Pelvic Prolapse

How Do I Deal With a Pelvic Prolapse? [Podcast Episode #103]

Imagine...

You know that something isn't right within your body. You can feel it. Something has changed, but the symptoms you're experiencing are embarrassing to talk about. 

You consult your doctor, hoping for an answer, but he tells you that what you're going through is common. There's "nothing to worry about"...

But, you still don't feel "right."

This is exactly what happens with up to 85% of women upon giving birth, and for years or decades afterwards. They experience symptoms of pelvic floor damage, but have no idea what's happening or what they can do about it.

It's NOT normal to live with a damaged pelvic floor. Let's take a look at the signs, symptoms, and treatments you may need to consider...

How Do I Deal with a Pelvic Prolapse? [Full Text]

 How Do I Deal With a Pelvic Prolapse

Dave: Hey, thanks so much for joining me in this episode of the Make Your Body Work podcast as you know this show is all about helping you live a healthier and happier life. Today's episode, it is primarily for mothers, but men, we can get something out of this as well, women, if you haven't given birth yourself, you're going to be able to get something out of it as well, but moms, this one is particularly for you and it all originated from a question that I got from Jennifer. 

Jennifer wrote in and she said, "I have a level three prolapse and four is the worst, it started years ago giving birth, but didn't cause many problems until recently. I've been doing some research, I now realize that what I've been doing for exercise is really making things worse. Totally unaware of it. I feel like it's back to the drawing board. The statistics on how many women have prolapse are very surprising, so I thought this would be something you could cover on your podcast,"

Jennifer, thanks so much for writing in. As you're going to hear in today's episode, this prolapse and pelvic floor issues in general are something that are very, very common and are also something that don't get spoken about as much as they should, and so I've gone out and I found, literally the expert, she runs a website called The Pelvic Expert and this is what she does. I'm really excited to introduce to you Heba Shaheed.

​Meet Heba Shaheed

Dave: Hey, Heba, thanks so much for joining us on the show today.

Heba:Hey, Dave. Thanks for having me, it's a pleasure.

Dave:Yeah, we were just chatting before we started recording here and we are literally on opposite sides of the planet, so right now it's 6pm my time and you're bright and early, 7am your time in Australia.

Heba:Yeah, super early.

Dave:So, you and I, we connected because I had received a number of questions like Jennifer's that we're going to tackle today from people who are experiencing pelvic floor issues or prolapses or just different issues with their pelvic floor and you have a website called thepelvicexpert.com​ and that's so specific, can you tell us how did you become the pelvic expert?

Heba:Yes, so I've been working in the area of pelvic floor physiotherapy for the last seven years here in Australia and while I was working, all the women that would come to see me would always say things like, "Why hasn't anyone told me that this could happen? Why isn't there any research? Why isn't there anything online about this? How do we find out about this stuff?"

It could be issues like pelvic organ prolapse or maybe they have pelvic pain or they have bladder or bowel control problem and there's just this lack of good quality information out there, so that's when I kind of decided I'll start a little blog and I started blogging about these types of women's health issues that are predominate because they affect the majority of women and I had a really good response and then I actually fell pregnant in June last year and I was like, okay what can I do now?

I still want to help people, I still want to support women, but I also want to be home with my daughter and so I kind of turned my blog into an online platform where women could come and actually improve their health from anywhere in the world and so we started creating our own kind of programs to help women overcome these issues.

And so where the pelvic expert comes from is my expertise in all pelvic issues and I find that it really kind of resonates with women, like as soon as they hear it they know what it's about and so they know that okay, if i want to know anything about pelvic floor issues or pelvic issues, I know where to go.

​Statistics: How Common Is Pelvic Prolapse?

Dave:You mentioned there that this is quite a common problem amongst women, can you throw out some stats or some numbers, like what percentage of women experience some sort of pelvic floor injury in their lifetime?

Heba:Yeah, so each country has their own kind of different exact percentage, but roughly globally, we're looking at 1 in 3 women will have pelvic organ prolapse, which is when their organs in their pelvis kind of sag down, so it could be that their bladder sits a bit lower than it should or their rectum sits lower or their uterus sits lower.

