KEGELS THE RIGHT WAY

Submitted by Christine on June 16, 2008 - 11:39am

Hi All,

Throughout the life of WW I’ve striven as much as possible to make this information “self evident” to women. There has been enough gobblety-gook from textbooks, MDs, PTs and so forth. Women have to know these techniques work because they can sense it for themselves.

That said, I’d like to describe the way I believe pelvic floor contractions should be done.

First of all we need to ask the question, what are we trying to accomplish with kegels? Here is the true anatomy of the situation:

• The pelvic diaphragm is attached from the lowest point at the back of the pubic bones to the highest point at the sacrum/tailbone.

• There are three sphincters along the way enclosing the urethra, vagina, and anus.

• In bipedal posture the pelvic diaphragm is adapted to close the sphincters with decreasing intensity – from lowest to highest.

• It therefore follows that the effect of this closure is most pronounced upon the urethra, then the vagina, then the anus.

• The pelvic diaphragm muscles are a vital part of the urinary continence system. They must contract and relax properly to maintain urinary continence.

• These muscles also play a role in vaginal/sexual health by maintaining the sphincter muscles of the vagina.

• Pelvic diaphragm muscle closure at the level of the anus is less important because the human anus itself has adapted a set of two (internal and external) highly functional sphincters that operate over and above the closure accomplished by the pelvic wall.

• At the level of the anus, the pelvic wall muscles are much more useful in helping things go out than keeping them in.

• Under extreme circumstances the pelvic wall can assist to maintain fecal continence – picture running to the bathroom with extreme diarrhea. The tailbone is tucked under and a hand probably pressed on top.

• It is only when the tailbone is tucked under that the pelvic wall has enough slack to reinforce the anal sphincter.

• This is why when doing kegels on your back you feel it most in the anal area.

• Yet, anatomically, tightening the top of the pelvic wall is of no practical value.

• Additionally, when this area is too tight symptoms such as tailbone pain, sexual discomfort and constipation arise.

• Tightening the bottom of the pelvic wall happens naturally with bipedal posture and therefore should be the goal of all kegel exercise.

So here I offer the maximum wholewoman kegel:

Sit comfortably on the floor. This can be done in a chair as well, but sitting crosslegged on the floor is far more beneficial. When the hips are externally rotated, the belly and pelvis (and therefore pelvic organs) can rotate into their most forward positions.

Now…keeping the upper body posture (shoulders down!), raise your arms into a graceful full moon circle above your head. Your hands should be above your forehead rather than above the crown.

Take a deep breath IN through your nose and hold it while moving forward over the tops of your thighs and maximally contracting your pelvic diaphragm. Hold.

Release as you breathe out, all the while keeping your spine straight from tailbone to top of head. Repeat as many times as you wish.

The arms do not move and the spine remains in one line from top of head to tailbone. There may be a little pelvic movement back and forth, but it should be very minimal (we maximize pelvic rocking in other exercises.) It is your belly that is expanding over the very tops of your thighs.

It will be self-evident that your muscles are contracting hard around your urethra while bladder and urethra are being pulled forcefully toward their proper positions.

• Alternate with your legs stretched out in front for a great hamstring stretch.

:) Christine

Comments

Christine

June 16, 2008 - 9:33pm

If this post was confusing it is because in the third bullet point I wrote "increasing" when I meant "decreasing"....sorry.

louiseds

June 17, 2008 - 1:27am

Hi Christine

I find myself questioning the tucking the tailbone when I am in a real hurry. I find that walking quickly and not breathing, in exaggerated WW posture will get me there best. My body tells me not to tuck my tailbone under as it will put me in a bowel opening posture, which is exactly what I don't want at the time!!!

Looking at the technique you have described, raising the arms will tighten (like a drum skin) the pelvic wall across the ischial spines and from pubic bone to coccyx/sacrum. Correct? Are you saying that I then have to pull up all those orifices as well?? It doesn't feel like they are contracting hard until I actually pull up at the end. Am I doing something wrong?

Cheers

Louise

Christine

June 17, 2008 - 12:28pm

Hi Louise :)

Actually, the buttocks muscles are the outermost, emergency part of our fecal continence system…and if yer runnin’, yer squeezing ‘em together! And if you’re squeezing, then you’re tucking your tailbone.

Yes…the raised arms are maximizing the motion by working the big fascial planes. You should feel a very strong squeeze around your urethra. You feel it a bit less around your vagina and even less around your anus because of what I described above.

You can certainly do them without the arms and even sitting upright in a chair.

Cheers,

Christine

Dancin

June 17, 2008 - 12:54pm

Christine, Thanks so much to you and all these ladies for the information you share. My sister and I both have pretty severe cystocele problems. She has decided on surgery - I have not. I am getting ready to order your book. Does your "Saving the Whole Woman" also have diet information in it or do I need to order something else? I've recently lost 47 pounds which only seemed to make the bladder situation worse for the time being. I don't take any hormones but my doc has told me that bio-identical HRT will help the cystocele. I'm 61 and learning alot from all of you about how to live with this glitch in life.

granolamom

June 17, 2008 - 8:46pm

first, thanks christine for that clear description of the pelvic diaphragm.
but I've got a question...

why kegel? if we kegel the way you describe, is the goal to reposition the bladder and urethra?
as opposed to strengthening the muscles so that they hold the bladder in its proper place?

sounds like that makes sense, if I'm understanding it correctly. because I didn't think a strong pelvic diaphragm could really do that (support the pelvic organs I mean).

