So – let’s talk incontinence!!!
I came across this article yesterday on the Women’s Running Magazine facebook page and it got me fired up.
So, so, so fired up.
In case you missed it, it’s a story from a running blogger named Steph, about her little quirks that make her #uncool. Here’s what Steph wrote:
A campaign was launched last week with the title and theme of #WeAreAllUncool. The idea is to celebrate that we all have quirks, habits and differences that make us unique. Sometimes these traits lead us to feel vulnerable and embarrassed about our shortcomings. We should not have to apologize or feel ashamed.
Steph goes on to talk about the fact that she wears a sanitary pad every time she runs or works out, because she has a postnatal continence problem.
I wear granny underwear under my running shorts—even spandex—because I pee my pants on every run and workout since having my son 9 months ago. I have to wear a maxi pad to help avoid soaked pants post-run. It leads to a super-hot look when I’m rocking light-colored spandex.
Now I don’t know Steph at all. I don’t know her story of her pregnancy and labour and I don’t know what she’s been doing in terms of pelvic floor rehab. She’s clearly very fit and healthy and is an elite level runner, so I’m presuming she has great coaches and (hopefully) a top-notch physio on hand. But the reality is, she has a serious continence issue.
Now I’m not setting out to shame Steph – not at all. In fact, I think it’s remarkably brave of her to put this out there in the public arena, and opening up this conversation is always good. So many women would simply keep this to themselves and pray that no-one else finds out. So kudos to you Steph, for your bravery!
But here’s my issue, and this is what I got fired up about.
There is no context around this article. And there is no call to action for other women who may be experiencing the same problem.
I applaud Steph for bringing this issue to light. Truly I do, because it’s a serious and extremely common concern for many women, particularly those who have had children.
But I wish that Steph – or Women’s Running Magazine – would have gone a step further and talked about what she’s doing – or could do – to address this issue.
Is she doing pelvic floor rehab? She’s still only 9 months postnatal, so really she’s still in recovery phase.
Did she consider taking time off from running to get this issue resolved before she started running again?
Does she have a great women’s health physiotherapist she’s working with to get this under control?
Or did she have a severe tear which has led to significant perineal damage and the resultant incontinence?
I don’t know, but I wish there was a little more context around her frank admission, in order to give all of her readership a little more food for thought.
Instead, what we got was several other women telling their stories of incontinence, and Women’s Running facebook page replying with “Don’t worry ladies, it is so common. It feels better knowing it happens to everyone!”
I think the basis of the #WeAreAllUncool campaign is great (though I think it should be renamed #WeAreAllCool) – it’s about embracing our uniqueness, diversity and all the little foibles that make us human. That is totally cool. It’s cool to be different. In fact, it’s completely freakin’ awesome and it’s what makes this big, wide, crazy world a great place to live.
The campaign encourages us to not be ashamed or embarrassed about who we are and how we are different.
Certainly, any type of urinary incontinence has the ability to make a woman feel embarrassed, vulnerable and ashamed. Which is why I talk about it a lot. Which is why we focus on this exact topic in my postnatal wellbeing and recovery program, Body Mind Baby. Because I don’t want women to feel embarrassed or ashamed if they experience urinary incontinence. I want them to be able to address it and overcome it.
But I don’t want them to celebrate it. And that’s what this campaign is about – celebrating our uniqueness.
I know it may seem like I’m nit-picking here – but I think an issue as important as this shouldn’t be included in a campaign about celebrating our bodies – at least not without context. Because it’s actually not something that should be celebrated. It’s something that should be addressed and treated – because for the majority of women it CAN be treated.
I want women to feel comfortable to be able to talk about the fact their experiencing postnatal incontinence. But I also want them to be empowered enough to say, “I’m not going to accept that – I know there are options available and I’m going to do whatever it takes to fix this issue”.
What I’d like women to know is that “no leakage is normal”. So yes, even if you just leak a “little bit”, even it it’s only when you sneeze, jump on a trampoline or do a star-jump – that is not normal. BUT, in the vast majority of cases it CAN be resolved. So that woman can undertake all those activities again without any leakage. It is possible for the absolute majority of people.
