When I was a practicing personal trainer, I was often made to feel that my skills and services were inferior to that of a physiotherapist.

Coupled with this, is a genuine fear among some Fit Pro’s that referring clients to an allied health professional will somehow deem them as responsible for the injuries of their clients and / or shine a light on their own knowledge inadequacies. And there is also a lingering perception that referring will then equate to losing a client.

It is hard to build relationships when:

• there is not a full understanding of what another does
• mutual respect is lacking, and when
• people react out of a scarcity mindset

And while it is true that the qualifications of a person who has Cert III or IV in fitness is significantly less than that of an Exercise Physiotherapists or physiotherapists – fitness professionals still have a valid role in the health equation.

A person who is on a mission to get fit are most likely to seek out the services of a fitness professional. This might be at their local gym, or it may be finding a more smaller boutique option. Even if they have injuries, there can be apprehension about cost and time and may skip seeing a phyiotherapist… when all they want to do is just get in shape.

This is even more true, when an injury can not be readily seen and either the client (or their trainer) does not probe the possibility. Such is the case for pelvic health issues, when leaking can be seen as normal, rather than as it should be seen which is common.

Leaking does not have to be you (or your clients’) normal. Having a service that you offer as a Fit Pro for women who are experiencing pelvic floor dysfunction (pain, leaking, prolapse… anything that does not feel right) can really set you apart and make you stand out as a true professional!

Creating a WIN WIN WIN situation

One of the key reasons that my personal training business mishfit® won several awards from Fitness Australia, was the formal relationships that we had with other allied health professionals. Namely pelvic health physiotherapists and dietitians.

This was a win, win, win relationship between the Allied health practitioner, the client and the mishfit® franchisee.

A win for the client because they had their pelvic floor assessed and knew exactly how to contract their pelvic floor and deep abdominal muscles. This was achieved with the help of ultrasound. Many of our clients did not even know that such a service existed. Or were reluctant as they thought such a visit was unnecessary. We sold them the benefits – as trainers we could not see if they were contracting their pelvic floor correctly and to train them approrpiately and importantly, we needed the diagnois from a professional. In the 10 + years I ran mishfit®,  I never had one client who took up the money back guarantee.

We don’t know what we don’t know!

Here is a video that I made showing the experience of having the pelvic floor ultrasounded. An ultra sound is a very unobtrusive way to get visual feedback to ensure you are correctly contracting your pelvic floor. It is also a good opportunity for women to ask questions or the pelvic health physio to ask questions to see if there are any other issues.

And of course, as the Fit Pro – we benefitted greatly. Pelvic health issues have no outward signs – it is not something that you can peg on how someone walks, what they wear, or how they look. Pelvic floor dysfunction comes in all shapes sizes. However, there is such a thing as exercise induced incontinence or exercise induced prolapse. This was the best diagnostic way to have the “inside knowledge” of just how at risk a client was. A report sent back to me from the physio to the trainer with all the relevant information on how to best support each individual client.

It was also a WIN for the Allied Health professional. They were introduced to new clients, who were more likely to return to them when and if they had other issues in the future – as they were a trusted and known professional. As well as knowing that they had a team of fitness professionals who were supporting the mutual client with monitoring the exercise prescription and execution.

mishfit® Care Package

I called this arrangement the mishfit® Care Package. And it also included options with a registered dietician for those clients who were also wanting weight loss.

This system not only boosted our professionalism, but it also gave the business an additional revenue stream.

Terry Wesselink

Terry Wesselink was one of our original pelvic health physiotherapist partners. Terry has not only been a great source of wisdom and knowledge, but she was also one of the first pelvic health physiotherapists who was genuinely excited about the benefits of a partnership, like that of the mishfit® Care Package could represent in holistic health for women. Terry promoted this idea amongst many of her collegues and together we have broken down stereotypes and the outdated women’s health models.

Terry now leads the team at the Continence Foundation Victorian Branch and is responsible of the full operation of this peak body organisation. This includes pelvic health education, resource development, health promotion and managing a busy NDIS continence clinic. 

I asked Terry to put her pelvic health physio hat on and tell us about:

Why do you think it is important that fitness and physio work together?

Health is something that needs to be actively pursued and pelvic health is no exception. I have learnt through experience that we cannot sit by passively and expect optimum health to be delivered to us. Quick fixes on their own, often have short lived results. In order to have good pelvic health in the long term, we need to understand how to exercise our pelvic floor and core muscles safely and effectively and then do that exercise regularly.

In my mothers era, women didn’t know they had pelvic floor muscles and even today the majority of women need some guidance in learning how to exercise their pelvic floors (and the rest of their body) safely and effectively.

Even if every physiotherapist who ever qualified, switched to women’s health there would not be enough of us to help every woman out there with a problem.

To give you some idea of the scale of the problem, take a look at these statistics:
1 in 3 women has a problem with incontinence,
Some women have overactive pelvic floors or pelvic pain, and
50% of women over 50 years have some degree of Pelvic Organ Prolapse.

