What to expect after baby?

One of the things I hear the most from my post partum moms is “No one told me this could happen..!”

Indeed, not many women are informed about what to expect in the pelvic area after baby is born. We spend soooo much time preparing for labour, birth and baby’s care. But once these adorable little humans are out of the uterus, it can be comforting to know what is normal and what’s not. No one needs an additional source of anxiety when trying to take care of a newborn, am I right..?

So here’s a list of the most common pelvic symptoms you may face after delivery:

1- Pain and soreness in the perineum

The perineum refers to the area between your vagina and anus. After all it’s been through, normal that it may feel sore and painful for a few days.

Your best friends will be: ice packs, sitz baths with epson salt, witch hazel pads, peri bottle to clean after urination & bowel movement, pain medication if needed. 

2- Painful bowel movement, hemorrhoids, blood in stool, constipation

Again, depending on how your birth went (pushing time, baby’s position, baby’s size, use of forceps or vacuum, tearing, etc…), your rectum area may have taken a hit in the process. Totally normal to have some of these symptoms for the first few weeks.

Your best friends will be: anurex (cooling device for the rectum – available to purchase at my clinic), stool softeners, squatty potty (to have a more optimal position on the toilet), ointment (ask your doctor), donut cushion. For constipation: water, fibre & magnesium supplements. For more detailed info about this topic, read my post about bowel health!

 

3- Difficulty to hold urine, stool or gas

That is to be expected to a certain degree for the first 2 months after baby. You may feel urine coming out with laughing, sneezing or coughing, or even on the way to the bathroom, or at random times. You may feel like you cannot hold gas anymore, and that you have to rush to the bathroom to make it on time when you need to have a bowel movement. These symptoms can be quite embarrassing to deal with, but they should slowly get better over time. Starting on your pelvic floor exercises a few days after birth should speed up your recovery. After 8 weeks, it is not normal to still present these symptoms and you should definitely consult a Pelvic Health PT if that’s the case.

Your best friends will be: pads specifically made for incontinence – they breath better than menstrual pads and will be less irritant for your skin

4- Vaginal heaviness

For the first few weeks after birth, you may feel like your organs are falling out of your vagina if you stay on your feet too long or go for a walk. My suggestion is to try and avoid activities that trigger this heaviness, and avoid lifting more than your baby weight. For example, if a 30-min walk triggers a feeling of bulge in the vaginal area, try and go for a shorter one next time and see if you still experience these symptoms. It is all about listening to your body at this stage, so you avoid long term damage such as prolapse.

Your best friends will be: anti-gravity pose (calves on a stool with pelvis elevated) or horizontal position when symptoms occur, pacing yourself to avoid triggering symptoms, avoid constipation and straining

5- Return to sex 

OK: first, most couples return to intercourse between 3-6 months after baby is born – those are just the statistics. The famous “6-weeks green light” from the doctor can be quite a source of anxiety for many women, actually. Indeed, some moms feel the pressure to get back to sex ASAP, when in fact they still have lots of healing to do, both physically and emotionally especially if they have experienced birth trauma.

Not to mention that moms may feel exhausted, overwhelmed, anxious or depressed. They may have a low libido, sore nipples and vaginal dryness. On top of that, they are figuring out their new role as a mother, their new routine, how to care for their baby, etc. How are they supposed to feel sexy in those circumstances?

Now, supposing that you tried penetrative sex again, I just want to let you know that painful sex after birth is a very common thing, but IT IS NOT NORMAL!  Even though your scar has fully healed and everything was fine at your 6-weeks check up, it does not mean that your scar is moving well, that there is no adhesions, and that it won’t hurt. There are so many things you can do to improve the mobility of your scar with simple massage techniques! Ladies, you don’t need to suffer through this!!

Your best friends will be: lubricant, Book “Reviving your Sex life after Childbirth” from Kathe Wallace – she shows great massage techniques to help with scars, pelvic health PT consult, Sofia Fortin from the Happy Vagina Project & her Sex After Kids masterclass

I hope I did not scare you with this post – but I just wanted to let you know that these issues are super common after birth, so don’t panic if it happens to you. But most of all, I want you to know that Pelvic Health Physiotherapists ARE YOUR BEST FRIENDS for your post partum recovery. They will carefully listen to your birth story, let you cry if you need to cry, let you share your concerns without discrediting them. They will ask you all about your urinary, bowel, pelvic pain & sex symptoms, and they will make a plan with you. They will guide you through your recovery, so you are not alone.

