Educate Yourself about Incontinence, Prolapse, and General Health

How Can Swimming Benefit Me?

I thought I would write a bit about swimming because whether you are pregnant, just delivered, or well beyond those points in your life, swimming is a great exercise choice. It is simply a fantastic way to get your heart rate up and strengthen muscles through non-impact activity.

I love this exercise choice because it promotes extension. I have blogged extensively about the importance of working the muscles on the back side of our bodies. If you think about it, everything that we do throughout our day is out in front of our body. This tendency to work our flexors and forget about our extensors, rounds our shoulders, flattens our back, and tucks our tail bone under. When you combine this with the never-ending pull of gravity, we can begin to understand why so many of us stand with poor posture and have significant muscle imbalance that can lead to pain and muscle dysfunction. The lack of extension, for many women, can lead to symptoms of incontinence and prolapse. A flexed or “tail bone tucked under” posture can cause our pelvic floor muscles to be ineffective.

Swimming is an activity that can reverse this flexion and get you in an extended position. It will work your transversus abdominus, your low back, your legs, your arms, and your cardiovascular system. It is a great exercise to work into your cardio rotation, alternating it with walking, running, biking, hiking, dancing, or whatever else you choose. It gives your joints a break and promotes extension, all while maintaining your cardiovascular conditioning.

If you are not a fan of the water, you can ease yourself into it. Grabbing a kickboard and doing some laps is a great exercise that will work your back extensors, your transversus abdominus, and your legs. And maybe you prefer to have your feet on the ground when in the water. Then water aerobics with the option of resistance paddles in your hands can offer the same benefits, promoting extension, muscle strengthening, through the resistance of the water and relieving joint compression forces.

So, if you are heading to the gym and looking for a non-impact work out, pass by the elliptical and arc trainer, and get in the water!!! Steer yourself away from the first two exercises listed that again work your body in a flexed position and begin a swimming routine. The extension will feel great and will benefit you far more than you will immediately recognize.

Cardio Questions July 21, 2010

Types of Medication to Help Treat Incontinence

There are many treatment options for incontinence. One of these treatment options may be medication prescribed by your physician. Let’s review the different classes of medication used for incontinence and how these medications treat the condition.

Anticholinergic drugs are used to treat incontinence. They act by blocking the chemical messenger, acetylcholine, which is responsible for stimulating bladder contractions. The goal of anticholinergics is to limit the number of unwanted bladder contractions.

Topical estrogen is also used in the treatment of incontinence. It is a cream that is applied directly to the vaginal and urethral tissue with the goal of increasing blood flow to tone and rejuvenate the muscular and connective tissue of the pelvic floor.

Desmopressin is another drug used to treat incontinence. It is a synthetic version of a natural hormone called anti-diuretic hormone or ADH. This hormone decreases production of urine. Our bodies normally produce more ADH at night so our need to urinate is less. Desmopression may be given to elevate ADH levels and control night time incontinence. For this reason it is commonly used to treat bedwetting in children.

For more information on the different types of medications that can help treat incontinence, I recommend reaching out to your physician.

Understanding Incontinence July 12, 2010

Kegels: Past, Present, and the Mind-Body Connection

by guest blogger, Michelle Herbst, MPT, DPT

What is a Kegel? Do women know how to do Kegels to make a positive impact on their overall health? Yes and No. But, first a brief history lesson.

In 1956 Dr. Arnold Kegel described physiological therapy (later named the Kegel) in a landmark journal article entitled Early Genital Relaxation – New Technique of Diagnosis and Non-surgical Treatment. The Kegel exercise described by Dr. Kegel was a contraction that was not excessive and isolated to just the pubococcygeus muscle while avoiding the use of gluteals, abdominals, or muscles in the mid-back region. Dr. Kegel recommended his physiological therapy to women of child-bearing age through menopause to prevent, improve, cure incontinence, prolapse and pelvic pain and be an adjunct to surgical interventions.

Sixty years has passed since the Kegel was first prescribed to positively affect genital and pelvic muscle relaxation. By now women around the world should know and consistently use this effective and efficient non-surgical treatment method. However, real barriers exist with respect to the perception, education and regular application of the Kegel. Barrier one: Most women question the effectiveness of Kegels and therefore may choose not to practice them. Barrier two: American women typically first encounter the Kegel exercise in a pre-natal course. Typically, a picture of the pelvic floor muscles or pelvic basket are presented and a nurse describes how to contract the muscles and for how long. The attendees of these prenatal courses are also learning about delivery options, how to breast and/or bottle feed, initial stages of labor, who to call when labor starts, etc. The list of new information and challenges are almost endless. Get my point? The education on Kegels is likely lost or forgotten. Barrier three: The exercise prescriptions for the Kegel is typically are not clear and have been over simplified. These barriers often leave women confused, frustrated and anxious and result in most women making the decision that Kegels are too hard and not worth the time or effort.

