myth of the "saggy" pelvic floor

Yes Christine, you are right. I could have phrased my comments about the recovery of my pelvic floor differently. When I had the e-stim type treatment (TENS??) the physio specifically explained that it was to help the nerve pathways to become active again. I do remember that, but may not have specifically said it every time I have posted about it. My muscles were in fact not working because they were not being told to work by the nerves that operate them! Prior to the treatment the muscles would not move at all, not one twitch. Once the nerve pathways were re-established it took very little time for me to be able to control the pelvic floor muscles again.

If the stimulation my pelvic floor muscles received had been acting on the muscle fibres themselves I cannot see how the muscles could have regained tone as quickly as they did (only a couple of treatments). It was definitely a nerve treatment, not a muscle treatment. I can only conclude that the muscles of the urogenital diaphragm were once again under control of the relevant nerves, and that was the end of the story.

I don't remember having fecal incontinence. In fact I do remember having my first bowel movement a couple of days after that birth, and it was quite normal. Sensation of fullness, and emptying was quite normal, better than the first birth in fact, probably helped by the absence of episiotomy or tearing, second time around. I would remember if there was any fecal incontinence postpartum.

Your illustration about the tautness of the ano-genital triangle and its effect in maintaining the anogenital angle, thus conserving fecal continence, makes great sense to me. Of course, my anogenital triangle muscles must have been working. Both sets of muscles had been subject to the same stretching during the pregnancy, labour and birth. If it was pelvic floor muscle tone that was the problem I would have had fecal incontinence.

Thanks Christine and Louised for this interesting chat. I don't know much about nerves to comment on it. I've kind of been left at the starting post as I'm still finding it hard to see the relevance of Kegels for prolapse.

I could very well be one of the kegel queen’s ladies who do (or rather did) Kegels wrongly. But although Kegels reportedly exercises the whole pelvic floor, I found when I tried kegels it mostly centred in the labia, and the sphincter muscles of the urethra and anus and pulled my tummy in. If I had been leaking urine and fecal matter because of lax sphincters then maybe strengthening the sphincter seems ok in theory.

But I am not really sure it does anything for the rest of my pelvic floor muscles, and on further thought, I wondered whether it was doing the right thing? There are a lot of muscles, connective tissue and ligaments down there and I think I can safely assume they all pull in different directions. And besides, my prolapse was actually pushing past the urethra sphincter and through the labia. I can’t for the life of me see how working on the urethra sphincter could have helped my uterine prolapse.

If you want to strengthen or sculpt your arms, you work on your biceps by pulling the weights towards you. When you work on your triceps you push the weights away from you. You not only need to work both so that you stay in balance, you also need to be able to exercise these muscles in isolation so that they do not work against each other, and you are not working against yourself.

I am sure that this applies all over the body and for our specific purposes the pelvic region.

With an upright, ambulatory body our pelvic organs have central position. It makes sense to me that it is not just our pelvic area we need to exercise but our legs and our trunk. We know that our prolapse has its pressures from above as well as below and beside, so we need to be doing total body work.

WWposture gives us this.

Fab,
That is how it feels when I do the whole woman exercises. It is like my muscle are tightening and pulling things up in an internal way. Where as some of the other exercises, like the more ballet type ones really feel like they are strengthening my groin, upper thighs, across the perineum to my buttocks. When I try to do a kegel, it does nothing for me. I had 3 quite long episiotomies with my children, and from what I have been reading that is partly the reason for my sagginess down there, but I really believe in time I can or will be able strengthen the muscles in and around that area for even better comfort.
Seriously, I don't know how Christine came up with a group of exercises that works so specifically areas most people would never fathom strengthening. But, so far it is giving me relief from some of the most painful symptoms I had in the beginning, and I don't want to go back there again!

Hi Aging Gracefully. I totally agree with you about the exercises that are so specific. I always thought myself to be in fairly good physical shape since I do a lot of yard work, snow shoveling, etc. but I found out that these exercises are difficult. I think that in reality, I am in terrible shape in all the ways that really benefit my health. I am having to take these exercises slowly and I cannot at all sit with my legs straight out and touch my head to my knees. I am really not very flexible at this point. I am feeling some relief as well and so I will continue each day to refine and perfect these exercises and hopefully I will be able to do them all in the near future. Best wishes to you!

