I remember after I gave birth to my daughter trying to perform my first kegel; trying desperately to lift that pelvic floor up off the ground as that’s where it felt it was. After months of kegels, slowly but surely, my pelvic floor began to remember who it was, and gradually started playing ball. I’m lucky that I don’t wee myself when I sneeze, or dread the thought of going on a trampoline because I can just about take it, yet I know my pelvic floor will never be the same and I seem to spend a disproportionate amount of time going – or should I say running – to the toilet.
Celebrities like Carole Smile and Nadia Sawalha have come out in the open about the issues they have struggled with post birth. But what I want to know is- why is the rehabilitation of the pelvic floor so overlooked? In France, nobody bats an eye lid about having pelvic floor rehabilitation and actually it’s par for the course, so why are we still living in the dark ages about this here in the UK?
Today on the blog I have a Q&A with internationally renowned postnatal chartered physiotherapist, pelvic pain recovery specialist and Mummy MOT founder, Maria Elliott, who has just launched a new clinic at Queen’s Tennis Club every Monday in their state of the art rehabilitation pilates studio to talk all things pelvic floor.
What sort of issues do women experience post pregnancy and childbirth in the pelvic region and why?
Oh, unfortunately, there’s all sorts. Many women have a weak pelvic floor which can then give them complex bladder issues. One in three women have bladder incontinence after giving birth – so they leak when they cough, sneeze or run and 6% have faecal incontinence. Often this means mums aren’t able to go back to the sports (or life) they enjoyed before pregnancy – in particular running.
Often mums come in angry and upset as they still have a significant gap in their Tummy Area Rectus Diastasis. This creates loss of core stability and spinal / pelvic support. A detailed assessment allows us to work out why the gap is still present and start a tailored rehab programme.
They can also get pelvic pain if they’ve had internal stitches – this ends up as pain with sitting, when wearing tight clothes or pain in the pelvic bones which is called pelvic girdle pain. PGP pain is often present due to altered pelvic alignments and tights muscles pulling on the area. Sex can be painful, leading to relationship pressures and mental wellbeing issues.
Women can also experience painful haemorrhoids or even a prolapse where the bladder, uterus or rectum descend down and cause pressure and discomfort at the entrance to the vagina.
And what sort of symptoms might women experience?
Leaking when you cough, sneeze, run or lift a baby is a key postnatal signal there’s something not right. To be clear, this is not normal, although many women just assume it is.
Women can also experience a feeling of dragging or heaviness in the pelvic area, especially towards the end of the day. Other possible symptoms include constipation, back pain, pain with sitting, pain during sex, prolapse, hormonal imbalances, low energy and low mood.
Sometimes women have a thyroid deficiency that they don’t know about and this can often be misdiagnosed as postnatal depression.
We’ve heard of kegels…but is rehabilitating your pelvic region more than just about pelvic floor exercises?
Yes, very much so. It is important to do kegels and tighten the pelvic floor but this needs to be integrated with the breath and other muscles. Just doing a few kegels in an isolated way is not enough – it’s often about retraining women in basic functional movements like squatting, pulling and lifting etc while incorporating the kegels.
Can you talk us through what might happen in a pelvic rehabilitation session?
In France, every woman gets a postnatal assessment and personalised rehabilitation programme to follow.
I founded The Mummy MOT to provide women in the UK with a new innovative bespoke recovery programme because I truly believe it is a key way to improve women’s health both during pregnancy and afterwards, for the rest of their lives – ensuring that it doesn’t become a defining moment in a woman’s life for all the wrong reasons.
So what does an MOT entail?
Well anytime from 6 weeks after giving birth a woman can come for their initial assessment.
All MOT practitioners around the UK are experienced women’s health practitioners and have been trained by myself. We take a detailed history of the person, establishing any previous issues, trauma etc as well as all current symptoms. We assess the biomechanical side – that’s posture, alignment etc, conduct an in-depth assessment of the pelvic floor and abdominal muscles and check functional movement.
We also make sure your organs are in the right place and check your pelvic floor and deep tummy muscles contract together to stabilise the pelvis and the spine and support the organs.
Rehabilitation involves building strength from inside out through bespoke exercises. Marta Kinsella is joining us now as a specialist consultant.
Once we have activated and strengthened this ‘deep corset’ layer, then clients can come to the new state of the art rehab’ studio in Queens Club for tailored postnatal pilates and resistance work with balls and bands to retain the strength.
For patients suffering from ongoing urinary or faecal incontinence then we may recommend our new cutting edge PelviPower treatment chair in our Chiswick Clinic. It’s the first in the UK and has already had absolutely staggeringly great (and painless!) results!
How would someone know if they needed to have pelvic rehabilitation?
I believe everyone should have a Mummy MOT to ensure they achieve the best possible postnatal rehabilitation they can and avoid problems further down the line. Early screening can catch potential issues early when they are often treatable without surgery. Early intervention and early rehab’ are key!
Many people will feel something is not quite right but a lot of women just ignore the issue and put it down to their body after childbirth.
It’s such a shame as it can lead to chronic discomfort as well as lack of confidence and impact mental wellbeing. There is still an issue with women not wanting to talk about it and the ‘embarrassment-factor’ as well as finding the time to look after yourself whilst tending to a new born baby. Often patients only come once their kids are at school but my vision is that everyone is checked and given treatment early to prevent long term complications – not to mention the savings that could be made for the NHS on treatments, pads and surgery etc.
And how does pelvic rehabilitation help ease some of the post-partum problems that mums may be experiencing?
If a birth has been traumatic the pelvic area can go into a ‘freeze state’, so we need to release the muscles and relax the pelvis again. This means taking the trauma out of the nerves and desensitising them. Sometimes the muscles need to be released and relaxed to decrease pain and mobilise scar tissues but sometimes they need to be strengthened and powered up. Pelvic rehab will release any tight & painful muscles and strengthen any weak or overstretched muscles in the area.
Often mums don’t want to touch their pelvic area or their C-section scar and disconnect from the area hoping everything will just miraculously snap back and get better. But like any other injury or surgery, scar tissue needs to be mobilised, released and strengthened to get back to functionality and this happens with support focussed rehab.
If there’s only one thing you could say about pelvic rehabilitation it would be….
Every Mum should have a Mummy MOT Assessment! Get your pelvic floor checked so you can be a strong functional mum and get back to where you were before babies.
Anything else you would like to add?
There are lots of non-surgical treatments available but before buying stuff on the internet and hoping it’ll work, it really is worth going to see a good women’s health specialist who can assess and possibly treat, but can also give advice on what’s the best thing to buy for your own personal rehab. There’s so much out there it can be confusing and you may end up with something totally ineffectual.
Maria Elliott, is the founder of Simply Pelvic Health, a leading Pelvic Health Specialist and founder of The Mummy MOT. Having been a specialist in women’s postnatal health for nearly 30 years, she developed The Mummy MOT to help women recover their bodies soon after giving birth and avoid further consequences in later years. This year she launched her first pelvic exercise programme – The Ultimate Guide to Pelvic Pain Recovery.
Monday – Queen’s Club, Palliser Rd, London, W14 9EQ
Monday & Tuesday – Riverview Clinic, 18 Riverview Grove, Chiswick, W4 3QJ
Thursday & Friday – Cione Clinic, 10-11 Bulstrode Place, London, W1U 2HX
Trial Mummy MOT assessments or copy of Maria’s new online video course, The Ultimate Guide to Pelvic Pain Recovery are available for purposes of review. For more information visit www.themummymot.com or www.simplypelvichealth.co.uk or contact Emily Manson for interviews and pictures on firstname.lastname@example.org or 07767 322 209.