can use their body to create mobility for activities like crawling. As adults it is obviously unlikely that you will lose full mobility when you begin to lose stability. But what does happen is that you find new strategies to get the job done that either create immediate pain/dysfunction or set you up for failure down the road. This is not to say that some compensations are not necessary and beneficial. But, ass adults it is easy to begin to over utilize the mover muscles we are most conscious of and underutilize postural muscles we were designed to rely on. So, instead of worrying if your shoulders are back, think about how much your breath translates deep into your body in any given position.
Not sure how your posture is impacting your back pain or pelvic pain? Call for your complimentary Discovery call today!
So mamas, we should be able to do it all, right?
We should be able to heal post baby without help physically and mentally. We are expected to. We are told we will be back to normal in 6 weeks. A small subset of women feel this way and then there are the rest, who feel like a failure on the inside but hold it together on the outside, waiting to feel like themselves. Some return to feeling good and compensate well and others struggle with feeling like they live in a body that is not theirs. Some may have occasional back pain or infrequent leaking- nothing that will slow them down. There are others who enter motherhood feeling like their body has betrayed them. Either way, our issues are marginalized and often women feel the need to push through no matter what. All well and good until, pain and dysfunction sets in again or ramps up. This is no time to admit you are unravelling. Now self blame enters and we blame ourselves for not getting help sooner. So, we take ibuprofen, wear pads since we leak playing with our kids and eventually politely decline social activities that will aggravate our symptoms.
Adding to this conundrum is our traditional medical model of treating disease not treating for prevention. Most of my clients come feeling unheard by medical professionals and feeling lost because their problem isn’t “big enough” to insight medical action. Many just wait and sit tight because there are few places to turn. Our intuitive body awareness is negated because we do not fit full diagnostic criteria of a particular dysfunction. We wait until the pain is bad enough, wait until a loss of function and joy is big enough that we begin to look for change.
So here’s how the American Model has failed us. We are taught that being Type A is the only successful characteristic to tout. Throwing yourself under the bus for everyone else is mandatory to prove your worthiness. Asking for help is admitting failure. It is ok to live with dysfunction if it isn’t terrible and if there is no obvious diagnosis you must be a hypochondriac. Prevention is for the few not for us all.
Think I am exaggerating?
How many of you have said, well, pain with sex isn’t that bad… I will just try to avoid it when I can.
A 2012 study (and you can find more like this) showed that women utilize preventative care more than men. This should mean a lower incidence of healthcare needs but that is not what the data shows. Instead, women are seeking out medical care more than men. The study wrote, “Perhaps, worse self perception of health and health related quality of life, self preference, worse state of health and the different overall approach to illness might have led women to a different process for seeking healthcare…” Maybe we are not getting the care that we need. Maybe we are not allowed to voice our intuitive sense of what our body needs. Maybe we aren't given full permission to ask for help without criticism.
Maybe we all need “to take a different overall approach to illness!”
I hope that someday, I have few women to treat who have spent years “dealing” with dysfunction or trying to unravel their symptoms on Google. I hope that all women feel safe and supported getting support early so that they don’t need to walk the path so many of us have.
Want to be heard? Call today for your free Discovery Call!
72% of women complain of back or pelvic pain in the first year postpartum and many still have complaints for up to 3 years. It is clear that work needs to be done to restore core control and strength postpartum. This means we need to encourage a progression of recovery and core activation. The shifts in workload, posture and muscle activation patterns during pregnancy may not spontaneously return to your pre pregnancy motor pattern. It doesn't mean you are destined to have back pain because you had a baby. It means we need to re-think recovery.
Recovery Weeks 1-2 "HEAT" and "BRICE"
Hydrate- Your body needs to cleans our waste and needs lots of water to fuel recovery and nursing.
Eat- Eat plenty of nourishing soups and stews to have the fuel to heal.
Accept- Accept help. Your body needs to recover, just like if you had an injury. Yes your body was "designed" to give birth. That doesn't mean it is an easy task.
Tend & Temper- Make your primary focus tending to your baby and to yourself. Listen to your body. Rest when you need to without heeding your internal desire to push through things and get going with your postpartum body. Temper the desire to "get back to normal." This is a process that determination can't rush.
Breathe- the best way to reactivate your core stability and reduce the risk of pelvic floor dysfunction and back pain is to breathe! (Not sure how- watch my video!)
Rest- rest- sleep when you can. Allow your body to begin to restore energy and to begin the recovery process.
Ice icing perineal area (ask your healthcare practitioner for details), will help reduce pain and decrease swelling of the pelvic floor.
Compress- when your up out of bed, you may feel heavy and sore in your pelvic floor. Wearing supportive underwear or shorts with some support may help to give support to your tired pelvic floor.
Elevate- just like you would elevate a sprained ankle, laying down to unload your pelvic floor will help it to heal.