So it's about 1 in 3. If women have a forceps birth, then that actually goes up to 1 in 2, so it is quite predominant and if you're looking at bladder control issues, again it's about 1 in 3 and in pregnancy and immediately post birth, it can go up to 85% of women are having bladder control problems.

And then things like bowel control problems, which is even more taboo and not talked about actually effects quite a number of women, about 13%, so 1 in 8 women will have fecal incontinence, which is quite shocking and it's not talked about, it's silent, it's swept under the rug and then other things like abdominal separation or diastasis rectus abdominis or diastasis recti as it's known in the states and in Canada, affects about 40% of women after they give birth.

It affects 100% of women at the end of their pregnancy, but after six weeks post-birth about 40% of women will still have that abdominal separation and then they can go on to keep that abdominal separation for months or years even after birth, sometimes it's like 10, 15 years and they've still got that abdominal separation because they haven't learnt how to overcome it.

Many of your health issues are so easy to prevent or overcome if you become more aware of your body

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And then the other thing is that women who have abdominal separation, two thirds of them will also have some type of pelvic floor issue. So they don't just have this abdominal separation, they've got bladder leaking or bowel leaking or pelvic organ prolapse as well.

So everything's kind of related in the body and if you have one thing, you're more likely to have another thing, and then there's also things like back pain, which are also influenced by what's happening in your pelvic area. So back pain, pelvic pain, and those can also be related to abdominal separation and can also be related to pelvic organ prolapse as well.

Everything process within your body is related. One health issue is more likely to cause another.

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"Common" vs. "Normal" - There is a BIG Difference

Dave: Heba, I can just feel the enthusiasm coming from you as you talk about this. Obviously you've been doing it for a long time. When you were mentioning one of the symptoms and one of them was incontinence, I remember when I was early on in my personal training career, I had a boot camp, an all women boot camp.

I was just a young guy and sort of had no idea of these sorts of things and one of the women had to run out to the washroom a couple times during class and each time she came in she was really apologetic and a little bit embarrassed.

Then the other women, they started talking about it and all of them have been through it and it's just really interesting because no one said anything until that one woman was put in that position where she sort of had to, and then all of a sudden it was this out-flowing of, "Oh yeah, me too."

Heba: Yeah because here's the thing right, pelvic floor issues and particularly incontinence, they're very common to the point that society and medicine and everything has kind of normalized it.

So when you go to your doctor and you complain of leaking, then your doctor usually says something like, "Oh, that's normal after birth.

You know you've given birth, what do you expect, that's normal or that's just part of life. You're just going to have to live with it." Or when you chat with your friends about it, it's the same thing, you're kind of like, "Oh, everyone's leaking, so it must be normal, so I guess this is just the rest of my life," and so, I think we have to differentiate between what is common and what is normal.

Oftentimes we assume something is "normal" just because it's "common" - common ailments are NOT necessarily normal.

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So, yes, incontinence is incredibly common, up to 85% of women after birth will suffer from incontinence, but it is never normal and it can actually be overcome. You just need to know how and so we've done research here in Australia and the research shows that 85% of women who have incontinence can be cured or significantly reduce their incontinence simply by doing pelvic floor exercises.

So this stuff is huge. It's kind of ridiculous that women don't know they can actually improve, and that they think they have to put up with it and it is embarrassing for a lot of women because there's fluids coming out of your body that you don't have any control over, or maybe you have urgency and you're just always busting to go to the bathroom, or you're just always going to the bathroom, or your jumping or skipping or running and you're leaking, so bodily fluids coming out your control, it can be embarrassing, but at the same time, it can be overcome and you just need to know how.

Pelvic Floor Symptoms You Should Watch For

Dave:That's really encouraging. A couple things there that I just want to point out. One, that it is normal, and number two, just because it's normal doesn't mean it's something that women have to live with. I was wondering if maybe you could go through for the women who are listening and talk about some signs and symptoms aside from what we've just discussed that might suggest that they have some sort of pelvic floor issue.

