PELVIC HEALTH

By: Rochelle Cowan, Women’s Health Physiotherapist

There is a mitzvah in the Torah that tells us 'םֶכיֵתֹשְׁפַנְל דֹאְמ םֶתְּרַמְשִׁנְו' - we are commanded to look after our bodies a lot. It is one of the only places in the Torah where the word דֹאְמ - a lot, is used, which highlights the importance of this mitzvah. םֶכיֵתֹשְׁפַנ encompasses our mental, emotional and physical health and it is the responsibility of each person to look after themselves in all of these ways. As Jewish women, we have the potential to place a lot of strain on our pelvic floor muscles throughout our life cycles, and it is important to know the best way to take care of them. As many as a mind-blowing thirty three percent of women will experience some sort of pelvic floor dysfunction in their lives, yet unfortunately, only a small percentage of those will seek help.

What are the pelvic floor muscles? The pelvic floor muscles are the muscles that sit like a hammock at the bottom of our pelvis. They have a number of functions in the body including bladder and bowel control and pelvic organ support. They also help to form ‘the core’ which creates our internal stability and gives us the strength to be able to live strong and healthy lifestyles. We use our core in a variety of functions of daily living, for example lifting, pushing buggies, sneezing, coughing, exercise and running.

As women, we go through many different phases and stages in our lives from childbirth all the way through to menopause, and symptoms of pelvic floor dysfunction can occur at any stage. Symptoms can include urinary leakage, urgency and frequency, constipation, pelvic pressure or persistent pelvic pain. It is important to recognise that these symptoms, although common, are NOT normal and there is freely available help. A very common treatment for some women who suffer from pelvic disorders is to strengthen the pelvic floor by incorporating easy pelvic exercises into their everyday life. For those who would like to give them a try, here are three basic ones that you can do at home. 1. Breathing: allow the air to reach all the way down to your belly, and feel the pelvic floor expand with your breath. A nice position to do this in is lying on your back. Take 4 deep breaths, hold for 2-3 seconds, then exhale slowly. Repeat 4 times.

2. Upon exhaling, squeeze your pelvic floor and hold for up to 10 seconds, making sure you are breathing at the same time. Repeat 10 times.

3. Upon exhaling, squeeze your pelvic floor. Hold for 1 second and release. Repeat 10 times.

It is possible to perform a pelvic floor contraction incorrectly. If any symptoms increase, or if you are not sure that you are performing them correctly, then it is advisable to get checked by a Women’s Health physiotherapist who can help to teach and guide you.

Rochelle Cowan is an Australian physiotherapist who currently lives and practices in London. After qualifying in 2001, she went on to obtain a post-graduate certificate in exercise for women. She uses her life experiences along with her professional knowledge to provide evidencebased treatment to help women alleviate their symptoms. Rochelle uses a very holistic approach to her work and her aim is to empower women with knowledge and tools to deal with their conditions and to normalise the conversation surrounding pelvic health. Whatever the goal, she will give you the tools and knowledge to improve your condition. Rochelle can be reached on 07415 50 5858, or through her website: vital-physio.co.uk

By Chaya Mellinger

Chaya Domnitz is a prenatal and postnatal specialised personal trainer based in North West London. For exercise advice, tips and motivation you check out her Instagram @ eat.burn.live, or visit her Facebook page @eat.burn.live. If you have any questions or for more info, feel free to contact her. Please consult your doctor before completing any prenatal or postnatal exercise programme.

We’re lucky to live in a time where the dialogue regarding exercise during the prenatal and postnatal period is changing. With so much more accessible knowledge regarding exercising safely and intelligently, medical advice now promotes prenatal and postnatal exercise when done in a safe way. Whilst many women focus on exercising for weight loss, when we redirect our motivation to exercise for fitness we can tap into the transformative power of exercise for physical and mental health. Particularly at this stage in life, where many women struggle with perinatal and postnatal disorders, the benefits of exercise can be life-changing. Contrary to popular belief, exercise does not necessarily require a huge amount of time and skill; rather it’s about smaller lifestyle changes you can make to support yourself throughout this time.

The prenatal and postnatal time is full of changes to every aspect of a women’s life - never will something change your routine, body, identity and dictate your time in such a way. It is natural that every woman experiences days during this period where they struggle with motherhood and this new identity. Scientific research and trials have proven that exercising throughout pregnancy and in the postpartum period significantly reduces your chances of postpartum depression. Therefore, putting physical benefits aside, we’re focusing in this article on exercising for mental health.