I am with you on that petrified! I can't stand on one leg very well either, but I keep trying and I get a little better each time! The thought of doing fire breathing for 2-5 minutes seems impossible right now, but I am determined to accomplish it at some point here, because if it all feels so good now, can you imagine what we are going to feel like in the future?!?!
The other thing I have noticed is that sitting on the toilet properly, which wasn't easy for me either, really has helped with my bowel movements. Wondering if my episiotomies had something to do with past problems with that? Most of this is still way over my head, but I keep searching and learning as I go.

Graceful, I don't firebreathe for that long, at least I've never done it yet. So don't worry if you aren't already there! What I do right now, is incorporate some jiggling and 6 or 8 good firebreaths at various points throughout my day. Morning shower, bathroom visits.... Any time is the right time! I think this weekend I'm going to try 2 full minutes in one stretch, just as a little experiment. See, even in my 3rd year I have a long way to go and many improvements ahead. It's OK to pace yourself on this journey, in fact, it's probably wise to do so. - Surviving

My balance is atrocious right now. And for the time being I have not tried fire breathing. I know that I will get to it. My coordination needs quite a bit of work as well. I want my husband to get me a breakfast tray like Christine uses so that I can use my laptop while sitting on the bed. And I totally agree with you about the correct posture for sitting on the toilet. It is definitely helpful and reduces my fears of visiting the bathroom. I too had a large episiotomy with my son who weighed 9 pounds 13 1/2 ounces and his chest was 14 inches. They said that I still tore even though they cut me as far as possible. I was so exhausted from the labor that a nurse laid her arms across my abdomen when I got a contraction to help me push while my husband lifted me up at the shoulders. I also experienced massive bleeding right after the birth and now I wonder about all the implications of those experiences now almost 27 years ago. We will keep learning and now I feel compelled to mention these principles whenever I hear the words "bladder repair" or "hysterectomy." Best wishes.........

Wow Petrified - similar experience. My first was 10 lbs 4-1/2 ounces at birth. Right near the end, the doc reached over and wrapped his arms around my belly and pulled. Like he was trying to drag a big boulder out of the ground that was determined to stay there! Can't recall if I loved him or hated him for that.......even without drugs, birthing is such an altered state of consciousness....... - Surviving

My first was 10 pd. 5 oz. his head made it through, and then they made me stop pushing so they could get his big old shoulders out one at a time. They pushed pitosun through like it was water, and made me lay on my back the entire time, because of the moniters. Women have so many better options it seems today. I felt like cattle at the time!

Yes, aging, I too had pitosun as they didn't feel my labor was progressing well enough on its own. I also was at a teaching hospital so there was a line of interns waiting to check me for dilation until my husband said, "that's enough, no more." One intern said that I was going to have a 7lb. baby. They were only off by almost 3lbs. My doctor did repair my episiotomy himself which I am glad about as the book says something about interns possibly doing that. I was 25 and had no idea what should or should not be happening. Also did the lamaze breathing and classes. Wonder what the thoughts are on that?

Surviving, I guess that we do have many similarities here. My mom had 5 large babies and she has suffered with prolapse without help for 15 years. Her bladder is protruding but I still hope that this site and materials can help her. I am the oldest and my next brother died 3 days after birth as the doctor used forceps and punctured a blood vessel in his head. He weighed 10lbs. 5 ounces. I was the smallest of the 5 that she had at 8lbs 6 ounces and my mom was 16 at the time. I did love my doctor at the time. I totally trusted him and he really seemed to care about his patients.

What is funny now that I look back on everything. I had been having pains in my lower abdomen for years. I thought it was from the sit ups that I was taught to do. NO MORE SIT UPS. Now I believe my bladder was falling down. I was feeling the pain of that. I told my doctor about the pain and she did not know what it was she said it could be from the sit ups. Lately I have been spotting and my doctor was not concerned at all. Since I started on the WW posture the spotting seemed to be getting less. But today I had to walk a lot for work so I spotted a lot heaver. Well the pain in my neck along with not being a person who sleeps.........the bladder....... I am just so tired. Hopefully just a bad day. Just needed to share. Thanks.