Heba:Yes, so, I'm just going to interject on what you just said before, so pelvic floor leakage, so incontinence is common, but not normal. So I'd like to change the language, I want women to realize that it isn't normal, it's not something you have to put up with, it's actually abnormal to leak, but it's common. So you can take comfort in knowing that it's common, but don't allow yourself to accept it as normal.

Now in terms of symptoms of pelvic floor problems, so women can have urgency, so that feeling of always busting to go to the bathroom. They can have frequency, which is like, they might be going to the bathroom more times than they're comfortable.

So maybe before birth they were only going 6 times a day to empty their bladder, but now they're going 10, 15, 20 times, so frequency is something that's subjective, so it depends on your definition of what's okay for you in terms of how many times you go to the bathroom.

And then of course leaking, so it could be leaking with coughing, sneezing, laughing, jumping, running, exercise, even doing sick, so any type of leaking that happens because of a large amount of pressure that goes through your body, that's known as stress incontinence, and any type of leaking that occurs because of urgency is known as urgent continence.

Now in terms of pelvic organ prolapse, the common symptoms of that are things like you can see or feel that there's [bodge: 11:18:00] vaginally. It looks different down there, feels different down there and then you can also have symptoms like incontinence, of course, so you could have urinary incontinence, which is usually a bladder prolapse, or you can have fecal incontinence, which is usually a bowel prolapse.

Women can also experience lower back pain or lower abdominal pain or they might feel like there's dragging sensations or heaviness or pelvic pressure sensations. Some women also experience pain during sex and that's related to usually when a women has a uterine prolapse and the cervix is sitting low, so when they're having sex it hits up against their cervix and it's quite sensitive.

Other symptoms can also be things like when they go to the bathroom and they're weeing, the strain is slower than it used to be or it starts and stops or maybe when their weeing, they feel like they haven't completely emptied their bladder or maybe they get up and then they feel like they need to go back and do a second wee within 5 to 20 minutes.

So it's things that are changing in terms of the voiding, which is the way that you wee or your bladder sensations or your bowel sensations, again you can have feelings of incomplete emptying in your bowel and that's usually related to a bowel prolapse. Or you get this feeling like there's an obstruction in there, some people feel like they need to use their fingers, applying pressure either at their perineum or vaginally or anally to help get out their bowel movement.

So it's these types of things, things that are not normal. You don't feel like your body feels before you gave birth. That could suggest that there's something going on in terms of prolapse, does that make sense?

How Heba Helps Women Heal

Dave:Yeah, totally, that's fantastic. I could imagine many women who maybe are experiencing some of those symptoms, not taking it as an urgent thing that they need to go see a doctor about or that they need to take care of. Is that your experience? Would you have women coming in who have been dealing with this sort of thing and just sort of though, "Oh, you know, my body's changed because of pregnancy."

Heba:Yes, so it's quite unusual for me to see women immediately post-birth, unless I have seen them through their pregnancy or through exercise class or something, because we kind of accept that changes in our body are normal and this is how it's going to be forever, or maybe it's just going to get better on its own, and so usually the women that I see are 5 years postpartum, 10 years postpartum.

They've had two, three, four, or five kids. It's very unusual for me to see someone early on and if I do, like if I've seen somebody through their pregnancy or I've taught exercise classes to them through their pregnancy.

Then I will recommend that they come and see me at six to eight weeks postpartum because when you're having all your other checks, you should be having a women's health physiotherapy check or physical therapy check as it's known it the states, because we can assess what's going on down there as early as six to eight weeks.

So we can say, "Okay, has there been any damage to your pelvic floor? Has your pelvic organs descended? Is there any tears in your pelvic floor muscle? Is there any scar tissue around your vaginal area?" If you've had a c-section you're not safe either, because c-section is related to rates of uterine prolapse.

Just fact that you've had a pregnancy, the growing load on your pelvic floor muscles, that sets you up for developing continental problems, it doesn't matter whether you've had a vaginal birth or a caesarian birth.

So I always recommend that women have at least one assessment with a women's health physio or physical therapist at six to eight weeks postpartum and if you're beyond that then as soon as you can, just so that you can get assessed for your pelvic floor to see what is happening down there and here in Australia.

