Featured: Premium Foam Playmat, Nordic (Pebble)

Continence adverts make leaking seem so normal, and something we have to live with. As women, we are use to wearing pads so it seems we accept we have to just live with it. But men are horrified and disgusted by it so it seems their motivation is higher to get their issue sorted.

| Very simple changes can make a massive difference. Something that is an odd leak now and then, can potentially cause you bigger issues in 10 years' time if you do nothing.

It may not seem important now with a hectic life. Bad habits like going to the loo more frequently to stop leaking can make your bladder smaller, and therefore make the problems worse.

Seeing a professional ensures you don’t develop bad habits. In France, all women postnatally are given 12 weeks of physiotherapy so they can rehabilitate their pelvic floor and abdominal muscles."

Our conversation continued with Charlotte answering some questions from our Toddlekind community ...

Q: What are some of the signs and symptoms women might have, and should seek help with?

A: The areas of the body to think about include your bladder, bowels, tummy, pelvic pain, vaginal symptoms, and discomfort.

For your bladder, ask yourself:

• Do you have to pee frequently (more than twice hourly)? More than twice a night?
• Do you leak if you laugh, cough, sneeze, jump, or run?
• Do you find yourself avoiding activities for fear of leaking?
• Or do you know where every toilet is in town?

If you answer "Yes" to any of these, you might want to look at seeking some treatment.

When it comes to your bowel, ask yourself:

• Can you delay needing to poo, or do you have to rush immediately?
• Can you control wind?

| Some women join a yoga or pilates class, and discover they “toot” unexpectedly, and that’s when they realize about wind.

Vaginal symptoms to keep in mind include:

• Is sex painful?

It can be due to several reasons. Possibly from a birth injury, where perhaps the stitches have over-healed, or the nerves in the area have become over-sensitive.

Painful sex does not have to be happening when you’re post-natal. Some women have it prior. Also, sex can become painful if you are peri and menopausal.

• Do you have any vaginal heaviness, dragging, sagging sensation, or discomfort?
• Does your tampon (or moon cup) fall out or no longer fit? You might notice it is worse when up on your feet.

If so, it’s a good idea to see a pelvic health physiotherapist. You may have vaginal laxity (ie your vagina has a bit more give in it) but not a full prolapse. Or, it could be a prolapse.

| Most people will be surprised to know that prolapse is very normal - 60 - 80% of women will have some form of prolapse - some are bothered by it, and some don’t notice it at all. If you are more symptomatic, it can be improved with physiotherapy.

Thinking about your tummy:

• Do you have doming when you sit up, and try to get out of bed? Or an unresolved tummy gap? Or doming with back pain?
• Pain along your c-section scar?
• Perhaps you might have a “feeling” of mummy tummy that is not resolved or an excessive pouch with a lot of excess skin?

If you have unresolved pelvic pain after pregnancy …

In the last weeks of pregnancy, a lot of women get pelvic pain. Sadly there's often not enough time to get to a physiotherapist. Some women may not feel it's bad, because they are resting but find it doesn't get better after birth.

It is worth seeking help from a physiotherapist.

| Pelvic pain can have different names including Pelvic Girdle Pain (PGP), Symphysis Pubis Dysfunction (SPD).

Q: There were a few questions about gadgets. Being time-poor, committing to coming to an appointment and potential embarrassment means some women may try to treat themselves. Is that possible?

A: Some women do decide to self-treat, and there are gadgets on the market like biofeedback units - (for example Elvie) which are electrical stimulation units.

If you have zero pelvic floor, and can’t feel anything then this type of device is a good start. But once you have some ability, to contract the muscle then you need to do the work so the muscle can get stronger rather than relying on the machine. Sometimes biofeedback can allow you to “cheat” by using the wrong muscles. If you do this, it can cause you more harm than good.

I would advise women to see someone like a pelvic health physiotherapist who can advise on gadgets, and discuss if they could benefit you or not.

Q: What is a prolapse, and how do I avoid having one?

A: Prolapse is a very normal part of aging. Our skin and breasts start to drop a bit. Things inside our vagina are going to drop (move) but for some people, it's more problematic than others. Don’t be embarrassed, and don’t be frightened.

