Physiotherapy Now

Jerusalem physiotherapy by Tamara May

Pelvic Floor

Exercise After a C-Section

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Getting the right balance after a C-section is extremely important. Your body needs to recover and rest is very much needed. Rest whenever you get the opportunity in the first 4-6 weeks. Whenever the baby is sleeping, forget the housework and take a nap too (and anyone who knows me personally will know that me saying forget the house work is not something to be taken lightly.)
Eventually your body will start to feel like yours again and exercise can help the healing process along. A good form of general exercise is walking, starting with as little as 5-10 minutes daily and gradually building the time up to 30-40 minutes over the first 2 months.
Your lower trunk will also need to be strengthened and stabilised. This includes pelvic floor muscle exercises – which should not be forgotten by any women, not just those who are post c-section. Pelvic floor exercise should be carried out at least 3 times a day. Holding a contraction for 10 seconds and doing 10 reps of these, and also doing a quick contraction with a quick release also doing 10 reps of these.
Transversus abdominal exercises are another main area to focus on, (which includes pelvic tilts).

Lie on your back with your knees bent and feet flat on the bed. Pull in your tummy and tilt your pelvis up, flattening out the lower back. Hold this position for 2-3 seconds and then slowly relax half way. Continue tilting your pelvis up and relaxing to the half way position. Aim for the movement to be slow and smooth.


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.

Diary with a Capital Pee: Keeping a Bladder Diary

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When trying to improve any area of your life you will only know if you have done so by recording the figures and measuring the change. This is the reason I ask my patients who come to me for pelvic floor rehabilitation to keep a diary. In the diary I ask them to jot down the following activities:
  • Date / time of day
  • Type and amount of fluid intake
  • Type and amount of food eaten
  • Amount of urine excreted (small, medium, large)
  • Amount of leakage (small, medium, large)
  • Activity engaged in when leakage occurred
  • Was an urge present? (Yes or No)
  • Change of pad required?
It is very important for all women to be doing their pelvic floor exercises every day. The reason being that we have so many factors against us that we need to be one step ahead of the game. Pelvic floor muscles get weakened with every pregnancy. 65% of pregnancies come with incontinence. Although lots of women then have no incontinence problems once the baby is out, it is important to remember that the muscles have been weakened so exercise is still crucial.
If you are lucky enough not to fall in the above 65% you are still not home free because the actual delivery can also cause weakness. 60% of women who have had 4 or more babies complain of incontinence.
I am very pro breastfeeding, it has many advantages and I do it myself, but unfortunately it is also a contributing factor, due to hormones. As mentioned in previous blogs, relaxin weakens joints and ligaments, and it takes 3 months for this hormone to leave our bodies after birth – but while we are breastfeeding, this hormone is mimicked. It is more important for breastfeeding mums to do their exercises and they often see little improvement for there efforts – but it would be far worse if they don’t.
Another contributing factor is the neurological one. It is important to remember your pelvic floor contracts reflexively before we cough or sneeze. Reflex inhibition is the brain’s way of protecting a part of the body that is damaged. Unless these reflexes are re-established, chronic injury can be a result. You are probably more familiar with ankle sprain, and probably know 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 re training the reflex. So to it is the same with pelvic floor after childbirth. The protective reflex contraction of the pelvic floor when you cough or sneeze is lost, but this protective reflex can be re-learnt. You can teach yourself to actively squeeze and lift before each cough or sneeze.
Even if you do not suffer incontinence post-birth, the muscles have gone through a real beating and exercise to regain strength should start no later than 24 hours post delivery.
The pelvic floor muscles fatigue like all other muscles do. It is important to realise that fatigue is also a contributing factor to the fall of the pelvic floor. Therefore rest is also important, especially just after giving birth.
Quite often if you have recurrent cystitis/urine infections it can lead to bladder instability. It is the inflammation in these cases that is the cause of your incontinence.
Now let’s mention menopause. Many women sail through life blissfully unaware of the time bomb ticking away between their legs. Quite often they are totally unaware of the stresses and strains that have weakened their pelvic floor until they reach menopause and this is the final straw. During menopause the oestrogen level drops. Oestrogen factor is also responsible for the thinning effect that can occur within the vagina and urethra. Meaning the pelvic floor needs to be stronger.
Ageing can also take a toll on your pelvic floor like it does with all your muscles, so too with constipation, chronic cough and being overweight.
As you can see the odds are against us women, but the dairy helps monitor all aspects of the bladder routine and can hopefully help show the effects of exercise and work out what needs to be changed.
If you are suffering from incontinence 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.