Christine

June 18, 2008 - 11:58am

Hi Granolamom,

I wouldn’t sit down to do a bunch of kegels either, but someone newly diagnosed or postpartum might.

However, a version of what I described here is part of my daily firebreathing program, which not only moves organs toward their natural positions, but also frees the spine. The energy gain is tremendous.

There's something else, which I won't know until we get more data from women. It never occurred to me until I developed this program that there might be a need to stretch the lower abdominal fascia. One would think that for many of us that area is stretched enough! But is the internal fascia really open in a way that not only allows the organs to move forward, but also allows the lumbar spine to fully expand? When doing the sort of exercise I described above, there is a feeling of deep stretching of the inside of the lower belly. I think it feels great, but we'll have to wait to determine the benefits.

Christine

Christine

June 18, 2008 - 12:11pm

I'm glad you are not opting for surgery, but please do keep us posted on the course both you and your sister take. Cystocele does not respond well to surgery - hence the need for additional "reinforcement" procedures such as sub-urethral slings and vaginal wall mesh. Yet, if you have your uterus, cystocele responds very well to this work - recreating the natural shape of the external framework your internal organs suspend from. To answer your question, STWW talks about the importance of healthful food, but is not a recipe book. It's all about the breath, gravity, and posture...I hope you enjoy the book!

P.S. Congratulations on the weight loss...use the search function here to learn about the "rectal pillars" and why rapid weight loss can make prolapse worse for the short term. If you are interested in no-meat, no-dairy cooking, you might enjoy Diet for the Whole Woman.

Mae

June 18, 2008 - 12:33pm

Hi Christine,

I am curious about the comment you made to Dancin about the Cystocyle repair, "if you have your uterus, cystocele responds very well to this work." The doctors have always told me that my uterus would have to come out when they did the bladder repair because it would just drop anyway and then I would have to have another procedure to remove it. Are they wrong about that?

One of the deciding factors for me against surgery was I wasn't willing to give up a perfectly good uterus unless I really had to, so I began to look for other alternatives and found you. Glad they didn't suggest "just a repair" because I didn't know much about all this back then and I might have let them do that!

Just curious...as always.

Warm regards,

Mae

Christine

June 18, 2008 - 4:14pm

Mae...maybe we are saying/reading it differently...by "work" I meant ww work :)

Blue

June 18, 2008 - 7:19pm

Thank you for the clarification, Christine. Like Mae, I too wondered if "work" referred to the sling and mesh surgery mentioned in the sentence that preceded your "responds well..." comment. I wonder if an edit of your post clarifying "ww work" might be something to consider for future search results(?)

On a bummer of a note, I've been lying low lately due to a severe cold. Love, love, love my dear granddaughter's little hugs and kisses, but her little cold bugs via sniffles and sneezes, this grandmom could do without!... Every sneeze and cough is testing the limits of this already popping POP of mine, that's for sure; pushing a head/chest cold into an 'outa body experience', of sorts, if you know what I mean. = : /

I'll 'see' you gals once I hit the better side of well. Be good

(((safecyberHUGS)))
~♥Blue

alemama

June 18, 2008 - 8:30pm

Christine I think Nauli stretches facia. Maybe that is why I have had such great results with it. Maybe it is that with Nauli you forcefully stretch it and then by staying in the posture the facia is able to sort of rethink itself....

Blue- sorry you are having a rough time. A cough can be so discouraging. Just try to get in a good position as much as you can when you cough and rest well so you will feel better soon. And don't freak out if things are worse for a little while- they will get better again.
((((safecyberhugstoyoutoo)))

shalom

June 19, 2008 - 4:37pm

when you say take a deep breath in while moving forward over the tops of your thighs...by moving forward, do you mean leaning your upper body forward over your thighs or just your arms? just want to be sure im doing all this right. thanks for your help. Denise

Christine

June 20, 2008 - 10:02am

Hi Denise,

Thanks for helping to clarify this point - I edited my original instructions to hopefully make them more clear.

Here's another exercise we do that may also help you get a better feel for the one above. We do a series of exercises like these and then end with the following:

While sitting crosslegged clasp your wrists with your hands at sternum level. Breath IN through your nose and hold it while leaning slightly forward (spine straight!) while you pull your pelvic diaphragm up strongly. As you do this try to pull your arms apart all the while holding them tightly with your wrists. Your lower belly will expand over your thighs with the in-breath. Release and repeat.

We are creating the maximum amount of intraabdominal pressure while also providing the proper anatomical place for it to go, so that pelvic organs are moved into their rightful positions.

Hope this helps!

:) Christine

Dancin

June 25, 2008 - 10:23am

Hi everyone, Thanks again for all the info. It does give one hope! Christine, I just ordered your book and CD and can't wait to get it. I understand that after losing 50 pounds my body needs some time to adjust to it's new self. I think that maybe doing your program while it adjusts may be a great thing. My sister and I both have pretty severe cystocele and rectocele problems. She has opted to have surgery right away and is looking for a good clinic. She has about decided to go 2 1/2 hours from home to a clinic in Mississippi (we are in Alabama). I, on the other hand, am squeemish about any surgery I don't absolutely have to have. Some days I feel like just getting it over with and having the surgery because I'm so uncomfortable. Then I come to this site and remember why I don't. I'm 61 years old and in good health. I recently read a post about using two tampons to hold things in place. One tampon seems to turn sideways and come right back out. I'm not sure how to use two at the same time. Anyone else know about this and can give me instructions?