I believe:

• While some symptomatic women really should have a physiotherapy (or medical) assessment and treatment, not every woman who is uncertain about how to exercise safely needs pelvic floor physiotherapy.
• Fitness instructors are already in the business of teaching correct and safe exercise, it makes perfect sense for them to also be involved in helping clients with correct pelvic floor activation.
• Fitness instructors are also at the frontline of health and can easily screen their clients for pelvic floor issues.
• Fitness instructors have their client’s trust and can encourage those who need extra help to seek it in the right place.

And as I mentioned earlier, exercise is really important in the pursuit of health. I also need to be able to refer my patients to fitness instructors who understand how to help my patients exercise safely and in a way that is appropriate for their particular pelvic floor issue.

I need fitness instructors I can talk to about my patient’s needs.

How do you see a service like the mishfit® Care Package helping women, regardless of whether they are symptomatic or not?

The mishfit® care package was a great way for women to have a brief session with a Women’s Health Physiotherapist and find out how well their pelvic floor is working. Being able to see how their pelvic floor is working on Real Time Ultrasound is a real eye-opener for many women. Many women gain extra confidence in their ability to activate (or relax) their pelvic floor muscles and some women learn the right action for the first time. Incorrect pelvic floor technique is more common in women who have symptoms, but can occur is asymptomatic women too. Getting the technique right can prevent problems developing in future.

After the Real Time Ultrasound, I could give the mishfit® instructor clear objective information to help her chose the right level of exercise and progression for each woman.

I believe it’s really important for everyone involved in your health to have access to the right information.

What are your top tips for women who need pelvic floor support?

Learning to use your pelvic floor muscles correctly is both learning a new skill and establishing a new habit and the first step in learning any new skill is to get the right instructions and instructor.

1. Make sure you understand the instructions and aim to perform the new skill correctly from the start.
2. Learn to self check or ask your instructor to check that you are performing the new skill properly.
3. Practice your new skill often to gain confidence in your ability.
4. Apply your new skill in lots of different situations to become a master.
5. Once you have mastered the skill, then work on your strength, coordination, speed etc.

It’s easier to establish a new habit if you associate it with an existing habit.
I work with my clients to identify appropriate habits to associate with their new pelvic floor muscle habit.
It is a true advantage if you have an instructor (fitness professional) that helps women to establish their new pelvic floor muscle habit as part of the exercise classes.

Where can people find a pelvic health physiotherapist?

The National Continence Helpline  has a directory with suitably trained  physiotherapists from all over Australia. Or alternatively you could ring the National Helpline 1300 33 00 66 which is staffed by continence nurses, that can help you trouble shoot any sort of pelvic floor / continence queries.

People don’t need a referral to make an appointment with a physiotherapist, but if they have symptoms, then they can speak to their GP to see if they are eligible for an Enhanced Primary Care Package which entitles them to a Medicare rebate for some of the costs.
If they have private health cover, they can check with their insurer what cover they have for Physiotherapy treatment.

Pelvic Floor education is important for everyone… what can you recommend?

The Victorian Continence Resource Centre has a great resource called Reclaim your Core – which I highly recommend:

Click on the image to purchase

 

 

And I am sure Mish, you might remember helping me with the many edits of my own book – WeeFree Women!

From Mish:

Terry is caring and funny and what is more – loves promoting Fit Pro’s who share our vision of working collaboratively to get women moving, and keep them moving – safely! 

If you are a Fit Pro and especially if you are working with women, I strongly recommend that you connect and build a relationship with a pelvic health physiotherapist near your practice, to enhance the services you provide. Although this can be a WIN WIN WIN situation, don’t be disheartened if you meet an Allied Health Professional who does not seize this opportunity… keep looking – because connection, my friend, is the way of future proofing your business!

Can you find a Terry in your community?

If you’re a fitness professional or any other service provider for women and want to become an EVEolution™ partner CLICK HERE.

If you’re interested in learning more about EVEolution™ CLICK HERE.

 

If you enjoyed this blog…. you might also enjoy these ones.

Just click on the image below!

If you would like a FREE copy of Active Pelvic Practice meditation — be sure to read to the end!

I started out in the fitness industry, like many Fit Pro’s did, running group classes. mishfit mothers™️ was my signature group exercise program. Women could bring their bubs and kids and for many mums, this was their preferred option rather than put them into childcare. Most of the time the babies and toddlers played nice. But there were times it was very chaotic and I would often teach the classess with one baby on my hip!

On joining the program all women were encouraged to visit their local pelvic health physiotherapist and have an assessment. This meant that I was better able to train them, because then we both understood where each client’s pelvic floor was at. mishfit mothers™️ followed a 10 week exercise program that slowly built on both cardiovascular and  muscular strength.

Most group exercise classes do this, right? But this program was a little diffferent.

Let me explain why

My clients had common (and some not so common) issues addressed in a supportive environment.

Every woman started with an assessment form that covered:

• their birth — was there any trauma, including epistimolgy
• a physical diastasis check (the splitting of the abdominal muscles),
• questions about incontinence (both fecal and urinary),
• questions about prolapse (and information about this condition if it was an unknown term)
• questions around periods
• questions around physical pain — especially pelvic and lower back
• questions around mental health questions. What support were they getting at home? How was their sleep? How were they feeling about their body right now?
• many open ended questions that allowed them to share as much as they were comfortable with

This gave me the opportunity to provide health promotion, the resources that are available (that aren’t always know about) that support women. I had a band of Allied Health partners (dietitians, physiotherapists, mental health specialists, naturapaths) that I was able to confidently refer them to,  because I had personally vetted their services. This important initial conversation also created a safe environment where they could come back for trusted information and non-judgemental support.