You are not alone, momma, and you deserve the best care.

xx

Sophie

 

 

 

Bladder health 101

As any part of your body, your bladder can become unhealthy if you don’t take good care of it. That’s when people start consulting me for overactive bladder issues (going to the bathroom too frequently), urinary urgency, incontinence and so on.

What can you do to keep your bladder healthy? Here’s a few pro tips!

1- Stop going to the bathroom “just in case”: there is a muscle around your bladder, the detrusor, and if that muscle does not get stretched enough because you are constantly emptying your bladder before it’s full, this muscle can become stiff overtime! Start listening to your bladder signals to maintain a good bladder capacity – it will tell you when you need to go, no need to anticipate it 😉 This is also valid for any parent who may be encouraging their kids to go to the bathroom just in case – I tell ya, these kids will be in my office for overactive bladder issues when they grow older! It’s okay to do it for a “one off” before a long car trip, but in the day to day, try and teach them to listen to their bladder signals 🙂

2- Stay hydrated: to provide your bladder with a healthy, non irritant environment. What does that mean exactly to “drink enough water”? If you look at your urine colour, it should be pale yellow – not dark (exception is made for the first pee of the morning). The darker your urine, the more irritant for your bladder, which can in turn creates symptoms like urinary urgency (that unbearable sudden feeling that you need to go to the bathroom right now and you can’t postpone it!)

3- Be aware of bladder irritants in your diet: coffee, carbonated drinks, sugar, spicy & acidic food,  alcohol can all be triggers for urinary urgency and frequency, as they are considered bladder irritants. If you suffer from these symptoms, try to eliminate one item at a time for a few weeks to observe the effect on your symptoms. If you don’t have symptoms, just make sure to keep a healthy balance in your diet so you do not develop symptoms in the future.

4- Avoid straining while urinating: I know sometimes it is tempting when you are in a rush to try and  push your urine out through holding your breath. But all this extra force on your bladder can be damageable over time and lead to a bladder prolapse (when the bladder starts descending into the vaginal canal). Instead, take a few extra seconds to let your bladder empty on its own as you release your pelvic floor muscles. To do so, visualize the blooming of your vagina and release all the muscles around your vagina and urethra. You can do a gentle contraction of your pelvic floor muscles once the last few drops have gone through, in order to close the urethral sphincter properly – this is super helpful especially if you have symptoms of urine dripping while standing from the toilet. If you have no clue of what I am talking about by contracting and releasing your pelvic floor, consult with a Pelvic Health physio, or watch my video:

5- Do not hold urine for too long: meaning more than 3-4h between voids (depending on your liquid consumption). As much as it is not recommended to go to the bathroom too often, there is also a limit to what your bladder can hold! It is definitely not a good idea to hold your urine for too long – indeed, it can lead to pelvic floor muscle tensions and fatigue (as you will have to contract your pelvic floor in order to hold your bladder for that long…). This can lead to pelvic floor dysfunctions in the long run! So if you are a nurse or any worker on a the road who do not have easy access to a washroom, time yourself or put an alarm or something if you tend to forget to empty your bladder!

Hope this helps!!!

Sophie

 

 

3 key elements to have your pelvis on your side for labour & delivery

Your best friend just signed up for a full marathon in 9 months.
42 km!!! 
You are impressed, especially that she has never run before!

– So how are you preparing for your running event? you ask her.
– I don’t know. I’ll just go with the flow and see what happens I guess!

This story does not make sense, doesn’t it?

Why do we think it makes sense then when it comes to pregnant women approaching delivery then?

…when birthing a baby is the most physically challenging event a woman will ever go through?

In this 20-min webinar, you will learn
3 key elements
to have your pelvis on your side
during labour & delivery

Doing your Kegels right: pro tips!

“I have been doing Kegels but I am not sure if I do it right, so I would like you to check…” – so many women consulting me…!!! 

I don’t blame you ladies. Before taking my first Pelvic Health PT education course, I did not know either… Isn’t it crazy that we are not educated about pelvic health in school as early as teen age? Knowing how to contract and release your pelvic floor is such an important part of maintaining good pelvic health as a woman! It can be a game changer in your sex life, it can avoid embarrassing urine leakage symptoms, it keeps your your bowel & bladder health on the ball, it provides stability to your pelvis & low back… It is extremely connected to so many functions!! But still, we barely know these muscles even exist, let alone how to exercise them…!

If you want to get my pro tips to learn how to contract & release your pelvic floor (aside from the typical “try to stop your flow of urine” exercise that many women were told to do but is so unhealthy for your bladder!!), this video is for you! 