But, recovering from postnatal incontinence takes commitment, time and effort. It also requires a great deal of respect for the body and its healing process, and an avoidance of high impact activities – such as running – until continence issues are resolved. Because if you continue to place lots of pressure on a dysfunctional pelvic floor – it is NEVER going to heal.
But so what? I hear women say. It’s just a “wee bit of wee” and it’s only when I run, and I just wear a pad, so it’s really not a problem. Right? This is what I hear from women an awful lot.
So I always encourage them to think long term. If your pelvic floor is dysfunctional in your 30’s, how’s it going to be in your 50’s? Your 60’s? Your 70’s?
Have you ever worked in an aged care facility? Have you ever seen a grown adult who simply can’t control their bladder or bowels? Did you know that incontinence is a significant factor in many aged care admissions? I’ve spent time working in aged care facilities and I know too well the pained, shamed expression of a woman (or man) who has just wet their pants. It’s tragic and I’m damned sure I’m not going to let that happen to me (at least not without a serious fight).
When I talk to so many women who say their pelvic floor is “mostly okay” as long as they don’t jump, run or do a handstand, I tell them they should be able to do these things without leaking. Most of the time they just brush it off and say it doesn’t really matter. Well I say it does. I want to be able to jump on a trampoline with my kids – and play “Pop, Bang, Go”* with them like I did when I was a kid.
But the most tragic thing, is that when I ask these women if they regularly do their pelvic floor exercises, or actively work on pelvic floor rehab (because it’s not JUST about kegels), the majority of the time they say NO.
So we have a whole bunch of women, who have just a “little problem” but aren’t doing anything about it???
That’s just not on – not in my book.
One of my favourite phrases – and I say it ALL THE TIME, in every single presentation I give, is this:
Just because something is common, it doesn’t mean it’s normal.
In case you’ve never heard me talk about this before, I wrote about it here.
So getting back to this article, (which also reminds me of this article, which I got steamed up about on my facebook page). I truly hope Steph can get her pelvic floor rehabbed. I really do. I’d love for her to be able to run leak-free. And I’d love for her to be able to have more children and to not have this issue again.
I also want for this topic to be opened up to a bigger discussion, on a more regular basis, especially amongst the postnatal community.
But what I really want, is for this issue to stop being “normalised”. What I’d love is for women to be able to feel comfortable talking about this, while at the same time taking control, respecting their bodies’ limitations and doing absolutely everything possible to address the issue. And not just accepting “leakage” as the status quo.
That’s what I want.
Until next time, Be Well.
* for those of you who don’t know, “Pop Bang Go” is a totally awesome handstand game to see who can hold their handstand the longest. I never won as a child. I still don’t win. But it’s all about how you play the game.
ps. If you’re here in Adelaide, and want some support to rehab your pelvic floor and core I’ve got a few options for you.
If you want to work one to one with me, check out my OT Core Restore program here.
Or, if you’re a new mum with a baby under 12 months old, you can join my Body Mind Baby postnatal wellbeing and recovery program. Our next program starts on February 4, 2016, and don’t forget we have a $50 early bird discounts available until January 15.
How long did it take you to “recover” after you had your babies? Was it six weeks? Six months? A year? When we talk about “post-natal recovery” there’s an awful lot we need to consider.
I read with interest this article from the Daily Mail in UK, which suggested that post-natal recovery timeframes are actually closer to 12 months, a lot more than generic 6 week time frame that is so often bandied about.
I think the issue here is with the definition of “post-natal recovery” – because in my opinion, there’s a lot more to it than simply waiting for your episiotomy wound to heal.
Of course, there’s the “physical recovery” – pelvic floor function and rehab, repairing any abdominal separation (diastasis recti), regaining your core strength and returning your body to a better posture and alignment, addressing any back, neck and shoulder complaints you may have from pregnancy or constantly lifting and carrying your baby, plus whatever other physical issues may have cropped up for you. This is all really important if we want our bodies to be functional for the next 60 odd years, and to not be reliant on incontinence pads in our 40s.
When did you feel “back to normal”?