Most women formed strong bonds within the group as they navigated motherhood together while working out 2 – 3 times per week. And when the wheels fell off the bus, as inevitably they do for both children and the mumma’s, we were all there to step in with a tissue, listen, laugh and support.

mishfit® Personal Training won many awards because matching physical training with education worked.

Delivering this program week after week, year after year

 was how I learnt my craft.

I have put my fingers into the soft belly flesh of literally hundreds of women to check for diastasis. This is an essential post-birth assessment (though usually overlooked), as diastasis can really affect the ability to contract the core muscless effectively and may affect continence, lower back pain and even the look of the postnatal belly.

I have listened to numerous birthing stories, watched these babies turn into toddlers and then go off to school.

Following up with the women’s health phsyiotherapist after each client’s assessment greatly deepened my knowledge of pelvic floor issues and how to accomodate them as part of our exercise programs.

And still to this day I remind women that this is an absolutely essential first step to understand exactly what is happening for them when they experience incontinence, prolapse, painful sex or other pelvic concerns. Pelvic health is a large and complex area and I can never presume to know better than the experts.

I am a teacher, but I have a huge passion for learning. Over time I worked out exactly what the messages women needed to hear to empower them to make wise exercise decisions for their body at that time. I was able to craft them succinctly. And to ensure that all women received all of the knowledge I had to impart, I scheduled the messages into the 10 week program.

Every session was bookended with partner stretching and a pelvic floor meditation. We never skipped this part. I watched the women lie down, visibly relax and take this precious 10 minutes to re-center. for many women it was also the only time they dedicated to strengthening their pelvic floor (in isolation). We all know pelvic floor exercises should be practised daily… but how many days has it been since you last thought about them?

The role of hormones have an enormous influence on our physical body and how it responds to exercise. Exercise raises cortisol and that is not necessarily a bad thing, as that is how we get stronger. However too much cortisol can impact on sleeping habits, weight gain and overall wellness. What I saw on the faces of the women who lay down, closed their eyes and went within, backed the research that including a short meditation in an exercise session was incredibly beneficial.

I wanted to create a resource that women could use on the days that they were not working out with me. And so I partnered with a beautiful meditation teacher — Sara Brooke from The Space in Between to create two meditations:

1. A meditation. Just like the one I had honed at the exercise class. But I also wanted to embed powerful messages. Sara knows all the science around the crafting of a meditation, the power of music and the appropriate tempo and tone of voice to allow the mind to accept these messages.
2. An active practice. The research makes very clear that pelvic floor exercises in isolation (i.e. when you are not moving, and completely focused just on these muscles) strengthen the pelvic floor and positively impact incontinence and prolapse symptoms. However, we need to condition our pelvic floor to switch on when we are lifting heavy washing, putting our toddler into the car seat, running after said toddler and of course when we work out. This active practice programs the brain to think about switching on your pelvic floor when you lift, move suddenly, cough or sneeze, until it becomes your habit.

Together we physically created the CD’s with barcodes (remember those things!) and also put it up on iTunes. WOW, another professional learning curve! I charged $35 for the double CD and sold plenty.

Here is what others have said about Active Pelvic Practice — the Gift of Inner Strength:

“This CD set is a brilliant tool, not only for better health but for improved wellbeing. A stroke of genius to combine positive affirmations and pelvic floor exercises. Talk about efficient multi-tasking!”

Claire McFee, Author of Organize Your Health and Wellbeing Naturally

“As a Women’s Health Physiotherapist, and mother of two, I believe Active Pelvic Floor is a wonderful tool to help guide and motivate you in your pelvic floor exercises.”

Hillary Schwantzer, Inform Physiotherapy.

“Active Pelvic Practice has turned my life around. With a holistic approach to vitality and fitness this program has worked from the inside out. It has strengthened my pelvic floor and my confidence, in intimacy and in living a vital life.”

Thea Bates, beautiful client

Starting November 9th, my friend Deb Johnstone has put together a free online event with over 7 expert women in midlife (plus me!) to help women in middle life create the life they love.

I had a great time in the interview (pre-recorded), sharing my passion and three effective tricks to exercising safely. Deb asked each of the presenters to provide a free gift. I knew exactly what I would like to gift for women who join us — a copy of the Active Pelvic Practice meditation!

As CD’s are a bit of a relic, and to get it from iTunes will cost $35, I have re-released it as an MP4 file which is easy to access via your phone, plug into your ears and go! Go and reduce your cortisol, take time to relax and strengthen your pelvic floor!

If you would like to join me and Deb and seven other amazing speakers

And you will receive the Active Pelvic Practice Meditation for FREE – as my gift to you!

Please feel free to share.

If you’re a fitness professional or any other service provider for women and want to become an EVEolution™ partner CLICK HERE.

