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Tag Archives: pelvic floor

Demystifying Diastasis-Rectus Abdominus

The first year of mother-hood is accompanied by vast physical, hormonal and emotional changes. The female body undergoes remarkable transformation during pregnancy, the most obvious change being the growth of the abdomen, stretching to accommodate the growing fetus. In fact, studies show that during the third trimester around 70% of pregnant women develop a condition of over-stretched abdominal muscles (Boissonnault & Blaschak, 1988). This over-stretching is medically referred to as Diastasis-Rectus Abdominus (DRA) and occurs along the linea alba, the tendon that cuts through the middle of your “six-pack muscle.”

 

DRA is most commonly identified by measuring the space between the two inner edges of your rectus abdominus muscle (six-pack muscle). This is referred to as Inter-Recti Distance (IRD). In a clinical setting, finger widths are often used to measure this space. An IRD of two or more fingers widths is considered to be a DRA (Noble, 1982). However, IRD is not the only measurement to consider when diagnosing DRA. More recent studies have been focusing on the tension that one is able to generate along the abdominal wall and the linea alba. What that means is that the distance between your six-pack muscles is not the be all and end all. The ability of the abdomen to generate force, fully contract and maintain its structural integrity is more relevant than finger widths.

 

 

Identifying Diastasis-Rectus Abdominus

 

Let me be perfectly clear, DRA is a normal change that occurs during pregnancy. Your lower ribs will flare, the pelvis will broaden and your abdominal wall must expand to accommodate the watermelon-sized uterus underneath. It is the persistence of a DRA in the postnatal period which is not ideal. This is because the lack of abdominal tone, endurance or integrity can lead to dysfunctions elsewhere in the body. Many of the symptoms reported by women during their first year of mother hood can be explained by an underlying DRA. Some of these common symptoms include low back pain, pelvic area pain, stress urinary incontinence and urogynecological discomfort. Researchers Parker, Millar and Dugan (2009) found that 74% of women seeking care for low back and pelvic pain had a DRA. Multiple pregnancies very close together, previous abdominal surgeries and a mean maternal age greater than 34 years old have been shown to increase one’s risk of developing a DRA.

 

Currently, postpartum care consists of a six-week follow-up with a family physician. Granted there are no complications with delivery, surgical incisions or perineal sutures, the majority of women are cleared by their physicians at six weeks to resume all regular activity. Sperstad, Tennfjord, Hilde, Ellstrom-Engh and Bo (2016) observed a DRA present in 60% of the women at six weeks postpartum. Diastasis-Rectus Abdominus is often overlooked by physicians, although the awareness around the condition is growing, it is important for women to advocate for themselves and ensure they are getting the right care.

 

Steps to Core Restoration:

In the case of repairing Diastasis-Rectus Abdominus it is vital to strengthen the deep core muscles and to establish functional thoracic and pelvic floor mechanics. Diaphragmatic breathing and correct kegel work are important places to start for new moms looking to fix DRA. Following your six-week check up with your physician, I would recommend booking with a Pelvic Floor Physiotherapist. They will help you to restore all the muscles of the pelvis and pelvic floor, which are often significantly impacted by pregnancy and birth. It is well understood that the maximal contraction of the transversus abdominus muscle (your deep corset-like abdominal muscle) relies on the full contraction of the muscles of your pelvic floor. In other words, you can perform plenty of Rocky Balboa-style crunches (strongly NOT recommended) without actually engaging the right muscles because your pelvic floor has not fully recovered. Osteopathic manual therapy can offer additional relief and restoration by increasing the mobility of the thoracic spine, thoracic diaphragm and pelvis.  