Mika, when you walk for work, are you walking in excellent WW posture? There's nothing better. Don't waste such a good opportunity for working on posture. I feel best after long walks. Think about all aspects of posture while you're doing it. - Surviving

Thanks Christine for this explanation on kegels and muscles, these explanations really help.

Petrified and Graceful thanks for your stories. It’s nice to listen to people who know where you are coming from.

When you are in WW posture your pelvic floor muscles are already stretched. When muscles stretch they 'reflexively' contract to prevent over lengthening, or something. So they are contracting already when you start a Kegel. That's why you can't feel much tightening. It is the same reason as why you can't stretch a taut rubber band much. Make sense?

So, when you tell us to go for a ww woman walk, is that also reinforcing and strengthening those muscle groups around that area as well?
I guess what I am asking is if that area is pulled up tight by ww posture, what muscle groups are holding your organs in place, and if it is the muscle groups you use when walking that do it?
I am probably way over my head again, but it is interesting how you ladies explain something I never even thought about, but has such great importance in our well being.

Mika, I also had that aching up inside for years; I just attributed it to another symptom of perimenopause, until I noticed my cervix popping out! I felt so sick and scared, and then found this site. I felt really silly that I didn't know more about my body, and I even worked in healthcare!
But from now on it's all about being proactive. Even old dogs can learn new tricks, I think!

Graceful, I’m a follower here, not a teacher, so I don’t have a technical answer for that question. When we are upright, posture is everything. For me, lots of walking in posture helped me get over the hump of the posture being automatic and not requiring constant thought. I started to feel my torso seating itself securely over my hip joints in a way that Christine has described many times. Posture allows the organs the chance to be supported in the lower belly, pinned over the pubic bones. I think of walking as a way to cram lots of posture into a short time! If standing in posture is good, how much greater benefits could we get by moving in posture? - Surviving

Thanks Surviving,
I don't know why I still have this fear of walking, when I know time and again you all say it is the best thing for prolapse. When I have been on my feet too long, I start to notice the burning again, and then I start to have flash backs of the beginning stages where the burning and pain was everywhere!
Before all this I was a walker, up to an hour and a half at times! I really have to get over myself, because there is always the magical jiggling and fire breathing to rely on!!

Hi Aging Gracefully. I know how you feel about the walking. I live across the street from 2 churches and I sometimes walk laps around their large parking lots. I went over there the other day and after one lap I started to scare myself so I came home. It will be so much easier, I think, when the posture finally becomes automatic. For me, I think it will be quite a while after so many years of slumping, slouching and wearing jeans that pull the stomach in. I haven't tried the fire breathing yet as I am having trouble with the coordination. I think that it's a bit hard to coordinate the in and out breaths with some of the exercises. I have always been a shallow breather and I hope that I am breathing into the abdomen when I am doing the exercises. One thing is true. This is "work."

So true petrified! Did you get the first wheel yoga DVD? It seems to have a more relaxing easing into things aspect to it. Although, yes the balance thing is still challenging. And, Christine's book gives a really good description of fire breathing. Once you learn it, you will be so amazed how it makes you feel!! It still amazes me!! I think I will go for that first walk soon, even if it is just around the block.
Thank you Petrified! You and I really are in the same boat aren't we?

Yes, Aging Gracefully. I do think that we are in the same boat. I did not get the first wheel yoga. I got the older woman video and the regular First aid for Prolapse. I was so scared to move when I first found out about the prolapse that I ordered the older woman video for the gentle exercises. It is still helpful for stretching and easing into things. Now that I have the regular video, I am giving the older woman video to my mom. She is 68 and has been dealing with this for many years with no help and no one to talk to about it. I wish I had been more supportive of her through these years but at the time I just wondered why she didn't just "go get it repaired", like most people were telling her. I'm glad that she chose not to do that. I have read the description of fire breathing in the book and will concentrate on getting that right. I will try to add the yoga video in the near future. Thanks for all your feedback.