How do we overcome these barriers? One way is to use the principles of motor learning to take advantage of the mind-body connection to teach, learn, and master a contemporary approach to Kegels. Using motor learning techniques to learn a new exercise, skill or task addresses the perception and understanding of what the activity is and how to put the activity or skill into action. In a nutshell, motor learning is a process in which the mind and body are engaged in active learning of a new skill or task.
The Hab-It program offers a contemporary approach to learning a Kegel and takes full advantage of motor learning principles. Rather than teaching the Kegel in isolation, the Hab-It program’s 2-step Kegel incorporates natural movement patterns of the pelvic basket working together. The audio-visual presentation of the 2-step Kegel uses motor learning principles by creatively and effectively addressing the perception of what a Kegel is and then educating the client on how to fully engage the pelvic basket. Lastly, Tasha’s exercise prescription for the 2-step Kegel is appropriate for many individual users and can be changed, modified and progressed through as described in the Ask Tasha section of our website.

Knowledge is power. Dr. Kegel gave us a good foundation and a place to start. Sixty years of research have pushed us forward to our current understanding that our bodies do not work in isolation but in functional movement patterns. When barriers are adequately comprehended and addressed, success will come with consistent work and effort. Use of the 2-step Kegel is today’s version of how to prevent, improve, cure incontinence, prolapse and pelvic pain and is a great adjunct to surgical interventions.

References: Shumway-Cook A, Woollacott M. Physiology of Motor Control. In: Motor Control. Translating Research into Clinical Practice. Fourth ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010: 46.

The pelvic basket is an intricate weaving of muscles, tendons, and ligaments that support our pelvic and abdominal organs and assists in bowel and bladder control. As discussed in Tasha’s blog post, The Positive Side Effects of Pelvic Floor Muscle Weakness, “the pelvic basket incorporates the front, back, sides, and floor of your pelvis and lower spine that provide the deepest layer of stability to your body.” Muscle tissue is normally pliable but poor postural habits, trauma to the pelvic basket or chronic tension

Kegel June 30, 2010

What is the Best Abdominal Workout for Me?

We have discussed, in depth, how important the transversus abdominus (TA) is to a maximum pelvic floor contraction. These lower abdominal fibers that begin below our ribs and funnel down into our pelviscontract in coordination with the levator ani muscle of our pelvic floor. The muscle fibers of our TA act like a corset as they wrap around our abdomen and pelvis instead of running up and down or at a diagonal like our other abdominal muscles. Much like a corset, these fibers tighten, forcing the air within our abdomen and pelvis up under our ribs as we draw our belly button “up and in.” This cinching action, along with the coordinated elevation of our pelvic floor, helps to displace our intra-abdominal pressure upward, working against the effects of gravity that our pelvic floor works against every minute that we are sitting or standing throughout our day.

It is important to note the differences between the action of our TA and our other abdominal muscles. These other abdominal muscles lie over the top of our TA and include our right and left internal obliques, our right and left external obliques, and our rectus abdominus. The common action of all of our abdominal muscles, with the exception of our tansversus abdominus, is to curl our ribs closer to our pelvis. Our TA, which runs in a transverse direction, works like a shrink wrap, giving increased stability to our pelvis and lower lumbar spine. We strengthen this muscle not by curling our ribs closer to our pelvis, but by challenging the stability of our spine. This can be done in many different positions, but the positions I find most effective are in a hands and knees position and in a plank position. There is a progression of difficulty for TA stabilization within the four workouts on the Hab-It: Pelvic Floor DVD, with the plank position being the most difficult in workout #4. Below I have also included 4 more examples of plank exercises of progressive difficulty for you to try when you have mastered all the exercises on the Hab-It DVD.

Plank hold with horizontal abduction – (3 sets of 10 repetitions, on Right and Left) Holding plank position, posting on your hands and toes, pull your belly button in toward your spine and tighten up. Lift one arm out to the side, with a slight bend in your elbow, focusing on squeezing your shoulder blade down and in. Hold your shoulder blade squeezed down and in for a 2 count before bringing your arm back down to allow your hand to barely brush the floor and then repeat. Perform 10 repetitions with your right arm and 10 repetitions with your left arm. Take care to stay parallel to the ground, not letting your body rotate as you lift your arm out to the side.

Swiss ball slalom – (3 sets of 10 repetitions) Position yourself in push up position with your hands on the ground and your feet on a Swiss ball. Pull your in knees toward your chest by rolling the ball in, pause in this position for a count, and then straighten your legs back out. Repeat these slow reps with good control of the ball for 10 repetitions. Remember to keep your belly button pulled in toward your spine throughout this exercise and stop if you feel any back pain! Depending on your abdominal strength, the ball may be placed at your shins or at your laces. Start with 3 sets of 6 repetitions and gradually work up to 3 sets of 10 repetitions.