Florence is due to begin her research on “The effects of global osteopathic treatment on diastasis-rectus abdominus in postnatal women” in the fall. If you are interested in participating in her research or learning more, please contact her via e-mail at: Florence@rpmstudio.ca

 

FLORENCE BOWEN

Florence was first introduced to alternative therapeutic modalities in her teens, as a dancer and competitive athlete. After high school, Florence furthered her dance training and obtained her Honors Bachelor of Science in Kinesiology from McMaster University. Teaming up with the artistic director of the McMaster University contemporary dance company, she developed introductory dance classes for children and teens across Hamilton. Inspired to further her teaching skill-set, she obtained her yoga teacher certification in Hatha yoga. Florence teaches across the city and combines her knowledge of human kinetics, dance, strength and conditioning, and yoga. Teaching movement to pre and postnatal women, and coaching as a birth doula, she gained a unique perspective into the supportive systems available to new and expecting mothers. Florence has an affinity for the holistic approach to women’s care. She is passionate about the assimilation of progressive knowledge to educate and empower women at any stage of life including: pre-conception, pregnancy and recovery after birth. Most recently, Florence completed her five years of study at the Canadian College of Osteopathy in Toronto. As a manual therapist, she believes in having her patients actively participate in their healing. She currently is working to complete her thesis which will examine how osteopathic treatment effects diastasis-recti abdominus in postnatal women.

 

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Your Bladder Matters! –  5 Common Myths About Bladder Habits

As a pelvic health physiotherapist, I love to talk about the pelvic floor and bladder interaction as it relates to incontinence (refer to my previous posts, “Paediatric Incontinence” and “Pain Down There”). Research has shown that approximately 1 in 5 adults over the age of 20 report some type of lower urinary tract symptom (LUTS)2. A healthy bladder is a main contributor to overall health and LUTS has been linked to decreased quality of life and depression1. That being said, bladder “health” is much more than remaining continent with a cough or sneeze.

 

Some anatomy background:

Imagine your pelvic floor muscles as a trampoline that attaches from your pubic bone to your tailbone. Sitting on the pelvic floor lays your bladder, uterus and bowels. As your bladder fills up with urine from your kidneys, the pelvic floor naturally tightens up to close the bladder sphincter from releasing its contents. When the bladder is at its full capacity (average is 300-400mL in healthy adults1), a signal is then sent to your brain to release the urine. Once you are in a safe and convenient place, your pelvic floor relaxes to release the bladder sphincter, essentially relieving the urine.

 

(Pictures taken from Lukacz, E. et al.2)

 

Sounds pretty simple, right? Unfortunately, these 5 bladder myths may contribute to your less than “smooth” urine flow.

 

I should go to the bathroom as often as I can

Many people think the more they go to the bathroom, the less they will have accidents or discomfort. In fact, the normal amount to release your bladder is 8 times/day – that means once every 2-3 hours. Going too often may train your brain to send signals to release your bladder prematurely, meaning, next time your bladder fills up just a little you’ll be running to the bathroom with your legs crossed.

 

I’m drinking less water so I don’t need to go as often

Unless you’re getting up more than once in a night to use the bathroom, limiting your water intake will not improve your bladder habits. Instead, it may actually increase your urine concentration, leading to bladder irritation. Focus on improving your bladder habits and strengthening your pelvic floor while ensuring you are staying fully hydrated.

 

I do my kegels over the toilet to strengthen my pelvic floor

Abort. Mission. Immediately.
When you are voiding (urine, feces, gas, whatever it is), you should be fully relaxed and comfortable. Stopping-and-starting your urine flow will train your brain to continuously tighten your pelvic floor during voiding, which is the opposite of what your body is trying to do and may add to further bladder irritation.

 

I’ve always had poor bladder habits as a child

This may be true, but it doesn’t mean you have to accept it as an adult. There are many external behavioral factors that influence our bladder habits, including what we eat and drink, how much sleep we get, smoking and alcohol, etc. It is important to know exactly what is triggering and irritating your bladder.

