Physiotherapy Now

Jerusalem physiotherapy by Tamara May

Pelvic Floor

Pelvic pain, not pelvic floor pain

by Leave a Comment

Let’s start off with a message of b’sha’a tova to Will & Kate (a.k.a the Duke and Duchess of Cambridge) – and all other expectant mothers out there. I’m reliably informed Kate is a regular reader of these blogs, but in case she misses this one, I have no doubt she’s getting this advice from her own physiotherapist (By Royal Appointment).

I will address pelvic floor pain sometime in the near future as most of my pelvic floor blogs are more to do with incontinence. However today I am focusing on pelvic pain, the various causes and what is in the realms of normal-no-need-to-worry pain. 

Pregnancy is a very exciting time in one’s life but it can also come with lots of fear and worry. The fear and worry is normal, as long as it’s all about ensuring that this new life is safe and healthy and has everything it needs for the best start in there life.
As mentioned in previous blogs, two common causes of pelvic pain are relaxed joints and pressure from the weight of your growing baby. If the pain is constant or there is bleeding, unusual discharge, or strong cramping, it is time to see your doctor rather than visiting your physiotherapist.
With that in mind, it is very common to experience cramp-like pain that feels like your period is coming between weeks 8-12; this is your uterus expanding and as long as there is no bleeding this is within the normal realms of pregnancy.
Functional ovarian cysts, which form due to changes in the way your ovaries make or release eggs are also very common and and normally harmless. They can grow larger during pregnancy and the pressure that your growing uterus puts on your ovaries can cause persistent pain. If the cyst ruptures, the pain may suddenly get worse. It is therefore important to tell your doctor if you have a history of ovarian cysts so he can keep an eye on them or any potential growing ones. On very rare occasions a cyst can twist. This is called torsion, it is serious and needs immediate attention. It sometimes occurs after vigorous activity or having intercourse and is followed by very sharp pain, severe and constant and sometimes nausea, vomiting and sweating. 
As mentioned in a more recent post another common pain is round ligament pain. It is common to the second trimester and the pain is felt from your side, as the ligament that goes from the top of the uterus down to the groin stretches. It is felt more when walking or standing up from a chair. The uterus tilts and pulls on the ligament. Lying on the painful side can often help with this
Especially is the third trimester one can experience pain from the pressure on the baby in your pelvic region, often during movement when walking or in a moving car, because the baby bounces with your movements. Rest can ease this pain.
Braxton Hicks contractions is the pressure or tightening in the pelvis that comes and goes spontaneously. They are often described as practice contractions, often from week 20 onwards and triggered by dehydration (drink lots of water). If however they continue for more than 4 an hour for 2 hours and you are before week 37 it is good to check that it is not preterm labour and go and get checked out.
Relaxed pelvic joints also cause a lot of pain; this is one for the physiotherapist. Caused by the hormone relaxin which relaxes your joints a ligaments, it is common to feel pain over the pubic bone, and down your legs. There are many previous blogs on this.
Constipation is another common complaint and can cause pelvic pain; drink lots of water and eat fibre rich food. It is also important to assume a good position while on the toilet. Ensure your knees are higher than your hips and learn forward. This is the optimum position for the stool to come out with the least obstacles. 
There are many other reasons for pain, some of which are more serious than those mentioned above. For this reason, it is important to get regular check-ups throughout your pregnancy. If you experience any of the below list it is important to go to the doctor immediately
  •  
  • Pelvic pain that you can’t walk or talk through
  • Any bleeding
  • Fever and/or chills
  • Severe headache
  • Dizziness
  • Sudden swelling of the face, hands, and/or feet
  • Persistent nausea and/or vomiting
  • Less than 10 fetal kicks in one hour, from 28 weeks until delivery
  • More than four contractions in an hour for two hours
  • Watery, greenish, or bloody discharge
If you are suffering from pain during your pregnancy and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you privately or through Leumit in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Pelvic floor tips