Exercise to stop leaking when you sneeze or cough!

“I want to stop peeing my pants every time I sneeze or cough” is one of the most common reasons of consultation I hear in my clinic. Clients often develop the strategy of crossing their legs to compensate for the poor pelvic floor muscles who just got a little lazy after childbirth or menopause.

Here is a simple exercise you can practice to start re-educating that reflex called “The Knack”. The Knack is a pelvic floor contraction before any increase in intra-abdominal pressure (such as when you sneeze, cough or laugh hard). It normally happens naturally without thinking about it, but when the pelvic floor does not work properly following hormonal changes or pelvic trauma, this reflex can be lost.

But hey!! Don’t worry, there’s something you can do!! Try this out:

Do’s & dont’s for core workouts

You have been told that some core workouts are better than others during & after pregnancy but you’re not sure what that means? Watch this!

PS: This also applies to anyone doing core workouts to protect your back and avoid injuries!! But moms are just more vulnerable to injuries because of their overstretch core from baby growing in the abdomen!

My top 5 recommendations for an A1 gut health!

Pooping is such an essential body feature. Actually, if you don’t poop, you die… Does that convince you? In my intake form for my clients, I always ask about presence of constipation, because it is totally part of the big picture when we talk about pelvic health. For example, constipation leads to straining, which in turn increases your chances of developing a pelvic organ prolapse (when your bladder is falling out of your vagina!). Having a rectum full of hard stool can also push on your bladder and create urgency and frequency (going to the bathroom too often).

I would have many more reasons to advocate for a great bowel health, but let’s get to the point here. Don’t you think there is something so satisfying about having a nice long sausage-like stool that just slips right out of your bum? I never heard of anyone being stocked about straining to push those hard nuggets out that come along with constipation. I guess this is not something we normally discuss on a Friday night with friends, to be fair…!! But I’m sure you know what I’m talking about, right..?

OK so let’s go ahead with my 5 top recommendations for healthy pooping!

1- Stay hydrated

The best way to assess hydration is to look at your urine colour. If it’s pale yellow, you are good. Darker urine is okay for the first pee in the morning, but throughout the day it should be pale.

Stay away from recommendations such as “everyone should be drinking 8 glasses of water a day” – everyone’s needs are different. A breastfeeding mom will have lots of water coming out of her body from feeding her baby, therefore will need to drink more. Same with someone who exercise a lot, or has a very salty diet.

Your urine colour is a much better gauge to dictate how much water you should be drinking, rather than relying on a general recommendation.

2- Eat enough fibres

Again, that may look different from a person to another. My philosophy is: fix your water intake first, and see what happens with your stool – if it does not fix your constipation problem, then try increasing fibre intake. We want to target a stool that looks like #4 on the Bristol Stool Chart – like a sausage or snake, smooth and soft, with no cracks.

So first thing guys: LOOK AT YOUR STOOL BEFORE FLUSHING! Obviously, I’m assuming that you are pooping in a toilet and not in an outhouse (which is an unfair assumption especially in the Yukon where many people live in a dry cabin…!) But please if you can, do it!

For the longest time I had the Bristol chart by my toilet at my house and my roommates were making fun of me for it. But I wanted to bring awareness in the household and it worked!! Soon enough, people started saying “Hey I had a #4!!” with so much pride – it made me so happy!! #pelvicfloormafia

But coming back on fibre intake – if you see that even with proper hydration, you are still struggling with a #1 or #2 type of stool, you should look at increasing your fibre intake. Some easy ways are:

  • Adding 2 tbs of ground flax seeds to your breakfast (in your oatmeal, smoothie, yogurt, or simply mix it with hot water – not the best taste though..!) – they need to be ground otherwise it go straight through your body without doing anything for your guts!
  • Prepare some celery sticks snacks for the week  – if you are not a fan of the taste, add a dip or hummus to make it tastier!
  • Snack on dry fruits such as prunes, or fresh fruits like berries

There are many other ways to increase your fibre intake – a naturopath or dietician would be the best professional to guide you through this if you need more assistance. One important thing to mention with increasing fibre intake is that you should also increase water consumption proportionally, especially if the food item you chose does not contain water. For example, celery already has water content, whereas seeds do not. So if you choose to eat more seeds, you should also increase water intake to balance that out, otherwise you will get more constipated…!

 

3- Squat to poop!

If you have never watched the Squatty Potty advertising, this will convince you!!