ChannelD

July 2, 2008 - 4:16pm

Hi Christine;

I studied very intently your advice about how to do kegels. Is there a particular time of day that it is best to do this set? Like first thing in the morning, or just before bed? Is there any benefit to doing them standing? I had started adding them to my pre morning walk stretches - am I helping at all? Hurting myself?

This forum has been such an enormous help to me. My quality of life has improved dramatically since I began asking for help and trying the suggestions I have received. I know it is easy to say, but try not to be too discouraged (if that is the right word, I do not want to presumptuously name your emotions) by women turning to surgery. The pressure in our society for women to be "good women" and listen to "the nice doctor who knows best" is enormous. And of course the temptation of a quick fix instead of a long road of work is also enormous. But it is so rewarding to learn to listen to your body and give it what it needs naturally.I am very thankful that both of the doctors I have seen - my GP and my urologist - are very supportive of me working on myself instead of them working on me. You just keep on keeping on and if someone does opt for surgery, well, surely there are forums and groups and supports out there for them as well.

Cynthia

louiseds

July 2, 2008 - 10:16pm

Hi Cynthia

When talking Kegels I think it is important to keep it all in perspective. Kegels can be very useful for exercising the muscles of the pelvic floor, which improves their ability to act as sphincters for the pelvic organs, and it does mean that the 'back wall' of the pelvic cavity is covered in 'stronger, more bouncey elastic' rather than weaker elastic. Kegels will also improve your awareness of the whole pelvic area which will enable you to be more mindful of how you move, and what is happening in there during different activities. Having this awareness, and 'stronger elastic' can also enhance your sexual experiences.

However, Kegels will not enhance support for the pelvic organs past having 'more bounce' and ability for the pelvic floor to not sag back all the time. The pelvic organ supports are primarily the three dimensional fascial tissue that surrounds each organ, like flexible honeycomb, supporting each organ in three dimensions. Prolapse happens when that three dimensional support net is damaged and the contents spill out and fall backwards if gravity is pulling them in that direction. The only way to prevent pelvic organs sagging back and down is to tip them forwards so their centre of gravity is over the pubic bone, and not over the vaginal opening, and give them room in the lower belly to move into, so they can stay in place, supported on bone.

The rectum is a bit different because it sags forwards if its supportive fascia are damaged, and if there is a space to move into. The important factor with rectocele is to prevent regular distension of the rectum into the vagina by preventing constipation and the straining to empty that goes with it.

So Kegels are a secondary tool in the battle to keep your organs inside your body. It probably doesn't matter what time of day you do them, but like all exercise, muscles will get fitter when they can move through their full range of movement. I think you are the best judge of how much pressure caused by your organs will reduce their movement at different times of day. I think I would just do a few several times a day, rather than an organised workout. Like many practices, a few often, rather than a lot in one dose, will be more effective. They are little, sinewey muscles that are not designed to pump iron. They are not designed to be primary load supporters, simply to kind of bounce back and forth in response to intraabdominal forces, like a drum skin.

It is WW posture during waking hours, clothing that give your lower abdomen room to expand, a diet that keeps your system moving, and whole body exercise to strengthen the muscles that will maintain WW posture and help you to go about your daily activities in a physically efficient way, that will look after your prolapses.

Kegels are background exercises. WW posture stretches the drum skin tight (see STWW, edition 2). Without WW posture your pelvic floor muscles will still be floppy.

Hope this helps you to see where they fit in to the whole system.

Cheers

Louise

queenmother

September 29, 2008 - 7:56pm

I read with interest what you said about the relative influence of the pelvic floor muscles over the urethra, vagina, and anus. Since my 3rd degree tear I've struggled with very mild fecal incontinence and bowel urgency. Kegels helped a lot after my first birth; after the second (with the prolapse) I have Kegeled and Kegeled with very little improvement in my strength or my symptoms. The only exercise prescribed was Kegels. Do Kegels not exercise the other sphincters you mention above? If they don't, is there something that does?

And do you know why it would be so much harder to develop a strong pelvic floor after the second birth? Is it a side effect of the prolapse or a symptom of unrepaired internal injury? I remember that it was relatively easy to build up quickly with these exercises the first time (and it made sex so much better! Oh, I miss that...). The second time, not so much.

Thanks,
Sarah

Christine

September 30, 2008 - 12:33am

Dear Sarah,

There is only one “genital hiatus”, or opening down the middle of the pelvic diaphragm. Three sphincters are embedded in and around this split. Contracting the diaphragm contracts all three. However, depending upon how your spine is positioned, the different sphincters close with different intensity. Kegeling sitting up with the lumbar curve in place will contract the urinary sphincter more intensely, while kegeling on your back will contract the anus.

You now have organs (bladder and rectum) holding the hiatus open so that voluntary contractions of the pelvic floor are more difficult and also less effective at developing a tightly closed sphincter.

Sarah, learn to live in this posture. The human female body has built into it layers of support that reinforce each other and can compensate for injuries such as yours.

The seated postures are very important because they pull all of the fascial planes of the pelvic interior into anatomical alignment while also lifting your weight off your anus.

Get to know your deep external hip rotators by enjoying releve’/plie’ excercies in the foot positions of ballet. If your belly is relaxed and you are pulled up into the posture, you will feel a pleasant snugging together sensation at the top of your buttocks. All the outer muscles surrounding your anal sphincter are strengthened in this way and will do more for both your prolapse and your incontinence than kegels ever could.

There is much more coming soon (to fabulous music!) on dvd!

