August 12, 2013 at 3:20 pm #5626KTGuest
Hi – I’m a very active 40 year old with children aged 7 and 5. I had TVT surgery mid April for fairly severe stress incontinence due to internal tearing during childbirth (after staying silent about it for far too many years). I had 9 months of excellent uri/gyne physio prior to that, but we’d got as good as possible which was still really not very good at all! Surgery has been a success, but about a month ago I finally saw a doctor about the symptoms of heaviness and bulging in my perineum and discovered I have a rectocele and cystocele (grade 2 I think, which apparently had been there as grade 1 with no symptoms for years without me even knowing). I’m due to see physio next week, but in the meantime I have been getting on with exercises sent by physio, and also the hab-it DVD which I bought last week.
I have a few queries to ensure I do this right and don’t cause further damage.
I have got very used to holding my pelvic floor in most things I do now (alhtough I realise they need time to relax too!), and wanted to check if I should be holding them tight during all the exercises in the DVD? I’ve only gone through workout 1 so far, so e.g. in the glute squeeze exercise, do I actively tighten and lift the pelvic floor before tightening the glutes?
Is it OK to get straight into doing a workout every day? Or should I start with 3 a week and build up? Is it best to do the same workout a few times or work through the first 3 in rotation before incorporating the 4th one too? In one session of exercise is it OK to do a second workout straight after the first or will that fatigue the muscles?
I understand that at this stage I need to not exert any extra strain on my prolapses, but is it likely that I will be able to return to full on mountain biking and road cycling, or will there always need to be an element of restrain and caution?
I am concerned that I won’t be able to be fully active again, and am desperate to ensure I optimise my opportunity to bring my prolapses under control to get rid of the symptoms, and never have them return.
many thanks for your time with this queryAugust 12, 2013 at 4:01 pm #5867
Do not actively contract your pelvic floor with every exercise. Rather follow my cues exactly. You have said it correctly, your pelvic floor muscles need to relax a bit too. They need to ask for help from your entire pelvic basket. They are no more important than your TA, your multifidi, your adductors, or your deep hip rotators. You have to work them all. By squeezing your pelvic floor ahead of every other contraction, you won’t be able to recruit the maximum number of muscle fibers from these other pelvic basket muscles.
Yes, you can work your way through a work out every day if you choose, even multiple work outs per day (just be sure to keep your 2 step Kegels to just 8-10 contractions per day). So if you toss in an extra workout on any given day, just skip the 2 step Kegel instruction on subsequent workouts.
I like you to work your way through the workouts in order. They are progressive in the way I have you isolate each muscle in workouts 1 and 2, and then there are more co-contractions in workouts 3 and 4.
Yes, you should be able to return to mountain and road biking. Your postural positioning on the bike is perfect support for your pelvis. You will want to progress after 4-6 weeks to my 7 Day Advanced stabilization program due to the high level of activity you want to return to…but put in the work first with building your base through the Hab It dvd!
TashaSeptember 4, 2013 at 6:45 am #6527KTGuest
Thank you so much for your reply. I was so excited to read it, and hear the optimistic outlook! Your further guidance about the excercises is excellent and I’ll be more confident with them now. I see my physio tomorrow morning – again another exciting way forward. I’m looking forward to experiencing the results… and getting fully active again. The caged in/ limited feeling I have just now is not where I ever imagined to be in my 40’s! (or any age actually).
Enormous thanks again Tasha – I’ll no doubt be in touch with further queries, and hopefully good feedback.September 6, 2013 at 10:13 am #8444KTGuest
thanks again for your help. I saw my uri/gyne physio 2 weeks ago and she eased out some ‘stringy knots’ in my pelvic floor so it could work better. She agreed with what you’ve said about not working the pelvic floor too much – which I definitely had been. I told her all about your HabIt DVD, which she hadn’t come across. She’s an NHS physio (National Health Service in Scotland), and was going to check out your DVD so she can recommend it to other women who come to see her.
I progressed to workout 4 today, and am beginning to feel like a normal fit woman again. Thank you. I also went out on my road bike and felt good. Am looking forward to how good I will feel after 6 weeks of the program when I can proceed to the 7 day advanced program. (am at the end of the 2nd week of regular DVD use)
I have a few questions:
– for the TA stabilization with straight leg raise, should I have the straight leg turned out as much as possible? I find I get a bit of a twinge in my lower pelvis if I turn it out quite far, so end up rotating it far less, but then I don’t feel the workout more in the quad than inner thigh.