Supervised pelvic floor muscle training is recommended by NICE (national institute of clinical excellence) guidelines as first-line treatment. Studies show they are effective, and work to fix prolapse with improved symptoms for 70-80% of people.

Sometimes it might be that your vaginal tissue is low on estrogen. So that’s when you need a GP or Pelvic Health Professional (PHP) who can look at, and determine the best way forward to help you. Your treatment will usually involve some exercise, and in some cases may require some medication.

| There is so much evidence to show that pelvic floor exercises work.

Featured: Charlotte Church at Oxford Physiotherapy Clinic

Q: Is there anything I could have done to prevent (or minimize) the impact of pelvic pain (SPD / PGP) during and post-pregnancy?

A: For future pregnancies, go and get treatment early because pelvic pain can start earlier with each pregnancy. Also, enroll in a pilates class that is physiotherapy lead (it is very different from gym pilates).

Rehabilitation pilates is all about strengthening the pelvis and lower back. To be honest, everyone should do it anyway.

It’s worth noting that sciatica and thoracic pain (rib pain) can often occur before and after childbirth.

A physiotherapist can help with all of this before, during, and after pregnancy so don’t suffer through it.

Q: I had a C-section after my son got stuck (facing the wrong way), so 'down there' was unaffected by tears etc.

However, I didn't get much advice post-C-section. Is there anything that might have helped me not end up with a horrible ridge on my tummy, and avoid being numb in places?

A: There is a lot to be said about scar management, and how to look after it. Scars can dehydrate so there is special silicone paint and patches to hydrate the scar and get it as smooth as possible.

Also, massaging around the area helps to break down the scar tissue and prevent the ridge, and other potential symptoms like numbness.

You can also seek professional help with scar management.

Q: I had 3 c-sections but the pelvic floor is a problem all these years later, and it has become worse in the last few years. It is so bad I am now seeking help, as I think I have a prolapse.

A: Pelvic floor stress comes more from the pregnancy itself than delivery. It's a misconception that your pelvic floor is okay because of a c-section.

| Two c-sections are the equivalent of one vaginal delivery, so it's not protective of your pelvic floor and you can still have issues.

All women regardless of delivery should do pelvic floor exercises.

It's not just having babies that can weaken your pelvic floor. Other things that can cause weakness include:

• being overweight
• constant constipation
• chest problems including coughs, asthma, COPD (chronic obstructive pulmonary disease)
• if your body is hypermobile, your tissue stretches easily and this makes you more susceptible
• if you have a history of bulimia, vomiting sickness, or morning sickness.

Things completely unrelated to childbirth and pregnancy which can weaken your pelvic floor are:

• hysterectomy may weaken your pelvic floor, also, after a hysterectomy, you have more space in your pelvis.
• estrogen - If you are peri-menopausal or post-menopausal, you will have less estrogen in your tissue which makes it more fragile, and so your pelvic floor doesn't function as it should.
• elite athletes can also experience a weakened pelvic floor because of the training their pelvic floor is put through.

Q: What should I keep in mind when looking for a physiotherapist?

A: Regardless of where you are in the world, when you call, explain what your symptoms are, and then ask: Is this something you would be comfortable treating?

Note: They should be able to give you reasons why (or why not), and refer back to their experience without too much thought.

Other questions you should ask before you make an appointment:

• How many treatments do you think I will need?

If they say ‘at least 6’ that is a red flag. The response should be ‘I need to assess you, but usually it's between 3 -4 treatments.

• Do you have ties with fitness professionals?

Physiotherapists work with you in the acute phase, but a fitness professional who specializes in post-natal or women's rehab is required. If they don’t, question why they do not.

Red flags:

>>> They can’t answer your questions

>>> They don’t want to answer your questions

>>> They are suggesting far too many appointments

>>> They are not linked to a trusted, professional membership

A special thank you to Charlotte Church from Oxford Physiotherapy Clinic for sharing her time and expertise with us. You can find her on Instagram @clinicoxfordphysiotherapy