:) Christine

fc12

February 19, 2009 - 5:18pm

Sorry about this. I have been doing 'traditional' Kegels for so long that I'm trying hard to get my head around this new version.

Just one question, when you've bent your torso over your thighs as you tighten your pelvic diaphragm, and then after you've 'released' do you come all the way back up and then move back down again for the next 'Kegel'? Does this make sense?

I guess what I'm trying to work out is whether you do a series of the tightening exercises as you're bent over your thighs or whether the series of exercises requires you to come back sitting upright before you start the next one.

Also, are these exercises in the new DVD?

Many thanks in advance
fc12

mumtogirlslondon

April 7, 2009 - 5:22am

Hi ladies
firstly, i'm new to internet forums so please excuse any errors/etiquette probs, esp that this is quite a long posting!
secondly, thank you all so much already for the incredible wisdom and warmth you all show in your posts - I've learned so much from reading both new and old posts in the last few weeks. I'm so glad I found this site and the wonderful women who bring it to life.

I'm hoping someone can spare some time to help steer me in the right direction:

I'm a 36 with 2 lovely daughters, most recent of which is now 10weeks old. I also have a loving husband and supportive wider family, so I count myself generally fortunate in life. but since No 2 swung by, I've also got a mother of a rectocele which has rather rocked my world, and not in a good way (in the UK there's a phrase 'bowel-shattering' to describe big bad events- never has it seemed so appropriate...!)

the rectocele is not particularly huge physiologically, but it is very symptomatic:

It needs routine splinting to BM, and I'm weathering the full panoply of symptoms I've read so much about in the many posts and threads on this site (especially the constant need to 'go' despite morning evacuation, but no momentum to get it out). As a fish-eating vegetarian with a high quality diet I dont' have problems with constipation as such - it's evacuation. though my various attempts to eliminate any kind of constipation are making me crampy and diarrohea-y sometimes too.

Over the last 8weeks or so I've been yo-yoing between determination to learn everything about it and damn well get the better of this thing, and total despair. Usually this depends on whether I've got the 'apple stuck in my rectum' feeling that accompanies the need, but inability, to go other at any other time than in the morning. I know one thing only - I don't want that surgery.

meantime I've got the book and DVD and have been working on my posture.

so, with apols for the long prologue - my current question:
I was a bit confused by Louise's response on the Kegels the right way thread, about the relevance of posture for rectocele, because the rectum is sagging forward anyway. Does this mean posture and other exercises are not going to do much for symptomatic improvement of rectocele?

(PS Louise, I know it's been said before, but you really are a special woman - your posts are always so thoughtful, informative and generous)

I'm trying not to get my hopes too high about a significant postpartum improvement in the rectocele (my PT said she thought this unlikely because a) I'm splinting every day and b) I had a mild problem with it after my first child was born, though it got 99% better then). so i'm pinning what little hopes I still have on the posture and exercises making my quality of life just a bit better.

If posture etc isn't going to do much for my rectocele, is there anything else i could be doing which might. I got the impression Nauli was more for bladder/uterus side of things.

PS I also have a very slight cystocele (acc to my gynae, the kind commonly seen postpartum in women with 2 or more kids, and will prob resolve of its own accord, so I'm sure I should still be doing the posture for that anyway)

Any comments or thoughts will be extremely gratefully received! I really need some hope here!!

Mum to girls in London

louiseds

April 8, 2009 - 1:59am

Hi Mumtogirlsinlondon

I think Christine has explained very well about the rectocele being the last to respond. I rarely have trouble with my rectocele now, though it was the main problem when I was first diagnosed over four years ago. I used to have to splint almost every time, now it is almost never. I think it is important to think of the three organs as a semi-connected unit, though they don't move in unison. Mine all move around all the time. Occasionally the rectocele is presenting first, often it is the bladder, and sometimes the cervix. Mostly though, nothing is presenting, but after a few days of heavy physical work, where I have been unable to move in a controlled way, I sometimes feel the bulge for a couple of days, then it goes away again after I get diligent again with posture etc. In time you will be able to straighten out the kink (rather than just push it back) most of the time, and fill the space occupied by it with other parts of the intestines.

You just gotta realise that this pelvic cavity is a 3D structure, and that the other parts of the intestinal tract, which is arranged like a kind of spiral, can move into the bottom space instead of the bladder, uterus and rectum doing the sagging.

I can see that once you are over the three month hump you will get a lot of benefit from nauli and firebreathing. You really just have to be patient with this body of yours, put the Yummymummy thing out of your mind for a bit, and just let your body recover its composure in its own time. It can be very frustrating for a while. All you want is to have your body shape and normal bowel function back, yes? :-(

Believe me, your quality of life will get a *lot* better, whether or not you do anything to help it along. From that point of view your PT is right. Your body may take over a year to recover to its 'best' shape after pregnancy and birth. This makes sense after 9 months of ballooning out during pregnancy. By taking Wholewoman precautions, ie mindful WW posture, clothing that doesn't squash your lower belly (mothball those pre-pregnancy jeans for a while - get some funky leggings instead!), your good diet, minimise straining for evacuation, go easy on other physical exertion that produces extra intraabdominal forces, do appropriate exercise, you will be helping your body to retain its structure while it is still like old elastic on the inside. Your body will be much improved in 9 months, and will continue to improve for several years.

You will have temporary setbacks for quite a while. At first there will be setback after setback with short periods of feeling no POP (maybe only a couple of minutes at first), then it will be longer periods of absence of symptoms with lots of setbacks, then less setbacks, then you will only have occasional setbacks. By this time you will be trusting your body to recover each time.