During pregnancy evidence indicates that the walking patterns of women changes along with the position of the spine, center of gravity and therefore head/neck, shoulder positions. Studies are sparse with regards to providing exact values on all of these shifts and the long term effects. Until we have substantial studies to review, it remains unclear if all of the shifts return to baseline postpartum. From studies in other arenas, we know that it is very easy for the human body to adapt and create a new norm. To assume that pain and the mechanics you needed to use when pregnant will "just go away" postpartum is perhaps idealistic.
Walking is good. Slowly build your tolerance to avoid pelvic heaviness, increased bleeding or back pain. Walk around the bed/ in the home for the first 3 weeks postpartum and slowly progress walking distances from there if you have no medical complications where your doctor has advised you to limit activity. It is good if you can walk without pushing a baby or holding your baby for some walks. Walking mindfully will help you to reconfigure your body awareness to midline and symmetry. Don't worry about speed or distance. Focus on how your muscles feel left to right, sensations of pelvic heaviness and breathing with the activity.
Restoring Your Core
Dare I say it again??? Breathe. Breathe Breathe. And, begin to assess your motion. Are you feeling tight when you turn one direction? Do you feel like your pelvic floor is still on high alert even though tears are healing? Or do you feel like you can;t connect at all with your pelvic floor?
Think posture. It is easy to fall asleep in wacky positions in a nursing chair and slouch when nursing for what seems like hours on end. Slouching can put your pelvic floor in an unsupported or strained position. It also detracts from the efficiency of breath to activate your core. Lastly, maintaining the over arched position you rocked during pregnancy inhibits breath by reinforcing malalignment and forces upper abs to grip for dear lift to hold you up while your lower abs become more and more disconnected from their participation in core stability and posture. It doesn't mean you can't slouch or arch your back to hold your baby, but be sure to move in and out of a variety of positions.
What core exercises are best? Sorry ladies. You are all different and that means what you need to do to connect with your core postpartum can't be googled. Studies show that it is often not what you do but how and why you do it. I can't recommend enough a postpartum assessment by a whole body movement expert who is competent in pelvic health awareness.
Want to learn more? Are you uncertain about really connecting with your body postpartum? Call for your complimentary Discovery Session!
I have always had back pain
I was told my pelvic pain would go away eventually after childbirth
My whole family has bad backs
My back hurts because I am overweight
I know the doctor says I should exercise but I just can't seem to motivate when I am in pain
If you have said or thought any of these statements, you are not alone. But hear me now... You are not destined to a life of back pain, pelvic pain, peeing or a life without exercise and freedom of movement just because you have been told you will. If movement causes pain, it can be so hard to see a way that movement can be a positive experience. Clearly chronic pain is complex. But as we learn more about the brain body connection, it is clear that there is not only more to uncover about the brain's ability to reroute motor plans when there has been an injury but how active work can override ineffective motor plans and overeactive central nervous system responses to pain.
Benefits Of Movement On Chronic Pain
Studies have compared the effects of traditional exercise, yoga, mind body relaxation and psychotherapy on chronic pain. Many studies look at conditions like low back pain or fibromyalgia. Results are promising for some improvement with each of these interventions. Often regular exercise is recommended for chronic conditions such as back pain, endometriosis, PMDD (premenstrual dysmorphic disorder) and more. The idea of exercise and yoga is to increase strength and mobility. Yoga has the added benefit of promoting a brain body connection via breath. The added bonus of movement for chronic pain is to improve mood by increasing serotonin levels in the body. However, for many these options are pain provoking or simply not enough to reduce pain appreciably. If you can't exercise you can't improve your mood with exercise either.
The Brain's Response To Chronic Pain
There are three factors that don't often get discussed when it comes to chronic pain (pain that lasts longer than 3 months)
1. You brain literally reconfigures the connection with the injured body part and this can result in a shift on how you use your body during movement. For example, in patients with low back pain, it was found that the area in the brain where a key core muscle is represented shifts from its original position. In addition, it is delayed in activation with motion. Similar findings have been found with other body parts post injury.
2. In a study looking at injury, it was noted that within 24 hours of an arm becoming immobile, the brain began to disconnect neural connections with the body part.
3. If your body has found an alternate way to get the job done, exercising a weak muscle will not change the faulty pattern. this means that straight up exercise is not the best solution to injury recovery.
What This all Means
To put it all simply it means this:
The sooner you address a pain, injury or dysfunction the better. Postpartum pain and dysfunction should not be considered as a natural consequence to "having a baby." Take time for self care now.
If you have struggled chronic pain or dysfunction and have not found success with traditional strengthening you may need a new motor plan instead. Reconnecting with an efficient motor plan is critical. Keep in mind that you can strengthen a muscle all day long, but if you don't use it properly, it doesn't matter how strong it is. These studies also indicate that it doesn't take long after an injury for your body to move to plan B. Meaning it finds a new way to get the job done. So for all of the times I have heard my clients say that they only had an episode or two of back pain or stress incontinence and then all of a sudden it got bad, we need to understand that the more severe dysfunction was likely a work in progress all along.