Plank holds with hip extension – (3 sets of 10 repetitions) Position yourself in plank position, posting on your elbows and your toes. Make sure your belly button is drawn in tight to stabilize your lower back as you lift one leg off the ground, squeezing the back of your thigh and your glute for a count. Reposition your leg and then lift the opposite foot off the ground, squeezing the back side of your thigh and glute for a count. Repeat these lifts for 10 lifts on each leg. Note that your hip extension is small if you don’t allow your back to arch, so don’t expect a big leg lift for this exercise.

Plank hold with knee drive/rotation – (3 sets of 10 repetitions) Holding in plank position, this time with weight on your hands (instead of elbows) and toes. Pull your belly button in toward your spine and then pull your right knee up and across, under your body, toward your left elbow and hold for a two count. The closer your knee gets to your elbow, the better the oblique contraction. Then extend that same leg back out straight, taking it into a hip extension, squeezing your glute for a count and then again draw your knee up and across and repeat. Begin with 3 sets of 6 repetitions on this exercise and then progress as you are able up to 3 sets of 10 repetitions. Remember low back pain/ache is a sign to stop.

A quick note : I have not listed any abdominal exercises lying on your back as my favorites for working transverses abdominus because it is hard to not let your rectus abdominus take over in a crunch position. I also recommend against any type of leg lowering exercise, as the weight of your lower body is quite often too much for your transverses to hold and therefore will increase the pressure forced down on our pelvic floor as the other abdominals take over.

Pelvic Basket Muscles June 23, 2010

Give Your Tail Bone a Lift!

Did you know that if you don’t extend your tail bone, your pelvic floor will never fire with optimal strength? A tucked under tail bone takes our pelvic floor, which attaches at our tail bone and our pubic bone, and makes it slack. And, over time, this loose muscle responds poorly and becomes weak because we are never able to fully activate all of the fibers because our two attachments sites are sitting too close together.

If we extend our tail bone, giving it a slight lift, we put our pelvic floor muscles at the perfect length/tension ratio where it can fire all of its muscle fibers efficiently and effectively.

As a visual, picture a trampoline. If the springs on that trampoline are loose and stretched out, the trampoline itself has too much slack and doesn’t respond with a good spring when you jump on it. But, if those springs are tight, the trampoline is taught and gives you a good bounce with every jump.

Your pelvic floor needs solid springs to support your pelvic organs and to close down the pathway from your bladder to your urethral opening. Our springs are our tail bone and our pubic bone, so we have to keep these attachment sites solid.

There are two particular times in our lives when it is common to see these attachment sites begin to move closer together. One is immediately after having our babies and through that first year or more when we carry our babies the most. As we spend time sitting with our little ones, usually in a very relaxed position rolled back on our buns, our tail bone gets tucked under for a good portion of our days. Then once we stand, we like to thrust our hips forward and our tail bone under to allow our baby to lay on our chest or to provide a hip or belly for them to perch on.

The second time in our lives when tucking our tailbone under is most common is around those menopause years. Our spine slowly loses mobility as we age unless we work its full range of motion. The most common postural change with age is to flatten out the curves of our spine, including our lower back and tail bone. Remember, a healthy spine must have both flexion and extension to maintain good blood flow and prevent degeneration changes. Throughout our years, every task we perform throughout our work day is in front of us pulling our spine, including our tail bone, into a forward flexed position. Unless we actively work to maintain the extension of our spine with specific exercise, we are all coming forward, rounding our shoulders, and tucking our tail bone under, giving our spine the same curve as a turtle shell.

Think about this for a minute! What do you do throughout your day to work the back side of your body? Check to see if you are comfortable lying on your stomach. This is a great starting point. Then begin to work the multifidi extensions, the glute lifts, etc. from the Hab it: Pelvic Floor DVD to strengthen the extensor muscles of your spine. Because we all do so much work out in front of our bodies, it is important to do at least two extension exercises every day to maintain the extension in our spine.

So for those of you who have been so diligent about working your pelvic floor muscles but have not bought into the importance of working the surrounding support muscles, you are selling yourself short! The posture that we hold throughout the hours that we are either standing or sitting has a dramatic effect on our pelvic floor function. As I recommend on our Hab It: Pelvic Floor DVD, just 8 repetitions of endurance and short burst repetitions for your pelvic floor muscles every day is plenty, but I also stress that complete rehabilitation of your pelvic floor has to include strengthening of your multifidi muscles, your tranversus abdominus, your inner thighs, and your deep hip rotators. Strengthening your entire pelvic basket is the key to resolution of your symptoms. Good luck!