 

My personal favourite: It is normal to pee yourself after having children

This may be common but it most definitely is NOT normal. Our pelvic floor experiences a lot of trauma with childbirth and soon after we may notice some urinary incontinence with certain activities. This could be a result of your pelvic floor muscles being too weak or tight and unfortunately, kegels are not always the answer. The sooner you get it checked out, the sooner you can return to your pre-baby state.

 

Now that you’ve learned a little bit more about having a “healthy” bladder, come see a pelvic health physiotherapist to learn more about what you can do for your own pelvic health!

 

References:

1- Lukacz, E. et a. A healthy bladder: a consensus statement. International Journal of Clinical Practice. October 2011; 65(10): 1026–1036

2 – Maserejian, et al. Incidence of Lower Urinary Tract Symptoms in a Population-Based Study of Men and Women. Urology. 2013 Sep; 82(3): 560–564.

 

Sandra Ghaly – Pelvic Floor & Paediatric Physiotherapist

Sandra graduated from Dalhousie University with a Masters degree in Physiotherapy after completing her Bachelor of Kinesiology degree with honours from McMaster University. She has worked with a variety of clientele but has developed a true passion in working with both the paediatric and women’s health populations. Sandra has extensive experience assessing and treating a variety of paediatric conditions and most recently has become certified as a pelvic health physiotherapist. She also has additional training in acupuncture and kinesiotaping. Sandra finds great value in guiding each individual through a tailored rehabilitation program to optimize their function and quality of life.

If you have enjoyed this blog and would like to learn more about health and wellness from our team of expert practitioners, sign up for our mailing list or follow us on facebook and Instagram.

Paediatric Incontinence: How to Help Children Who Suffer From Poor Bladder Control

Approximately 90% of children achieve urinary continence by the age of 5, but what is it like for those 10% that are “accident-prone”? Day- or night-wetting for children is not only uncomfortable but can also limit participation in sports, sleepovers and other social activities; and although less than 1% of affected children continue to experience incontinence into adulthood, it is crucial to identify and treat the cause of it sooner rather than later.

There are two types of paediatric incontinence: nocturnal (night or bedwetting) and diurnal (day wetting). Children can experience either one or both types of leakage. Many factors can contribute to ongoing urinary incontinence, including:

  • voiding dysfunction or deferral
  • urinary tract infection
  • pelvic floor weakness
  • distraction/avoidance
  • uncompleted toilet training
  • unnatural voiding positions (e.g. legs close together)
  • family history

Very commonly, urinary incontinence is associated with constipation that may or may not be diagnosed. In many children, treating constipation first may relieve signs of accidental wetting and allow them to regain control over their bladder.

If your child is over 5 and still having trouble holding in their urine, it is important to have them assessed by a paediatric or pelvic health physiotherapist.

 

What to expect from your child’s first appointment?

Unlike adult pelvic health exams, there is no internal component for the child. Instead, the physiotherapist will take a detailed history from the parents and child to determine the root cause of the problem and offer suggestions for behaviour modification as well as exercises to treat the incontinence.

References:

Figueroa, T. Urinary incontinence in children. Merck Manual. Jan. 2018.

Nankivel, G., Caldwell, P. Paediatric urinary incontinence. Australian Prescriber. Dec. 2014; 37(6):192-195

Sandra Ghaly – Pelvic Floor & Paediatric Physiotherapist

Sandra graduated from Dalhousie University with a Masters degree in Physiotherapy after completing her Bachelor of Kinesiology degree with honours from McMaster University. She has worked with a variety of clientele but has developed a true passion in working with both the paediatric and women’s health populations. Sandra has extensive experience assessing and treating a variety of paediatric conditions and most recently has become certified as a pelvic health physiotherapist. She also has additional training in acupuncture and kinesiotaping. Sandra finds great value in guiding each individual through a tailored rehabilitation program to optimize their function and quality of life.

If you have enjoyed this blog and would like to learn more about health and wellness from our team of expert practitioners, sign up for our mailing list or follow us on facebook and Instagram.

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