What to Do
1. Recognize that it is not what you do for an hour but what you do minute by minute that matters most
2. Take time to slow down and listen to your body. can you detect how your body feels different left to right? For example, if you walk slowly can you feel your glutes work the same on each side?
3. Consider reaching out to a clinician that will help you to redefine a solid motor plan to get your body back "online."
4. If tackling an exercise program or yoga feels scary or threatening, recognize that you will likely not find success. working with someone to find a safe space to nurture movement is key. Your body will not move well when your nervous system is on high alert!
So, here it is. Intuition meets science. For years I have been promoting exercise as a primary intervention to boost perinatal mental health in my inner circle. A recent study published by the Frontier's in Women's Health was just released. It states that the rate of high anxiety in pregnant or newly postpartum women has gone from 24% pre-pandemic to 74% during the pandemic. It also reports that those partaking in moderate intensity exercise has a significant impact on improving mental health. For those women riding that line of anxiety and depression, this may be easier said than done.
YOU ARE NOT ALONE
First and foremost it is critical to remember that you are not alone. There is a continuum of normal emotional variances during pregnancy and beyond that often don't get talked about enough. I am remembering back to when I went to a concert after my first daughter's birth. I was so anxious about the crowds, being away from her and everything else in between I never heard the music! I had no idea that postpartum anxiety was a real thing. I only had heard of postpartum depression. My husband thought I was being dramatic and the entire day out was depleting and exhausting. When I finally learned that there really is a continuum of experiences and emotional variances that occur to women around the stages of pregnancy and postpartum I felt a bit frustrated that no one had educated me about this part of motherhood. I only had heard of severe postpartum depression and I didn't fit in that category. If I had been aware of what might happen, I would have been more gracious with myself and maybe done some reading to resource some assistance if needed.
Pregnancy and Postnatal Recovery are meant to be surrounded by a tribe
Pregnancy is a time to listen and guage activity
What can women do to take action especially during Coronavirus?
EXERCISE DECREASES PRENATAL AND POSTPARTUM SYMPTOMS OF ANXIETY AND DEPRESSION
Exercise can reduce prenatal and postpartum symptoms by up to 67% according to a study referenced by the Frontier article. Many pregnant and postpartum women I have met often know that they should try to exercise if they are medically cleared to do so. However, it is often hard to get started whether it is finding the time, energy or ability to revamp an exercise plan now that many are avoiding gyms and studios. As we learn more about grading the return to exercise postpartum, many women are left in the dark about how or when to proceed.
The recommendation sounds easy enough, but there is really a lot to navigate for many women during this period of life, especially now with Covid-19. Exercise gyms and studios have been great about transitioning to virtual classes during Covid-19. What if you are not an exercise class kind of gal? What if you have a toddler at home so you can't focus through a class? What if you know you could add exercise, but can't seem to motivate yourself?
A FEW IDEAS ON INTEGRATING EXERCISE
1. If the mountains seems high, start small. Sometimes a walk outside seems monumental, so try 5-10 squats every time you get up to go to the bathroom or go up/down the stairs one extra time several times during the day.
2. If you have kids- set up a date to play whether it is tag, simon says or taking a nature walk. Know that they will feel better too after some quality time!
3. If you are new to exercise don't go it alone. If you don't want to hire a personal trainer for weekly sessions, can hire them to make a simple program for you to follow? You can stay accountable by enlisting the help of a friend.
4. If you are working from home, don't forget to get to get up every 52 minutes and move for 17. If your meetings last longer, set aside the time in your schedule. Remember that you have gained the time of your am commute. Guard your personal time vehemently. Work can wait.
5. Do you have more questions? Call! I am here for support!
BEST FIRST EXERCISE....BREATHE
Breathing is really the best and first exercise to begin with. We think that breathing comes naturally, but breathing to optimize core activation and support to protect your back, pelvic floor and reduce potential for excessive diastasis recti takes a bit of education. Breathing also reduces heart rate and regulates our body's responses to stress. If exercise is not possible, just start with breathing. Then reconfigure your web of wellness to support the next steps.
Everyone's pregnancy, delivery and postpartum experience is different. You may not feel well enough to partake in exercise at all points of time during your pregnancy. And the more we learn the more we know that you should not be expected to pop back into a full workout at 6 weeks postpartum. You may have a pre-existing injury that limits your ability to exercise with large groups on line or in person. Maybe you are like me and big classes were never your thing. The point is that every woman needs to begin to listen to their intuition and push when they can, rest when they can and do the kind of exercise that suits their body. This by no means that you have to do it all alone. This is the time to define your web of wellness, built with a network of people who are there to guide and support your individual goals.
Here in the Merrimack Valley of Massachusetts we have a great sight for women to find local support called Pentucket Mom's Support.
Do you want to learn more about breathing technique? Check out my video here
Ready to start coaching or PT to help connect you during this journey? Call today to set up your complimentary Discovery Call.
Is a mom of two, life long exercise enthusiast and women's health coach & physical therapist.