Then there’s the “emotional recovery” – adjusting to the role of motherhood and all the feelings that come along with it: fear, anxiety, bewilderment, helplessness, overwhelm, concern, failure, confusion, anger, loss, and guilt that can go along with this. Not to say that all our emotions are negative. There’s also love, joy, passion, gratitude, purpose, connection, fulfilment, and so much more. But you know what – these emotions can be overwhelming too – and it can take us a while to settle into these new feelings and emotions as well.
And what about the “social recovery” which I think is often forgotten, but which can be really challenging for so many women. Adjusting to changed relationships – with your husband or partner, your friends, your own mother. Adjusting to no longer being a worker or bringing in an income. Navigating the maze of postnatal and baby services and making new friends. Redefining who you “really are” now that your a Mum. Feeling like you’ve lost your own identity. Feeling trapped or unable to escape. There’s a lot that happens in the social front – these are all challenges and women often need support to adjust to these changes.
So bearing all of that in mind – how long would you expect it to take to “recover” from childbirth? It’s an intensely personal experience, and it’s about so much more than whether or not you’re “all healed down there”. Some women bounce back from childbirth straight away – both physically and emotionally. Others may take longer to sort through the emotional challenges, others may not notice the physical challenges until after they have their second baby. Some might not notice issues until they decide to go back to work, or until their children start school.
It’s not a precise science, and there’s a lot of factors to consider. But for the majority of women, their postnatal “recovery” continues much longer than their 6 week post baby check up!
Here’s my top five tips for supporting your postnatal recovery:
1) Realise that postnatal recovery involves a LOT of different factors
It’s so much more than just losing the baby bump. I mentioned all the factors above that have an impact on how well we “bounce back” after birth. Take a few minutes to review those areas of your life, and then give yourself a little credit for ALL the adjustments you’re currently dealing with. There’s always more happening than meets the eye – wellbeing involves a lot of different factors.
2) Give yourself time – aka: Please, please, please don’t set yourself deadlines.
I posted on facebook recently about this US Runner who was back training for Olympic trials five weeks after childbirth, despite having a significant abdominal separation and lots of incontinence issues. As a professional athlete, this woman makes her living through running, she’s on a tight timeline when it comes to Olympic trials, and she also has a huge team of health professionals supporting her in her rehab. I’m hopeful she’ll make a full recovery at some point. But I wonder how much faster she might have healed her abdominal separation and pelvic floor issues if she’d had the time to recover properly – without loading her body up with a heavy running schedule while simultaneously trying to rehab. Most of us aren’t professional athletes, so there’s no hard and fast timeline for us to have to recover from.
3) Know what’s “normal” and what’s just common in the postnatal period
There’s a big difference between “common” – as in it happens to lots of new mothers, and what’s “normal” as in what’s the way something “should” be. Some postnatal concerns can be uncomfortable or embarrassing – such as incontinence. And in the rush to make women feel better about these embarrassing conditions we’re quick to reassure them it’s “totally normal, nothing to worry about!” But this does women a huge disservice. Labeling something as “normal”, when it actually isn’t, means that women may think these things are what “should” happen to new mothers, and therefore not seek help to address it. Let’s recognise that issues such as postnatal incontinence, abdominal separation and back pain are “common”, very, very common in fact – but they’re not normal – it’s not how the human body is designed to be. And we can work to address these issues – we just need to be aware that we CAN. #commonnotnormal
4) Get the right professional support
One of my clients last week told me she was considering changing her personal trainer. She’s not 100 percent happy with his level of knowledge on what is and isn’t suitable for postnatal and pregnant women, and after having a few back pain twinges recently, so she’s reconsidering whether he’s the right fit for her. Working with pregnant and postnatal clients requires a detailed understanding of female anatomy, and an excellent knowledge of what is and isn’t appropriate for this group. Make sure you find health professionals (whether it be your physio, personal trainer, or group fitness instructor) who has additional training in pregnancy and postnatal care. Even the best trainer in the world can unintentionally cause damage if they don’t have training in this field.
5) Do the work!