Useful tips after birth

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Now many of you may think that this topic is not physiotherapy-related, but the job of a women’s health physio sometimes involves treating patients within hours of them giving birth. In these cases, we provide general advice on advisable body positions, as well as treating the patient for the uncommon discomforts post-labour.
My number one tip of the day would be to keep drinking water, and lots of it. You may quite often hear many of the different medical professionals say this, but this is because it affects so many systems in the body that it is an all round good substance for the body. Many might recall the soreness down below when urinating. Now the water can change the pH of your urine making it sting less. If you find it very painful when you urinate then you can pour water on yourself, down the toilet whilst urinating. I might also add that doing your pelvic floor exercise can also increase the healing time as it increases blood flow. (There is just no escaping those pelvic floor exercises).
While on the topic of soreness, some patients have told me they have difficulties in sitting on a hard chair. So here is another piece of DIY make it yourself equipment advice. Take a towel and roll it up into a sausage shape. Then place the towel in a horse shoe shape on the chair and sit on the chair, thus relieving you of putting pressure on the pain. 
While you are not in company or even if you are you can put some ice on the sore area. The recommended method would be to use a bag of frozen peas wrapped in a tea towel. It is best to do this 10 minutes at a time, giving yourself a 10 minute brake before repeating. 
One of the less talked about problems that can follow is constipation. Whilst on the toilet, put a foot stool (mind the pun) under your feet to raise your legs, knees bent hips flexed above 90. This creates a smoother route for the stool to exit your body.  
I don’t talk about it much, as physiotherapists are very much advocates for exercise, but do remember to rest after giving birth. Birth is a wonderful and traumatic event on your body and rest will help improve healing times.

If you suffer from any type of muscle pain during or after 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 in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Pelvic Floor: Key Questions to Ask Yourself

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Due to my short break from writing because of the chagim, I thought I would go back to the pelvic floor muscles before I move on to a host of different topics that some of you may not have heard of.
The onset of incontinence is gradual but never unnoticed. It is the body’s way of telling us that things are not quite as they should be. Leaking urine can bring on a downward spiral with loss of self respect as well as anxiety and depression. 
The initial leaking is called stress incontinence, caused by weakening of the muscles that keep urine stored inside the bladder. These muscles, called the pelvic floor muscles, fail to fight forces which push down from the abdomen when you laugh, sneeze, run or jump.
If left untreated, stress incontinence can lead to urgency and frequency. An example of this could be when running to the bank before closing time you suddenly feel dampness between your legs. You take a quick diversion to the toilet to check that this is not obvious to the outside world, you don’t really feel the need to go but as your mother probably told you better to be safe than sorry and you go to the toilet. Anxiety can begin to set in out of fear of a re-occurrence, causing you to take a trip to the toilet just in case, to really make sure your bladder is empty, thus establishing a pattern of frequency. 
Before you know it you are a confirmed toilet hopper, you know all the ladies toilets in town and which petrol stations along your driving route have conveniences too. You will then start to cut down your fluid intake (don’t ever do this) and before you know it you are laughing this situation off with all your friends, they are laughing in a supporting sympathetic way or are laughing because they have these same problems.
The three main symptoms are stress incontinence, urgency and frequency.  Stress is when leaking from a high impact movement. Urgency is the really strong need to pass urine that if ignored you feel you will probably end up with wet knickers. Finally frequency, which is how frequent you are going to the toilet. A combination of any of these three can be present.
Most people consider their toilet habits normal, however if the answer to any of the following questions is no, then your habits are not normal and it is time to really step up your exercises to your pelvic floor muscles to more than 3 times a day, which is the prescribed amount for people who do not suffer from this. It might also be the time to seek physiotherapy help as there are much higher success rates when treatment is started earlier on.

