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Pelvic Floor Exercises for Women: What No One Tells You After Birth · Life After Birth by Her Health Room

• 0:00
  Remi Mogekwu: today we're gonna be talking about the pelvic floor.
• 0:01
  Remi Mogekwu: So when most people think about the pelvic floor, especially in relation to pregnancy, we think about problems with leaking urine, but what about the back passage?
• 0:09
  Remi Mogekwu: What about when you're not able to control the wind, you're not able to control the stools from the back passage?
• 0:14
  Remi Mogekwu: And that's what we need to dive in today because there's so much shame around this topic, but I'm joined today with Nike to discuss why you shouldn't feel shame and why you should seek support Adenike, who's a physiotherapist in the NHS, has a lot of experience with pelvic floor dysfunction, especially in women during pregnancy and the postnatal period, and much later in life.
• 0:35
  Remi Mogekwu: So I'm gonna ask for her to introduce herself
• 0:37
  Adenike Ibikunle: I work within the NHS, as a pelvic floor physiotherapist.
• 0:40
  Adenike Ibikunle: And I see lots and lots of women with pelvic floor dysfunction ranging from, ages 18 to 91, and this is spanning from pregnancy, uh, up to postnatal period, even in their menopausal age.
• 0:52
  Remi Mogekwu: Yeah.
• 0:52
  Remi Mogekwu: So what did you say the oldest woman you've treated is?
• 0:55
  Adenike Ibikunle: I think over 90,
• 0:56
  Remi Mogekwu: Over 90, wow.
• 0:58
  Adenike Ibikunle: yeah.
• 0:58
  Remi Mogekwu: Yeah, I think one of the most interesting things about working with women is that you're looking after them really from cradle to grave.
• 1:05
  Remi Mogekwu: And the pelvic floor matters through all of that.
• 1:08
  Remi Mogekwu: So I think it's really important, and thank you for joining me.
• 1:11
  Remi Mogekwu: And even when we had our talk before this, I remember you mentioned that you had treated almost 800 women within the NHS?
• 1:17
  Adenike Ibikunle: The stake is gone up to a thousand now.
• 1:19
  Remi Mogekwu: Oh, over 1,000.
• 1:20
  Remi Mogekwu: Wow.
• 1:21
  Remi Mogekwu: Well done.
• 1:22
  Remi Mogekwu: So we know that we're getting really good, expertise when we're having this conversation.
• 1:27
  Remi Mogekwu: So for people who don't know, I'm an obstetrics and gynecology doctor, and I'm building Her Health Room as a platform to help women navigate the pregnancy and the postpartum period fully, so recovering physically, socially, and mentally.
• 1:38
  Remi Mogekwu: And if that's something you're interested in, subscribe to this channel.
• 1:41
  Remi Mogekwu: But otherwise, stay tuned while we find out more about the pelvic floor and why it's really important for us as women, especially during pregnancy and postpartum.
• 1:49
  Remi Mogekwu: So my first question to you, Nike, is that most people feel surprised when their pelvic floor starts to misbehave, and almost in the sense that it's a muscle that we don't know that we need until it stop working.
• 2:02
  Remi Mogekwu: So what do you say to women who don't have any leaking from the bladder, who don't have any leaking from the back passage, who don't have any lumps or bumps coming down the vagina?
• 2:11
  Adenike Ibikunle: To be honest, I just tell them, you need to note, you need to protect your pelvic floor, you need to keep strengthening it." So in every stage, whether or not you're leaking, protect your pelvic floor.
• 2:20
  Adenike Ibikunle: So if you're like a gym girly, lift a lot of weight, think protection.
• 2:24
  Adenike Ibikunle: Think that you need to protect your pelvic floor because sometimes the results of everything that we do may not come now.
• 2:30
  Adenike Ibikunle: You might just see them in the future.
• 2:32
  Remi Mogekwu: When you're working with women who are pregnant or after pregnancy, what are the main things that you're seeing in that group?
• 2:37
  Adenike Ibikunle: With women, so women that are pregnant, we weakness.
• 2:40
  Adenike Ibikunle: Sometimes they develop stress urinary incontinence with the baby, is quite, like, very common.
• 2:45
  Adenike Ibikunle: And then they also have, like, pelvic area pain, very common back pain, hip pain, and then, yeah, you just have to-- So that is with pregnant women.
• 2:52
  Adenike Ibikunle: You see lots of stress incontinence or you see urgency.
• 2:55
  Adenike Ibikunle: So they're always urgent.
• 2:56
  Adenike Ibikunle: They always wanna get to the bathroom.
• 2:58
  Adenike Ibikunle: They always want to wee.
• 2:59
  Adenike Ibikunle: then, yeah, I think those are the very, very common ones.
• 3:01
  Adenike Ibikunle: Some very, small ratio might begin to experience prolapse, but it is, like, it is very, very small.
• 3:08
  Adenike Ibikunle: You see a lot of pain.
• 3:09
  Remi Mogekwu: So break down stress urinary incontinence for us.
• 3:11
  Remi Mogekwu: You said it's when they're coughing, when they're sneezing, that that's when they're experiencing the leaking.
• 3:15
  Remi Mogekwu: But what's actually happening at the pelvic floor when a woman coughs or sneezes when she's pregnant?
• 3:18
  Adenike Ibikunle: So with stress incontinence, you want to know where the pelvic floor is sitting.
• 3:21
  Adenike Ibikunle: What is the pelvic floor?
• 3:22
  Adenike Ibikunle: What does it do?
• 3:22
  Adenike Ibikunle: Okay.
• 3:23
  Adenike Ibikunle: The pelvic floor is a group of muscles.
• 3:25
  Adenike Ibikunle: That sits on the floor.
• 3:26
  Adenike Ibikunle: So basically, they are like the, they are the foundation.
• 3:29
  Adenike Ibikunle: They hold things together, so they work with the abdomen, the muscles of the back, and the diaphragm to give you that stability.
• 3:35
  Adenike Ibikunle: When people are pregnant or when they have...
• 3:37
  Adenike Ibikunle: abdominal muscle sometimes tend to use its elastic property, it weakens.
• 3:42
  Adenike Ibikunle: Okay?
• 3:42
  Adenike Ibikunle: And it's actually a really major muscle.