If you’re interested in learning more about EVEolution™ CLICK HERE.

 

 

 

 

 

 

And if you enjoyed this article you might also enjoy these:

Just click on the image

Most women accumulate the risks of prolapse over time. Although just one may tip you over the edge, they are certainly not usually in isolation. Understand the 10 most significant risk factors for prolapse. Being fore warned is being fore armed.

49% of all post natal women will experience prolapse*

So if you have had children, you have one chance in two of this being you.

* Statistics from Continence Foundation of Australia

Often when women experience prolapse, they can pin point it to a single activity. Here are a couple of examples that have been given to me:

• straining to quickly do a poo
• lifting a heavy wheel barrow at a school working bee
• pulling down a broken garage door

For other women prolapse can’t be pinpointed to a specific activity, but was a feeling that something wasn’t quite right down there. Many women have described finding their prolapse in the shower while washing themselves. And the discovery can be quite a shock. For many women prolapse is not even a word or issue they are familiar with. And Dr. Google can be incredibly confronting.

If you are not 100% sure what prolapse (also called POP – Pelvic Organ Prolapse) – then I recommend this blog – Prolpase 101

It is easy to assume that your prolapse was caused by a single incident. Or an unfortunate by-product of childbirth. But the reality has a lot more layers. In fact, prolapse is more often a build up factors and with only one being the straw that breaks the camels back.

When we unpack all the details of how we move, work, breathe, deal with stress, how we birthed, our toileting habits and exercise history – a larger story unfolds.

It may have been the one movement that caused the prolapse, but rarely was is it the starting point.

Understanding your unique set of risk factors can really help you make informed daily and larger life decisions.

Here are my top 10 to be aware of!

1. Exercise Induced Incontinence. Exercise Induced Prolapse

Yes, it is a thing. And it is not limited to women. Men can also rectally prolapse, have incontinence and erection problems from pushing weights that are too heavy. Weight training is essential, especially for bone density as we age. But we need to lift to our weakest point. The pelvic floor is a muscle like any other – it can get weak with little use, tired from over use and increase in strength with correct training. We want to aim to build pelvic floor muscle mass, much the same way you would with other muscles. And just because you can’t flex it in the mirror, doesn’t mean it is not important.

High impact cardio exercise, trampolining and gymnastics top the list of exercise options with worst pelvic floor outcomes. There are lots of ways to modify to get the sweaty work out you might crave and remember that they may be off the table for now, but train right and they might be able to return to your exercise regime in the future.

To read more about how you can negate pressure on your pelvic floor – check out this blog – How to say NO! to your Personal Trainer.

My advice:
Find out if your trainer has certified education around pelvic floor. Women specific training, especially practical information around pelvic floor and exercise prescription is not covered in Certificate III or IV in Fitness. If they look blank at your question, this trainer is not for you. If they do not ask you about your pelvic floor as part of your initial assessmen, this trainer is not for you.

I have written a number of research based education courses to help Fitness Professionals better work with women. You can find them here!

2. Multiple births or birth trauma

If you are postnatal (and postnatal is not limited to having small children, but is your considered life stage until you either get pregnant again, or hit menopause) – then you are at risk of prolapse. The more children you have, and the older you are when you have them –  increases your risk.

Physical birth trama is something that may or may not be indentified right away and may include:

• perineal tears
• episiotomy (the incision made in the perineum during childbirth)
• pelvic floor muscle damage, including levator avulsion
• pelvic fractures
• pelvic organ prolapse (POP)

My advice:
If you already have a significant prolapse, or levator avulsion – explore your options to have a C-section instead of a vaginal birth. And for each and every birth take time post birth to heal.

For more information and support around birth trauma – be sure to check out Australasian Birth Trauma Association (ABTA).

3. Are you a bendy person?

Hyper-mobility of our joints and ligaments affects our whole body, including pelvic floor and all the fascia that holds up our internal organs (ie: bladder and uterus). If you can do any of the things in the image below (or take the beighton score here) your hyper-mobility will definitely impact on the ability of your pelvic floor to work with gravity and other strains on your pelvic floor.

My advice:
If this is you, be super observant and movement conservative just before you menstruate, or on the first few days of menstruation – with the added hormone of relaxin you may be able to become a human pretzel… but just don’t.

4. Tummy Grippers

This is very common with new mums. They have their babies and look down on their tummy in dismay. In order to minimise their pouch, they suck it in. This sucking in becomes their normal and after awhile, they hardly recognise that this is what they are doing. These same mums might go to pilates, with even more emphasis on “core” or told by their yoga instructor to “pull their belly button to spine.” But never reminded to relax their abdominals and obliques. To test if you are a tummy gripper, breathe deep and watch if only the shoulders move, and not the belly. 

Why does this matter?

Your breath initiates the movement between diaphragm and pelvic floor. Inhale and diaphragm descends and pelvic floor relaxes. Exhale and pelvic floor contracts. This is the correct symbiotic relationship between diaphragm and pelvic floor. No muscle should ever be ON or OFF all of the time, not if we want to move for optimal functionality and be pain free.