Basically, when you sit on a regular toilet without squatting, you are anatomically setting yourself for a harder time during your bowel movement. If you are already a bit constipated, having your knees higher up versus down can make the world of a difference!

 

 

 

 

 

4- Relax your pelvic floor muscles!

The pelvic floor muscles are the ones around your urethra, vagina & anus. If you pretend to pick a berry with your anus and pull it up, you are contracting your pelvic floor and closing your anal sphincter. Now pretend to let go the berry and bring it back down, you are releasing and opening the anal sphincter. While pooping, you want to let the berry go, not pick it up!

If those instructions seem very foreign to you and you have no awareness whatsoever of what is going on in this area, go see a Pelvic Health Physiotherapist so they can assess your pelvic floor to optimize elimination!

5- Breath!

You would be surprised how many people hold their breath and tuck their belly in while having a bowel movement. Actually – that was me before becoming a Pelvic Health PT!!!  And even now, I need to be so mindful about not going back to those bad habits, and keep breathing properly & let my abdomen relax while having a bowel movement. All the pressure you are adding onto your rectum and intestine while holding your breath and clenching your abs is definitely not helping for your stool to come out. It is rather squeezing everything and restricting the motion of your stool.

Image result for breathing

So when you are about to have a bowel movement, squat, release your belly, unclench your abs, and start breathing in through your nose, out through your mouth. Your abdomen should be rising and falling with your breathing, very passively, and this nice rythme will help moving the stool along.

 

 

 

 

 

OK now I realize that I said 5 tips but I actually have 6… Is that okay?

There is a super cool intestinal massage you can do to trigger a bowel movement. It is recommended say if you have not had a bowel movement that day and you would like to trigger it, or else you are bloated or feel intestinal cramping. It helps moving things along. Normally, you should feel a signal to go for a bowel movement within 15-20 minutes after doing it. I recommend this massage after a meal to benefit of the great digestive enzymes that are naturally secreted after eating.

The best thing: I made a video to demonstrate it!!!

I hope this was helpful!!! Don’t forget that gut health has so many components and it is hard to summarize it in 5 recommendations. There are many other things that will affect gut health such as stress level, diet, level of activity, medication & medical conditions, to name a few. But I think if you apply those tips to cover the basics, you will have a head start on many people… !!

Thanks for reading!

Sophie

Top post partum recommendations to protect your floor

Delivering a baby puts a huge amount of pressure on your pelvic floor muscles, and sometimes tearing. It is not surprising that our pelvic floor needs some rehabilitation and care once Baby is born, after all it has been through!

In the first few weeks after your delivery, you have to be extra cautious in the activities you are doing so you do not injure your pelvic floor during its precious recovery time (normally up to 12 weeks – the famous “4th trimester!”). Even if you feel good, you have to remind yourself of taking things slow, as going back to your normal activity level too fast would likely lead to pelvic floor dysfunctions. No one wants to deal with prolapse or urine leakage when they go back to their running or work out class!

Watch this video to get my top recommendations to protect your floor after baby!

Healing the Body during & after Pregnancy

It all started last spring. There was this Birth Healing Summit advertised on one of my pelvic health groups on Facebook, and since it was presented online and free, I decided to sign up. What did I have to lose anyway..?

This summit was put on by a Pelvic Health physiotherapist called Lynn Schulte who had interviewed different speakers in the birthing field about various subjects. When I saw that Julie Wiebe & Sinéad Dufour – two experts that I highly respect in the pelvic health field – were going to be interviewed, my heart was won already.

I listened to all the interviews with much interest, getting everyone’s perspective on how to heal the body after delivery. But the interview that really got me was Lynn Schulte’s herself. She spoke about her experience treating pregnant and post partum women, and how she found these similar patterns in all of her clients. It was like a light bulb flashing to my eyes, so brilliant, so clear. She was mentioning about how the pelvic bones (sacrum & ilium) need to move and open to let the baby go through the pelvis during labor and delivery. She called it “the open birthing pelvis” pattern. She also mentioned how these bones were stuck in a very stereotypical way in almost every post partum mom she had assessed, leaving the right side of the pelvis (especially the sacro iliac joint) out of whack after birth, triggering similar symptoms such as right-sided low back pain, pubic symphysis pain, feeling of unsteadiness in the pelvis, difficulty to recruit the pelvic floor & core after birth, etc.

But wait…!!? My moms were reporting that too!!! That damn right-sided pelvic pain! This feeling of getting out of bed in the morning and feeling like an 80 yo! This hip pain while sleeping! This “unsettled pelvis” sensation, or feeling that you don’t own your body anymore after delivery! Then it became clear to me:

I had to meet Lynn Schulte in person.