by Leave a Comment

I have written many blogs about the importance of doing pelvic floor exercises but now here are some tips to help you do them every day. Pelvic floor muscles are functional, which means they need to get used with other muscles. Now it is true that often in sessions I get patients to isolate the muscles but it is important to do the exercise when lifting something heavy and incorporate the exercise in all heavy lifting activities.
Now it has to be said but breathing is very important. When holding your breathe during exertion means bearing down on your pelvic floor. So it is very important to breath through all exercise.
When exercising it is important to remember that high impact exercise can weaken the pelvic floor so if you are having problems choose a sport with little impact such as cycling and avoid things like your star jumps and wide leg stances. If the muscles are overstretched during exercise it is harder to contract properly.
Now just as important as it is to get a good strong contraction during exercise to the pelvic floor so it is it to be able to relax properly. That means in between each exercise make sure you are fully relaxed before continuing your exercise routine.  
When trying to get you pre-pregnancy body shape back the term core is often thrown around. Core exercises are really important and will help get your body back into shape. However what is often forgotten is that correct pelvic floor exercise can also strengthen core muscles too, so incorporate them into you regular exercise regime.
Often when leaking one starts to cut back on the water that they drink. Especially in this hot weather I do not advise this. Lots of water and fibre are important in maintaining a healthy pelvic floor. Straining and constipation only weakens the pelvic floor (remember the pelvic floor holds up your bowels as well as bladder and uterus). A healthy diet of lots of fresh fruit and veg with lots of water is great for the pelvic floor as well as the benefits it gives the rest of your body.

If you are suffering from pelvic floor problems and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you privately or through Leumit in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

How should I get back into exercise a few months after having my baby?

by Leave a Comment

Months have gone by, everything has healed nicely and you are in a good routine with your baby. Some of you might only get round to thinking of exercise at this point in your life, but where to start? You may be a few pounds heavier than before pregnancy and introducing exercise into your lifestyle is a really good idea.
I just have to mention it before I get into the nitty gritty but starting with your pelvic floor exercises is a good idea; it might not get you the flat tummy you’re after but it will give your body a good head start into avoiding incontinence.

Now for the tummy exercises, the pelvic tilt is a really good one to start with, it helps flatten the tummy even if there is a gap (RAD) above your belly button. You need to tilt your pelvis and hold for 3 seconds. Start with 10 a day and build the number up.
Another good exercise is the plank, again this is good for the tummy muscles and again it will not cause damage to those that do have a weaker pelvic floor. You need to hold yourself in press up position, tightening your abdominal and glutes. When you have mastered that and can hold for 10 seconds without too much wobbling then raise 1 hand in the air and let your body turn and follow through. Aim to hold this position to for 10 seconds. Start less and work your way up.
Now exercise can be incorporated into your lifestyle instead of setting time aside which can easily be pushed off and forgotten. On that note another one of my favourites is with your baby, and as your baby grows, so too the weight that you are using. Place your baby over your legs when you are in a lying position and raise your legs up and down, your baby might like this one too.
If you are suffering from any pain and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Pelvic Floor: Practice Makes Perfect

by 1 Comment

There are many contributing factors to the downfall of your pelvic floor, many of which I have discussed in previous blog posts. Another reason your pelvic floor can be weakened is the neurological factor. It is important to remember that your pelvic floor contracts reflexively before you cough or sneeze.
For those of you who have already given birth, you may or may not remember the soreness down below post-birth. It may have been so sore that you simply ignored the medical advice to pull up the area between your legs. Opening your bowels was a nightmare, getting your stitches to heal nicely and keeping your self dry and clean may have been your limit. Plus looking after your newborn (and your husband and anyone else in the house.) Squeeze tight, that male doctor who will never know what child birth is like had to be kidding but this is called the reflex inhibition.
Reflex inhibition is the brain’s way of protecting part of the body that is damaged. Unless these reflexes are re-established, chronic (long term) injury can be a result.You may be more familiar with an ankle sprain, you may be aware that if the ankle is sprained badly there is a tendency for that ankle to twist and give way again.
When treating sports injuries the physio concentrates on retraining the protective reflex action of the muscles around the ankle. There is no point in treating the joint without retraining the reflex. So too with your pelvic floor after childbirth. The protective reflex contraction of the pelvic floor when you cough or sneeze is lost, however the protective reflex can be re-learnt by teaching your self to actively squeeze and lift before each cough and sneeze.
The bottom line is it is important to re-train your body’s lost reflex by actively being aware before coughing and sneezing and doing your pelvic floor exercises. In this way, when a sneaky sneeze comes your way your body knows what to do without you having to take any proactive action, resulting in dry underwear all day long.