• 3:44
  Adenike Ibikunle: And when it weakens, all the load then goes to the pelvic floor, the back, and things like that, and then people begin to experience loads and loads of weakness.
• 3:51
  Adenike Ibikunle: Coming to your question, so stress incontinence, people would say when you cough or sneeze or whenever there is any increase intra-abdominal pressure, so we talk, urethral sphincters that would normally close.
• 4:00
  Adenike Ibikunle: Just like when I see you, and I'm trying to poke my hand into your eye, you, like, close your eye.
• 4:03
  Adenike Ibikunle: So there is a normal physiological response.
• 4:06
  Adenike Ibikunle: Now, whenever these sphincters any sort of pressure downward, they would close.
• 4:10
  Adenike Ibikunle: Okay?
• 4:10
  Adenike Ibikunle: But in stress incontinence, they are not really necessarily closing.
• 4:14
  Adenike Ibikunle: It's either they are not closing as fast as they need to because there is a bit of coordination in your muscles to quickly recruit itself so that it can give you that maximum support.
• 4:22
  Adenike Ibikunle: Stress incontinence is most times related to pelvic floor, either the coordination or the function of your pelvic floor.
• 4:29
  Adenike Ibikunle: So whenever there is a breach in these sphincters working, then we'd be having the leak.
• 4:33
  Adenike Ibikunle: So we're having the pressure that's coming from on top is greater than closure of these sphincters.
• 4:38
  Adenike Ibikunle: so we have the leak happen.
• 4:40
  Adenike Ibikunle: So it's usually a leak whenever there's any discrepancy the pressure gradient
• 4:44
  Remi Mogekwu: I like to describe the pelvic floor muscles like a hammock, so like the sling of the muscles on the bottom.
• 4:50
  Remi Mogekwu: And then you mentioned the urgency as well, which is when they're rushing to the toilet and they have some episodes of leaking before then.
• 4:55
  Remi Mogekwu: And when they've had the baby, what types of things do you tend to see on the postnatal ward?
• 5:01
  Adenike Ibikunle: So immediately, we get to see most times first and second day would be sometimes leaking, Especially if they've had a tear.
• 5:08
  Adenike Ibikunle: Maybe second-degree tear, third-degree tear, or even fourth-degree tear, of weakness, lots of trauma to the pelvic floor, lots of stress to the and so they might already start leaking, and some experience lots of pain, pain vaginally, pain, you know, just around that area.
• 5:20
  Adenike Ibikunle: So we see first, the second day, third
• 5:22
  Remi Mogekwu: So with the leaking, are we talking leaking from the bladder?
• 5:25
  Remi Mogekwu: Are we talking leaking from the bowel, or are we talking both?
• 5:28
  Remi Mogekwu: Because I think, again, I want the people watching to really understand, it's not just the bladder that leaks
• 5:34
  Adenike Ibikunle: When there is any tear, so let's say a third-degree tear or a fourth-degree tear, now we're leaving the perineal area, into the sphincters now.
• 5:43
  Adenike Ibikunle: And I'm talking the external anal sphincter, internal sphincter, and even the rectum.
• 5:48
  Adenike Ibikunle: Tendencies are not just, urinary incontinence or urinary leakage.
• 5:51
  Adenike Ibikunle: They sometimes would experience fecal incontinence, so leaking from the back passage, sometimes flatal incontinence, so where they're not able to control their fart.
• 5:59
  Adenike Ibikunle: And yeah, they could have bowel urgency or fecal urgency, where they just need to get to the bathroom in time.
• 6:04
  Adenike Ibikunle: If not, they leak.
• 6:05
  Adenike Ibikunle: And then also urinary urgency as well, and sometimes prolapse
• 6:08
  Remi Mogekwu: so when you were talking about the sphincters, so that's the muscles around the back passage that you're saying sometimes when they're damaged during childbirth, they can cause the leaking of the bowels.
• 6:19
  Remi Mogekwu: So when you find women in that situation, what are they most shocked by?
• 6:23
  Remi Mogekwu: What are the things that they're saying at that time to you on the ward in the first three days?
• 6:29
  Remi Mogekwu: 'Cause after a while we know that they get discharged, and then a lot of what the follow-up would be for those particular women will happen after delivery.
• 6:36
  Remi Mogekwu: So on the ward, what are they saying in the first few days when they meet you?
• 6:40
  Adenike Ibikunle: So usually when I see them in the first few days would usually say oh they first they feel some level of pain from the stitches and everything And then if most times they might not have emptied their bowels yet they're afraid So basically they're guarding their muscles are guarding the ones that might have and maybe experienced any sort of leaking they already started feeling start feeling like Oh what do I do now I mean most of the times they're just not happy yeah about the outcome But that's where we get to see them first and just reassure them at least until once they have So the way the pathway in my hospital is built is that once you've had third degree tear talk more fourth degree tear you're automatically going to be referred to physio
• 7:21
  Remi Mogekwu: and so how often would you see them typically on the NHS?
• 7:24
  Remi Mogekwu: And then if you were seeing them privately, how often would you want to see them?
• 7:28
  Adenike Ibikunle: With building muscles especially the pelvic floor muscle we follow the NICE guidelines We usually give at least three months from the time they would come to see us to start whatever it is Them to start So whenever they come in from that time Try to also let them know that the body would heal So there is a good space sometimes six months sometimes a year the body would definitely heal But whenever it is they do come to find us we begin the process from then treatments are usually individualized depending on what they feel you know how the symptoms are how severe it is
• 7:58
  Remi Mogekwu: So I've actually sat in a physiotherapy clinic before for women who've had babies, and one of the things that I was really impressed by is that you're examining the woman, and you're asking her to feed back to you at the right time, like trying to see if you can feel those muscles work.
• 8:15
  Remi Mogekwu: Because I think for a lot of people, even knowing where those muscles are, are really hard to explain.
• 8:20
  Remi Mogekwu: I know we described the hammock.
• 8:21
  Remi Mogekwu: You described the pelvic floor and the abdominal muscles, but actually trying to isolate your pelvic floor is a skill that a lot of people struggle to learn because it's hard to visualize what it is we're talking about.
• 8:32
  Remi Mogekwu: So when they come to you at that first appointment, what type of things do you do with them to try and engage that pelvic floor?