I had to learn everything she knew about fixing the body during and after pregnancy.

The first thing I did was to read everything about her and the Institute for Birth Healing which she had opened a few years ago in Denver, Colorado. I realized that this amazing experienced physiotherapist had worked for more than 25 years helping moms to recover from birth. I discovered her youtube channel which I spent many hours on, watching every video, positively nodding to everything she said, and wanting more. This woman knew what she was talking about, holy!

But what caught my attention was this Birth Healing Specialist Certification that she was offering for professionals in the birth/pregnancy field. This included 3 in-person practical courses at her Institute in Denver. Mmm… this would be a big investment if you count the courses/certification fees as well as travel fees… Plus the Canadian to US dollar change rate was not really helping me…!

But hey! My heart was really calling for this training. Everything I had done so far was leading me to it. Working with pregnant and post partum moms was clearly my path, I knew it deep inside. I needed to offer more to my moms. I needed to help them in an effective way and understand what was going on for them. Make them more comfortable so they can get back to what they love doing without discomfort from pelvic floor disorders. Go back hiking, running, playing with their kids, camping, and whatever they like doing, and feel like their body was not restricting them to do those things.

Doing a grounding exercise with my colleague from California 🙂

So I signed up for the certification. In October & November this fall, I flew to Colorado (long travels!!!) to meet with Lynn Schulte and all the amazing women who wanted to learn from her. Our first course was the Holistic Treatment of the Pregnant Body, and the 2nd one the Holistic Treatment of the Post Partum Body.

There is no word to say how much this training has changed my practice already. A few realizations I made…:

  • This open birthing pattern where the pelvic bones move for delivery can remain in the post partum body for years if it is not addressed through manual treatment, it can lead to pelvic floor disorders symptoms like pain, prolapse, urine incontinence and so on. So big “hah!!!” moment for me to learn that we cannot just approach things from a strict “muscle” perspective.
  • There are quick and effective external manual techniques to fix the bones and put them back where they should be. After trying it in clinic with a few patients, I was so surprised to see how effective these techniques are!!
  • During pregnancy, the organs (liver, stomach, small intestine, bladder, uterus) are pushed in all directions to make room for the baby, and can remain “stuck” in these positions after baby is born, causing various issues. I learned how to mobilize these organs and put them back into place. I am thankful for the visceral knowledge that PT school never really brought up…!
  • Urinary urgency/frequency that is often reported post partum can be caused by the urethra/bladder being shifted to one side or the other, and I can now fix this with quick effective techniques!
  • There is an emotional component from pregnancy and birth that can be held in the tissues, and doing a body/mind connnection through a pelvic bowl meditation (credits to Lynn Schulte :)) can be so so powerful to release it!

    Lynn Schulte demonstrating pelvic mobilization techniques to fix the open birthing pattern after delivery
  • Yes, internal vaginal techniques have a big role to play in assessing my moms, but there is much more to it such as external joints & organ mobilizations, release of the abdominal wall & diaphragm, etc, and I am thrilled to now be able to offer more to my clients with a holistic approach
  • These techniques are not only helpful for moms or moms-to-be – I have been applying them to many other clients (back/pelvic pain, urinary problems, etc) and they proved to be effective for so many people!!!

These are just a few “wow” moments that I picked up, but there are so many more!!! My last course is coming up in December and we will learn more advanced post partum techniques which I am so excited about!

By the way, I am proud to say I will be the second PT in Canada who has this Birth Healing Specialist certification – the other one being in Toronto. Yay!!!

I will keep you updated when I am officially certified!!! Oh and I encourage you to join my Facebook group Yukon Moms & Pelvic Health Community, as well as Institute for Birth Healing Community if you want to connect with moms & birth healing professionals and learn more!

Sophie

New tool at the clinic: pelvic floor biofeedback

This month, I decided to invest in a new piece of equipment to help my clients in connecting with their pelvic floor muscles. It is called a “biofeedback”. It can be a great tool especially for people who have trouble “feeling” their pelvic floor contracting or releasing – the ones who come back to me after their first session and say “I don’t really feel if I’m doing it right or not when I’m at home”. It can also help people to remain motivated in their home program as they see their strength and endurance progressing from a week to another.

Want to see how it works? Watch this short video 🙂

My biofeedback is now available for my clients to rent – let me know if you are interested in giving it a shot!