Favorites Pelvic Basket Muscles Posture June 10, 2010

“Stress” vs. “Urge” Incontinence

The symptoms of incontinence can vary from person to person. Some may experience minor leaking every once in awhile, while others may experience complete loss of bladder control daily. There are also different kinds of incontinence, the two most common being “urge incontinence” and “stress incontinence.” Let’s take a closer look at the differences between these two types of incontinence.

We will first define “stress urinary incontinence.” It is the involuntary loss of urine as a result of increased intra-abdominal pressure from activities such as laughing, coughing, sneezing, or jumping.

And the definition of “urge incontinence” is the involuntary loss of urine following a strong, unexpected urge to urinate due to involuntary bladder spasms.

Although the result of these two types of incontinence is the involuntary loss of urine, there are many differences between urge and stress incontinence. For example, stress incontinence is caused by distinct activities that increase our intra- abdominal pressure, whereas urge incontinence is unpredictable and unexpected.

Another difference is that stress incontinence is due to ineffective contraction of our pelvic floor muscles, meaning that we can’t get our muscles to contract when we want them to. On the other hand, urge incontinence is due to involuntary contractions of our bladder muscle. These are unwanted contractions that we can’t voluntarily stop.

And the final difference is in the treatment of these two types of incontinence. Stress incontinence is most often treated with pelvic floor muscle training and strengthening, whereas urge incontinence is often treated with a combination of medication, bladder retraining, and pelvic floor muscle strengthening.

Understanding Incontinence June 8, 2010

Questions from You to Me: Holding Breath While Activating Abs

When I activate my Transversus Abdominus (TA), should it feel like I am holding my breath?

You may feel like holding your breath, but don’t allow yourself to do so! Contracting your TA does lift your chest because when you do so, it’s like squeezing a snow cone – the most narrow part is down by your pelvic floor so it squeezes and displaces the pressure up under your ribs, expanding and lifting your chest. Remember, if you feel any bearing down or pressure forcing your pelvic floor down, you are activating the wrong muscle group.

Pelvic Basket Muscles June 3, 2010

Questions from You to Me: Proper Posture When Not Carrying a Baby

Can you remind me again about the posture I should hold when I am not carrying my little one?”

If yours is a tendency to lock your knees and tuck under, then find reminders throughout your day to essentially stick your butt out. This is the gymnast posture and is extreme, but when you activate your Transversus Abdominus (TA) in this position, it will rock you back slightly to your neutral spine position. Remember, stick your buns out – this will give better tension to your pelvic floor – and that is passive tension, not an active muscle squeeze.

Pregnancy/Post Partum June 3, 2010

Questions from You to Me: Hip Flexors

My hip flexors are tight. What is the best way to stretch them?

To stretch your hip flexors, spend atleast 5 minutes per day lying on your stomach playing with your little one. You can also work your multifidi extensions in this position if you want. This will passively stretch your hip flexors while you intermittently turn on your multifidi – a very important postural muscle.

Posture June 3, 2010

Lifestyle Changes to Help Manage Incontinence Symptoms

Experiencing incontinence can be life-changing. In order to better manage your symptoms, there are some lifestyle changes that you can make to give yourself the opportunity for better control.

The first lifestyle change is to quit smoking. The harmful effects of cigarette smoking have been well documented. It is the secondary effects such as incontinence that are often overlooked. The chronic cough associated with cigarette smoking significantly increases the pressure on our pelvic floor muscles and, over time, can lead to incontinence. Also, the poor oxygenation of muscular and connective tissue associated with cigarette smoking has a direct impact on the muscular and connective tissue of our pelvic floor. This can cause decreased strength and endurance of our pelvic floor muscles and, ultimately, can lead to symptoms of incontinence.

The second lifestyle change is weight reduction. Our pelvic floor muscles have the responsibility of holding up our pelvic organs against the effect of gravity throughout the day. Every additional pound of abdominal fat that we carry is an extra pound that our pelvic floor must support. 15 to 25 to 50 additional pounds of stress on our pelvic floor muscles may eventually lead to pelvic floor dysfunction and incontinence.

A third lifestyle change is dietary changes. It is important to avoid bladder irritants such as caffeine, carbonated beverages, spicy or acidic foods, and artificial sweeteners. A common mistake is to restrict water intake when trying to control incontinence symptoms. This practice can not only lead to dehydration but it can also cause further bladder irritation due to increased concentration of urine. Another dietary change is increased fiber intake. This will allow better bowel regulation and decreased pushing and stress on our pelvic floor muscles.

The final lifestyle change is to increase your activity level. Quite often, people who experience incontinence tend to restrict their activity levels when, in fact, just the opposite needs to happen! It is important to learn about the muscles of your pelvis and abdomen and how to strengthen these muscles as well as how to directly strengthen the muscles of your pelvic floor. Continuing with recreational activities you love while working a strengthening program for your pelvic floor and surrounding musculature is important for you physically and emotionally when experiencing incontinence.

Understanding Incontinence May 27, 2010