K IS FOR KEGELS ;)
The Nest's Noticings for the Week...
Favorite Product: This Earth Mama Angel Baby Nipple cream.
Parenting Resource: The Playfully App - gives you daily ideas for things you can do with your baby based on their development and milestone's they're working on!
Baby Signs to Use: More, All Done
Baby Songs to Sing: 10 Little Monkeys, ABCs
Developmental Play Tip: I know you've all heard that the "pots and pans" in your kitchen are great toys for your baby. It's a well-used phrase because it's true! There are many other non-toys that you can repurpose and use for your child! Some of my favorites in my kitchen are: muffin tins (great for sorting different things), egg crates, tongs, silicone muffin cups, dustpan and small broom, hot pad holders, oven mitts, all kids dishes, and measuring cups and spoons.
K IS FOR KEGELS
Jenni Gabelsberg DPT, MSc, MTC, WCS, BCB-PMD, Linda, and Maryssa
Women’s Advantage/Men’s Optimal Health Physical Therapy
20911 Earl Street, Suite 300
Torrance, CA 90503
Notes from class
During pregnancy, your belly gets bigger, your muscles lengthen and the connective tissue between your muscles start to open – it’s called Diastasis. One finger width in between the abdominals is normal prepregnancy, which increases up to 2-4 fingerwidths during pregnancy, Jenni begins to get concerned at 4 finger widths. If a pregnant mom notes a widening and a lot of protrusion when getting up from bed, it is recommended to wear a binder for the remainder of the pregnancy to prevent a permanent separation. If the fascia is pushed further than it can handle, there is also a chance for an umbilical hernia (a true tear versus just a separation/lengthening of the fascia). The same thing elongation happens to the pelvic floor during pregnancy and during a vaginal birth– it descends between the sitz bones and lengthens. Pregnancy hormones help our muscles to relax, but they can stretch and tear.
C-Section – your skin should not hang below your scar. You need to check your C-Section scar starting at 14-21 days post delivery! Put your hands on your scar, the scar should move easily. You should be able to pinch the scar and lift it easily. Adhesions begin to build at 6 weeks so you want to gently work the scar so this doesn’t happen. With a vertical C-section scar (on the UTERUS – most are horizontal, but with an emergency C section, sometimes they are vertical), you don’t want to do a vaginal birth for subsequent births. (VBAC). This is because the contractions can cause the scar to split. (Most everyone has a horizontal scar on their abdomen).With a horizontal scar in the uterus, it can be possible to do VBAC. (Most MDs like an 18 month window from birth to birth to allow a woman to try a VBAC - Vaginal Birth After C-section) C-Section wait 8-10 weeks before exercise (in general).
If you’ve had a bad pelvic floor tear, you definitely need to be doing pelvic exercises! 4th degree tears often lead to fecal incontinence later in aging after menopause. If someone has a 3rd or 4th degree tear and has no symptoms after birth, Jenni often sees issues later,around menopause, because the lower estrogen makes the tissue thinner. With a 3rd/4th degree tear, wait 3-4 months before running.
Check vaginal scar beginning at 14-21 days after delivery – ideally before sex. The scar should move side to side, in and out, and roll it. If it hurts or hurts to have sex, work the scar a couple of times a day. If that doesn’t resolve it, you may need to see a physical therapist.
For subsequent deliveries, talk to your doctor about delivery position options. If you have an epidural, delivering side-lying is most protective for your vaginal floor. Without an epidural, hands and knees is most protective. Squatting is not great for North Americans.
Urine Leakage is common but it is not normal!! There are 2 main kinds of Urine Leakage. Urine leakage with physical things (Stress Incontinence): laughing, coughing, sneezing, running, jumping. Usually little leaks – this is the most common. Urge incontinence: the bladder has gotten overactive and irritable and contracts when it’s not supposed to. Usually big leaks. Either of these can be caused by vaginal births. You need to strengthen your pelvic floor to tighten everything back up. 92 % of people who have Urine Leakage at 3 months still have leakage at 5 years if they don’t do anything about it. Urinary incontinence is the #1 reason women get put in nursing homes. You want to resolve it now so it doesn’t become a problem you deal with years on end! Don’t “just give it a year”.