If somebody has prolapse, so if I assess somebody and they have prolapse, then we're trained to fit support devices, they're known as pessaries for women who have prolapse, because the thing is if you leave a prolapse for a long time, then it's more likely to get worse over time because a prolapse, a sagging organ puts pressure on your pelvic floor and over time your pelvic floor becomes weaker and weaker and fatigued and the pelvic organ can even push your pelvic floor out of the way to the point that your pelvic floor can't even activate at all.

So having that support device early on will push those organs back up, so that the pelvic floor muscles don't fatigue, don't get tired, don't get weak and also, in women that I see as early as six to eight weeks postpartum, we can completely reverse their prolapse if they have that support device inserted that early on, because we use the hormones in the body in that postpartum period and exercise to help her regain the correct positioning of where things should be.

So I really do advise that women have that assessment, but then that they do, do their pelvic exercise retraining programs and when they're going off to do exercise with a personal trainer, wherever it might be, that they are incorporating their pelvic floor muscles as well.

​Exercise: The Pelvic Floor Awareness Approach

Dave: Okay, that's very, very key, because I imagine some listeners who are thinking right now, Dave, why are you guys talking about this? Usually this show is primarily focused on weight loss, we talk a lot about healthy eating, exercise strategies for weight loss.

But you just nailed exactly kind of why we're having this discussion is, there are so many women who ... right now there's quite a big, I don't want to say fad ​but there's a big push towards women doing more and more resistance training​ and as a personal trainer, I really endorse that.

I think it's really important for many different reasons, but when you talked about those statistics at the start of the show of how many people, women, who might be going into a training program with damage in their pelvic floor, that significantly changes the safety factor of them going into a resistance training program. Is that correct?

Heba: Yes, so like the thing is, I'm completely for resistance training and actually through my work, all the exercise classes that I've ever taught and through my online program where we teach exercises as well, we really do emphasize the importance of resistance training, but with a pelvic floor awareness approach, so that you're aware that your pelvic floor is engaging, that your pelvic floor isn't being pushed out of the way, that you're now bearing down when you're exercising because we know a lot of women, in fact, the research shows that about 50% of women when told to activate their pelvic floor, will bear down instead of pulling up.

So if you're doing that consciously, imagine what's happening unconsciously when you're squatting or doing a bench press or whatever it might be. You could be pushing out your pelvic organs and women have felt this, they have felt that there's a lot of pressure going down through their pelvis, when in fact it should be the opposite, they should be squeezing and tightening and pulling up as they're pressing away the barbell or rising out from a squat.

When you're not aware of the right type of exercise you need, you could end up doing more damage than good

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But if you're not aware of what's happening in your pelvic floor, you could be doing damage and we know that, personally, in some women that I've seen who do resistance training or boot camps or crossfit, sometimes they come in with their prolapsed worsened.

Or even if you're doing things like jumping and skipping, if you're jumping and skipping and your pelvic floor is not supporting you, there's this higher impact going through your pelvic organs and your pelvic floor, which could be making things worse and the connective tissue in our body, our fascia, it holds up in our ligaments, it holds up our organs in place, and if you have this constant pressure going down on it, pushing it down, pushing it down, you can create more over stretch on those already stretched ligaments and fascia.

So we don't want them to do damage, and that's the thing like with women who also do high level strength training or high level impact exercise, I always recommend that they have a support device when they're doing it, because we don't want them to get worse, we want them to be as healthy and as strong as possible.

​Are You Doing More Harm Than Good?

Dave:Yeah, you alluded to a couple things that are exactly to Jennifer's question and comment here, she says, "I've been doing some research, I now realize that what I've been doing for exercise is really making things worse, totally unaware of it," and I imaging many of the women who come to you would be in that camp. They were doing exercise that they thought was helping strengthen their core muscles, strengthen their body and they're actually damaging themselves.