Here’s my motivational tips on how to exercise during this period:

Prenatal Throughout your pregnancy, it is important to keep active, with 150 minutes a week of exercise being the recommended minimum. Keep in mind though, that from the second trimester onwards you will need to modify many abdominal focused exercises. Exercising during pregnancy empowers you to have some sense of control over the changes occurring in your body. When you stay active, you will find that you feel physically stronger, you have more energy and an easier postnatal recovery. In the first trimester, many feel sick and lack energy. Exercise may well be the last thing on your mind but amazingly, exerciseactually helps to minimize nausea and to increase energy. My tip is to keep active and do your workouts early in the day, as you’re likely to have less energy as the day goes on. Unless you are having a high-risk pregnancy or are medically advised otherwise, pregnancy is no reason to stop a safe exercise programme. Take longer rest periods, listen to your body and modify throughout, but carry on and enjoy exercising; you will see what a positive pregnancy you have.

Postpartum When you are newly postnatal, you’re likely feeling weak and exhausted, and every spare second is precious. Exercise may be the last thing on your mind and sound too stressful, which is why I encourage my clients to focus on movement.

You will have enough voices telling you to take it easy, rest, and stay in bed. Yes, sleep is the number one priority. But when you’re not catching up on sleep, prioritise nourishing yourself by eating well and getting your weekly required movement in. There are so many health benefits to maximising movements in the postnatal stage:

Pregnancy and birth are a stress on your body and the postnatal period is a time to rehab and rebuild your strength. There’s no bounce back, however, safely and gradually you can work your way back to a strong body.

The psychological benefits of exercise at this time are as (if not more) important than the physical benefits, especially if you are struggling with your mental health. Physical activity releases dopamine,

Motherhood is a journey and you give so much of yourself all the time! When you take some time for yourself, you become mentally and physically able to keep giving to your family whilst not losing yourself.

Exercise is a physical and mental challenge. When you see yourself able to progress and do things you previously couldn’t, you take that physical and mental energy with you into your life.

Exercise gives you structure. Once the baby arrives your daily routine will disappear. It may feel that your time is no longer yours. Creating a routine, even if it’s just starting the morning with a walk or some stretching, puts you back in control of your daily schedule.

Low mood is often exasperated by physical changes and many women feel upset that they have ‘lost’ their prepregnancy body, whether it be weight gain, loss of muscle strength or other postnatal changes. When you rebuild your strength through a supportive exercise programme you learn to appreciate what your body is capable of. It has stretched to hold a child and has returned to strength. Shifting away from weight loss, you focus on a positive relationship with your body.

In order to make an exercise programme work long term, you need to look at your lifestyle, your support network and your usual habits in order to find the right exercise for you, which fits into your schedule and childcare. There isn’t a ‘one size fits all’ with exercise, and it’s important to modify your workouts throughout the stages, and to always seek advice from professionals. See your exercise as a necessary form of therapy; you would find childcare for a medical appointment, so don’t be scared to ask your support network to help out so that you can get your workouts in.

When can I exercise again and what can I do? It is advised not to exercise until 6 weeks postnatal. This gives your body recovery time and is when you will have your medical check-up and be signed-off to exercise. I advise that in addition to this, every woman should have a postnatal health check, which is carried out by a woman’s health Physiotherapist capable of doing a full assessment. You can then design your fitness programme accordingly. Otherwise, if you are training with a personal trainer, make sure they check how your core is functioning during the exercises.

In the early days, the best exercises to do are stretching and diaphragmatic exercises so that you are ready to exercise at a higher intensity once you have the all clear from your doctor (usually at the 6-week health check). This can all be done with babies sitting in a bouncer, or lying down next to you on a mat. It doesn’t matter if it takes all day to get it done, you don’t get long periods of free time as a new mum, but there are many small increments and they all add up.

At this stage, don’t push yourself to wake up early or stay up late to exercise, you need your sleep. Finding time during the day with your baby or whilst they nap is the best way. Taking long walks whilst pushing your baby in a pram is great for vitamin D and low intensity movement, and you’ll probably never have a time in your life that your child is so easily entertained. So enjoy lots of nice walks together! Be mindful of your birth experience when choosing which exercises to do, and never compare yourself to others or to your previous postnatal experiences.

Exercising through pregnancy loss, treatment and infertility Exercising through this time is challenging, as you may want to be extra cautious. The mental benefits of exercise will lessen the stress and help you through this uncertain time.

However, every person’s situation is unique and I advise you to consult medical advice and have someone to closely guide your exercise programme. What is important to recognise, is that whatever the outcome of a pregnancy, a women’s body will always be postnatal afterwards and the same exercise guidelines apply.

Whilst there are general exercise guidelines, no rule fits all, and the key to a sustainable workout programme is to modify accordingly. If you need some help, you can also seek professional advice for a programme which suits your level. Exercise is all about challenge, empowerment and strength, and we modify it throughout our lives to strengthen us. Committing to an exercise programme through this time of extreme change in your life is the biggest gift you can give yourself and your child. The more you are, the more you have to give, so fill yourself up first.