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How posture affects the pelvic floor

The way you carry your body all day affects the pelvic floor muscles. 
Some tips: 
Standing:  Keep your knees unlocked, buttocks and abdomen relaxed. 
Sitting: Use proper support for the back.  An additional cushion under the thighs keeps pressure off the pelvic floor and buttocks. 
Lying:  Elevate the legs on a pillow or two. 

Preventing stress on the pelvic floor
Lifting correctly
As you get ready to lift: 
Bend your knees
Gently hold in your stomach muscles
Exhale or breathe out as you lift (Don’t hold your breath!) 

Moving out of a chair
Take your bottom with you! 
Scoot to the edge of the chair 
Tighten the muscles around your vagina
Suck in your lower belly muscles
Push off the chair using your leg and arm muscles as you breathe out 

Diaphragmatic Breathing

The diaphragm, a dome like muscle that forms the floor of the rib cage, is the most efficient muscle for breathing and relaxation.  The correct use of diaphragmatic breathing can help to quiet brain activity resulting in the relaxation of all the muscles and organs of the body.  This is accomplished by slow rhythmic breathing concentrated in the diaphragm rather than the chest. 

Learning Diaphragmatic Breathing 
Place one hand on your chest and one hand on your abdomen.

 Exhale completely, breathing out through your mouth.  Allowing your abdomen and chest to fall.

 Inhale deeply.  Breathe in through your nose and mouth while contracting the diaphragm.  It will move downward causing your abdomen to rise.  Keep your shoulders and chest relaxed during this exercise.

 Remember to breathe slowly.  Do not force your breathing. 

Do you know what causes the pelvic floor muscles to become weak?

         This is the major, but not only, factor that stretches and damages your perineal muscles.  If                   strength is not resorted in these muscles after delivery, they will remain stretched like an old               hammock, and continue weakening as you resume your normal activities.  Future pregnancies             will further weaken these muscles. 
sustained coughing or sneezing 
Heavy lifting 
Hormones associated with menopause 

The good new is that we can help you! Call us today to schedule an appointment with us. 

Scar Management For Mothers Who Delivered By Cesarean

Following surgery, the incision heals by a process called scar formation.  Scar tissue does not stretch easily and may cause adhesions deep in the tissue.  Adhesions can restrict movement and cause pain.  By massaging the tissue, adhesions and discomfort may be avoided. 
 Desensitization:  (2 weeks after surgery and no scab or seepage from scar) Use a rough wet towel to rub across the scar in all directions.  Repeat with dry towel if tolerated.  This helps decrease sensitivity of the scar and helps you feel more at ease touching it. 
The following is a list of scar massage techniques with the approximate time to start them. 
Push and Pull:  (after incision is completely healed four weeks) Place two fingers directly on the scar and move it slowly straight up toward ribs.  When the skin stops “moving”, continue to hold firm pressure on the scar for one to two minutes.  This should be a strong pulling sensation, but should not cause sharp pain.  Then push down towards the pubic bone and hold again.  Repeat to the left and to the right in similar manner 
Skin rolling: (Four weeks after surgery)  Pinch the skin on either side of the scar line.  Start at either end and move forward rolling and raising the skin as you move.  A free scar bulges upwards (try and pinch skin on your arm/ hand and notice the upward bulge).  A “stuck” scar dimples inward.  
Plucking: (6-8 weeks after surgery).  Put your index finger on one side and thumb on the other side of the scar. Try to pick up the scar, separating the underlying tissues.  If you can get under the scar, move your fingers slightly from side to side for one to two minutes.  Start at either end and work toward the center.  If the skin slips out of your fingers, you may not be ready for this stage, but keep trying. 
Points of emphasis about scar massage 
The more often you effectively massage the scar, the more complete your recovery will be.  You can make a difference by helping your scar move more freely.  All massage of your scar should be a gentle smooth movement. 
Try making the massage a part of your daily routine (while watching television, listening to music, reading). 
The benefit is greatest when the skin is worked firmly and just below pain threshold. 
You should never feel sharp stabbing pain. 
The sensation is one of strong pulling or light burning. 
Duration – 5-15 minutes/day. 
You may find massage more comfortable immediately after a shower.  You may use warm compresses before and after treatment. 
The pads of your fingers should “stick” to the skin NOT slide across the skin. 
When you massage your scar you may notice one or two directions that feel especially “stuck”.  “Stuck” areas of the scar do not remove as freely as other areas.  You may feel some resistance when massaging these areas.  Spend a little more time holding in those directions if possible to free “stuck” tissue.  This should be a gentle “hold” motion, not a forceful movement.