• 8:39
  Adenike Ibikunle: So one of the funny things I get to see is people that do um Pilates they come in and they tell me oh they engage their pelvic floor and almost 80 of them still struggle Like they've not been doing it right because they also like They When they say suck it all in that's the instruction they get and so they hold onto their stomach hold their breath hold everything in and that doesn't work Okay So most of the times we want to isolate We don't want other muscles you know bearing them up or holding up to them now wanna isolate those muscles first We wanna see what those muscles are doing how strong they are Are they weak What level of weakness Can they endure What is the function Can they coordinate themselves quickly Can they move fast So you wanna think about how that is really important to isolate that muscle So first things I need to tell them or one of the easy things I tell them would be You know what Sometimes just Relax Just think about that area and if you can divide your body into two So first things you need to th-think about, which is quite easy for them, is, um, could you try to stop a wind?
• 9:33
  Adenike Ibikunle: So imagine I'm in front of you.
• 9:34
  Adenike Ibikunle: We're in the ballroom, and I'm dancing with you, then you want to fart.
• 9:37
  Adenike Ibikunle: Do you just explode?
• 9:38
  Adenike Ibikunle: No.
• 9:38
  Adenike Ibikunle: You try to hold it in, but you don't clench your muscle.
• 9:40
  Adenike Ibikunle: You don't clench your buttocks because when you do, I would see it.
• 9:41
  Adenike Ibikunle: Imagine you're wearing a tight dress.
• 9:43
  Adenike Ibikunle: I would see it if you clench your buttocks, right?
• 9:44
  Adenike Ibikunle: So what I would say, I would...
• 9:45
  Adenike Ibikunle: what I would say is, you to close the back passage." So try to stop a wind, and then once they do that, I would say,"Try to stop a wee." So I want you to stop a wind and stop a wee.
• 9:53
  Adenike Ibikunle: Okay?
• 9:53
  Adenike Ibikunle: And so we could see them pull, and sometimes we'll have that extra pull when they try to stop a wee as well, and they can feel the lift in the vagina.
• 10:00
  Adenike Ibikunle: tell them,"You know what?
• 10:01
  Adenike Ibikunle: That's absolutely it." And then the other thing I could say is,"Imagine you're sitting on the toilet seat, and then the tissue rolled down the floor.
• 10:07
  Adenike Ibikunle: do you do?" Most of the time is you don't want to pick them with your hand.
• 10:10
  Adenike Ibikunle: You use your feet to try to roll them in.
• 10:12
  Adenike Ibikunle: So think about sucking a spaghetti into the vagina, and what you should feel is a lift in the vagina.
• 10:17
  Adenike Ibikunle: Okay?
• 10:17
  Adenike Ibikunle: The aim is to feel that lift, and once you feel the lift in the vagina, if you think about it a lot, you would see that, but the back passage is actually also squeezing.
• 10:25
  Adenike Ibikunle: you want to make sure that you...
• 10:26
  Adenike Ibikunle: because the pelvic floor is not just there.
• 10:28
  Adenike Ibikunle: It is from the back towards the front.
• 10:30
  Adenike Ibikunle: It is from the pubic bone, all right?
• 10:32
  Adenike Ibikunle: And then it goes all the way to the coccyx.
• 10:34
  Adenike Ibikunle: So you wanna engage all of it at the same time.
• 10:36
  Remi Mogekwu: So you said imagine sucking up a spaghetti, and then imagine being in a tight dress in the ballroom and stopping a fart.
• 10:44
  Remi Mogekwu: And even as you were saying it, I was imagining it, and I was like, I cannot speak about the pelvic floor without reminding myself to do my pelvic floor exercises.
• 10:51
  Remi Mogekwu: So it's one of those things that you can do mid-conversation, really.
• 10:55
  Remi Mogekwu: No one needs to know that you're doing them.
• 10:57
  Remi Mogekwu: So when you are in that phase, then, of recovery, it sound- obviously you need to know to isolate the pelvic floor, but what treatment options do you typically have for people who have pelvic floor dysfunction, whether it's bladder, whether it's bowel?
• 11:11
  Remi Mogekwu: What advice would you have for them?
• 11:13
  Adenike Ibikunle: So I do more, bladder patients, But if you do have any sort of bladder symptoms, the first things we wanna do, we would offer you all the options that we have.
• 11:20
  Adenike Ibikunle: From conservative managements, from you doing your exercises, some lifestyle modifications, which are very key.
• 11:26
  Adenike Ibikunle: Most of the times when I get a patient to change their fluids or change what they're eating, the symptoms already begins to look better.
• 11:32
  Adenike Ibikunle: If the symptoms still persist, like I would give them all the options at the first visit.
• 11:36
  Adenike Ibikunle: If your symptoms still persist, imagine you have stress incontinence, we have a device that once inserted, if you jump, run, exercise, nothing is gonna happen.
• 11:43
  Remi Mogekwu: So it's almost like a plug?
• 11:45
  Adenike Ibikunle: But then it's for the vagina to stop leaking of urine
• 11:48
  Remi Mogekwu: So where does the device go?
• 11:49
  Adenike Ibikunle: So the device goes into the vagina
• 11:51
  Remi Mogekwu: Okay.
• 11:51
  Remi Mogekwu: And then almost blocks off the bladder neck
• 11:53
  Adenike Ibikunle: with stress incontinence, we do have a continence device, and if things are not really going as planned, even with the continence device, and feel like you want more help, can then refer you.
• 12:00
  Adenike Ibikunle: We do have good a good rapport with our consultant.
• 12:03
  Adenike Ibikunle: I can then refer you to the consultants who now do what we call a urodynamic testing.
• 12:07
  Adenike Ibikunle: So with that urodynamic testing, we're able to see if what you have is true stress incontinence, and then they could also check if what you have is an overactive bladder and all the other bits.
• 12:15
  Adenike Ibikunle: If you have a prolapse, there is a pessary.
• 12:17
  Adenike Ibikunle: We could fit in a pessary or send you to a consultant.
• 12:20
  Adenike Ibikunle: With urge incontinence, urgency, there are medications, anticholinergic medications, and then there's different ones that are out and about now that are really good.
• 12:27
  Adenike Ibikunle: We can always send you into the consultant.