Gripping your abdominals and then adding extra intra-abdominal pressure eg: loaded movement,  your pelvic floor will wear the load.

My advice:
Channel your inner Homer Simpson… he never, ever cares about holding in his tummy. Give permission (at least once per day if you are a serial tummy gripper) to let your tummy be where it wants to be.

If you are doing intensive core workouts, make sure in the conclusion stretch you specifically allow your tummy muslces to relax.

If you are told to suck your belly to spine by your fitness professional / yoga teacher etc, IGNORE this cue and instead, draw in your pelvic floor and feel the your deep abdominal muscles (transversus abdominus) contract naturally.

And then take this opportunity to breathe deep. If you experience anxiety… this advice is especially important to you.

5. Constipation

Who talks about constipation? Exactly… and therein lies the issue! Straining over your stool (poo) creates massive pressure on your pelvic floor… and for many women who have never experienced constipation before – it can happen right after child birth, when your pelvic floor is already at risk!

If this is you… and you know that you don’t / can’t eat enough fibre, or perhaps it is  a part of your normal toileting behaviour… please, please, please don’t labour over your poo. There are plenty of cheap / easy / edible products that can soften your stool and improve your toileting behaviour. Plenty of water is a must.

Oh and check out this delightful video:

My advice: A stool for a stool!
You don’t have to purchase a squatty potty (in fact they don’t ship to Australia at the time of writing this), but you may already have a little stool that your kids use to reach the tap – keep this handy for your number 2’s!

6. Repetitive heavy lifting

This is different from your exercise routine. I want you to think about your life and the regular heavy lifting you might do.

This might include:

• lifting your toddler/s into the car
• gardening
• caring for another adult, that involves lifting
• basket of heavy washing
• carrying ALL your shopping bags in one trip from the car
• DIY around the house
• carrying heavy suitcases up and down stairs
• with your job ie: baker, nurse etc

What you need to remember is what is heavy for one person, may be light for someone else… so it is difficult to make hard and fast rules. But repetitive lifting (and many of these things listed above fall into that category) is what we want to be mindful of. As a mother it may be impossible to NOT do these activities, so learning how to lift correctly is key.

My advice:
Learn to squat using your butt, rather than your back.  Push from the ground using your legs and exhale, audibly, on the hardest part. The heavier the object the louder your exhale. The heavier the object, the more mindfulness on your pelvic floor contracting.

7. Smoking and /or seasonal hay fever / whooping cough / flu

It may seem odd to put these together, but all of these represent constant coughing, which in turn places ongoing stress onto your pelvic floor. We know smoking is bad for your lungs, however that persistent smokers cough, does no favours for your pelvic floor either.

Suffering from seasonal hay fever or catching a bad cold or worse, whooping cough can also play havoc.

My advice:
If you know you get hay fever, have the drugs on hand to deal with it. If you are opposed to taking medication, although it has been disproved, many people swear by ingesting a small bit of locally sourced honey each day for a few weeks  leading up to hay fever season.

For coughing fits: Sit down and use The Knack.  The knack is Make sure (like number 8 below) you take time to recover afterwards. Check out the video below how to do the knack!

Michelle Kenway – short video on how to do the “knack”

8. Vomiting

Vomiting, much like the list for number 7, represents enormous pressure on your pelvic floor. And although nobody likes to get a vomiting bug, it can happen to the best of us. And with young children attending day care, it can be difficult to escape when the vomit bug does the rounds.

I devoted a whole blog to this one here.

My advice:
Keep your distance from people who have had a vomiting bug and be sure to wash hands with soap before eating. After the vomiting has done it’s dash, make sure you allow time for your pelvic floor to recover – it will have just had a marathon work out and it may need extra time and care.

9. Your weight makes a difference

I am a big believer that healthy weight comes in all shapes and sizes, however, loosing just a few kilo’s can make a difference to your pelvic floor.

My advice:
Be mindful of how your weight affects your leakage. Notice any correlations and find the weight that works best for you and your body.

10. Age and menopause

Gravity and time affect us all. We see this in our skin, as a natural part of ageing. The saggy and thinning effect on the outside, is equally reflected on the inside. Add into the mix the hormone upheaval of menopause. For many women who managed the whole childbirth and lifting babies, menopause is the straw that breaks the camel’s back.  For the 50% of women who experience prolapse stistically, they are likely to do so during this changed hormone environment.

The main hormonal changes that come during menopause, is the decline of estrogen. Estrogen is responsible for elasticity and repair of our tissues. Estrogen decline is not only responsible for wrinkles, but also our loss of bone density. Weight training is essential for all older women to ensure strong bones for the later stages of life.

Also it should be noted, that if you mother or grandmother experienced prolapse, your chance is higher still.

My advice:
Absolutely include weight training for bone density and remember if you don’t move it, you loose it… but look at either getting training advice that is suitable for your age and stage of life, or learn to modify. Most of all, don’t forget to listen to your body!

Most fitness programs have been designed on men, by men, for men. They simply don’t accommodate the changing hormones in your life cycle of pregnancy, post-natal and menopause.

