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!

My review of the EPI-NO, a cool device for birth prep!

This year, I  can absolutely say that I learned a ton about birthing, preparation for birthing, pregnancy, post natal pelvic health, and so on.  This is in part due to the fact that my friend & doula colleague Clodie-Pascale Villeneuve (Artemis Doula) and I started offering a prenatal workshop called “Get Ready to Rock your Birth Experience“. This initiative has been so far the best opportunity for me to learn about the subject. Since then, there is no wrong place or moment for me to read an article or pelvic health PT blog about it. Actually, if you see me waiting in line somewhere in town, I might be reading this literature review about the effectiveness of such and such intervention to prevent perineal tear, or commenting on a blog post about sex life after baby. OK, I’m officially a nerdy.

THE POINT IS: through these workshops, it has been a treat to meet all these amazing moms-to-be who are interested in doing the best they can to have a smooth delivery. What are their fears? What are their thoughts? What do they want to know? And most importantly, how can I, as a pelvic health PT, help them? Every workshop brings me a better understanding on how to get them prepared for one of the most intense experience they will ever go through.

Just recently, after attending our prenatal workshop, three participants came to me asking some guidance about how to use the EPI-NO device which they had ordered online.

“What is the EPI-NO” you’re asking. Well, on the box, it is described as a “birth preparation and postnatal pelvic floor muscle trainer”. But let’s talk in words we all understand here, it’s a inflatable balloon that you insert in your vagina to stretch it before birth, and that you can also use for feedback to see if you’re doing your Kegels right (see my video below).

I had heard of the EPI-NO through the pelvic health physio community, but I had never made a step forward in ordering one. Having access to the device through those participants was the perfect opportunity to get to know how it worked and wrap my head around the thing.

So we tried it in my clinic – I was pretty stocked the first time I saw it. The first thing I observed is how much confident in regards to their delivery my clients were after trying the EPI-NO. It’s like if I had taken a huge weight off their shoulders. It’s like if they walked out of my door with a “I think I can do this” aura around them. This in itself can make a huge difference when you start labor, as you begin the process with a positive, empowered  and confident mindset.

OK, I needed to try it. After all, how could I recommend something that I had never tried myself? So this morning, I unwrapped the box, locked my bedroom door and did it. I tried the EPI-NO and stretched my vagina as if I was preparing for birth (if you’re reading this honey, don’t worry, I’m not pregnant).

Here is my review 🙂

Tightly Wound: short movie about painful sex

Dyspareunia. A fancy word for “pain with sex”. You would be surprised how many women come through my office expressing that sex is not enjoyable to them, even painful. For some, they have never known anything else than sex = pain (called “primary dyspareunia”). For others, it used to be comfortable and enjoyable, but it is not anymore (called “secondary dyspareunia”) for different reasons ranging from trauma, childbirth, hormonal changes, etc.

So how are you supposed to cope with painful sex? How can you fall in love or maintain a relationship? How can you be hopeful about having kids? Or have a gynecological examination performed if you need to? I can totally understand how distressing it can be.

This short video is such a great eye opener about “vaginissmus” – a condition where the muscles around the vagina contracts in a reflex manner when something is inserted (tampon, penetration). This is only one condition, amongst others, that can cause dyspareunia. However, I think some parts of this video  can speak to many women who deal with dyspareunia. I also love the message of hope that it provides. Because YES, there is hope, and we can help you!

Share if you care about raising awareness about Women’s Health 🙂

Sophie Villeneuve, Pelvic Health Physiotherapist

Kegels & Incontinence: The Truth

Since I opened Physio Borealis in 2013, I have been sharing my passion and knowledge about pelvic health on the Physio Borealis’ Facebook page. In addition, I thought it would be great to write a blog, so I can share more in depth about different subjects.

Wondering about the first topic I would like to write about, I immediately thought of that one question that we always get asked as Pelvic Health Physiotherapists:

“I have urine leakage problems – shall I do Kegels?”

I am going to answer very honestly: I don’t know.

Why don’t I know? Because – like any other symptom – if I don’t know the cause of it, it is impossible for me to give you an appropriate treatment for it. As simple as that.

To illustrate my point, let’s review three typical cases.

WARNING: I may lose your attention along the way, and I am truly sorry about this. But for those who make it ‘til the end, it will give you a taste of how complex urinary incontinence can be, and why physiotherapists who specialize in Pelvic Health need extensive training to help people with those issues.

So let’s start!! All of these cases consulted for symptoms of urinary incontinence with sneezing, jumping and running.

 

NEW YORK, NY – NOVEMBER 01: The Professional Women division of runners cross the Verrazano-Narrows Bridge at the start of the TCS New York City Marathon on November 1, 2015 in New York City. (Photo by Mike Stobe/Getty Images)

 

CASE #1

Story

28 yo female, long distance runner, nulliparous (fancy medical term to say that she has never given birth).

When she started training for marathons a few years ago, was told by a friend that she should keep her abs and pelvic floor tight while running “to ensure a good posture”.

Following this advice, she developed incontinence with running, sneezing and coughing and it got worse over time, to the point of having to wear a thick incontinence pad during her runs.

When questioned about a stretching routine after her runs, she said that she sometimes stretch when she has time, but not on a regular basis.