– for the prone leg raise/ glute squeeze, are the legs together or is there a slight gap at the knees?
– for the clam, do I actively squeeze the glute or just let it tighten itself while I concentrate on opening at the hip as much as possible. I hope that question makes sense!
– when cycling, should I hold my TA as much as possible to help protect my prolapse? Originally I had tried to hold my pelvic floor as much as possible, particularly going over any bumps, but now realise I need to not put too much focus on just the pelvic floor. I just need to know what muscles best to aim for by default when something unforeseen happens on the bike e.g. a bump, swerve etc. Also, when going up a long hill climb am I best to keep in an easy gear and hold my TA? I clip in to my road bike, so do take some of the strain of a climb on my quads by pulling up on my pedal strokes, but I still need some advice to make sure I’m doing everything I can to protect against any strain which will be bad for the prolapse.
– what’s your view on cross country skiing with a prolapse? My husband and I have been keen to take up the sport, and finally it looks like we might get a chance this winter… but I can’t figure out if it’d be good or bad for my prolapse!
– in yoga, is it OK to go into the shoulder lift or head stand positions? I’m just not sure if that’s Utilising the stomach muscles which would be good for prolapse or not.
– Finally, I know and accept that with a prolapse I’ve never to lift anything heavy. I have always happily lifted heavy items (lifting the petrol mower out of the shed, lift a heavy generator at work with a colleague, shiting big bits of furniture etc.) and can see that I won’t be doing those things again if I want to keep my prolapse under control… but wondered if you have advice on quite how much I can lift. I read somewhere that 20 or 30 pounds should be a max limit. I realise there’s no hard and fast rule as it will depend on the individual, but I’d really appreciate knowing your thoughts on it!
Huge thanks for your guidanceSeptember 10, 2013 at 7:03 am #8500
You talk about a “twinge” with the SLR if you rotate your leg out too far. This may be a sign of weakness of your adductors. Continue to work pillow squeezes between your knees whenever you think of it during the day. Better yet, challenge yourself to sit with your knees together without crossing your legs. We all cheat by crossing our legs, leaving our adductors unbelievable weak!
On the prone heel glute squeeze, your knees need to be apart in order to recruit your deep hip rotators. So knees apart, heels pinched together on that one!
On the clam. Let your glute medius work to open your bent knee clam, but at the limit of your range of motion, work to further squeeze your buns!
When you are biking – let your positioning take care of everything. Proper positioning on your road bike or mountain bike will have you rolled forward on your two sit bones and your pubic bone, which is perfect. This leaves your tail bone free from all pressure which give a healthy, natural tension to your pelvic floor. No need for active contraction there. Also, keeping your chest up draws your anterior connective tissue extending from your pubic bone all the way up to your sternum, taught, which is perfect. This positioning of neutral spine will automatically recruit your TA. This is why biking is such a great exercise!
Cross country skiing is perfect for women with prolapse. Think of the glute extension on every push off and glide!
Yoga is good as long as you do not breath hold!
Finally on lifting heavy weights. You will have to feel that out for yourself. I don’t hesistate to move furniture, I have built a boulder wall and love to work in the yard, but it is all done with knowledge of proper posture. I always have a focus on keeping my tailbone lifted and breathe out on exertion. Shoveling snow is a perfect example of an activity that can cause symptoms if these two rules aren’t followed.
tashaOctober 7, 2013 at 5:06 am #8622LinwoodGuest
Wow that was unusual. I just wrote an incredibly long comment but
after I clicked submit my comment didn’t
show up. Grrrr… well I’m not writing all that over again.
Anyhow, just wanted to say great blog!October 7, 2013 at 5:06 am #8626KTGuest
Tasha, I can’t thank you enough for your response. I truly appreciate it. I can’t wait to try cross country skiing!
On your final comment on lifting, you refer to keeping your tailbone lifted. Can you expand on that description a little more? My understanding of it is that if, for example, I was to lift a sturdy object from the floor I would have my knees bent and bottom out almost as if to have my back in a horizontal table top position – whereas normally (after compulsory manual handling training at work) I would have my knees bent but have my back in a very upright position so the strain is taken in my knees. I hope that makes sense and you can see why I’m looking for a more detailed description (or a diagram?!).