For Fitness Professionals, I have several online courses to help you train women who are peri-menopause / menopausal and post-menopausal safely and effectively – you can find them here

Leaking a little bit of wee (or poo) is actually your body telling you that it is struggling and needs some extra support, attention, care and love. However, getting back on the Kegel (pelvic floor contraction) band wagon may not be the answer either, and could make your incontinence worse! It is essential that you get the right diagnosis from a trained professional to work out exactly why you are leaking.

Other factors to trigger further investigation with a pelvic floor specialist:

• Do you have tampons that fall out or push out of place?
• Do have any heavy sensation around the vaginal area?
• Do you have painful sex or reduced sexual pleasure

If you are ticking quite a few things on this list, all is not lost. But do be more mindful. Learn the skills, or seek someone who can teach you the skills to move, walk, lift, breathe, and perform daily functions that work with your pelvic floor and intro-abdominal pressure.

My goal is to help women navigate exercise safely. Prolapse and other pelvic floor issues are NOT life threatening, but inactivity is!

I am creating a short course for women to help women work out safely – no matter what kind of exercise you do!

If you’re a fitness professional or any other service provider for women and want to become an EVEolution™ partner CLICK HERE.

If you’re interested in learning more about EVEolution™ CLICK HERE

If you enjoyed this blog – here are some others that you might also enjoy!

Just click on the image below:

A just-in-case wee might be something that your mother encouraged you to do before you left the house as a child. It might be something that you still do, or tell your children to do. But what if this piece of advice creates habits that are at cross purposes with good continence practice? Here’s how:

Women who are practising the just-in-case wee may be unintentionally shrinking their bladder size. The smaller the bladder size, the less urine it is able to hold, the more often you need to go to the toilet. However, training your bladder the right way means that you are able to enjoy adventures without the need to know where every nearest toilet is located.

Here are the real stories of two women (their names have been changed). However, over my many years as a Personal trainer working exclusively with women, I heard numerous variations of these stories.

Perhaps these stories resonate with you too.

Linda

Linda was in her early 60’s when she came to see me at my private mishfit® PT studio. Linda had a social life that many would be jealous of. She looked after grandchildren several times per week and loved to craft. It was Linda’s goal to travel to Europe with a group of  sewing girlfriends later that year.

However, Linda shared with me that her life was dictated by where the toilets were located. Yes, Linda had incontinence. But more than that, she had anxiety about her incontinence.

Linda’s biggest fear was to not make the toilet in time and disgrace herself in public.

Going out for Linda was carefully planned around where all toilets were located. Linda knew every public toilet at her local shopping mall. In fact, she knew every public toilet as part of all her routines. This meant that experiencing new places was a secret source of worry. Instead of admitting the shame of her inability to hold her bladder to those around her, Linda was more likely to make excuses and opt out and stay near to a toilet.

Linda shared the example of going with her family to the beach where after the picnic, there was always a walk. For many years now Linda had been opting to stay and keep an eye on their things, rather than join them. She wanted to go on that walk, but the fear and anxiety around how long the walk would be and if there was a toilet nearby was too debiliating for her to go. And her family had stopped trying to convince her to go.

Linda worried that if she did get to Europe with her girlfriends, that she would miss out on all the walks and end up only seeing the inside of her hotel.

Linda’s incontinence anxiety was making her inactive. Which in turn, further decreased her confidence in living her life to the fullest.

Mary

Mary was in her early 30’s and came to see me after the birth of her second child.

At our initial consultation I asked her about her toileting habits. Mary told me that she had suffered from Light Bladder Leakage (her words) after the birth of her first child. Mary had started being very careful about emptying her bladder before she left the house, whenever a public toilet presented itself and most certainly before she exercised.

Mary believed that she was minimising her risk factors of leaking.

When I asked Mary to count up the number of times she went to the toilet, she admitted that she had never really given it much thought. Mary counted at least 12 toileting times over a 24 hour period. Mary admitted that she did not wee very much each time. And with often forgetting to drink water, her urine was usually dark in colour.

Mary was habitually going to the toilet just in case.

The normal range of having a wee is between 4 – 8 times in a 24 hour period. And our bladders can hold up to 400-600 ml of urine (with the sensation of needing to empty starts at around 200-300ml’s). 

Mary was actually a younger version of Linda. Linda had also started her just in case wee habit after her postnatal incontinence. Linda did not suddenly wake up one day and find that her life outside her house was dictated by the proximity of a toilet. This behaviour had thoughtlessly become her normal over time.

Both Mary and Lynda had not really given much thought about their toilieting habits. Or just how much these habits might be influencing their continence.

Mary looked at me and she said that Linda reminded her of her Aunty.

A just-in-case wee is a learned toileting behaviour. However, a habit can also be un-learned.

Our bladders, if not allowed to experience fullness, will shrink in size. Keeping your bladder in healthy proportions means that we need to monitor our toileting and ensure that we are not emptying it until it is full (or near to it). The bladder system, complete with a valve system, works best when it is in the right position (so hence can be misplaced with a bladder prolapse) and when it is allowed to be full and then emptied. When there is only a little urine in the bladder, the urine can become very acidic and thus further irritate and cause more issues and / or pain.

It is never too late to change your habits!

