March is Endometriosis Awareness Month

Did you know that Endometriosis impacts 1 in 10 girls and women, and unmeasured numbers of transgender, nonbinary, and gender diverse individuals?

What is endometriosis?

According to EndoAct Canada, endometriosis is a gynecological condition that affects approximately 1 million people in Canada. Common symptoms include severe menstrual pain, chronic pelvic pain and infertility. There is neither a definitive cause nor a known cure for endometriosis – symptoms are managed using a combination of medical and surgical care. Despite the burden of endometriosis, awareness of this condition is low because of menstrual stigma and taboo.

Endometriosis occurs when the endometrial lining of the uterus abnormally grows outside of the uterus forming implants, lesions or cysts in the pelvic cavity and sometimes in other regions of the body. This often leads to pain, scarring and other medical conditions depending where the lesions are.

Symptoms of endometriosis can include:

Pain - can be cyclical in a pattern consistent with the menstrual cycle

• Pain with sexual activity

• Painful bowel movements

• Disabling or increasingly painful menstrual cycles

• Pelvic pain at any time of the cycle

• Back or leg pain during menstruation

Gastrointestinal symptoms

• Constipation, diarrhea, or cycling between the two

• Abdominal bloating

• Nausea and vomiting

• Painful bowel movement

Bladder symptoms

• Bladder pain

• Urinary urgency

• Urinary frequency

• Pain with urination

Fertility issues

• Infertility

• Recurrent pregnancy loss

Fatigue

If you suspect you or someone you know has endometriosis, the Endometriosis Network of Canada is an excellent resource including how to find a doctor who is knowledgeable and skilled in the treatment of endometriosis, support groups, educational resources, and how to get involved in raising awareness of this poorly understood condition.

You can follow this link for more information: https://endometriosisnetwork.com/information

June is Pelvic Organ Prolapse Awareness Month

Did you know that 33-50% of women will have some form of pelvic organ prolapse in their lifetime, and most have never even heard of it?⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀

Pelvic organ prolapse can be defined as the descent of the pelvic organs (the bladder, urethra, uterus, vagina, rectum, or small intestine) toward or through the vaginal or anal opening. Some women with pelvic organ prolapse have no symptoms at all, and some will experience:⠀⠀⠀⠀

• A bulge at the vaginal or rectal opening that can be seen or felt and that may change depending on position, physical activity or bowel movements.

• Heaviness or pressure felt in the perineal region (between the vagina and anus).

• Incomplete emptying of or difficulty evacuating the bladder or bowels.

• Difficulty initiating urination.

• Pain is not typically a defining characteristic of prolapse.

There are different degrees of severity of pelvic organ prolapse, that can be identified by a grading system such as the one below.

Baden–Walker half way system [6]. It consists of four grades: grade 0 – no prolapse, grade 1–halfway to hymen, grade 2 – to hymen, grade 3 – halfway past hymen, grade 4 –maximum descent.

While a woman with minimal prolapse may experience no or relatively minimal symptoms, the severity of a woman's symptoms increase along with the grade of organ descent. When a woman presents with a relatively minor grade of prolapse, they will tend to respond quite well by making lifestyle modifications that ensure good bowel health, activity modifications and a progressive pelvic floor exercise strength program. As the pelvic organ prolapse goes up in grade of severity, so does the need for intervention required to help manage the symptoms. Other options include the use of a vaginal pessary that is inserted vaginally to support the organs, or by surgical intervention. Vaginal pessaries offer a less invasive option than surgery, and it is advised that a woman complete 3 months of pelvic floor exercises before deciding on either option.

For more information about pessaries, see my next blog: A Pessary: what is it good for?

Pelvic health therapists can examine a woman and identify the type and grade of pelvic organ prolapse that she has, and help her determine the best plan of care to eradicate, minimize, or manage pelvic organ prolapse. Some pelvic health therapists who have the training and special equipment needed are able to offer a pessary service. They can determine the right type and size of vaginal pessary for a woman, provide them with a pessary, and teach them how to properly care for and mange a pessary to ensure good vaginal health is maintained.

If you are experiencing any of these symptoms and want to learn conservative options, ask your pelvic health physiotherapist to determine what the best treatment plan is for you.

PELVIC PLUS PHYSIO - HELPING YOU FIND FREEDOM IN MOTION!

Running after Baby without the Runs

ITCHING TO GET BACK TO THE GYM AFTER COVID-19 CRAZYNESS IS OVER?

YOU MIGHT BE BURSTING AT THE SEAMS TO GET OUT, BUT IS YOUR POST-BABY BODY READY?

I get it, you just had a baby and you’ve been patiently (or painfully) waiting for the ‘right time’ to get back to your pre-baby fitness routine. For you, this may mean attending yoga class, spin class, HIIT, Cross-Fit training, or hitting the pavement for a run. Whatever your fitness goals, here is some advice when getting back to exercise after having your baby...

