Fact or fiction..... When it comes to Women's Health

Our Women’s Health Physio, Jen shares with us some comments which she commonly hears from her patients.  Read below and see if you know whether these statements are true, false, or perhaps they could be a maybe and need further discussion.

1. I leak urine therefore I must have a weak bladder

This is not true.  Urine is stored in our bladder, and it will stay there unless the pressure on the bladder or from within the bladder becomes very large and the urethra (tube from the bladder to the outside our body) cannot remain closed.  So, we will have leakage if the pressure on the bladder or from the bladder muscle itself is greater than the ability of the urethra to stay closed. So really you could argue that if you leak urine you have a strong bladder!

2. Straining to force my urine out is a good way to empty my bladder and means that my pelvic floor muscles are strong

Again, not true.  The bladder muscle is not under our conscious control, and we need to give it the right environment for emptying.  This means the pelvic floor muscles need to be relaxed to allow the bladder to empty.  Straining is achieved by holding our, breath and contracting the abdominals strongly.  It is a bit like squashing the bladder from the top down.  Similarly, we should avoid straining to empty our bowels!

3. I leak urine and I have pelvic pain. This means that my pelvic floor muscles are weak, and I need to improve my core strength to help improve my symptoms

This one is a maybe, but not necessarily.  It is true that the leakage and pain may be related to weak pelvic floor muscles and a weak core.  (Remember that the pelvic  floor muscles are part of our deep core system). The leakage and the pain may also be related to the pelvic floor muscles not coordinating well and not being able to relax well. It could also be a combination of the two, or maybe the pain is related to something else. The best way to work out the reason behind these symptoms is to see a Women’s Health Physiotherapist which will allow for a detailed examination and then a suitable management program can be put in place, which may or may not involve core strengthening exercises.

4. Following my six week postnatal medical check, I will be cleared to return to the level of exercise I was at before pregnancy

This one needs a bit of a longer answer as it depends on any factors. Firstly, a postnatal medical check does not involve any type of assessment with respect to exercise.

 There is no one size fits all with this and there are many factors which we need to consider.  Some of these are:

• The form of exercise to which you would like to return. Returning to swimming will be a very different timeline compared to someone wishing return to trampolining
• What happened during the pregnancy – were you able to continue with your preferred form of exercise, or did you need to stop? If so, how far into your pregnancy was this? Stopping or modifying exercise may have been due to medical advice, physical limitations or just not feeling great whilst exercising
• What type of birth did you have? Most people will compare a caesarean section to a vaginal birth, but there are very different types of vaginal births – from a relatively uneventful, unassisted delivery, to a more involved delivery which may have involved forceps, and perhaps perineal tearing, which again will be variable
• Other important considerations relate to how you are feeling in this postpartum phase:
  • Do you have any aches and pains?
  • Are you having any issues with bladder or bowel control?
  • Do you have any sensations of vaginal bulge or heaviness (which may indicate the presence of a prolapse)?
  • How much sleep are you getting?
  • How are you feeding your baby?
  • How much support do you have around you?
  • Do you have someone to care for your baby while you exercise, or will you have your baby with you while you exercise?

So, you can see it is perhaps not as straightforward as you might think and there are likely any other additional considerations.

Booking an appointment with a Women’s Health Physiotherapist following your six week postnatal medical check will allow for a detailed postnatal assessment, which will include a discussion around your birth experience, new postnatal life, and your exercise/activity goals.  From there a suitable management program can be put in place to gradually build towards achieving these goals

 Written by Jen Tweedie – Women’s Health Physiotherapist