Here are 3 tips to improve your toileting behaviour:

1. Toileting Inventory. Start a taking a note of how many times you go to the toilet in a 24 hour time frame. If you are are going to the toilet more than the normal range of four to eight times in a 24 hour period: Stop and ask yourself each time you feel the urge, do you really need to go? Or is it your just-in-case-wee habit. Can you wait a little longer? Decreasing the amount of times that you go to the toilet will take time and effort. But it always starts with awareness.
2. How full is full? Recognise the feeling of a full bladder. One way to quanitfy a full bladder is to count in seconds how long it takes you to empty your full bladder. This will probably be the first wee in the morning (if you are able to not go during the night). This number can then become the bench mark of your full bladder. Count your wee at other times of the day and compare.
3. Self talk and good breathing techniques. Monitoring your self talk is also very important. If you are repeating the mantra; “I’m going to wet myself. I am going to wet myself” as you rush to the loo, there is a very good chance that you will be a self fulfilling prophecy! A better mantra would be to breathe deeply to settle any anxiety and repeat ” I can do this. I am in control of my bladder.”

The place where women most often feel anxiety around not making it to the loo in time, happens at the front door! This is actually so common, that it has the name keyhole incontinence!

So, if you find yourself with your arms full of groceries, hunting frantically for your house keys while desperately trying to keep your bladder under control…

Here is the best trick of all:

Perform a series of quick pelvic floor contractions – we call these flicks. Flick your pelvic floor on and off  as strong as you can muster. With practice and with accompanying positive self talk you will give yourself some time to calmly find your keys, unlock the door and get to the toilet on time!

Doing a just-in-case wee may be something that you have been told as a child, or perhaps you have used it as a strategy to deal with your incontinence. That’s ok. But it is not the best one to ensure that you stay active and enjoy life to your fullest. And sometimes your urgency to wee is a symptom of other issues. Investing in a pelvic health professional will ensure get the right help for you. And you deserve to live full of adventures. 

For more toileting tips and techniques to help yourself and your children, the CFA has many dedicated resources for you to use and share.

And, I am very happy to report that Mary mindfully changed the direction of her continence habits and Linda went on to enjoy a much anticipated European trip with her sewing girlfriends!

 

If you’re a fitness professional or any other service provider for women and want to become an EVEolution™ partner CLICK HERE.

If you’re interested in learning more about EVEolution™ CLICK HERE.

If you enjoyed this blog – Please share and / or leave a comment below.

Click on the images below to read some more good stuff!

Don’t know what prolapse is?

If you enjoyed this blog…

You might also enjoy these ones – Click on the image!

I have worked as a PT specifically for women, I have worked with numerous Fit Pro’s and I am a mum, often working out with other mums … yet there are still myths that still I hear over and over…

These myths only serve to hold women back, so therefore NEED to be dispelled!

Myth 1: “It’s normal to leak when you’re are a mum and work out”

Yes, it is common. Check these statistics. Have you seen the mass exodus of women to the toilet just before the high impact track comes on?

Yes, incontinence is common. But it does not have to be your normal.

Leaking a little wee, LBL (Light Bladder Leakage), loosing full control of your bladder or bowel, is your body’s way of asking for help. It is struggling! There are many reasons why this is happening and it is important to know that just doing more pelvic floor exercises, might not be the answer and in some instances may make it worse!

When you experience LBL or leak a little wee… this is a perfect time to address the problem. And the first step has to be a correct diagnosis of what the problem is. This can only be done by a Women’s Health Physiotherapist / Pelvic Health Physio or other Continence Specialist.

Often sorting out the issues when it is just (sometimes) leaking a little bit of wee, can really save money, time and grief in the long term.

Myth 2: “If I empty my bladder before I leave home / work out / go for a run, I won’t leak”

Possibly… but there is much more at stake with this myth.

Let me tell you about Francine.

Francine is family-loving Nana and leads an active life. However, every trip she makes, whether it be to the shopping mall or going to her weekly activities, Francine knows every toilet en route. And just to be safe, she always goes to the toilet when the opportunity presents itself… just in case.

Now Francine goes on a family trip to the beach with her children and grandchildren. After lunch the family decide to go for a walk along the beach. Francine opts to stay behind to mind the bags.

“But we can put the bags in the car Mum, you don’t need to miss out!”

“It’s ok,” says Francine. “I’m too full from lunch!”

The reality is that Francine does not know if there will be a toilet on the way, or even how long they will walk away from the toilet she is near. The fear of not being able to make it and possibly having an accident in public, is simply too stressful.

Francine, now unwittingly, starts opting out of life.

Francine’s just-in-case-wee has over time, has caused her bladder to shrink. This means now it is not physically able to hold as much as it had in the past. Because her bladder is now never full, the urine is strong which irritates the bladder and makes Francine feel even more like going to the toilet, even when she doesn’t need to.

Couple this with a couple of incontinence incidents, Francine is now incredibly fine attuned to her bladder’s demands and harbours a great deal of anxiety around not having enough time to get to the toilet.

But Francine did not suddenly wake up one day with this toileting behaviour.