Heba:Yeah, so I believe that all exercise​ is good as long as you know how to do it. So there's no wrong exercises really, like there's a lot of stuff, don't do this, don't do that if you have that, but I'm of the belief, that you can do all of that, but you might not be able to do it today because you're not strong enough, but you should be able to it one day

And then the other thing is that you just didn't know how to do it correctly and that comes down to where your pelvic floor and core aware, and by core we're not talking about your six-pack muscles or your obliques, we're talking about your deepest layer of your core, your transverse abdominis muscles, which is the stabilizer of your spine, the stabilizer of your abdomen, it supports your abdominal separation if you have one, so we're talking about the transverse abdominis when we talk about the core.

So were you aware of your breathing? Were you aware of your pelvic floor? And were you aware of your transverse abdominis when you were doing said exercise? Something in your mind will say, "Don't do crunches." The thing is, crunches, like realistically they're not super functional anyway, except that we do bend down, but crunches, a lot of the stuff online say don't do crunches if you have an abdominal separation.

I agree that you shouldn't be doing crunches if you have abdominal separation especially in the early days, because you might not know how to activate your pelvic floor and your deep tummy muscles, and the same thing with prolapse, they say don't do crunches if you have prolapse, because you might be bearing down or pushing down when you're doing the crunch.

The thing is, if you are pelvic floor aware, you know how to engage your pelvic floor, you know how to engage your transverse abdominis, you are breathing correctly through the movement, then you should be able to do a crunch without causing any damage to your pelvic floor, because you're doing it safely and effectively, and there are times when we crunch, there are times when we're lying in bed and we want to come up out of the bed.

We have to think about the day-to-day tasks that we have on a daily basis many, many times. We need to be able to do everything in our life with our pelvic floor supporting our organs and our transverse abdominis supporting our abdomen and our spine and our pelvis.

​Proper Breathing: How Does That Help?

Dave:Yeah, I completely agree with you. I was wondering, one of the things that you mentioned a number of times there was proper breathing and in my experience, many people don't even think about breathing, they're at the gym​ and they're thinking about, "I need to move this weight. I need to push this weight or pull this weight." Can you talk about what safe breathing looks like?

Heba: Yes, so our major muscle of breathing is our diaphragm and our diaphragm sits in our mid-thorax, our mid-rib cage area, so when we take a breath in, the diaphragm should expand in a three-dimensional fashion. It should expand forwards, it should expand sideways, it should expand backwards, it should expand downwards.

Now a lot of people do not engage their diaphragm when they're breathing and if you have pelvic floor issues, I can guarantee 100% that you are not using your diaphragm properly.

What they do instead is they might be breathing through the upper chest, so they have a lot of upper chest forwards movement or they might be breathing a lot through their bellies so they have a lot of belly forwards movement, but they don't really have that side-to-side movement, they don't have that rib cage widening expansion. So what should happen and a good way to practice this is to put your hand on either side of your rib cage and try and direct the air as you breathe in, into the sides of your ribs.

Now the reason why I say that women or even men who don't have appropriate breathing mechanics, have pelvic floor issues as well, is because when you breathe in, the diaphragm and the pelvic floor they're synergistic, so when you breathe in, your diaphragm expands downwards, it's connected to your pelvic floor by a connective tissue.

And so what happens naturally is when you breathe in, your pelvic floor will descend down because that's how it moves in your body and when you breathe out as your diaphragm shortens, as your diaphragm closes in and lifts back up, the pelvic floor gets pulled up as well. That's how it works.

It works in that way, as you breathe in, the pelvic floor drops down and as you breathe out the pelvic floor rises up, and so what we find a lot is that women will squeeze their pelvic floor when they breathe in and then let it go when they breathe out, and that seems natural, but it's actually incorrect.

It should be activating on the breath out, and so when you think about the exercise that you do, if you're doing, let's say you're doing a leg press, you need exhale as you press your feet and press away the weights, and as you exhale, your pelvic floor should actually be rising up, but what happens in most people is that they breathe in or they hold their breath while they're pushing.

And so they're bearing down and bulging down and if they're breathing out while they press out, they're actually letting their pelvic floor go, so it should be the opposite, it should be that their pelvic floor squeezes and lifts as they exhale and press away at the leg press machine. Does that make sense?

Your breath creates synchrony within your body. All movement should begin from your breath.