• 12:29
  Adenike Ibikunle: We do PTNS.
• 12:30
  Adenike Ibikunle: They do Botox as well.
• 12:31
  Adenike Ibikunle: So yeah.
• 12:32
  Remi Mogekwu: And what's PTNS for people who've not heard of it before?
• 12:34
  Adenike Ibikunle: Oh, PTNS is like posterior tibial nerve stimulation.
• 12:38
  Adenike Ibikunle: So I'm sure people hear TENS.
• 12:40
  Adenike Ibikunle: It stimulates the nerve that is supplying the bladder.
• 12:44
  Adenike Ibikunle: The aim is for it to, calm you down, so you don't have to always get that urgent need to go.
• 12:50
  Remi Mogekwu: So that's more for the urge, so that's more for the urge incontinence.
• 12:53
  Remi Mogekwu: And I know you said you don't do much of bowel, but what would the workup be for someone who has symptoms like that?
• 12:59
  Remi Mogekwu: So I know, you know, we've spoken about having a third-degree tear, a fourth-degree tear, and how the, For a large percentage of people, by the first year, about 80% I think it's quoted, won't have any symptoms at all of having had the tear.
• 13:14
  Remi Mogekwu: But what do you do for them in that first year?
• 13:16
  Remi Mogekwu: 'Cause it's still a really long time to have issues with leaking,
• 13:19
  Adenike Ibikunle: So one of the major things is we try not to do any sort of internal examination within six weeks.
• 13:24
  Adenike Ibikunle: We check if the pelvic floor is weak.
• 13:26
  Adenike Ibikunle: Whether or not they have symptoms, we'll already start to get them to do some pelvic floor exercises.
• 13:30
  Adenike Ibikunle: And we know that as the body's building, you don't want to do things that would then I say, should I use the word spoil what you're doing, what you're trying to achieve.
• 13:37
  Adenike Ibikunle: So you wanna always make sure that, hey, we're giving you some modifications on, oh, we don't want you straining on the toilet because we know that once you strain on the toilet, there is more pressure, there is more stress on the pelvic floor.
• 13:46
  Adenike Ibikunle: If you think of the pelvic floor like a rubber band, a new rubber band is quite a little bit tight, but the more you use it, the more it weakens, right?
• 13:53
  Adenike Ibikunle: The more it loosens, the more you keep stretching it.
• 13:55
  Adenike Ibikunle: If you keep straining on the toilet.
• 13:56
  Adenike Ibikunle: So we give you a lot of lifestyle modifications and exercises that befit you,
• 14:00
  Remi Mogekwu: so I think that's also really important to say'cause you're saying if you're straining, especially in the early days, and actually one of the things you said earlier as well is, like, sometimes when, in the first week or so people will have a lot of pain and struggle to go to the toilet, and you're guarding, um, probably not passing urine as much as you should, not opening your bowels as much.
• 14:18
  Remi Mogekwu: And then even further on the line, there's a lot of constipation that happens with recovery post-delivery.
• 14:24
  Remi Mogekwu: If you're anemic and you're taking iron tablets, maybe you're not eating well, you're not drinking as well.
• 14:29
  Remi Mogekwu: So constipation also can worsen symptoms,
• 14:33
  Adenike Ibikunle: Yes
• 14:33
  Remi Mogekwu: In terms of, like, devices for the back passage, are there any that can help specifically with the symptoms, or is that way further down the line if they're really not recovering?
• 14:43
  Adenike Ibikunle: I think they might be bringing back anal plugs, But usually, for me, I tend to get you to manage your diet first to make sure that your stool is soft and consistent.
• 14:51
  Adenike Ibikunle: Loose stools, we know where their heads do.
• 14:53
  Adenike Ibikunle: If your stool is hard and lumpy, we know that means constipation and you're having to strain to empty.
• 14:58
  Adenike Ibikunle: So can we get your stool to be soft and consistent?
• 15:00
  Adenike Ibikunle: So once that is happening, someone or one of the bowel guys tend to check from the to see how strong or how weak your pelvic floor is and begin to guide you on exercises that you can begin to do.
• 15:10
  Adenike Ibikunle: And if things are not moving in the direction that they should, they will begin to look out for all the things that could help you as well.
• 15:14
  Remi Mogekwu: Yeah.
• 15:14
  Remi Mogekwu: And so what I normally see along my practice is that people also have ultrasound scans into the back passage.
• 15:20
  Remi Mogekwu: It's called an endoanal scan, and what that does down the line, it tells us if the muscles, so the rings, the sphincters, are intact or where the weakness is specifically,, because again, that can help target treatment.
• 15:33
  Remi Mogekwu: And so women who've had a third or fourth degree tear in their first pregnancy, and they come back with their second, oftentimes, they need to be seen by an obstetrician and have a really frank conversation.
• 15:45
  Remi Mogekwu: If you have another vaginal delivery, we could re-injure that sphincter.
• 15:49
  Remi Mogekwu: And even if you're symptom-free, like say you're not leaking stool or gas or anything like that, there is always a risk of having that third degree happen again.
• 15:59
  Remi Mogekwu: And for some women, they don't want that risk, so then they opt to have a cesarean section.
• 16:03
  Remi Mogekwu: But I often will have seen like the results of the endoanal scan in those women specifically to see if the muscles are strong or have the right type of integrity that you would expect.
• 16:14
  Remi Mogekwu: So I'm just gonna move on to another question'cause I think we've spoken a lot about the pelvic floor, how we assess it, what it is, how you find it, what it means to the bladder symptoms, what it means to the bowel.
• 16:27
  Remi Mogekwu: And I think another thing that's also really important is prolapse.
• 16:30
  Remi Mogekwu: So I know you mentioned it be four about prolapse, and I actually recall a patient who had had a baby and maybe within the first or second week post-delivery came back with quite a significant prolapse.
• 16:42
  Remi Mogekwu: And then we just didn't really have a clear pathway of where she should go.
• 16:45
  Remi Mogekwu: It was very distressing for the woman.
• 16:47
  Remi Mogekwu: But if you see a woman who's had a baby who has a prolapse, what are the things that you do for them, from a physiotherapy point of view?
• 16:54
  Adenike Ibikunle: First things first is education.
• 16:56
  Adenike Ibikunle: I did have a patient who, quite sadly, she was, asked to start lifting weights, like heavy weights, post-delivery.
