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As women, there’s a lot of stuff we don’t talk about. Or if we do talk about it, we make jokes. Because we’ve long been conditioned to shut up and put up. Issues around pelvic health are the prime example. But after making a joke about bladder leakage with a previous Happy Mum Happy Baby guest and a doctor pointing out that while it’s good to chat about these things, it doesn’t have to be the norm, Gi wanted to bring this conversation to the fore. So she brought in Pelvic Health Physio Emma Brockwell to get to the heart of the issue.

Because when we don’t talk about these things, we don’t know what’s normal. We’re often not sure who to ask or where to turn. But when we asked you what you wanted to know about pelvic health, the questions for Emma came rolling in. Turns out, there’s a LOT we need to know about pelvic health.

Here are YOUR Big Questions on Pelvic Health.

 

A pelvic health physio sounds interesting. What’s the deal?

Emma explains: “We are healthcare professionals – physiotherapists that treat that middle part of your body. So I don’t want to just isolate it to the vagina and the vulva because it’s not just that. We look at the parts that are connected around that area – so even your legs, your bottom muscles, your back passage, your lower back, even your middle back.”

She adds: “We look at everything that connects the two into the middle of your body and we treat everything that is to do with the pelvis basically. That can be vaginal dysfunction, back passage dysfunction, any dysfunction. We will look at, treat and hopefully manage to get you better.”

And the good news? Around 84% of women will get better by seeing a pelvic health physio.

 

Alright. Sounds pretty good. So how do I find a pelvic floor physiotherapist?

You can ask your GP to refer you or if you go onto the app Squeezy (which supports people with pelvic floor muscle exercise programmes), there’s a directory. You can type in where you live and you’ll get details of NHS and private physios there.

 

Onto the nitty gritty. Isn’t it normal to leak urine during pregnancy or after giving birth?

Absolutely not. It’s common, but it’s not inevitable and it’s not ‘normal’. Around one in three women leak urine, but women in general are padding up and putting up with it and it’s not OK.

Emma is adamant that any person who is struggling with urine leakage should seek support, rather than living with it.

“Women are really embarrassed to talk about it. They’re really embarrassed to talk to their friends and family and open up which is understandable. But it’s it’s not just their friends and family they feel embarrassed to talk to, they feel embarrassed to talk to healthcare professionals about it.”

“There’s treatment and help out there for you and I just cannot encourage women enough to act on that and seek help because it’s there.”

 

Can I exercise during pregnancy?

There’s a lot of myth and misinformation around exercising and pregnancy. But if women feel well enough, there’s no reason for them not to exercise. You should always check with your healthcare team but for the majority of women, exercise is hugely beneficial for both physical and mental health. Not only that, but babies love it too.

Emma explains: “Babies love you exercising, as they get more oxygen in the placenta, more nutrients. You’ll find through the research that babies are actually less likely to suffer from obesity and cardiovascular problems when they’re older if mum exercises during her pregnancy. I know there’s a lot of concern around miscarriage and pre-term birth but actually research shows that for the majority of women, it’s just such a wonderful, brilliant thing to do.”

“We need to bust the myth because actually it is just that – a myth! I would strongly suggest visiting The Active Pregnancy Foundation because there’s loads of evidence-based information on there that should really put your mind at rest.”

Ideally women should be active for 30 minutes, five times a week. Whether that’s walking around the block, or keeping up running if you’re a runner already.

 

Will exercising during pregnancy help me after giving birth?

There’s been some evidence that shows your postnatal recovery will be much better and more effective if you’ve exercised when you’re pregnant. And that’s not just for your pelvic floor health but for your whole physical health – not to mention your mental health too. We all know the benefits of keeping moving. If you aren’t sure and you want to exercise during your pregnancy, check in with your team and then go for it.

 

When can I exercise after giving birth?

As far as Emma’s concerned, as long as you’re thinking about your pelvic floor symptoms, you should be moving and exercising from day one postnatally. “I would encourage women from the moment they’ve had baby and they have no catheter in place to start doing their pelvic floor exercises, to start stretching, to start being active. That might just be a five minute walk around the block – that’s exercise!

But when it comes to higher impact exercise, we need to consider how we can get the muscles in our body that have been lengthened and weakened moving, but do it steadily, with consideration of our pelvic floor health.

 

Alright, so I’ve heard all about pelvic floor exercises. But how do I do them? And is it too late to start?

First things first, it’s never too late to start. You can be 28 years postnatal and still benefit from pelvic floor exercises. Ideally, we’d be teaching this in schools but if you’ve never done a pelvic floor exercise in your life, now’s the time to begin. And as for how? Emma’s got you covered:

She explains: “Ultimately the best way to do your pelvic floor exercises is in an upright position so standing is your gold standard. Or if you’ve just had your baby, try side lying as opposed to lying on your back so that makes it a little bit easier.”

“You want to think about squeezing your back passage because when you squeeze your back passage you’ll also squeeze your front as well. You want to aim to hold for up to 10 seconds. If you’ve just had a baby, that might be quite a big ask so just thinking about squeezing back and front for a count of up to 10 seconds, or working up to that, but also then letting it go. Think about that contraction and relaxation. You’ve got to contract the muscle but you’ve also got to relax it as well. So once you squeeze for three or four seconds, let it go. Aim to repeat that 10 times at least three or four times a week.

 

I’m pregnant and I’ve got pelvic girdle pain. What can I do about it?

Pelvic girdle pain is essentially pain that occurs most commonly during pregnancy around the back of the hips and into the pubic bone. For some, it can be hugely debilitating, causing problems with walking. While some pregnant people are told not to worry about it because the pain will go away, Emma encourages anyone experiencing pelvic girdle pain to get support from a pelvic health physio: “We used to say that you experience pelvic girdle pain because of instability of the pelvis the research on that has been completely blown that out the water. We now know it’s really occurring because the tissues are very sensitive.”

“We can help you find ways of desensitising this tissue. That can be through exercise, through mindfulness, prenatal yoga is brilliant for pelvic girdle pain. There’s some lovely compression garments like leggings that exist that can really help keep the lymphatic system moving around the pelvis and desensitise the tissues.” No more putting up with pelvic girdle pain!

 

What about anal incontinence? What support is available?

One in ten women are suffering from anal incontinence, so know if you are, you’re not alone. If you’ve had a third or fourth degree obstetrics tear during labour, you’re more likely to experience fecal incontinence afterwards. There’s a great charity called MASIC who offer women considerable support to those who’ve had injuries as a result of childbirth and they exist to support women, challenge stigma and drive change.

Check out Gi’s conversation with the incredibly knowledgeable Emma Brockwell below for advice on sex after childbirth, pelvic floor trainers, using menstrual cups, perennial massage and much more below.

Need to know more about pelvic health? Find Emma Brockwell on Instagram, check out her website or buy her book, Why Did No One Tell Me.

Want more Asking for a Friend? Check out the 9 Things You Need to Know about Gut Health with Dr Megan Rossi.

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