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Dave: Yeah, that's very, very clear and maybe that's a challenge for the listeners to practice. The leg press is great example because it's very safe controlled movement. Go sit at a leg press, put no weight on it, begin by just thinking about exhale as you press and then think about where is your breathing coming from.

What motion do you feel? Do you feel that upward movement that Heba was just talking about, yeah, that's fantastic. Heba we just got a third person on this call, can you tell who we just heard?

Heba: That would be my six month old daughter, but I'm postpartum just like most mums who are probably listening on this call and she's just fallen asleep in my arms, so she shouldn't disturb us anymore.

Go-To Exercises for Your Pelvic Floor

Dave: That's all good. So we talked about breathing and we talked about, I really liked how you suggested that any exercise, if done properly, should be safe. Are there any specific exercises though that are sort of your go-tos for rehabilitating pelvic floor damage? Or properly strengthening, you talked about transverse abdominis, some of those deeper abdominal muscles, are there sort of go-tos that women listeners might consider using first?

Heba: Absolutely, so the first thing before you even think about the pelvic floor is make sure you learn how to breathe, and it is probably the hardest exercise for women and men, anyone to actually get right.

So learn your diaphragmatic breathing and then you add in your pelvic floor, so then with the pelvic floor, a good image is, imagine that you're weeing and you want to stop the flow of the wee, and what you should feel is a squeezing and lifting up sensation.

If that doesn't work for you, you can think about, imagine that you have a tampon inserted vaginally and you want to try and squeeze around that tampon and pull that tampon up towards your cervix.

Or another image that works for people is imagine that you have a straw in a thick shake and you're trying to use your vaginal muscles to pull up the thick shake through the straw, you should feel a real squeeze and pulling up sensation.

And so then once you've got those pelvic floor muscles activating, you want to try and connect that with your breath. So you take a deep breath in and then as you breathe out, you squeeze and lift your pelvic floor muscles and you hold it while you breathe out and then you let it go as you breathe in and you repeat.

And then the next layer of muscle is your transverse abdominis, and so to engage that you want to think about, well, really when you activate your pelvic floor, you should feel your transverse abdominis engaging as well, you should feel almost like a tightening compressing corset like feeling in the lower tummy. And that's your deep tummy muscles or your transverse abdominis engaging.

And then you take these three muscles and you incorporate into the exercise​ that you love. So I usually like, especially for beginners to start off with some basic Pilates type movements. So things like lying on your back and doing some bridges.

So with your knees bent and lifting your bum up into a bridge position. So using you pelvic floor and your breathing and your deep tummy in that exercise and then just the same thing, if you're lying on your back, you take a breath in and then as you breathe out, you squeeze your pelvic floor, you tighten your lower tummy muscle and you lift your bum up into bridge and then you breathe in to let that go and lower your bottom back down.

And so you just incorporate that same kind of principle in the rest of your exercises and what we actually do with The Pelvic Expert, is we have an online program specifically for mum who has pelvic health issues and within that program we go through a lot of these type of exercises, but then we even progress them up into functional exercises that include upper body and lower body exercises.

So the point is that, be able systematically go through, starting with the ba- and pelvic floor and then working up slowly so that they're able to get to things like doing squats with rotations or doing lunges with arm reaches or something like that, so that they're able to incorporate that into their daily life and their pelvic floor is activating without them even having to think about it anymore.

Dave: That's fantastic. One thing that I want to encourage the listeners is, is as you start to do some of this work, you're going to find that it's actually quite complex and it might mean that you're not able to do the number of reps or the amount of weight that you would have previously or the amount of time that you do with a certain exercise.

But that doesn't necessarily mean that you're working any less and Heba, when you were talking I was think about a plank, and I can go into an elbow plank and basically not consciously contract my core muscles at all and just kind of hang out there and I can hang out in a plank for a really long time.

If I am conscious about contracting, particularly in my transverse abdominis, my body starts shaking within a few seconds, and it's almost impossible to hold that, maybe 30 seconds and I'm done and so again, for the women who are listening, when you start doing this, think of about the leg press, which again, I think that's a great place for women who want to be doing some lifting, you don't need very much weight​ in there. Think about your breathing. Think about your core contractions. You're still getting a great workout.