*This section on scar massage has been reproduced with permission from Elizabeth Shelly, PT, Cambridge Physical Therapy, Cambrideg, Massachusetts. 

Exercises After Childbirth

It is very important to begin exercising the pelvic floor as soon as you can after delivery.  It is important to give yourself time to heal after your delivery before you begin exercising. Ask your doctor or your Physical Therapist if there are any particular exercises they would recommend for you to do following delivery. 
Start these exercises 24-48 hours after delivery if you are physically able and have the approval of your Physician to exercise. Only do the exercises that your physician or physical therapist approves of. 
It is important that if you experience sharp pain to discontinue the exercises and let your physician or your physical therapist know right away. 
Do these exercises 3-5 times and do them 2-3 times per day as tolerated. Remember it is the quality of the exercises that matter not how many you can do. 

Preventing Diastasis Recti

The Pelvic Brace is one of the activities you can do to prevent diastasis recti and also make your core stronger. 
How to do the pelvic brace? 
*if you go to our facebook page we actually just did a video on it so you can have a visual. 
   The pelvic brace combines a pelvic floor contraction with a contraction of the lower abdominal muscles.  Together these muscles create an internal girdle to support your bladder and pelvic organs.  To exercise the lower abdominal muscles (near the pubic bone) draw in your belly muscles as if you were trying to zip up a pair of pants that are too tight.  This brings your belly button towards your spine without moving or tilting your pelvis.  Most people find it easier to tighten the abdominals while they are exhaling or blowing out.  
Begin lying down with your knees bent and, take a diaphragmatic (belly) breath. 
As you breathe out, tighten and lift your pelvic floor muscles and keep holding them while you tighten the lower abdominals (bring your belly button towards your spine).
Hold the brace without straining for____ seconds. Repeat___times. 
Advancing the pelvic brace 
  If any of these exercises are difficult you may need additional exercises to strengthen your leg and trunk muscles. 

The pelvic brace and cough 
  Practice using the pelvic floor during a cough.  Breathe in, as you prepare to cough, bring your hand to your mouth and do the pelvic brace.  Hold the muscle and cough.  Now relax and brace.  If coughing is too much strain on your muscles try this activity while clearing your throat.  Repeat___times. 

The pelvic brace and lifting 
  Practicing using the pelvic brace during lifting. Place a lightweight object of __lbs. on a table or the floor.  Place your feet shoulder width apart and keep your back straight. Bend your knees to reach the object, do the pelvic brace and lift.  Repeat___times. 

The pelvic brace and sit to stand 
  Practice using the pelvic brace while coming to stand.  Breathe in as you prepare to stand do the pelvic brace.  Hold the muscles and stand up.  Be sure your therapist has shown you the proper technique.  Repeat ___times. 

Take Care Of Your Pelvic Floor

What Are Pelvic Floor Muscles? 
 Pelvic floor muscles are the collection of skeletal muscles covering the bottom edge of the abdominal cavity.  They run from the pubic bone in the front to the coccyx (tail bone)  in the back and attach to both sides of the pelvis.  They form a “sling” at the base of the pelvic bowl and help to hold up the organs of that area, which include the bladder, uterus and the rectum. 