You might even have a period of several weeks when you feel like you are back to step 1. This can be really hard. But you just pull a few more rabbits out of your hat and you can usually overcome it, and get on with your life.

You will always have POP, but it doesn't have to rule your life. Acceptance of the certainty of little setbacks is what you have to get used to.

In a way, it is kind of like my office. My office has about 5th degree POP at the moment. There are bits of paper spilling everywhere, in heaps that just keep falling over and spilling out the door. I have to keep working in it, but it won't be until I can clean out the filing cabinet and make room enough to put everything back in its place, and keep it there by diligently exercising my filing muscles, that it will be symptom free. I also have to pay attention to its diet, by not putting rubbish into it, clean it out regularly, get some new curtains, and some more cushions for the saggy chair, and keep each piece of furniture in its place. (Oh yes, plenty of sex too).

Ya just gotta look after it well.

Cheers

Louise

:-)

Christine

April 7, 2009 - 3:18pm

Hello Mum,

Welcome to wholewoman and thank you for taking the time to tell us your story. We LOVE hearing about improvement and I can confidently say that there is nothing but hope for a young woman still healing from childbirth. The rectocele will take longer than the cystocele to begin to resolve, but you will get there just like so many others. The problem, as you are painfully aware, is thinning of the rectovaginal fascia and subsequent stool-trapping bulge.

I think you first need to take a deep breath and begin to nurture the belief that the rectocele will resolve. I'm assuming nothing was cut, so your natural tissues will mend and once again form the barrier you need. It is a slow process because the lower bowel has to straighten for the fascia to strengthen. This can only be accomplished by all the things that are demonstrated in the dvd. Remember that the back vaginal wall is connected to the uterus, which we are strongly moving forward; and that the rectum is connected to the sigmoid colon, which we are also moving forward. It takes less to pull the bladder forward, because it is closest to the abdominal wall...that’s why it is commonly thought that cystoceles are easier to reverse.

I would suggest continuing to support the rectocele by gentle splinting. The less the fascia is allowed to balloon forward, the faster the bulge will recede. Try not to aggravate it by keeping your bowels too loose. Mini enemas may be very helpful to get you over the hump until you feel real change in the rectocele. Remember that it’s all about the breath. I’m sure we don’t have to remind you Never to strain against the toilet seat - a half squat is the natural position of elimination for women.

Wishing you well!

:) Christine

P.S. Sometimes responses to these blog posts get lost in the shuffle - I will email Louise to make sure she sees your message...

mumtogirlslondon

April 7, 2009 - 4:12pm

thanks so much christine for making time to reply when you're so busy helping everyone else come to terms with this and move on. how you keep your energy and commitment is a miracle but I'm so glad for all of us you do! I feel heaps better just for reading your message.

(And I'm enormously grateful for all you are doing - I so wish UK midwives knew of your work and felt able to direct mums like me onto WW before they do themselves more damage with straining - none of those who visited me in the weeks after the birth even seemed to know what a rectocele was, let alone were able to offer good advice for minimising further damage)

don't want to be presumptuous by asking a follow-on question, but am super-paranoid about straining. Am generally finding morning BMs exit pretty easily with the splinting but still a little bit unsure of whether the (pretty gentle?) internal 'contractions' required to move *all* the contents on out constitutes 'straining'. Certainly it's not the temple throbbing, hold your breath kind, but I find I do need those contractions to get the last bits out, even when splinting and with softish stool. The later in the day ones - on the odd occasion where they feel like they might be able to exit - seem to require a bit more effort though again I'm so paranoid about straining. Am learning not to bother trying to go until the next morning, but then I worry that having stool sit there for up to 18hrs might be distending the rectum further and damaging the tissues. maybe that's the lesser of two evils?

my PT suggested that a good way to stop yourself straining is to gently exhale or even say 'oooooooggge' while expelling (God knows what my family think I'm doing in there). does that sound plausible? has anyone got any suggestions of other ways of avoiding straining? I've tried the half squat but somehow can't seem to relax enough in that position - possibly because my thighs don't feel strong enough to support my body.

I also got myself prescribed a few mini-enemas by my doc in case of real blockage. Ihaven't quite had the strength of character to try them yet, but just having them in the medicine cabinet makes me feel a bit less worried about possibility of it all backing up.

Can I push my luck by asking you - or indeed other wise women on this site - whether it's worth me trying Nauli and firebreathing at this stage pp? I am mindful of you suggesting I be gentle in what I do while my body's trying to do what it can to heal as much as possible.

yours in eternal gratitude

Mumtogirls London

Christine

April 7, 2009 - 4:40pm

All animals strain to poop - it’s natural and okay. Stopping that pressure at the hips is where the trouble is - it causes reverse-pressure blowouts, a.k.a. rectoceles.

Sit up and down, up and down on the toilet, only using the half-squat when you feel the need to raise pressure. Your legs will strengthen and in any event they don’t have to hold you up for long.

Can’t respond to the PT’s idea except to say that the notion that it is desirable, or even possible, to avoid all straining is unrealistic.

We usually suggest that nauli and firebreathing not be initiated before three months pp. You’re almost there, though, so use your best judgment.

mumtogirlslondon

April 8, 2009 - 4:24pm

thanks so much for the crystal clear advice, Christine. I'm putting it into practice already! (looking forward to thighs of steel as well as improved bowel function...)