Heba:Exactly, and I think that's the thing that we need to move away from like trying to do more and trying to do hardcore and all that and go into how to do things safely and correctly because you will still get a workout and you'll actually get a workout for the muscles that need it, which is your pelvic floor and you transverse abdominis and you glutes, because a lot of the time we can do squats and lunges and leg presses and our glutes are doing nothing.

But if you're using your pelvic floor muscles, you're going to fire your glutes a bit better as well because they're also fascially connected, or connected by connective tissue. So I think focus on doing the exercise right and you will feel the burn and it will actually be better for you, not just today, but for life.

Make Your Body Work Takeaway

Dave: Again, I could not agree more. Heba, we like to wrap up the show with what's called a Make Your Body Work takeaway and that's just sort of an action step, for anyone who's been listening and thought particularly when you talked about signs and symptoms of pelvic floor issues, if anyone's been listening and thought, "Hey, I've experienced that, maybe that's me." What would you say a good first step would be for someone in that case?

Heba: A good first step would be just start with getting in touch with your pelvic floor muscles. Are you able to engage them? So think about those cues we talked about earlier, squeezing like you're sitting on the toilet or pulling that thick shake up through the straw, and try and just get those muscles switching on because once they're switching on, it's easier for them to get going.

If they're not switching on at all, you're just doing yourself a disservice. So just think about trying to activate those muscles and maybe just do five cycles of squeezing those muscles with breathing every few hours for the next couple of days and just really get in touch with those muscles.

Dave:I think that's super, super appropriate advice. As we were talking there I was practicing what you were talking about as you described it and I can feel it, it's working, like it is actually exercise, so I encourage listeners, if you didn't do it the first time through, rewind this episode and as Heba describes the cues that you should be looking for, give it a shot. Heba, I'm sure there are going to be women who listen to this who would like to learn more about you about your programs, where's the best place that they can get in touch with you?

​Connect with ​Heba

Heba:The best place is just to head over to our website, which is thepelvicexpert.com​ and we do have a 14 day challenge, directed specific for mums who have a pelvic floor issue and you can go ahead and just sing up to that challenge and it will help you get in touch with all these core muscles that we talked about and it will also introduce you to how to integrate these core exercises with functional exercises like bridges and squats, and we also have our 12 week online program specific for mums who have incontinence, prolapse, abdominal separation, and back pain, and that's a 12 week program that's really effective.

We have a whole bunch of mums in the program at the moment who are really seeing excellent results. Some women in a matter or five days have already improved their incontinence, which is pretty cool. So you can just head over to our website and you'll be able to access our 14 day challenge there and also see our 12 week online program for mothers.

Dave: Awesome, that's fantastic, and for the listeners, I'll have links to everything that we've talked about today in the show notes for this episode, so if you go to makeyourbodywork.com/103 that's 103, I'll have links to everything we just talked about and you can go and sign up for that 14 day challenge, get it a shot, let Heba lead you through some of the stuff that we talked about today, just it makes sense.

Heba, thanks so much again for being with us today, honestly it was awesome to have someone with so much experience and so much expertise talk about an issue that not a lot of people are talking about.

Heba:Thank you so much Dave for having me, I mean that's one of my missions is to make pelvic health common conversation and to just get the word out so that women do not have to suffer any longer.

Dave:Thanks again Heba for being on the show today and for sharing your excitement, your enthusiasm, and your expertise when it comes to pelvic floor issues, pelvic floor damage, prolapses, all these different issues that are often going unspoken about, and for the listeners, if you can identify with any of the symptoms that Heba described, don't just wait.

I know the more that I've gotten into this and the more that I've talked to women who I work with in my programs, this is something that so many women have labeled, as Heba talked about, as being normal when it's not. I think Heba did a great job of explaining this is common, it's not normal, and it's certainly not something that you just have to live with, so be sure to check out the resources again.

I've posted them at makeyourbodywork.com/103 and Heba can definitely lead you through the process of recovering, restrengthening your core, and getting you back to the exercise that you want to be able to do. So hopefully you enjoyed today's episode and I can't wait to see you here again next week.

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