What Do They Do? 
 Pelvic floor muscles have three main functions:  supportive, sphincteric, and sexual.  Strong pelvic floor muscles help to hold the pelvic organs in place against the pull of gravity.  They also help you maintain control of your bladder and bowels by lifting the urethra and rectum to keep them closed.  Finally, pelvic floor muscles play a role in sexual function by enabling the vagina to be lifted in tighter, thus increasing sensation, during intercourse.  They can become weak or injured in different ways including birthing injuries or neurological dysfunction. 

How Can I Keep Mine Strong? 
You can strengthen pelvic floor muscles by routinely performing some exercises that target them.  You should pull the muscles “up and in,” meaning if you had an object inserted into your vagina you would be pulling it into your body with these contractions.  You can tell if you are using the correct muscles because the sensation of contraction the pelvic floor muscles is the same as when you stop your urine flow (however, this is NOT part of the exercise program, do not routinely stop your urine flow). Perform these contractions, being careful not to 
substitute” with contraction of your abdominal, buttocks, or hip muscles.  Try to contract the muscles as strongly as you can for as long as you can hold the contraction.  Do as many of these “strong holds” as you can.  Another exercise involves contractions of the same muscles, but in quick succession and as many as you can.  A good format to begin with is: 

Strong Hold:                                                         Quick Hold: 
5 repetitions of 10 second holds                     15 repetitions of 1-2 second holds 
      Rules to go by 
Water intake should be 8-10  10 oz. glasses per day 
You should void only 6-8 times in a 24 -hour period. 
You should be able to go 2-5 hours between voids. 
You should be able to count 8-10 seconds during the urine stream. 
If you are younger than 65, you should not need to void in the middle of the night
Avoid bladder irritants such as caffeine, alcohol, acidic juices, sodas, and nicotine

Proper Bladder Habits

Proper bladder habits can aid a great deal in controlling issues such as urinary incontinence, urinary tract infections, and yeast infections.  Understanding how to keep your bladder healthy can keep you more active and self-assured as you age.  Following are guidelines to keeping and maintaining a healthy bladder. 
Drink 80oz of water per day. 
voiding should take place no more than 6-8 times in a 24 hour period 
Normal voiding intervals should be 2-5 hours apart. 
people under the age of 65 should not void during the night. 
Each urination stream should last up to 8-10 seconds long. 
Avoid bladder irritants such as caffeine, alcohol, acidic juices, certain medications, and nicotine. 
** If you decide to drink a cup of coffee or tea, make sure you add 10 ml of water to your daily intake. 

We Recommend Spanx

We recommend Spanx because: 
1) It helps to teach you how to maintain a neutral spine position 
2) it can help decrease back pain 
3) it promotes a pelvic brace posture 
4) it can help decrease pelvic pressure and pain
5) it can decrease and prevent disastasis recti post partum 
6) it can improve body mechanics and posture by tactile cues and compression 
7) it can decrease coccyx or pubic pain
8) Spanx are very affordable 

As wonderful as Spanx are to us they are not the only way to prevent the above. You must also strengthen your core and pelvic floor muscles. We are able to help with that. Come to our office for a pelvic floor assessment and we can teach you how to prevent and how to strengthen your core and pelvic floor muscles. 

Instructions For Controlling Urinary Urge

When you experience an urge to urinate: 

First            Stop and stand very still.  Sit down if you can or stand quietly.  Do not move; try to stay                           very still to maintain control. 

Second        Quickly squeeze and let go of your pelvic floor muscles 5 to 6 times to keep from leaking.                       Use moderate to maximal effort for the exercise.  This sends a message to the bladder to                        relax and hold urine.  Try to distract yourself by thinking of something other than going                         to the bathroom. 
Third          Relax.  Take a deep belly or diaphragmatic breath and let it out slowly.  Try to make the                           urge to urinate go away by continuing with distraction techniques and positive thoughts. 

Finally       If the urge returns,  repeat the above steps to regain control. When you feel the urge                               subside somewhat,  walk normally to the bathroom.  Do not rush.   Continue to do your                           quick flicks to relax the bladder.  You can urinate once the urge has subsided.