Assessment findings

Lower body, pelvic floor, abs muscle tightness +++

Overactive pelvic floor, inability to relax on command

Running: foot contact on heels, upright posture, abdominal clenching, chest breathing, i.e. all the things that favour high impact on her bladder and pelvic floor…!

Treatment

Pelvic floor relaxation and stretching exercises

Abdominal muscles release

Breathing exercises (ribs, diaphragm)

 Advice on running gait to reduce impact on pelvic floor:

– Avoid pelvic floor and abs clenching !!!

– Avoid chest breathing – allow mobility in ribs and diaphragm

– Foot contact on forefoot instead of heels

– Posture slightly bent forward to decrease vertical impact on pelvic floor / bladder

**Thanks to Julie Wiebe, PT (check out her website…!) for all her great work and knowledge about the running athlete – you have been such a great resource for me to help my runners!

Prescription of a stretching routine after her runs for long term pelvic health and prevention

Outcome

After 6 weeks, symptoms were reduced by 80% – was wearing a liner during her runs (as opposed to a thick incontinence pad). After 3 months, she was symptom-free.

 

Comment: Indeed, having a “tight pelvic floor” is not a good thing! As any muscle in your body, you need full length and mobility in your pelvic floor for it to be functional. If this lady had started doing Kegel exercises, she would have made her condition worse by creating more tensions in her pelvic floor, which is the opposite of what she needed. It is not surprising that her issues started after following this advice from her friend (re: tightening abs and pelvic floor during runs – which is NOT the right thing to do!). She was overusing her pelvic floor, making it tight and fatigued. No wonder these muscles were no longer able to do their job!

I would also add that I rarely see long distance runners who stretch enough for the amount of running they do. Guess what: not only are they developing tight gluts, calves and hamstrings, but they also get tight in their pelvis! 

 

 

CASE #2

Story

Mother of 2 children. Started developing incontinence with coughing and sneezing while pregnant from her 2nd child who is now 2 years old. Recently started running again and noticed significant leakage issues.

Assessment findings

Pelvic floor muscles weakness and lack of endurance.

Decreased pelvic floor coordination on cough.

Treatment

Kegel exercises to strengthen the pelvic floor

Program combining long contractions to address endurance and short contractions to improve coordination.

Program was reviewed every 2 weeks to ensure proper parameters (position, repetitions, sets, load) and progress.

Integration of her pelvic floor abilities through functional activities (cough, lift, sneeze).

Outcome

After 4 months of physiotherapy, her pelvic floor was strong with great coordination and endurance. She had learned how to use it through her functional activities. She was symptom free while running, coughing and sneezing.

Comment: In this case, yes, Kegels were indicated! But we made sure that she was doing them properly with the right parameters – which is the key for Kegels to be effective 🙂


CASE #3

Story

Post menopausal woman – developed incontinence with coughing and sneezing as well as vaginal heaviness after a severe episode of constipation. Along with these symptoms, she was reporting onset of pain during intercourse.

Assessment findings

Bladder prolapse grade 2

Tight pelvic floor muscles especially at the opening of the vagina

Vaginal atrophy and dryness

Treatment

Pelvic floor stretching to normalize muscle length FIRST!

Recommendation to use lubricant during intercourse, paired with pelvic floor relaxation techniques.

Recommendation re: vaginal moisturizer.

Once length was normalized, pelvic floor strength was assessed to be weak. Kegels prescribed to strengthen and increase bladder support. Exercise program combined endurance/coordination exercises.

Advice re: vaginal heaviness/prolapse management (exercises to relieve pressure)

Education about constipation management

Outcome

After 6 weeks with home program to stretch the pelvic floor, intercourse was comfortable again.

Once she started on strengthening program, her incontinence and vaginal heaviness symptoms were reduced by 75% after 10 weeks.

She eventually consulted with a gynaecologist who prescribed a pessary (external bladder support) to use while exercising only.

Comment: This is a more complex case who presented with different pelvic floor issues, and the order of each intervention was very important here.

First, menopause is a risk factor for pelvic floor disorders. This is due to the hormonal changes and their impact on muscles elasticity and tone. In this case, she had been through a severe constipation episode which increased the pressure on her bladder and led to a prolapse (i.e. bladder descending into the vaginal canal), thus causing vaginal heaviness.

We talked about weak VS tight pelvic floor – but watch this: sometimes people can present both!!! It is not always one or the other (how simple would that be…!) When it happens, it is important to start by normalizing muscle length first by stretching it, and then we can address the weakness by doing strengthening exercises (Kegels).

What?! You are still reading?! Congrats!!!!

You qualify as a Pelvic Health guru!!!

I know, I know, this was a little long for a first post. But I hope it raised awareness about the complexity of urinary incontinence. Therefore, it is impossible to give everyone a “recipe” about how to go about it. A thorough assessment by a Pelvic Health Physiotherapist is needed to determine the problem and an appropriate treatment plan.

So next time you meet a Pelvic Health PT in a gathering, I hope you won’t ask if you should be doing Kegels 😛

(just my little joke here – no one ever asked me this in a social context…!!!! Hahaha!)

Yours truly,

 

Sophie Villeneuve

Pelvic Health PT