• 17:03
  Adenike Ibikunle: I mean, just five weeks post-delivery, which was quite sad.
• 17:06
  Adenike Ibikunle: And then she began to notice...
• 17:08
  Adenike Ibikunle: so when it comes to prolapse there are four stages.
• 17:11
  Adenike Ibikunle: So one and two, we can almost say we can effect some level of changes.
• 17:15
  Adenike Ibikunle: With grade three and four, where the prolapse is, like, significantly more than two centimeter out of the vagina or out of the hymenal ring, we're not really able to achieve much.
• 17:24
  Adenike Ibikunle: And then we're thinking now about pessaries.
• 17:27
  Adenike Ibikunle: We're thinking more about surgeries.
• 17:28
  Adenike Ibikunle: So with a first to second grade of prolapse, loads of lifestyle modification and exercises.
• 17:34
  Adenike Ibikunle: And of course, so we're telling them,"Hey, we need you to do your exercise at least three times a day." We tell them how to do it, specifically so there are two types of exercises with pelvic floor.
• 17:43
  Adenike Ibikunle: The pelvic floor helps to support these organs.
• 17:46
  Adenike Ibikunle: So there's like three organs sitting in the pelvis: the bladder, the uterus, and the rectum.
• 17:51
  Adenike Ibikunle: It uses mostly its endurance property.
• 17:54
  Adenike Ibikunle: Okay?
• 17:54
  Adenike Ibikunle: And most times when we check, when we ask this patient,"Okay, could you squeeze?
• 17:57
  Adenike Ibikunle: And when you squeeze, could you hold on to that squeeze?" Th- Most of the times, they're not really able to hold on to the squeeze.
• 18:03
  Adenike Ibikunle: They're not really able to just sustain that squeeze for as long.
• 18:06
  Adenike Ibikunle: So we build their endurance, okay?
• 18:08
  Adenike Ibikunle: Because that is what we need to support, so we move you from laying down, from sitting down.
• 18:13
  Adenike Ibikunle: We move you to standing into other functional positions to make sure, like, you're moving from just like when you go to the gym, you're moving from zero kg and you're doing now ten kg.
• 18:21
  Adenike Ibikunle: So we try to do that pr-progression exercises.
• 18:24
  Adenike Ibikunle: We teach you the knack that, hey, before you cough, squeeze your pelvic floor.
• 18:27
  Adenike Ibikunle: Just hold on to things.
• 18:28
  Adenike Ibikunle: Squeeze your pelvic floor before you cough, before you sneeze, and before you lift.
• 18:32
  Adenike Ibikunle: Now, this is the very tricky one with lifting, because now they're having babies.
• 18:35
  Adenike Ibikunle: Even at one year old, these babies are increasing in age, and they still need to carry their babies, right?
• 18:40
  Adenike Ibikunle: And sometimes they realize that when they lift the babies or carry them for long, they could feel the prolapse.
• 18:45
  Adenike Ibikunle: They can feel that pressure, that discomfort, that bulge sitting down, okay?
• 18:48
  Adenike Ibikunle: So what we want to do is we can't just say,"Don't...
• 18:51
  Adenike Ibikunle: Stop carrying your babies." We modify how they lift.
• 18:54
  Adenike Ibikunle: So that there's not much pressure.
• 18:56
  Adenike Ibikunle: Remember what I said earlier?
• 18:57
  Adenike Ibikunle: I said, Always think protection.
• 18:58
  Adenike Ibikunle: Following the rules with prolapse.
• 18:59
  Adenike Ibikunle: You have to do your exercises.
• 19:00
  Adenike Ibikunle: You have to protect your pelvic floor.
• 19:02
  Adenike Ibikunle: You have to modify your lifestyle so that you can get better.
• 19:04
  Remi Mogekwu: And I think another point with the pelvic floor, so I guess specifically with a prolapse, if I see, say, like a grade one, grade two, my feeling is that hopefully with exercise that should over time improve.
• 19:15
  Remi Mogekwu: But, the lower the prolapse comes, so the sort of out-pouching from the vagina comes, the less likely it is that it could be resolved just with exercise.
• 19:23
  Remi Mogekwu: But I also think it's really important that if you have had one child and unfortunately have a prolapse, when you then see a gynecologist, like you have to be realistic that it you are not really going to have surgery if you're planning for two or three more children.
• 19:36
  Remi Mogekwu: I had a comment on one of my videos recently, something about saying,"Oh, I don't want a cesarean section'cause I don't want to ruin my vagina." And that's not incorrect, but the pelvic floor is still stressed, during pregnancy.
• 19:48
  Remi Mogekwu: So even if you have a cesarean section, you are still at risk of all the things that we're talking about.
• 19:54
  Remi Mogekwu: So you mentioned about the lady who was lifting weights and had a prolapse
• 19:59
  Adenike Ibikunle: Yeah
• 19:59
  Remi Mogekwu: So I had two questions to follow on from that.
• 20:01
  Remi Mogekwu: Is that someone that was already lifting weights before the baby was born?
• 20:05
  Remi Mogekwu: And, like, the second
• 20:06
  Adenike Ibikunle: Yeah
• 20:06
  Remi Mogekwu: when should you start lifting weights after the baby is born?
• 20:10
  Adenike Ibikunle: Even though you were lifting before, my dear, not now.
• 20:13
  Adenike Ibikunle: Okay?
• 20:13
  Adenike Ibikunle: So I would say give yourself six weeks before you start things like even Pilates, like yoga, all these things without weight.
• 20:19
  Adenike Ibikunle: At least six weeks before you start on any of those things.
• 20:22
  Adenike Ibikunle: Then 12 weeks, at least three months before you begin to introduce weight.
• 20:26
  Adenike Ibikunle: And I don't expect you to introduce 50kg.
• 20:29
  Adenike Ibikunle: No.
• 20:29
  Adenike Ibikunle: You're going to start with maybe one or 2kg, and then see how your body responds, because you are still in the healing phase.
• 20:36
  Adenike Ibikunle: For some people, that healing phase is six months.
• 20:39
  Adenike Ibikunle: For others, it might be 12 months.
• 20:41
  Adenike Ibikunle: Okay?