Mumtogirls London

Judith

May 12, 2009 - 9:35am

Hi Christine
I'm probably being a bit dense here but can you explain exactly what "up and down up and down on the toilet" means, do you mean sort of bouncing up and down on the toilet seat so that the pressure goes down the legs and you defecate whilst moving up and down? Sorry about needing more graphic detail. I've been reading whatever posts I can find about how best to evacuate the bowels without straining unduly. I agree that it's unrealistic to not strain at all. I also find, like the earleir poster, that the first BM of the day is very easy, only needs a light push down, whereas later on in the day the urge is less strong and requires more effort and I can empathise with the feeling that maybe it's better to just leave it till the next morning. However, it must be healthier to respond to the urge rather than suppress it, so really it's about limiting straining as much as possible. I suppose my main question is, is the half-squat only to be used as a last resort or is it safe to use it with some bearing down in order to evacuate? My experience of the squatting platform was pretty negative - instant aggravation of the cystocele - so I sent it back. I'm a bit confused about why squatting is considered a healthy position and why it is obviously fine for some women with POP. The only think that I feel I know for sure is that straining back into the toilet is bad. I'd be very grateful if you could give a bit more detail. BTW, whilst we're in the realms of way TMI for regular company, I eat a very good diet and my BM are usually soft and easy to pass. And thank you so much for all the detailed information and your patience. Whoever thought we'd need someone telling us how to poo safely.

mumtogirlslondon

May 12, 2009 - 4:29pm

Hi Judith
I'm so glad you posted this as I was about to post something similar myself (whilst sharing the absurdity that I'm having to ask how to use the toilet at 36!!)

I'm having a fair bit of hassle with the rectocele at the moment - 14-15wks pp - and wanted to put a few questions to the more experienced rectoceliacs (is that a word? feels like it should be) out there in hopes I can find some better ways of managing the damned thing. hold onto your pants, as it were, for a long posting...

Re: straining etc
I'm still a bit unsure as to what constitutes 'safe' straining. I've now just about mastered the art of the half squat when going, but it's quite tricky to splint in this position (which I have to do everytime) and I never quite manage to completely empty in this position either - once the first big 'go' is done, it's much harder to expel anything left behind. Maybe it's because I can't quite relax in the same way as when sitting down.
I've wondered about full squatting with a bowl but suspect that might make splinting all but impossible, and am very reluctant to try to go without splinting at the moment because I'm trying to avoid anythign that makes the rectocele bulge and stretch more than it needs to.

the straining issue is particularly problematic for the second (or third...) BMs of the day, because there tends to be much less volume and often much softer. sorry again for the TMI, people.
I've read several posts from people talking about never strainign at all, and how their BMs just come straight out without even an internal gentle 'push' but that doesn't seem to be the case with me, - I need the gentle peristalsis push thing even though my diet is good and i'm doing all the right things.
I'm paranoid about making the rectocele worse and wonder if anyone can shed any light on the 'safe' levels of straining debate.

Re: permanently 'still needing to go'
When the rectocele reappeared this time, in the first couple of weeks I would splint and then not have any feeling of needing to go until the next time the rectum was full (ie the next day). But over the last 3 months, it's got to the point that I have the feeling of somethign int he rectum more or less constantly - certainly within an hour or two of any BM; most often it's because there is a small amount there (which I can sometimes feel from the vaginal side) but not enough to expel. I know this is one of the intractable rectocele problems and I've been told by consultant that I'll get used to the feeling and it'll stop being such a nuisance, but it's driving me absolutely insane at the moment. And it's completely put paid to my sex drive because it feels so unpleasant (poor husband very supportive but increasingly forlorn...) Also means I frequently get wind later in the day/evening, so I'm also disinclined to do anything in the evening. I'm wondering about hte mini-enema thing but am concerned a) whether that might stretch the rectocele again and b) might not be suitable for regular use. Anyone got experiences of using them that might help me work this out? or any other bright ideas about how to deal with this horrible feeling?

Re: tummy upsets
I'm also having some probs with how my tummy is generally. My pre-rectocele diet was very good and I very rarely had any tummy or bowel problems. Over the past 3months I've refined my diet even further - upped the fibre, cut down if not completely eradicated the 'baddy' foods and drinks and drink lots of water. My diet is the very model of eating virtue! But i'm finding these days that I'm getting an upset tummy quite often - not full-on diarrhoea as such, but getting a slightly runny tummy, cramps and general ill guts feeling. And given the rectocele means I often can't 'go' to clear it, this is an unhappy state of affairs. I can't see any obvious trigger foods from my food diary. ANd today I've found myself getting mild stomach cramps after eating anything at all.
But I'm generally confused as to why something 'structural' like a rectocele could suddenly give rise to these 'gastric' symptoms? have others experienced this? and if so, any thoughts on how to resolve?

Basically, what I'm finding at the moment is my bowels are pretty much running my life. I'm anxious about it all the time (recognise that anxiety may be exascerbating the upset tummy stuff, though this hasn't been the case for me in the past). I'm starting to dread eating any time after breakfast because it triggers the stool to move into the colon which I then can't expel till next day, then dreading evenings because of the full bowel feeling. I'm finding it impossible to focus on anything else

I know it's still relatively early and I'm still around the 'worst time ie 3-4 months pp, but it's pretty tough going at the mo and i'd be so grateful for any thoughts and ideas.