KTOctober 7, 2013 at 5:20 am #8734
Do not bend over and have your back horizontal. Your second description of bending your knees and keeping your back relatively straight is correct lifting posture. when I say, “Keep your tailbone lifted”, I mean for you to keep a gently curve in your low back. Do not let your back round out- this is so tough on your low back discs and significantly increases intra-abdominal pressure which is bad for your prolapse.
So keep that arch in your low back and breath out with every squat and every lift!
TashaOctober 22, 2013 at 10:32 am #8869KTGuest
More wonderful answers Tasha, thank you. Apologies for coming back with more answers, but you are proving to be a lifeline in this!
My query this time is more about internal forces.
– This has come up primarily due to walking my dogs, who are lurchers (greyhound cross, large and very strong!). One of them pulls very strongly on the lead. Obviously, this is another dog training issue which we’re addressing – but for the meantime my daily reality is I need to walk this dog which pulls on the lead. Since discovering my prolapse I simply didn’t walk the dogs, but as my husband goes away periodically, I now have to. Do you think having a dog pull very strongly on the lead will worsen my prolapse? I can’t quite get my head around what muscles are being utilised and by which forces. As a workaround, I have tried putting the lead around the back of my waist ie. when the dog is on my right I hold the lead in my left hand with it crossing behind me. This seems to dissipate some of the force, but it’s not a great way to walk the dog when i’ve got another one and 2 small children and lots happening! I’m looking for your thoughts to either say ‘no don’t do it’, to reassure that it’s fine, or to offer some guidance on how to proceed.
– i’m also looking for further guidance on some yoga positions. I’ve gathered that with getting back to yoga the key thing is to do any necessary adjustments to keep appropriate posture, to never hold your breath during exercises, and also to avoid anything which utilises the rectus abdominus e.g. double leg lifts etc and anything which brings ribcage to pelvis. However, what I can’t get straight in my head is whether it’s OK to perform exercises such as a shoulder stand or full bridge. In shoulder stand you do bring you pelvis towards your ribcage on the way up and down. Whilst actually in the final shoulder stand position I assume everything is great for prolapse, but it’s the getting there and back i’m not sure about! As for full bridge (lie on your back then push up so your on just hands and feet with your back arched), I imagine it’s a great stretch for everything involved in prolapse – but amn’t confident that it wouldn’t cause any strain on the rectus abdominus or downward pressure on the prolapse. Can you clarify more about this Tasha?
– final query – earlier this week I started your 7 day advanced program after 7 weeks of the HabIt DVD. It’s harder than I thought (which is a good thing!) so have eased into doing it gradually (to focus on form first), interspersed with the HabIt DVD on some days instead, and will eventually have worked up to doing the full thing. I’ve also been doing a pilates class once a week called ‘pilates on the barre’ which is a mix of ballet and pilates. My instructor knows about my prolapse and so I avoid a few of the exercsies. The class a few days ago had lots and lots of ‘plies’ which are basically a samurai squat. In my youth I did a lot of ballet so these exercises felt lovely, and I go down so my thighs are approximately horizontal. In addition to just going up and down in this position, there was lots of pulsing whilst down… and boy did I feel the burn in my thighs! However, I’ve found the symptoms of my prolapse worse this week and am wondering what your thoughts are on the cause. Have I maybe launched into the 7 day program too soon and am still too weak? Or have I done too many of the ‘plie’ squats – or perhaps was my position in them just wrong? I wondered afterwards if I’d maybe automatically resorted to my old ballet mentality of ‘tucking under’ when down in the squat so you look nice and flat from a side view, whereas perhaps I should focus on leaving my tailbone sticking out a little more? Would the action of ‘pulsing’ when down in this position be too much for the prolapse?
many thanks again for your time – I know you must have a busy life outside of this blog, and your time on it is honestly truly appreciated! If I could send you a hug and smile of gratitude I would :o)October 22, 2013 at 10:32 am #8871KTGuest
Hi again – I should have added a bit more info about the dog pulling scenario. I’m not sure if you’ve ever walked a dog who pulls on the lead, but if not I realise I need to explain! It’s not like you just get dragged along by it, but by default you pull against it to control the dog and so there feels like there’s a lot of muscles in the torso being utilised, particularly abdominal although I’ve not quite figured out what exactly. It’s not a steady pull either, sometimes it’s very jerky. … and really very strong.