She has trained herself over time. And in fact this behaviour can be traced to a much younger version of herself – as a new mum, struggling with pelvic floor dysfunction post birth. Francine can also remember her own mother exhibiting the same behaviours around toileting. Francine had been told as a child, just as she told her children and now her grandchildren “Go to the toilet just in case!” Francine has conditioned her body, over time to behave this way. And now it is virtually impossible for her to behave differently.

Your toileting habits add up and make a huge difference in the long term.

Choose early how you want to live when you are older.

Myth 3: “My work-out is not related to my incontinence”

Allow me to share my story.

I had had my 2 kids and did not have any pelvic floor dysfunction. When my youngest baby turned one, I decided to change my career from the sedentary life style of teaching to becoming a Fitness Instructor. I spent the next year pushing myself physically to get into shape. (Or get into the only perceived shape I thought that people would take me seriously as a Fit Pro). It was during this time, I noticed that my incontinence started. But it was only sometimes.

It was easy to ignore.

The next year, when I went to study Certificate III and IV in Fitness, I was pretty keen to find out as much as I could. I would have dearly loved to have asked my tutors about my personal leaking, but in a room of new school leavers I just couldn’t. So apart from a few titters of laughter and stray comments from other mums at the gym, I was left thinking that I was the only one suffering. How could I have, what I thought of as, an old lady affliction when I was just 34?

I sincerely hoped my incontinence would just go away , but instead it started to get worse. Much worse.

It was not until I was teaching Body Pump to a sea of people who were eye level with my crotch, that I simply could NOT take the stress of worrying if I would leak through the pad, or that they would see the tell-tale pad bulge, anymore.

I went to my Dr. who sent me off to a Women’s Health Physio and she told me in no un-certain words, I had exercise-induced-incontinence. My work out was too hard for my pelvic floor, she said, and it was simply not coping. I was devastated. Working out was my sanity pill and now, my new profession.

It seems crazy that I did not completely or immediately equate my high intensity work out with my growing incontinence concerns. If I am completely honest, I did not even want to make that correlation. And hence why I had suffered in silence for so long and to the verge of prolapse.

Myth 4: “I have a weak core and that is why I do pilates and / or yoga”

The words “weak core” amuse me. Do women this term as an euphemism for “wetting my pants” or are they just repeating a phrase that the Fitness Industry has thrown at them?

Your core consists of a group of muscles, not just the rectus-abdominal that sits on top in the front (and can be flexed magnificently with a low percentage of body fat and considerable training). Your core actually refers to the much more important (and smaller) muscles that sit under the Rectus – the transverse abdominals, your pelvic floor, your diaphragm and your back muscles.

These muscles all need to be strengthened subject to one another. Having chiselled rectus and weak back or pelvic floor muscles, will undoubtedly challenge the tensegrity of these muscles working together and may result in dysfunction or pain.

Yoga and pilates are only as good as the instructor’s understanding of the core system and the impact intra-abdominal pressure has on pelvic floor. Cued incorrectly, and these “pelvic floor safe”* exercise options can push a weak or stressed pelvic floor to breaking point.

*I call BS on the term “pelvic floor safe exercise” – thinking that one exercise can damage or fix is pure folly. There are many more factors in play that you need to aware of.

Myth 5: ” My Fitness Instructor / PT is a mum. She knows about this stuff”

Anyone who enters the Fitness Industry does so because they genuinely care about people. Fit Pro’s truly want to make a positive difference in people’s lives. They are some of the most passionate people you can come across. And you have to be – because it is not the profession to choose if you want to make zillions of dollars!

However, when the Women’s Health Physio told me that my pelvic floor was not coping with my work out, I went immediately back to my text books to learn more. And to my horror I found that pelvic floor was not even in my anatomy books.

Pelvic floor as a muscle was completely omitted!

And although there was a little information around training pregnant women, there was absolutely NO information on exercise modifications for postnatal women. It would seem that when the baby is out, you can magically go back to training as you had before!

A Fit Pro who is also a mother absolutely brings their own personal experience into their work. But your personal experience does not and can not possibly include the myriad of issues that you need to be aware of when training pregnant / postnatal / menopausal women. Issues such as pelvic floor dysfunction, DRAM, pelvic or sexual pain. These require specialised learning that is simply not included in our current fitness qualifications.

It is not in a Fit Pro’s scope of practice to diagnose and fix these issues.

However, a Fit Pro is perfectly placed to start that conversation.

Ideally they would be able to provide links to other health professionals who can help. Fit Pro’s can learn how to modify workouts, so that women can remain active and enjoy all the physical, mental and emotional benefits that exercise gives.

Being pregnant, postnatal (no matter how postnatal) or going through menopause each bring challenges that need to be acknowledged and addressed when designing fitness programs. And being a woman is not a “special population” as some label this type of education.

There is absolutely no way that all of this information is innate in someone who is both a Fit Pro and a mum.

If you are a Fit Pro or are working with one, that needs some extra education – check out all the options here.

If you’re a fitness professional or any other service provider for women and want to become an EVEolution™ partner CLICK HERE.

If you’re interested in learning more about EVEolution™ CLICK HERE.

 

If you enjoyed this blog…. you might also enjoy these ones.

Just click on the image below!