• 20:41
  Adenike Ibikunle: And everybody responds to things differently.
• 20:43
  Adenike Ibikunle: You might feel like, oh, you were really strong before pregnancy, and after pregnancy, you just realize that you just lift only one weight and everything is just not working pr- as they should.
• 20:53
  Adenike Ibikunle: So you want to gradually move into what you were doing before.
• 20:57
  Adenike Ibikunle: Always listen to your body.
• 20:58
  Adenike Ibikunle: I tell people your body is very intelligent.
• 21:00
  Adenike Ibikunle: Don't just rush into anything.
• 21:02
  Adenike Ibikunle: You can't rush into your pelvic floor just stressing it like that.
• 21:05
  Adenike Ibikunle: No.
• 21:06
  Adenike Ibikunle: It wouldn't work that way, especially if there is already some weakness in the pelvic floor.
• 21:10
  Adenike Ibikunle: So six weeks for yoga and all the light, light things.
• 21:13
  Adenike Ibikunle: Twelve weeks begins-- before you begin to introduce any sort of weight or maybe running or anything like that.
• 21:19
  Adenike Ibikunle: At least 12 weeks.
• 21:20
  Remi Mogekwu: I think that's
• 21:20
  Adenike Ibikunle: You have to do that in
• 21:22
  Remi Mogekwu: think, again I always say it took 40 weeks to get you to the point of delivery.
• 21:27
  Remi Mogekwu: You can't expect
• 21:28
  Adenike Ibikunle: Yeah
• 21:29
  Remi Mogekwu: weeks it will all disappear.
• 21:30
  Remi Mogekwu: You need to give your body at least, I think, the same amount of time to heal properly.
• 21:34
  Remi Mogekwu: And you-- I know we didn't mention this at the top, but you're also a sports physiotherapist, therefore, I trust that you know what you're talking about, and therefore, people listening should hear that as really good advice.
• 21:46
  Remi Mogekwu: But no, Yes.
• 21:47
  Remi Mogekwu: Yes and so one of the other aspects that people, suffer with a lot in silence is sexual dysfunction after having a baby, whether it's from pain some people develop vaginismus, where the muscles really contract and mean that sex is either too painful or actually just feels impossible.
• 22:05
  Remi Mogekwu: Do you come across people like that in the postnatal space, and
• 22:08
  Adenike Ibikunle: Yeah, a lot.
• 22:09
  Remi Mogekwu: for those?
• 22:10
  Adenike Ibikunle: yeah.
• 22:10
  Adenike Ibikunle: So it's one of the most asked question so you wanna think about this pelvic floor has been stressed.
• 22:16
  Adenike Ibikunle: You know, maybe there was a tear, maybe there was an instrumental delivery, so we're talking either forceps or ventouse.
• 22:22
  Adenike Ibikunle: So if there happens to then be pain because the muscles are guarding so within the first six weeks, you don't want to have any sort of penetration.
• 22:30
  Adenike Ibikunle: You want to just skip it, allow your muscles to heal, allow your body to heal at least for six weeks.
• 22:37
  Adenike Ibikunle: Okay?
• 22:38
  Adenike Ibikunle: And then afterwards, then we can begin.
• 22:40
  Adenike Ibikunle: And when you're doing it, it has to be gentle, and you should be able to feedback.
• 22:44
  Adenike Ibikunle: So we teach them, okay, we teach them to, you know, relax, do a lot of breathing exercises just to allow those muscles to relax.
• 22:51
  Adenike Ibikunle: Okay?
• 22:52
  Adenike Ibikunle: And then we do have some stretches that we're able to provide for them.
• 22:56
  Adenike Ibikunle: We send them videos of stretches that they could just do to allow those muscles to relax.
• 22:59
  Adenike Ibikunle: Because if they're anxious, they are guarding as well, it could be painful.
• 23:04
  Adenike Ibikunle: And then the other thing we'll also, we'll also get them to do is use a lubricant just to make things easy.
• 23:09
  Adenike Ibikunle: But yes, pelvic pain, pain with sex, is usually quite common, and people ask a lot of questions about it
• 23:15
  Remi Mogekwu: And I think you're right to say about lubrication.
• 23:18
  Remi Mogekwu: So what we would often recommend is like a water-based one because it's nicer on the vaginal tissue.
• 23:23
  Remi Mogekwu: So definitely if you are gonna use a lubricant, use a water-based one.
• 23:27
  Remi Mogekwu: So the next bit I really wanted to touch on is the pelvic floor and specifically Black women.
• 23:32
  Remi Mogekwu: So I feel that we have a myth amongst us that we don't suffer from things like urine incontinence, the prolapse, the bowel leaking.
• 23:41
  Remi Mogekwu: And if I'm being completely honest, I've worked in East London where there is a high proportion of Black women, they are the minority of my patients.
• 23:48
  Remi Mogekwu: Like, often I'm actually quite surprised when I do see them, and not because we're not affected.
• 23:53
  Remi Mogekwu: Maybe we're affected in smaller numbers, correct me if I'm wrong, or maybe we just don't seek help when we have these things.
• 24:00
  Remi Mogekwu: I guess I'd like to hear your experience in dealing with Black women specifically, if you find that, they're affected to the same degree, or it's a case of they're just not speaking up when they have these issues.
• 24:12
  Adenike Ibikunle: Yeah.
• 24:12
  Adenike Ibikunle: So I come from Nigeria.
• 24:14
  Adenike Ibikunle: And in Nigeria, there is a lot, there's a lot women, women go through, let me say that.
• 24:21
  Adenike Ibikunle: And like you've rightly said, the Black women, I just never see them.
• 24:25
  Adenike Ibikunle: I could say most of my patients are, yeah, either white, Asian, just, yeah, I just never find them.
• 24:31
  Adenike Ibikunle: And the ones that come into clinic, most of the times they never knew that there was such kind of help available to them.
• 24:39
  Adenike Ibikunle: I mean, I even had a student.
• 24:42
  Adenike Ibikunle: She was telling me how they usually tell themselves,"Oh, it's normal now.
• 24:46
  Adenike Ibikunle: That's a normal thing that happens." And I'm like, No.
• 24:49
  Adenike Ibikunle: That is not normal." Okay?
• 24:51
  Adenike Ibikunle: It is common, but it is not normal.