hope that helps clarify!October 22, 2013 at 11:07 am #8897
KT – You are in luck! I am a dog lover and have a 1 year old Vizsla that is extremely active and my running partner. I am lucky enough to be able to run him off leash most of the time, but I am well aware of the pulling you describe. What naturally happens to your body when the dog pulls is that we brake with an exaggerated heel strike. A strong heel strike leaves us leaning back and all the force goes directly through our spine with our tail bone slightly tucked and its just no good. This is the exact opposite of my blog recommending that we all “Work Extension While you Walk”.
The best solution is to get a gentle leader or to draw your leash under your dogs belly between his back legs. They don’t like this and tend not to pull as much.
As for Yoga. The head stand and bridge are just fine. I recommend we avoid bringing our rib cage closer to our pelvis – you are correct – but as you move to more advanced moves you will find that you can control this compression by breathing out. Think about my plank hold with knee drive rotation in the advanced program. I have a couple of exercises in there that do bring us into slight flexion because a healthy spine has to both flex and extend. I also believe that by the time we are at the advanced level, we can control this limited flexion by holding our TA first before the rectus and continuing with an easy breathing pattern.
Final question on your plies. Positioning will be very important. I love the workout for the deep hip rotators with your feet turned out in your wide stance, as well as the adductor work. That is all good, but with the bouncing, your body may need some time to adjust. Much like ladies returning to running – it may initially cause a slight increase in symptoms, but as long as you give your body appropriate rest between challenging workouts, your body will adapt with a new level of strength and stability. That being said, make sure there are no tiny breath holds and that your TA stays engaged. If this hold true, I would love to hear from you in two weeks to see if you still have increased symptoms after this workout!
TashaFebruary 10, 2014 at 2:54 pm #9857KTGuest
Thanks for the tip on stopping my dog pulling on the lead! You’re a dog training guru too! My dog wouldn’t actually walk with the lead under her belly and between her back legs, but i just tuck it under her front leg and it works perfectly. People look at me a little odd – but really who cares?!
I’m progressing through the 7 day advanced programme and am feeling stronger all the time. It’s such a relief. I’ve had various setbacks, primarily when I’ve started doing a little more on my mountain bike, but i’ve got used to the pattern of it getting worse by about day 5 or 6 after the extra strenuous event, and then almost overnight it seems to get better.
I’m now in training for a 90 mile road cycling event in May, and am looking for your advice on saddles. My husband is (very handily!) a fully qualified British Cycling coach who will (when he has a spare moment) write me a training plan. He is also a SICI qualified bike fit specialist – so he’s been helping get my bike sorted so I can sit appropriately. What neither of us is sure about though is the saddle. I’ve had my sit bones measured so I know my width, but (as I’m sure you’re aware) there is a massive array of saddles out there – each promising something special, but none mentioning prolapse. The one which was advised to me by the shop which measured my sitbones, was a SQ-lab saddle, which sell for around £100. A lot of money if it’s not the right one. I’m happy to buy saddles on ebay once i’ve figured out what I’m looking for, but right now i’m stumped. There’s some with the centre part cut out to ‘relieve pressure’ but i’m assuming that with a prolapse I wouldn’t want that – or would I? The more I think about it, the more confused I get. I realise a lot of it does come down to personal preference, but any guidance would be much appreciated.
many thanks againFebruary 11, 2014 at 4:21 pm #9873
I hear you on the saddle issue. Such a tough decision. We are lucky enough to have a store here that lets us try the saddle for a ride or two before purchase. It is such an individual decision and one of comfort. Do not worry about the cut out being bad for the prolapse. Your positioning on your road bike will be rolled forward on your sit bones, no pressure on your tail bone so your pelvic floor is pulled tight for excellent support. Pair that with your chest being up as you reach forward for your handle bars and I can’t think of a more supportive position for your prolapse.
The cut out simply offers pressure relief for your pubic bone and the soft tissue that would be compressed. Try it. I personally like the cut out for my saddle.
- The forum ‘Ask Tasha!’ is closed to new topics and replies.