Fecal Incontinence: Anal sphincters can leak out feces.
Organ Prolapse: Your uterus sits at the top of your vaginal canal. If things get overstretched, the uterus can slide down the vaginal canal and come out. More commonly the bladder or rectum can come down and cause a bulge at the vaginal opening. Symptoms: You can feel a heavy sensation, a tampon may not stay in, it may feel like you have a tampon falling out, you may need to shift positions in order to urinate, or drops of pee may come out as you stand up after voiding. They do surgery for this but it can have complications such as mesh erosion or failure in the first few years– you can now do physical therapy and get the muscles stronger and the organs/vaginal wall lifted in about 16 weeks.
If nursing, your progesterone levels will stay elevated until you’re finished – this can effect your connective tissue and keep things lax (think foot or pelvic pain w increasing activity or exercise).
BetterBinder is the best binder for post-partum (find it at www.babyhugger.com). Nearly every woman should wear a binder for 6-8 weeks, 24 hours a day, after delivery! The exception would be a woman with prolapse – you would want to bind not as tightly.
When you start exercising, watch for leakage, pain, etc. If this happens, focus on getting your strength back and then resume. Don't forget to do some of the "boring" tedious subtle work to kick in your transverse abdominus. Make sure to do these even if you're doing higher-level activities! (Look below for exercise ideas)
Painful sex - If you've always had painful sex, you may have an overactive pelvic floor or sensitive nerves. If it's new after having a baby, it can be a tear or sensitivity. It can also be a hormonal issue - estrogen levels dropping with nursing, and they can give you a cream/ring. Jenni's favorite lubricants are coconut oil and Slippery Stuff.
We learned exercises for our Transverse Abdominus and Pelvic Floor Muscles. I attached videos of Jessica and Di explaining the exercises to your recap email!
Kegels (Pelvic Floor): 30-80 repetitions a day for strengthening, holding for 5 seconds each time if you’re having leakage. 20 5-second repetitions would be maintenance. If you can’t start at 5 seconds, start at 3 seconds and work your way up. If you can hold longer, you can work up to 10 seconds. Make sure when you do kegels, you hold the exercise – don’t just do quick squeezes – the holds are key! Overdoing Kegels can also lead to a chronic gripping and pain w penetration or exercise.
If you aren’t sure if you’re doing your exercises correctly, buy a box of tampons, put them halfway in, the tampon should stay in your vaginal canal if you’re doing your exercises properly. If not doing your exercises properly, the tampon may come out or not be held in.
If you start having more leakage or feel worse, you may be doing too many and fatiguing the muscles
Transverse Abdominus exercises: Transverse Abdominus is like your internal corset. You can do the exercise on your side on the floor or on hands aind knees. Do about 30 of those a day, holding for about 5 seconds. Gently hollow the lower belly toward the spine while keeping the ribs relaxed and saying a soft “shhh” sound.
Lisa Jewell in Torrance and Jay Granzow in Manhattan Beach – Plastic Surgeons that Jenni loves
Last Jenni checked the class for diastasis and also checked C-Section scars.
Notes from Jenni & her team:
**Check out our website for any questions about different diagnosis that we treat, or which insurances we take! We would love to assist you in your postpartum recovery! Or during your next pregnancy! www.womens-advantage.com
We would greatly appreciate any feedback on our facebook (or YELP) page as well. LIKE us to see women and men’s health research, info about the latest pregnancy and postpartum treatments, general nutrition or relaxation training work, etc.
We also offer 21 pilates classes each week with 4 reformers. Classes are $20 each and we sell 10 weeks per session. Call for more info and a schedule.