PS I'm doing the posture and WW every day

Whine over! Sorry all for such a self-pitying post

Mumtogirls London

Davi (not verified)

May 13, 2009 - 3:13am

MumToGirls

Pulling up into posture when you're feeling blue about the full feeling turns your attention to something positive. Sounds so simplistic, but it works. We dwell so much on the bad and our anxiousness makes things worse. Read Louise's post on her recent anxiety around supposed theft from her mother's room. The result, instantaneous flare-up of dormant constipation issues.

Sounds like your diet is good and fibrous; perhaps wheat is causing the tummy upset and gas. I find that any flour product consumed, muffins, scones, pasta, manifests itself within 2 days as a clogged rectum and lots of wind. A good digestive enzyme taken prior to eating wheat can help as would eating probiotics, but in the long term cutting out wheat products permanently is best.

DHs try to understand our symptoms, say they do, but really they can be quite dense. I often wish mine could live in my body for a day in order to really feel what its like to be me, but then I feel sorry for even thinking this, he would not be able to cope!

Whine on girl, let it all out, we're here for you!

- Davina

alemama

May 13, 2009 - 8:02am

." I often wish mine could live in my body for a day in order to really feel what its like to be me, but then I feel sorry for even thinking this, he would not be able to cope!"
who are you kidding-he'd cope just fine- I doubt he'd leave the house and instead he'd spend all day groping his boobs!

louiseds

May 13, 2009 - 8:39am

LOL, Alemama! I wonder how he would go peeing on all fours? L

alemama

May 13, 2009 - 9:04am

he would probably find a way to spell his name

alemama

May 14, 2009 - 7:50am

Davi wrote:
"Alemama, my remarks regarding husbands was not meant to denigrate them, but to point out the fact that we women are made of stronger stuff than men, that’s why we were given child-birth, looking after the hearth and the home and the vegetable patch, and they went out to hunt and gather."

"Hs try to understand our symptoms, say they do, but really they can be quite dense"

So here is the definition of denigrate- I am going to guess you intend the second definition.
1: to attack the reputation of : defame

2 : to deny the importance or validity of : belittle

not sure I can totally agree with your statement of strength in men vs. women- but anyway I had a good time thinking about what my husband would do if he woke up one morning in my body-it gave me a nice chuckle.
of course we can't all share the same sense of humor so hopefully you can take my comments in the spirit they were intended. I'm still claiming postpartum immunity-4 kids 6 and under - the baby just 2 months- me sleep deprived- I am amazed I can even form a coherent thought-
I don't want to make light of your feelings or pain. I am sorry you are not feeling well right now and hope you feel better soon.

Christine

May 12, 2009 - 6:02pm

Hi dearies,

The loo gymnastics are exceedingly simple - you’re making far too much of it. To help you understand, keep your skin in contact with the seat but lift your weight off so that just your skin is touching. Obviously, if you try to levitate straight up it will be very hard to do and not conducive to relaxing the pelvic floor muscles. Therefore, we lean over like we’re going to tie our shoe laces. Get the picture? This would be a half-squat if the toilet were removed and you were “going” in the woods. You can always leave your skin in contact with the seat as long as you lift your weight off. If you are taking a long time to go, alternate leaning forward during increases in pressure with sitting back down as many times as you need to. It is difficult and unnecessary to hover over the toilet bowl for the entire time.

A full squat tucks the tailbone under and closes the pelvic outlet, making anything going out (baby or bm) more difficult. A half squat lifts the tailbone and opens the outlet. Plus it positions your bladder into its anatomically correct position for emptying.

For years I suffered that stuck-bm-in-the-afternoon/evening feeling and for some reason I never experience it anymore. And I don’t even have a rectocele. But I have a cervical neck keeping the pelvic floor muscles from closing completely. One of the functions of the pelvic floor is to squeeze stool back up into the rectal vault so that it can stay there undetected until the vault is full. The only cause I can connect with this symptom is that the pf muscles are not staying closed. I like to think this is another sign of improvement in my condition. If nothing else it is a relief not to have to deal with it anymore. I also never get gripping gas pains and bloating in the afternoon/evening anymore. Is there a connection? I dunno.

:) Christine

Judith

May 13, 2009 - 5:15am

Thank you so much Christine, that is precisely the level of detail I seem to need. I presume that the tying the shoelaces thing works for peeing as well as BMs, even when no effort is required. You've no idea how much I appreciate that info.
I'm in a bit of a rush today, so can't do a long post right now, but there's quite a lot I'd like to say about diet, especially to mumtogirls. BTW, what you call a whine is absolutely fine, if you can't vent some frustration/negativity/despair here where can you? Being positive and constructive isn't the same thing as always trying to be an insanely happy shiny person and suppressing so-called negative emotions (personally I don't think that emotions should be judged as being negative or positive).
I've been doing a lot of research into diet for myself because I have an auto-immune condition that causes systemic inflammation and involves gut bacteria. The diet that I'm eating at the moment, and that seems to be working well in terms of minimal bloating/inflammation etc is no grains at all except for quinoa, which I've used to replace the various grains I was eating before. I eat lots of nuts, seeds, vegetables and very little fruit. Now, I'm not advocating this diet for anyone else, just making the point that it's well worth trying out different approaches. This isn't the diet I would have chosen, and the diet that I used to eat used to suit me too, I've arrived at the point I'm at after a lot of trial and error, but our bodies change as we grow older, and food tolerances change too. Another point is that I wonder whether withheld faeces can cause a change in colon bacteria? It's not uncommon for the ileo-caecal valve to stay open for longer than it should when stuff passes from the small intestine to the large and, as a result, to get bacteria from the colon entering the small intestine. This can also lead to candida. Sometimes, too much fibre, especially wheat bran, can inflame the ileo-caecal valve and cause it to remain stuck, open or shut. It's very easy for those of us who try to avoid constipation at any cost to take too much of the wrong kind of fibre. I may be totally on the wrong track so it would be interesting to hear from anyone who has more knowledge in this area than I do. In any case, I think that the biggest culprits for causing bloating and general GI discomfort, are grains (boo hoo). I've also found that pysillium and other FOS give me bloating and discomfort. Must go now, hope that this helps and maybe summons up some more knowledgeable input from other people, and thanks again Christine. best wishes Judith