Hi Ageinggracefully

There is a very good explanation with pictures of how WW posture tightens the pelvic floor muscles in Saving the Whole Woman. WW posture moves the tailbone further away from the pubic bones, and opens out the space from side to side, between the ischial spines, making the pubococcygeal group longer and narrower, and particularly the transverse perineal muscles, longer (sideways), as well as the other muscles of the urogenital triangle. These changes in position of the pelvic bones make the pelvic outlet larger, so the muscles have to stretch slightly to span the distance. Hence less or no sagging.

Guess I should do some more studying! So, this is the way we used to be and now have to make effort to get back to. Just amazing that all those parts are right there waiting to be realigned!
Thank you Louise, your patience is greatly appreciated!

Thanks everyone for all of the responses. Well the pain in my neck is so draining at times. I am going to another new doctor for that (5doctors and one dentists later). So between trying to walk in the WW posture and not sleeping at night and the pain.....no wonder I was exhausted. I am going to see this other doctor for light therapy and hoping I am able to sleep better. I might be having muscle spasums in my neck down my shoulder so I am seeing a interest for this, I can not get this to stop no matter what I have been doing (tried trigger point therapy, medication) also I have other autoimmune systems so seeing a doctor to see if he can help me with this. I went to a massage therapist and she said that is possible. Just feel broken down some times. I am still new to the WW posture just 2 or 3 weeks. So I am hoping to get better at it. both appt in Jan so just waiting and still trying to just survive at times.

I also need to forgive myself for trying to stay in shape and not realizing that staying in shape made my bladder fall out (LOL had to make a joke or I would cry....rather LOL than cry sorry I have a weird sense of humor). One thing I never liked is tight pants so at least one thing I did right. I think I am still in shock and need more time too.

I joke to get through crap, too.

I had this irrational fear that I would lose my uterus while grocery shopping.

"Clean up in aisle 5!" Literally. I was sure it was going to escape.

Hang in there.

Spamelah and Mika

You are both so right. Laughing at our misfortunes is a wonderful way of dealing with them and putting them in their place in our lives.

I had a co-worker once who would sign all her emails, "Life is too stupid to take seriously." It certainly got her through some hard times with a very difficult line manager!

Keep laughing.

Louise

Well things are coming out now (no pun intended)........I just mentioned to a friend that I was having woman issues (male friend)......he said his wife had that years ago......had surgery and it was the same....LOL so now I am realizing that this is so common. What were woman suppose to do with it before the internet. I am having more pain but hoping it is because things are going into place. Just trying to move forward but still having crying spells once in a while. Hoping that in time I can improve. Got my book but have not started it......I have no concentration right now because of the pain.......so hopefully it will improve shortley.

What you do, Mika, is just curl up with the book and immerse yourself in some history and knowledge. You'll feel your resolve growing and the crying spells will stop. I myself am incredibly grateful for the internet and wondering where else all of this might have led me if not for finding WW. It helps all of us to have someone we know personally who has gone down the wrong path. And once you scratch the surface you realize just how epidemic prolapse is. Look around you all the time - you're surrounded by it. And some of those stories have happier endings than others. - Surviving

I would start with the section on Firebreathing because this is a skill you can learn to help to reposition your organs. This may reduce your pain so you can concentrate on reading the rest of the book!

Louise :-)

Christine said: that it is reversible nerve damage that temporarily numbs the muscles, preventing them from fully contracting.
And is this not considered sagging?

I think maybe it feels like sagging, the laxity, or the inability to contract at all, just feels like sagging. Now, can a doc look and see this sagging? I have no idea, and the fact that they use this reasoning to do perineoplasty is deplorable, but I'm 100% certain that when Louise says she had pelvic sagging or muscle sagging, that she sure did! and never once did I hear her mention that kegals solved her problem. no sir!
And another thing! When I pull up into wholewoman posture, I feel a tautness in my perineum that I do not feel if I suck and tuck, a stability. So, maybe don't throw the baby out with the bathwater?
and maybe we are all taking about the same thing?

Yes Christine, to your last point I'd like to add this: often there's no feeling for awhile after childbirth, and I suspect it generally comes back on its own. Women who work at contracting the muscles after birth, probably think it's the contracting which brought back the feeling, when really, it was just natural healing that would have happened anyway. Is this part of the reason people still swear by kegeling?

