how can i stop leaking, relieve symptoms of prolapse and help heal my ab gap?

A really easy step you can take towards stopping leaking, relieving symptoms of prolapse or healing your 'ab gap' is by understanding how to control your 'intra-abdominal pressure'.

What exactly is 'intra-abdominal pressure'?

Intra-abdominal pressure (IAP) is the pressure that's generated in the abdomen during certain activities, for example coughing, sneezing, lifting, rising from sitting, pushing, pulling, holding your breath, straining to open your bowels and blowing your nose (or a balloon!). 

IAP is also generated with many abdominal/Pilates exercises for example planks, crunches and sit ups. General exercise will also create pressure, depending on your breathing pattern so, for example running has the potential to create higher IAP too.

There are 3 distinct cavities in our bodies - the abdominal cavity in the centre, the chest cavity above and the pelvic cavity below. When the pressure rises in the middle (during the previously mentioned activities), that rise in pressure will influence the pressure in the cavities above and below. 

Why is IAP relevant to me? 

The force of this pressure has to go somewhere. It will push out onto the abdominal wall (bad news if you are recovering from birth and trying to heal an abdominal separation) and down onto the pelvic floor (bad news if you have stress incontinence - leaking when you cough/sneeze/exert yourself, or you have pelvic organ prolapse).

If you have stress incontinence, pelvic organ prolapse or abdominal separation, it's really helpful to have a good understanding of IAP and be aware of how the movements/exercise you perform during daily life can influence IAP, and therefore your symptoms eg the heaviness of a prolapse or frequency of urinary leaking.

Use this knowledge to enhance your postnatal recovery! 

How do I control or manage 'IAP'?

The simple answer is by using your breath. There are a few other things to be aware of,  but using your breathing in a way which actually helps you is really powerful.

Let's understand some basic anatomy first - think back to the three cavities in the body. When we exhale, our diaphragm rises upwards. The effect of this is to reduce the abdominal cavity pressure which in turn reduces pressure/stretch on the tummy and the downward force on the pelvic floor. We can use this to our advantage by simply co-ordinating an EXHALE with a movement/task/exercise which would cause a rise in pressure.

For example....

Lifting your baby from the floor/cot. Breathe in as you bend, exhale with purpose as you actually come into standing.

Picking up baby in the car seat or a heavy bag. Breathe in as you bend to grasp the seat handle/bag, exhale with purpose as you lift up.

Taking the pram/ heavy item out the car boot. Inhale as you get ready and bring it close to your body, strong exhale as you lift it out, until the heavy weight is on the floor.

Rising from a chair, especially if holding a weight/child in arms. Inhale as you prepare to stand, purposeful exhale as you rise from sitting.

Hopefully the principle is clear....EXHALE as you EXERT. 

On adding load, or on impact....BREATHE OUT. You can apply this principle in many ways, it's simply a question of co-ordinating your movement with your breath.

What other strategies can I use to control IAP?

Straining in the bathroom to open your bowels is an action that will generate a big rise in IAP, and so is really unhelpful. There are a number of things we can do to avoid any straining. Cover the basics to keep stools soft (adequate fibre and fluid intake, take regular exercise, consider stool softener medication) then look at your 'toilet posture' and breathing habit when opening your bowels.

Sitting with your feet up on a small step/6" pile of books or even upturned loo roll will position your knees higher than your hips. Also lean forwards a little and relax your belly fully. This allows your pelvic floor muscles to fully relax, so you don't have to strain to go. 

Breathing wise - no breath holding! Keep breathing, in and out. Remember that your exhale 'blows away' pressure which would otherwise be bearing down into the pelvis, thanks to the rising diaphragm. 

Did you know you can also use your pelvic floor muscles to assist in controlling the rise in pressure that occurs in many daily activities or with exercises?

If you pre-contract your pelvic floor muscles ahead of a cough/sneeze/lift etc this acts as a backstop to resist the rise in downward pressure. This can stop that little leak of wee/wind you weren't expecting and avoid any further downward pressure on your pelvic organs. 

It's a question of getting the timing right, and can take a while to learn. A bit of conscious effort with this initially, and you will re-train your brain to do this automatically, which is how it's designed to work. 

If you would like some expert guidance to assist your pelvic floor and abdominal recovery, you can access this via my in studio & online Physio led core and pelvic floor rehab classes. I'll teach you modified pilates exercises that are specifically designed for the postnatal population, drawing on my many years of clinical experience as a Chartered Physiotherapist. We can pave your way back to running, fitness classes and jumping without pelvic discomfort and leaking, through postnatal rehab.

Free trials (online tasters) are available should you wish to try a class with me; studio classes are held in Leighton Buzzard, Bedforshire and resume September 2020 with all Covid risk assessments in place. Further details on my classes can be found here.

Jo Dyson

Mother Nurture Pilates | Physiotherapist led Antenatal & Postnatal Pilates classes