• 24:54
  Adenike Ibikunle: Number one, I think we don't have a lot of education.
• 24:57
  Adenike Ibikunle: I wasn't taught pelvic health in my university.
• 24:59
  Adenike Ibikunle: I got to start learning pelvic health during my first posting.
• 25:03
  Adenike Ibikunle: And it's the same here as well.
• 25:05
  Adenike Ibikunle: When student come in, they're like,"Oh, this is?" So they don't really know that pelvic health really exists.
• 25:10
  Adenike Ibikunle: They don't know that there is help.
• 25:12
  Adenike Ibikunle: They need to understand that these things are not normal.
• 25:15
  Adenike Ibikunle: It's not normal for you to be weeing 17 times in a day.
• 25:18
  Adenike Ibikunle: It is not normal for you to just pass wind without knowing.
• 25:21
  Adenike Ibikunle: It's not normal when you're done wiping, and after a while you still see a fecal, some soft smearing on your knickers.
• 25:28
  Adenike Ibikunle: It is not normal for you to cough and leak, or laugh and leak urine, or jump and leak urine.
• 25:35
  Adenike Ibikunle: These things are not normal.
• 25:36
  Adenike Ibikunle: They're common, right?
• 25:37
  Adenike Ibikunle: But they are not normal.
• 25:39
  Remi Mogekwu: Yeah, and I think that's one of my mantras as well.
• 25:41
  Remi Mogekwu: Just because it's common doesn't mean it's normal.
• 25:43
  Remi Mogekwu: And I think if you think about the whole of women's health, because it's under-researched, it's underfunded, we don't speak about these things, we almost justify the presence of abnormality as,"Oh, but everybody goes through it." And just because it is common doesn't mean there isn't treatment for it.
• 26:03
  Remi Mogekwu: And high blood pressure is common, but people take tablets, you know?
• 26:06
  Remi Mogekwu: So it's the same rationale.
• 26:08
  Remi Mogekwu: And I think you're really correct.
• 26:09
  Remi Mogekwu: So I was in a clinic once, and a older Black woman came through, and she had a prolapse.
• 26:14
  Remi Mogekwu: And one of the nursing staff, who was an older lady herself, an older Black lady, when I was, uh, examining the woman and treating the woman, after the woman left, she was like,"Oh my gosh, I've never seen that." And I was like, You've been in this clinic for how many years?
• 26:27
  Remi Mogekwu: I'm sure you have, but you've probably never thought it could happen to someone that looked like you," and that's where the shock came from.
• 26:34
  Remi Mogekwu: And I'm glad that you said in Nigeria you've seen it plenty.
• 26:37
  Remi Mogekwu: So I'm sure it's happening.
• 26:39
  Remi Mogekwu: It's probably just a thing that's not being escalated.
• 26:42
  Remi Mogekwu: It's not being talked about.
• 26:43
  Remi Mogekwu: And I've had, I've had two children of my own, and I remember when post-delivery I was with a group of moms, I was the only Black one there, and they were talking about diastasis recti, so when the muscles in the abdomen split.
• 26:55
  Remi Mogekwu: And in my head I was just like,"Yeah, that's not...
• 26:56
  Remi Mogekwu: You know, Black people, we have strong muscles." And it's just medical,
• 27:00
  Adenike Ibikunle: Oh my goodness
• 27:00
  Remi Mogekwu: racism, and lo and behold, many years later I'm like,"Oh, actually I do have the thing that I thought I didn't have," because I didn't take the steps of dealing with the pelvic floor, dealing with the core muscles specifically.
• 27:11
  Remi Mogekwu: So yeah, I think all those things you said, they are not normal, and if you have anything that Nike just suggested, you should seek help.
• 27:19
  Remi Mogekwu: You shouldn't suffer in silence.
• 27:21
  Remi Mogekwu: And there is treatment available.
• 27:23
  Remi Mogekwu: So you go through...
• 27:24
  Remi Mogekwu: Often when I see patients I'm like,"You go through the stages of you have conservative management," so that's like lifestyle modification You have the pelvic floor exercises, sometimes you have tablets, especially for the bladder symptoms.
• 27:36
  Remi Mogekwu: And then you go on to surgery if any of those things haven't worked.
• 27:39
  Remi Mogekwu: So if you are a Black woman watching this, make sure that you're aware that these things can happen to us, and if ever you're in doubt, then you should seek help.
• 27:52
  Remi Mogekwu: You mentioned education, and when we think about when women leave the hospital, some of them go with leaflets, some of them go with huge books, but actually, like I know, once you've had the baby, your mind is not there.
• 28:03
  Remi Mogekwu: And you probably don't engage again until you have problems.
• 28:06
  Remi Mogekwu: But what type of information do you wish these people knew either before the baby came, after the baby came, or even years later?
• 28:14
  Adenike Ibikunle: So during during pregnancy I would say Do your pelvic floor Do your pelvic floor And even if you're not pregnant protect your pelvic floor like literally protect that muscle okay Because the honest truth is that you pelvic floor dysfunction doesn't just come from pregnancies or vaginal deliveries You could be lifting hundred kg two hundred kg You could be doing lots of jumping and just weakening a ligament because it's not sometimes it's not just a muscle It could just be a ligament structure that is causing things to just sit into the vagina So do your pelvic floor So with people that have just given birth you know one to two days postnatal I would say first things first and need to you need to be sure that you're getting the urge to go and then when you've been you're feeling like you've completely emptied okay Things not to do never strain on a toilet either to empty your bladder or to empty your bowel Never strain There are positions that you can take when emptying your bladder and emptying your bowel okay If you sit and just strain you just would only make things worse in your diet have good fibers in your diet Make sure you're drinking well Make sure you're walking Make sure you're moving around right All of these things help things to move with your bowel If they've had tears to manage you know the stitches and if they see any sign of infection somebody to call If they're beginning to experience anything with the bladder leaking or anything reach out to your midwife and your midwife would always refer you to a pelvic floor physio So anything that you feel is unusual if you've not experienced it in the last 10 years like just seek help
• 29:42
  Remi Mogekwu: and even mentioning the liquids
• 29:44
  Adenike Ibikunle: Mmhmm
• 29:44
  Remi Mogekwu: what I would tell women in the clinic is avoid caffeine.