Alemama, just to clarify. I cannot remember whether or not I was having continence issues. All I remember was that I could not move my pelvic floor muscles at all. I was quite newly postpartum, possibly under a week, and I was still in hospital, but possibly i had been discharged and it was several weeks later. I have just emailed the hospital to find out.

I had a bulging perineum during the whole pregnancy, after infertility treatment that blew my ovaries, and consequently my abdomen, up like an exercise ball from 6 weeks pg, and the bulging and fullness was still there after the birth. I could not do Kegels at all after the birth, even though I tried. That was the problem!

Even though I could not move my pelvic floor muscles I was so proud of myself because I could hold my tummy right in, even though I had to tuck my butt right under to do it. "Oh dear", is all I can say about that now! Perhaps if I had waited longer my pf muscles would have come back to life by themselves, but with sort of yummy-mummy posture the way it was I wasn't giving them much chance, was I?

Louise

Well sometimes my neck pain is so bad I just want to cry and now the bladder problem. Well the WW posture has helped with the pressure and the burning so much.......just trying to move forward. I am exhausted sometimes from everything. Just want some kind of normal life again. I want to be able to do some things. Walked in the mall yesterday and I was so tired by the end.......went with hubby and he drove which was good. I can not get comfortable sometimes sitting down I use a pillow or sweater in the car. I do love the WW posture I think it is natural but I was not used to natural and it will take some time. I need to be nice to myself and give my self more time. Just want to enjoy life again soon. Thanks everyone I need to know I am not alone and you do that for me.

Mika, you can only mould your body at a rate that it can adjust to. There are no prizes for making yourself go faster, and putting yourself in pain. You have the rest of your life to do this.

As long as you are sure that there are no other undiagnosed injuries affecting your neck, just take it a little slower, so that being in posture doesn't make your body go into stress mode and seize up just at the thought of it. If you start to feel really tired and uncomfortable just give it a break. Do some stretches to ease any muscles that are working too hard at the moment. Then go back to it again after taking a break. Eventually, it will become more comfortable, as long as you are doing it right, and you will actually feel better in WW posture than out of it. WW posture can be so pleasurable. You don't want to ruin that pleasure before you find it.

Louise

Interesting discussion. It occurred to me to wonder whether the sag (if there is one) could be caused by ripped or torn muscles rather than stretched?

Yep. Muscles are very resilient and can contract and lengthen as long as they are used regularly. Damage to the muscle, eg episiotomy, will damage and scar the muscle permanently, so it may subsequently not have full function. It is very difficult to repair pelvic floor muscle effectively (ie suture an episiotomy), especially where a 'controlled' incision into the tough edge of the perineum, tears further when it is into less tough tissue further in.

Fascia gets damaged during birth interventions too. It is all through and around our organs. As the uterus distends during pregnancy and the vagina, (and its tethered organs, the bladder, urethra and rectum) stretches during late pregnancy, labour and birth, all the fascia will stretch too, and may not go back to their pre-pregnant size after pregnancy.

Louise

Well I did the first wheel last night. It felt really good. I think I like it better than first aid for prolapse. Is it okay to do the yoga not the first aid? It is easier than the first aid (never did any dance classes). I have done yoga before. Not sure if I am doing the firebreathing right inhale and let lower belly out and exhale and pull stomach in. I hope that is right. I am eating a couple of prunes everyday just in case do not want to accidental push anything else out.
I remember they wanted me to push when I was in Labor and I did not feel like it. Well when the baby came out I felt like something tore my insides apart.....also from pushing I bursted all the blood vessels in my face.
Question? What do you do when you travel? I used to carry a back pack and never worried about lifting it. How much is safe to lift? I always brought something to eat and read. This trip my hubby will do everything. But in the summer I travel alone to daughters. Also I figure I would ask a nice gentle man to lift my suitcase off of rack ( I used to help old people with this)