If you are suffering from incontinence or not sure if you are doing your pelvic floor exercises correctly and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

The Pelvic Floor Questionnaire

by Leave a Comment

I have written a number of blogs now on the pelvic floor area. Many of you might be asking yourselves whether it is this really that important, or thinking “this may apply to others but I am fine now and therefore I do not need to do my pelvic floor exercises”. However, yes this does apply to you; even if you suffer no problems at the moment, it can prevent future problems, so start exercising today. I have made a pelvic floor questionnaire that will help you determine whether you are a high risk or lower risk for future problems developing. If you find yourself in the higher risk category, which applies if you answer yes to any of the following questions, then you might find it worthwhile spending a session with a physio to ensure you are doing the exercises correctly. So here we go.
1. Do you suffer with your waterworks i.e. do you leak urine when you cough, sneeze or do exercise (stress urinary incontinence) or get a desperate urge to go and not make it to the toilet in time (urge incontinence)?
Facts
Up to 1 in 3 women will leak urine during their lifetime. Women under the age of 50-55 tend to suffer from stress urinary incontinence while post menopausal women tend to suffer from urge incontinence. However you can suffer from both regardless of your age.
2. Do you have a pelvic organ prolapse? (a bladder prolapse, cystocele, uterine prolapse, the womb, or bowel, rectocele, or a combination of any of these.)
Facts
1 in 2 women will develop a pelvic organ prolapse and women with a prolapse are 3 times more likely to suffer from urinary incontinence.
3. Have you had a normal vaginal delivery?
Facts
10% of women will have damage to their pelvic floor muscles after a vaginal delivery. After a normal vaginal delivery you are at double the risk of developing a prolapse. The risk increase if you have a big baby (over 4kg) or twins.
4. Did you have an instrumental delivery, either ventouse or forceps?
Facts
25% of women whose babies are delivered by ventouse will sustain pelvic floor damage, 65% for forceps.
5. Did you have a prolonged second stage of labour?
Facts
This is associated with neuromuscular damage to the pelvic floor.
If you are suffering from incontinence or not sure if you are doing your pelvic floor exercises correctly and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women’s Comprehensive Medical Centrein Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Prolapse: Don’t Let It Be Your Downfall

by Leave a Comment

One in two women will develop a prolapse, but again this is one of those secrets that is never spoken about and therefore often never dealt with. Strengthening your pelvic floor muscles and making some lifestyle changes can reduce or resolve symptoms of a pelvic organ prolapse.
A pelvic organ prolapse is when either the bladder, bowel or womb bulges into the walls of the vagina which have often been weakened through various stages of life, such as pregnancy, birth and menopause, as well as chronic constipation and jobs involving heavy lifting. This may or may not be accompanied by symptoms. However, if you feel a lump, or a bulge in the vagina, or as if something is there or something has come down, or you get an aching, dragging feeling if you have been on your feet all day, then it can really affect the quality of your life. It can also cause urinary and bowel symptoms or make you feel uncomfortable during sex.
The pelvic floor muscle has two roles. One is to help with toileting and the other is to support your bladder, bowel and uterus. With a prolapse, the muscle fibres that need to be strengthened are the endurance ones. Therefore they are constantly working. If you brace your pelvic floor muscles every time you are lifting this can help strengthen them. Ideally if you have been diagnosed with a prolapse then you should avoid lifting heavy objects.
One way of dealing with a prolapse is surgery, but it is not always the best option and you should always first try a more conservative approach – which often produce very good results and avoid the need for surgery entirely. Your women’s health physiotherapist can show you suitable exercises and other treatments, and suggest appropriate lifestyle changes.

If you have a prolapse and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.