mumtogirlslondon

May 15, 2009 - 4:46am

Thanks so much christine and judith for your insights.
Judith, you're so right that something as simple as pulling into posture does help just by being a positive step in itself, and very interested in your thoughts on stomach probs (as per below)
Alemama - lol on the husband stuff!

Christine, I'm encouraged that the bunged-up-butt feeling might go over time with posture etc. amazing what a bit of hope does to lift the sprits!
I was also intrigued by your pelvic floor muscle closure hypothesis. I'm not quite sure I understand what is meant by 'not closing properly', but I'd like to try and work on this if i can. The two specialist physios who've examined me lately have told me my pelvic muscle strength and range is already at the top end of the spectrum (like many others on this site, I'm proof that a strong pelvic floor does not protect against prolapse). Whilst I recognise the limitations of kegels, I still do them in moderation(standing up or walking around), partly because it's another of those little positive steps to help lift me out of despair and also because I can feel temporary strengthening feeling when I do - placebo improvement is good enough for me ;-).
I'm now getting to the point where it feels like I could differentially contract the front, middle and back groups of muscles, and I wonder whether if I could find away of focussing the contraction particularly around the rectal end of the muscles maybe it would help improve the 'drawing up' reflex for unexpelled stool? Do you think this is remotely feasible?

Re: tummy trouble
Although I do go at least once a day (so not witholding faeces as such) I'd been wondering whether the structural problem of stools not moving round properly might be causing some additional bacteria to form. I've been recently cutting down - if not quite out yet - on wheat as part of general attempts to maximise my gut health. And I'm pretty sure fruit is a bit of a culprit if I overdo it. I guess it'll have to be chocolate instead. sigh...

i fear cutting out wheat altogether would be a fairly major undertaking for me just now with the two wee ones - I'm a keen cook and like to think I'm rising to the challenge of changing mine and my family's food habits to suit my post-prolapse life(they all sneak out for ice cream and think I don't know...!), but to cut out a staple that the rest of my family eats might stretch my resources a bit. Plus I'm mindful of introducing too many changes to my diet at once as I think this seems to exascerbate the tummy troubles. so I think I'll try to keep to reduced wheat for the time being, and up my probiotic intake. see if that helps bring things under control, and if it doesn't do the full-blown wheat thing for a while.

I'd actually had a couple of much better days though today seems to be dodgy again. I think too much fibre and fruit over the last 24hrs may be to blame.

Right, got to go as my wee baby has got bored of the baby gym and is demanding some hands-on attention.

thanks again for all the thoughts and ideas!

Mumtogirls London

Judith

May 15, 2009 - 6:27am

Hi mumtogirls
Left-behind faeces: there's an interesting series of posts on this site about somebody's positive experience of using a kind of enema rinse to completely empty the rectocele after a BM. The name of the poster is Pam, you can do a search on enema.
I definitely agree about making dietary changes gradually and I know how hard it is when it's as much as you can do to get meals on the table with young children and prolapse etc etc. It might be worth trying the enema thing in conjunction with cutting back on wheat eg not having it as many times a day. Also, grains that have been well-soaked before cooking and sourdough, as opposed to yeasted, bread are more digestible. Every little thing can help. Wish you all the best with it Judith

Christine

May 15, 2009 - 9:51am

Hi Mumtogirls,

No, I really don’t think kegels are the way to a “closed pelvic floor”. The sphincters do play a role, but it’s my belief that most of our sphincters are adequate. And that stuck feeling has nothing to do with the sphincters.

You may have heard me say that this posture is the best thing for closing an abdominal diastasis. And even the mummy-tummy folks know that shortening, or crunching the rectus muscles is the worst thing you can do, for that sort of exercise will only widen the gap.

The pelvic floor muscles are really an extension of the rectus abdominis and behave in the same way. When you “crunch” or kegel them, they shorten and the gap actually gets wider. We have had many women report that kegels aggravate rectocele.

In my view, maximally lengthening the muscles through Whole Woman Posture is the way to close the gap.

:) Christine

P.S. I sometimes feel we don't give enough credit for how healing the seated postures are. Sitting strongly pulled up into WWPosture may be as good for your rectocele as anything!

mumtogirlslondon

May 15, 2009 - 4:34pm

many thanks again to all of you for further information on this niggling rear issue.
Also - thanks to Davi for your earlier reply about wheat being a possible culprit: I haven't quite got the hang of the forum threads yet and missed it first time round.

i'm putting the tips into action. Hopefully the improvements I have noted in tummy probs over the last few days will continue a bit longer. I'm sure so much of it is psychological - having had a couple of better days this week, when my tum was a bit tricksy earlier today I felt much more confident that it'd pass, or at least that it was theoretically possible that I wouldn't always be feeing like that. So I went out for the afternoon with my girls anyway. And, hey presto, the tricksiness abated somewhat.

great example of how valuable this forum is for those of us feeling we've been left 'stranded' by our prolapses!

Mumtogirls London