First, let's define the post-partum period

In the literature, the post-partum period is considered the first 6 weeks after pregnancy, during which time women have been encouraged to focus on gradually getting back to walking and strength training of the pelvic floor muscles. I wish I could tell you that everything goes back to normal after 6-8 weeks, and that you are given the green light to go back to your exercise routine at that time. I’m afraid it’s not always that simple. Every new mom's experience is unique. Plus, who came up with 6 weeks anyway?

Tissue healing is generally considered to take between 6-8 weeks, this explains why the post-partum period is considered to last this long. The graph below shows the process. I want you to notice in the graph that overlap in the healing phases exists, and notice that after 6-8 weeks the tissues are at 50% of normal tissue strength and still going through a process of maturation and remodeling.

• Nerve injury to the pelvic floor muscles has been demonstrated in %30 of women at 6 weeks post-partum, and of those only %35 recovered by 6 months (South MM, Stinnett SS, Sanders DB, et al. Levator ani denervation and reinnervation 6 months after childbirth. Am J Obstet Gynecol 2009;200:e1-7:519.

• Women postcaesarian section must also be aware of the time required for complete repair of the abdominal fascia. Abdominal fascia is the white connective tissue layer that supports the abdominal wall and it regains only 51%-59% of it original strength by 6 weeks post-surgery, and by 6-7 months has only 73%-93% of its original tensile strength (Ceydeli A, Rucinski J, Wise L. Finding the best abdominal closure: an evidence-based review of the literature Curr Surg 2005;62:220-5).

Next, take a deep calming breath, and know you should not be comparing your recovery to your girlfriend’s! We are not all the same, and the science is not precise when it comes to how long recovery takes – so don’t be so hard on yourself if you are not at HIIT class or running like your friend was at 8 weeks post-partum! (You will later see that she shouldn’t have been in my opinion anyway!).

A common-sense approach is needed that considers:

· the unique elements of every new mom’s past physical activity level

· the new mom's pregnancy and childbirth experience

· their lactation & family demands

· and their long term fitness goals need to be considered to provide a flexible and individualized program to return to sport.

So, what is the advice? How do you make a safe return to the exercises you love?

What does the evidence say?

1. Post-natal women can benefit from individualized assessment and guided pelvic floor rehabilitation for the prevention and management of pelvic organ prolapse, the management of urinary incontinence and for improved sexual function.

2. Return to running is not advisable prior to 3 months postnatal or beyond this if any symptoms of pelvic floor dysfunction are identified prior to, or after attempting, return to running.

What should you do? Here is your guide:

Week 0 to 2:

• Pelvic floor exercises (once catheter removed)

• Lifting restricted to the weight of your baby

• Start with gentle strolls of 5-10 minutes

Week 2 to 4:

• Add basic core exercises (the bridge, bent knee drop out, the clam)

• Add basic stretches including for the chest, buttock muscles, hamstrings, calf and hip flexor muscles

Week 4-6:

• Increase duration and frequency of basic core exercises

• Gentle walk increased gradually up to 20 minutes

Week 6-8:

• Introduce squats, lunges – still no impact!

• Moderate walks increasing in duration and intensity up to 40 minutes

• Progression to power walking

• Increased duration, frequency, intensity of low impact core exercises

• Introduce light hand weights during core and lower limb exercises

• Introduce low impact exercise (stationary bike, elliptical). Stationary bike should only be introduced if comfortable sitting on the bike seat

• Commence scar mobilization (for either C-section or perineal scar)

Weeks 8 to 12:

• Introduce swimming (if lochia/bleeding has stopped and there are no issues with wound healing)

• Spinning – if comfortable sitting on spinning saddle

Return to running/impact exercise @ 12 weeks postnatal and beyond:

• Graded return to running

• When increasing running intensity, increase the duration of the run before the intensity

• Monitor signs and symptoms, modify or cease the program and seek help from a pelvic health physiotherapist as appropriate to assist you in your return to your fitness goals.

What are the signs of pelvic floor and/or abdominal wall dysfunction to watch for?

· Urinary and/or fecal incontinence

· Urinary and/or fecal urgency – when you get a sudden strong need to go and have difficulty holding

· Heaviness/pressure/bulge/dragging in the pelvic region

· Pain with intercourse

· Difficulty having a bowel movement with a feeling of obstruction

· Pendular/hanging abdomen, doming of the abdominal midline, separated abdominal muscles and/or decreased abdominal strength and function

· Low back or pelvic pain

If you experience incontinence on normal daily activities – you are NOT ready to start exercise that involved impact and should seek professional help from your doctor and a pelvic health physio if possible.

If you experience the above symptoms during or after exercise – you are NOT ready for that level of exercise and need to modify or cease that activity for now.

My final advice: see a pelvic health physiotherapist for a full postnatal check from 6 weeks postnatal.

At Pelvic Plus Physio, this would include

· a detailed assessment o your posture, back, pelvic, pelvic floor and abdominal muscles.

· a readiness for impact screen prior to returning to impact exercise.

· regular follow up as required to get you back on track and meet your fitness goals through an individualized, progressive exercise program.

PELVIC PLUS PHYSIO - HELPING YOU FIND FREEDOM IN MOTION!