It sounds like you are doing a great job figuring everything out with travel plans. You actually should be able to carry a small backpack once you are strong in WW posture. There is a thread somewhere on here about a type of backpack that was good but I do not remember when that was posted. When your posture is really beautifully set, the carrying of a bit of weight is actually just fine. Good for you to ask for help when you need it! As for Prolapse and First Wheel DVD, I am sure others will post responses about that, but it is my feeling that you will do quite well with the yoga dvd if that is your preference. I try to alternate them since I really like both of them and they strengthen in similar but some different ways. Feel it out because the important thing is not that you do every dvd, but that you practice a program that will help you to strengthen the proper muscles and most importantly the posture. If you like the yoga one, then you will do the yoga one and that is what is important. How is your walking coming along in posture? You are right about the breathing for firebreathing. The belly gets big on the inhale and on the exhale, as you blow out all that air, the belly pulls in. Best wishes to you!

Dear Mika,
I don't know how to find thread link numbers, however click on forums, go to Bodywork forum & at the bottom of page 2, there is a thread titled " Carrying Backpacks/Rucksacks", by me, where I asked the same Q on the best ones etc.
I ended up using a Lonsdale back pack which was comfortable.
Lift bending knees, bend from hips with legs wide to accommodate belly, keep back curve, & lift close t o body, put on higher surface if poss & put on. Reconsider how much you really need to carry.
There are some good recommendations on that thread.
(((hugs))) & best wishes to you
Aussie Soul Sister

Msnightingale,
I too find that alternating between the DVDs is the most helpful. They seem to work different groups of muscles. I have to admit that the first aid for prolapse isn't the easiest for me, because i really am not as graceful as my name(lol), but my body appreciates my efforts. I notice how my abs seem too be stronger and lengthened, if that makes sense. The first wheel is very relaxing and strengthening in a different way, it seems to me anyway. Can't wait to try the others.
Can't do my fire breathing right now, because I got my period. This is making me feel nervous, because I can feel the pulling on my uterus. My periods don't last as long as they used, so then I can get back to the lovely fire breathing soon!
I started finally taking walks again; I have been too afraid the past month, and you know, nothing fell out onto the sidewalk! Lol! Actually felt good!
Just wanted to tell you that you have such a gentle and encouraging nature that inspires.

Thank you for your kind words. Great that you have begun to take your walks again. Yes, you will see that you will be okay. I remember in my first weeks, feeling fear of moving or walking. I can tell you with confidence that the WW walk is the best thing. About grace.....you have it in your name :-) I like to be alone when doing my dvd's so I do not worry about being graceful or not graceful. I do think that when we stay on the path of something in pursuit of something (in this case the beautiful WW posture) then grace will come of it's own. We do not need to worry about it. I am wondering if during your period, it is okay for you to rest on knees and elbows. Since firebreathing needs to wait and you feel the pull of POP, maybe that position is okay to rest in? It is a position that helps me when I have days of set-backs. Love and Best Wishes to you!

Thank you MsNightingale!
I had thought about doing the knees and elbow resting, but didn't know what the effects of having my period would have on all this. Another hurdle in my mind to cross over. I know the ladies always say everything is moving around all the time up there, and I can actually feel that now, but when I finally got some relief and confidence I get my period and another worry develops! Really gotta get over myself!! Thanks so much! Will just do it!

I am post meno and I do not really know what is best for the period time of the month. I do know that the knees and elbows has been a great restful position for me. If there is any reason to not do this during your time of the month, I will hope that Louise or Surviving will let us know. I remember in yoga classes that inversions were not to be done during that time, but this one seems so mild. Lets see what the other lovely ladies have to say. Have a lovely day.

Hi Graceful (I've always declined to call you "Aging" and now that I know you still get periods, I think of you as a sweet young thing!). Don't worry too much about what you do during your period. You might want to avoid the deep vaccuum effect that you get with full-blown firebreathing (for reasons explained in that other thread we dug out recently). But virtually all the moves in WW are based on the same breathing sequence, so just get down and do some good belly rolls in seated or hands-and-knees posture. - Surviving

Ok, will do that!! Thank you Surviving!! I hope to be done with these periods soon! I am 50 and feel like I am going to keep having periods until I am 60! Lol! I am really ready for the next stage of my life; I think each has something new to offer.
Thank you again ladies, you are all such special people to do this!