I am embarrassed to say that I have been hoarding this little gem away for the last 6 months. In my defence I started an intensive training program the same week I finished this. Alas, its timeless…. read on for some advice to savour.
An interview with Jodi Ganton, BSc PT from Rise Health on leaky bladders, ‘just in case pees’, planks, and everything in between.
When you feel a tickle in your nose and know a sneeze is on its way do you quickly cross your legs in anticipation? Do you avoid running at all stakes or go pale when your children beg them to join them on the trampoline? The fear of leaking urine has severely impacted many women’s lives and has been normalized for far too long. Many women leak urine when they sneeze, cough, laugh, run, or jump. This leaking, also known as Stress Urinary Incontinence (SUI) is a sign of pelvic floor dysfunction, and just because someone has given birth does NOT mean they should leak. It is not normal and there are specialists who can help you, like Registered Physiotherapist Jodi Ganton based out of Victoria, BC. She joined me for coffee to discuss what exercises could be negatively affecting your pelvic floor health and the importance of visiting a pelvic floor specialist.
Since 2000, Jodi Ganton has been honing her skills as a pelvic floor physiotherapist. A niche that very few physiotherapists zone in on. In Victoria there are only six, and only about ten on the entire island itself. Since it is not deemed a specialization by the College of Physiotherapists in Canada, those who call themselves pelvic floor physiotherapists have sought out training through privately offered courses. Since there are no flowsheets and no set guidelines, finding a pelvic floor physiotherapist who has a lot of experience, has taken relevant training, and is up to date on current research is of upmost importance. I first met Jodi as a patient and after spending more than an hour chatting with her I was blown away by her wealth of knowledge, passion to educate, and her willingness to share. When I approached her and asked if she would share some information to help fitness professionals like myself to appropriately train their postpartum clients, she willingly agreed.
What does a Pelvic Floor Physiotherapist do?
I specialize in dysfunction of the pelvic floor, bladder and bowels, sexual dysfunction, pain in the pelvis, hips or lumbar spine. Along with the boney structures I also assess the muscles of the pelvic floor via internal exam. Some Physios (PT) say they treat postpartum women and incontinence yet don’t do internal exams which I feel is not thorough enough. Along with perinatal women I also see older women and men.
Do you use ultrasound in your practice?
I have taken a course on real time ultrasound and I see the value in it. It gives visual feedback to the client. However, ultrasound can assess whether muscles of the pelvic floor are contracting or not but no information is provided about the tone of the muscles.
When should a pregnant woman visit a Pelvic Floor Physiotherapist?
If she does not have any problems to report, has good bladder habits, no constipation and no risk factors then I ideally recommend women to check in at least once when they are pregnant and once postpartum. I see some women pre-conception, some while pregnant and some postpartum only. It really varies from person to person.
What are some of the predisposing risk factors for pelvic floor dysfunction?
Allergies, childhood constipation, chronic urinary tract infections, chronic cough, smoking, COPD, heavy labour jobs, pregnancy (no matter what mode of delivery), and being overweight.
At 6 weeks postpartum most Mamas are cleared to return to exercise by their health care provider….
But what exercises should she avoid in her return to fitness?
- NO Sit ups/crunches of any sort
- NO planks of any variety (therefore push ups too)
- NO high impact activities (running, jumping)
- NO wide squats
- Postpartum exercise progression is very individualized depending on many factors (pre-pregnancy fitness, delivery method, tearing etc.)
- I do remind clients that it always takes 8-12 weeks for soft tissue healing…. so be patient.
This is a tricky question to answer speaking about all postpartum women in general. The length of recovery time depends on her fitness before pregnancy and her fitness before delivery as well as a plethora of other factors. A woman’s body changes for nine months, she can’t get back to where she was in six weeks.
My simple answer for most exercises is: can you engage your pelvic floor? Can you keep it engaged during that activity? If you can’t, don’t do it.
What is your advice to pregnant women who are looking to start exercising?
Women can improve their fitness in the first trimester and somewhat in the second but in the third trimester I tell women to just hang on. They (medical experts) used to be too restrictive on pregnant women in terms of exercise. We aren’t all the same, we are all individuals. I know you are looking for “what every woman should do” but there is no every woman. The same treatment or fitness programs don’t work for every woman. However, I would stick to the same exercise restrictions as for postpartum women (see above).
What are some of the complications of working out too hard in pregnancy and postpartum? Will they always show up immediately?
If the muscular system is having trouble controlling intra abdominal pressure (IAP) a woman won’t always have symptoms immediately and quite possibly for a very long time (prolapse, incontinence, and DRA (diastasis recti abdominus), are all pressure control problems). But repetitive strain on their pelvic floor could cause weakening over time and there could potentially be a prolapse down the road. Often times the uncontrolled pressure will progress over a decade and then one day as a fit 55 year old they will lift a heavy bag, or have a bad cough and they will suddenly feel a bulge in their vagina.
Can you help a woman with incontinence without surgery? What sort of therapies do you use?
Incontinence is a pressure control problem, as is prolapse (but they don’t always come together). Treatment and management options for incontinence are pelvic floor exercises to strengthen and coordinate the muscles, pessaries or IncoStress to support organs or Hypopressives. Hypopressives are a relatively new posture and breathing program that decreases abdominal pressure and strengthens pelvic floor muscles, some women respond very well to it.
Rumour is that Kegels are out… why? And what should a mama do instead?
Dr. Kegel published a paper in 1948 outlining the benefits of using pelvic floor toning exercises to correct incontinence. Some women have hypertonic pelvic floors and actually need to relax the pelvic floor to decrease symptoms. Again, its individualized and they work for some women but not for all. However, I think its been a big pendulum swing, people used to say do 500 kegels every day. Now some people say don’t ever do a kegel. There needs to be a balance. Women need to be assessed and then recommendations can be made based on their own pelvic floor.
Where do you think postpartum women should start in terms of exercise?
Diaphragmatic lateral costal breathing and engaging pelvic floor.
There is a lot of hype about correcting posture these days, especially in terms of postpartum clients…. do you work with clients to ‘improve posture’? Not as much as I used to. I focus more on what is causing problems for my patients and perhaps I may look at posture in that certain position, ie: if they leak when they get out of bed I would look at what strategies they are using to change positions and optimize their strategies as needed. But I don’t try to change my clients static posture all day, that’s too hard on them and unrealistic. We need to have good postural muscle control in different positions and while moving. What I say to people is if they are lifting 100lbs pay attention to where your body is, if its just your body weight then move and just make sure your pelvic floor is firing.
What do you think of belly wrapping?
I do believe the first 8 weeks are important but you don’t want it to be so tight that you end up prolapsing, you need to balance the pressures. You still need to work on retraining, engage the pelvic floor and avoiding high pressure activities such as sit ups. I will tell some women to still keep wearing the binder at 16 weeks if they haven’t quite gotten their transverse abdominus muscle function back and are still feeling they need the support
Any final words of wisdom?
Don’t do ‘just in case’ pees: every once in a while is no big deal. But over and over again they will retrain your bladder to be overactive. Also, try not to harass your kids to do ‘just in case’ pees.
Don’t hover over the toilet to pee. Just sit on the toilet. It puts stress on the pelvic floor muscles.
If you are leaky- tighten your pelvic floor as best as you can before you cough or sneeze or whatever it is that makes you leak.
Sexual activity is a great pelvic floor muscle strengthening activity
If your leaking take a look at your dietary habits (i.e. stop drinking coffee)!