Okay, I admit it. Postnatal rehab can be boooooring! There’s a lot of breathing, a lot of checking your posture and alignment, a lot of repeating the same several exercises with perfect form. I know it can be boring. But it’s effective. It does the job – if you do yours! Rehab only works when the rehabber puts in the yards to do what their therapist asks them. This is true for postnatal women, professional footballers or injured workers. People who follow their rehab programs properly will always recover better than those who don’t. Rehab may not have the same level of exhilaration as an early morning run, or a Body Attack class with your bestie, but those things will always be there. In six weeks, or 12 months, they will still be there. But if you don’t do the work now – if you don’t take the time to make rehab a priority, what might also be there in 12 months is incontinence or abdominal separation – and the long term implications aren’t that much fun. Do the work. It will be worth it, I promise.
What has been your experience? I’m always keen to hear from my readers, so shoot me an email to email@example.com if you have any queries or comments.
Until next time, keep well and take the time to rehab properly!
ps. If you’d like to know more about rehab for motherhood, make sure to check out my Core Floor Restore five week online program. It’s chock full of information about abdominal separation, pelvic floor dysfunction, posture and alignment, back and neck pain, and it’s been specifically created for Mums to support their own understanding of their recovery and wellbeing. Click here to check out the Core Floor Restore program details and pricing.
Everywhere I turn these days I keep hearing, seeing and reading about how much weight women have (and should!) put on during their pregnancy. This, of course, is closely followed by how and when they should “shift the baby weight”, once they’ve popped that little blighter out of their expanded bellies.
All this baby weight talk irritates me. It seriously does.
Not because it’s not important. I’m not brazen enough to suggest we should totally ignore weight loss and gain as an indicator of health and wellbeing.
What really cranks me up is how often it is seen as the ONLY gauge of health – and post-natal health in particular. This is complete BS. Especially when it comes to post-natal health.
The realm of post-natal health and wellbeing is enormous – and no I’m not just talking about the DD cups you sprouted on Day 3 post-birth. What I’m talking about is the crazy hormone roller-coaster that can go on for months, indeed years, during and post-pregnancy. Then there’s also the structural changes and injuries which can cause disability and dysfunction post-pregnancy. And let’s not forget social and psychological wellbeing.
So let me think – what’s more important for a new mother than “losing the baby weight”?
Restoring hormonal imbalance. Reducing stress. Overcoming fatigue and sleep deprivation. Addressing anxiety and depression. Rebuilding their core strength and pelvic floor integrity. Recovering from carpal tunnel and other pregnancy related neurological disorders. Repairing a diastasis recti. Dealing with lower back pain, pelvic girdle pain, upper back pain, neck and shoulder pain. Restoring nutrient deficiencies. Emotionally adjusting to their new role as a mother and potential loss of other life roles – such as worker, monetary provider, friend. Reigniting a sexual relationship with their partner.
I could list more, but I’m pretty sure you get the point.
All of these things affect a new mum’s health and wellbeing. In most cases significantly more than whether or not she can rock a two piece at the beach.
But there’s also a secondary, more sinister, issue with this focus on baby weight. Because when the societal pressure to drop that weight hits, many women will resort to measures which will actually endanger their health – not restore it. I’m talking meal replacements, ridiculously low calorie diets, consuming zero-nutrient diet-foods and embarking on extreme physical training programs for which their recovering body is still not ready. These actions are NOT HEALTHY. But so many new mums head down this path, because they feel the eyes of the world on them. Much like Kim Kardashian’s rumoured resolution not to appear in public with her baby until she’d lost the weight. Because a mummy is only valuable when she’s “yummy” right?
Come on. A little bit of perspective please.
I’m not saying don’t talk about weight gain and weight loss. But let’s consider it in relation to everything else going on in a new mum’s life and body. Because at the end of the day, health and weight do not necessarily have a linear relationship.
And to all you new mums – this is my message to you. Don’t worry about your weight – just focus on your health and your baby’s health – because that’s what is really important. Now, I would love to say – “focus on your health and a killer body will come your way as a result”. But I can’t in all honesty say that. What I can promise you, however, is that if you look after your health, your body will look after you. You will be strong, fit and healthy enough to take on whatever life (and that new little bubba) can throw at you. Whether you’re wearing a bikini or not.