• 29:48
  Remi Mogekwu: So caffeine is an irritant.
• 29:49
  Remi Mogekwu: Smoking is an irritant to the bladder.
• 29:51
  Adenike Ibikunle: Yes
• 29:52
  Remi Mogekwu: Fizzy drinks,
• 29:53
  Adenike Ibikunle: Yes
• 29:53
  Remi Mogekwu: at night as well.
• 29:55
  Remi Mogekwu: And drinking water is probably your best bet, and aiming for, like, a liter to a liter and a half of water specifically.
• 30:02
  Remi Mogekwu: But the positions you mentioned, I'm really interested.
• 30:05
  Remi Mogekwu: So I know with the bowel, the idea is that you have a stool in the bathroom, and then you put your feet
• 30:11
  Adenike Ibikunle: Yes
• 30:11
  Remi Mogekwu: to get your
• 30:12
  Adenike Ibikunle: Yeah Yes
• 30:13
  Remi Mogekwu: higher than your hips.
• 30:15
  Remi Mogekwu: And that's something that I actually practice, and have done really since I've had children.
• 30:19
  Remi Mogekwu: But what's the position to empty the bladder?
• 30:22
  Adenike Ibikunle: So with the bladder you don't need a stool okay But you want to sit feet flat on the ground and lean forward Most people when they lean forward or most people when they try to sit on the toilet seat they're literally hunching their back like this trying to wee So no you lean forward with your back straight and your pelvis tilted inwards Just think as think like you're trying to pour a juice out of a big can how you tilt it right So think think of tilting your pelvis inward okay So you're having like a little arc in your back okay And then you lean forward like you lean completely forward while resting your elbows yeah So that that way
• 31:03
  Remi Mogekwu: And
• 31:03
  Adenike Ibikunle: and then you rest your elbows on your thighs
• 31:06
  Remi Mogekwu: Okay
• 31:08
  Adenike Ibikunle: Yeah So that way your pelvis is ready to empty okay the other thing you can do is rock So just move forward move backward move forward So it's just like you know when you're trying to get the last bit of the juice like Come on where are you Push it come on And then you rock backward forward and then sometimes I would say stand up and sit down back and you'd empty a little bit more and that is it for the day Don't strain That is all You've emptied your bladder Nothing is coming out again
• 31:37
  Remi Mogekwu: But okay, so what about when you're out in public and you don't wanna sit on the toilet?
• 31:41
  Remi Mogekwu: Then what do
• 31:42
  Adenike Ibikunle: Now that's that's one issue to be honest You have to sit on the toilet I know that it's not the ideal but yes because when you hang most most likely you will not finish
• 31:54
  Remi Mogekwu: I think I'd rather not finish than sit on a public toilet personally.
• 31:59
  Remi Mogekwu: When I visited America, they had these toilet seat covers in every toilet, which I just wish
• 32:04
  Adenike Ibikunle: Mmhmm
• 32:04
  Remi Mogekwu: the UK, had.
• 32:06
  Remi Mogekwu: But yeah, maybe you go with, like, your own wipes in your bag or your own toilet
• 32:10
  Adenike Ibikunle: Yes
• 32:11
  Remi Mogekwu: to,
• 32:11
  Adenike Ibikunle: ma'am
• 32:12
  Remi Mogekwu: figure it out.
• 32:13
  Remi Mogekwu: yeah, I think I'd rather
• 32:14
  Adenike Ibikunle: Yeah
• 32:18
  Remi Mogekwu: So before we finish, could you talk us through one, short, simple exercise?
• 32:25
  Remi Mogekwu: I know we, you know, we've spoken about positions just now, and at the top we kind of spoke about how to isolate the muscle.
• 32:31
  Remi Mogekwu: But could
• 32:31
  Adenike Ibikunle: Mmhmm
• 32:31
  Remi Mogekwu: us through, like, a really simple, basic exercise that you could do for the pelvic floor that anyone that's listening can do right now before we finish
• 32:43
  Adenike Ibikunle: Just think about closing where you poo and closing where you wee You should feel a lift and then you squeeze So that causes you to squeeze your pelvic floor or should I say contract your pelvic floor and then you relax So just squeeze and relax okay And as much as you can don't hold your breath and I don't want to see all your shoulders up and things like that No Just yeah just close where you poo Or you can just think about like I said sucking the spaghetti into the vagina You just pull that in and relax it So think about it What should be happening is it feels like your coccyx so the tailbone w your your spine the end of your spine and your pubic bone you think about them coming together and opening up coming together and opening up That's basically what you need to do Just squeeze relax At any time you can remember when you're driving when you're just laying down just do it relax Do it and relax
• 33:38
  Remi Mogekwu: Perfect.
• 33:39
  Remi Mogekwu: Thank you so much.
• 33:40
  Remi Mogekwu: I think,, you've touched on so much that's useful.
• 33:42
  Remi Mogekwu: Where can people watching or listening, where can they find you?
• 33:46
  Remi Mogekwu: Where can they connect with you, to learn more about things like this?
• 33:49
  Adenike Ibikunle: You would find me more on LinkedIn If you go to my Instagram you'll find nothing My Instagram is filled with my pictures
• 33:57
  Remi Mogekwu: Okay perfect
• 33:59
  Adenike Ibikunle: find me but yeah that's where you find me
• 34:02
  Remi Mogekwu: So we can find you on LinkedIn which
• 34:05
  Adenike Ibikunle: Yeah.
• 34:05
  Remi Mogekwu: down below.
• 34:06
  Remi Mogekwu: But yeah, I think it, it was a really valuable conversation around pelvic health, and if it's
• 34:11
  Adenike Ibikunle: Thank you
• 34:11
  Remi Mogekwu: resonates with you, drop a comment down below, like how has your pelvic health recovered after having a baby?
• 34:17
  Remi Mogekwu: I've also got a few videos on the channel about the importance of the pelvic floor muscles, how we need to engage them because of all the symptoms that we've discussed here today, as well as diastasis recti which I mentioned that I've had.
• 34:30
  Remi Mogekwu: So feel free to
• 34:31
  Adenike Ibikunle: yeah.
• 34:31
  Remi Mogekwu: those videos, and if you have any specific questions for Nike, drop them down below, but until next time, thank you for watching.