  • Do you go to the toilet 4 to 6 times each day only?

  • Do you sleep through or get up only once through the night?

  • Do you have dry knickers all the time?

  • Do you pass 300-400mls each time? 1 mug is approx 250mls

  • Do you pass water easily, without straining or stopping and starting?

  • Do you find urinating is painless and quite a comfortable thing to do?

If you suffer from any type of incontinence 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.  

Part II: Exercise after Birth

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Last week I wrote about the importance of exercise during pregnancy. But what about exercise after giving birth? Don’t lots of people from all walks of life say and keep reminding you mothers how important it is to rest? (Rest – wouldn’t that be nice with a new born around the house…).
Indeed, rest is extremely important after giving birth. I don’t need to tell you that birth is a major trauma on you body; you probably already know that. (There is a reason why men don’t give birth). However, exercise is also important. Pelvic floor exercises can start and should start within 24 hours of giving birth. Without even seeing your faces I can see some of you shouting at the screen, the tears, the stitches, the soreness; yes, I know. But in fact, exercise to this area will increase blood flow to this area and increase healing times.  
How about other forms of exercise? You have to let your body be your guide. You can exercise as soon as your body feels ready. (If you had a caesarean-section, recovery time will be longer and should wait until your check up with the doctor).
Your lower back and core abdominal muscles will be weaker then they used to be. Your ligaments and joints are also more supple and pliable, so it is easier to injure yourself from over-stretching and twisting too much. So make sure you include some strengthening exercises as well as an aerobic workout, such as a run.
If you are doing too much your body will let you know, and you should listen and slow down. You will experience extreme fatigue, feel run down and take longer to recover from exercise sessions. If your bleeding becomes heavier or changes colour to more pink or red this is also another sign.  
If you suffered with any musculoskeletal conditions such as SPD then your approach to exercise needs to be a little different. You should still exercise, but stick to specific exercises which are beyond the scope of this blog. 
If you suffer from any type of pain during or after pregnancy and are not sure if it’s safe to exercise 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: laugh in confidence

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There is a 1 in 3 chance that the person reading this blog has a secret: incontinence (either stress, frequency, urgency or a combination of the three types). Chances are if she has confided in a friend the response was “I do too, it’s the price you pay for being a mum. There was this one time, it was so funny I laughed so hard I had to change my knickers.” 
Is it common to leak? Yes. Is it normal to leak? No.  Can something be done? Hell yes!  The easiest time to gain control over this problem is when leaking begins, and before it spirals out of control. Currently 50% of women in old age homes are incontinent and quite often that is the only reason they are in an old age home. However, these numbers can change if we do something about it at an earlier stage in our lives, when treatment is still possible.  
The pelvic floor muscles are a sling of muscles that form a figure of 8 that go around your front and back passage. They also support your bladder, bowel and uterus.
Initial leaking is called stress incontinence and caused by weakening of the muscles that keep urine stored in the bladder. It is no longer strong enough to withhold the pressure of the forces which push down from your abdomen when you laugh, sneeze, run or jump.
As the pelvic floor muscles have two different jobs of supporting and reacting to quick responses like a sneeze, they are made from two different fibres – slow twitch and fast twitch – and therefore it is important to exercise in two different ways.
Every woman should exercise three times a day for the rest of her life. This secret exercise should consist of two sets. This first set should be a quick contraction followed by a quick release and you should do 10 of these. The second set should be a contraction and holding it for 10 seconds followed by a slow release. This too should be repeated 10 times.
To test that you are doing this secret exercise correctly simply stop your urine mid flow. You should be able to stop your urine instantly, without tail-off. However, only use this test every other week. Do not use the toilet as a place to exercise.
If you are have problems and need additional help or you think you are doing these exercises incorrectly please contact me for an appointment at tamaramay.physio@gmail.comor call 0544485086.