In women’s health and fitness circles, Julie Wiebe doesn’t need an introduction. She’s a world-renowned sports medicine and women’s health physiotherapist whose passion is helping women return to fitness after giving birth. Julie’s evidence-based approach to post-pregnancy rehabilitation promotes diaphragm and pelvic floor integration, strengthening women’s cores for function in fitness and in life.
See previous posts with Julie Wiebe:
Fix Me After Pregnancy: Diastasis Recti
Fix Me After Pregnancy: Belly Binding
Fix Me After Pregnancy: Pregnancy and Post-baby Exercise
Discussing the Pelvic Floor with Julie Wiebe, Women’s Health Physiotherapist
Jen: How does diastasis recti affect a woman’s pelvic floor function?
Julie: One of the best analogies I have ever heard was from physiotherapist Rhona Kotarinos.
If we take a straw and submerse one end in a glass of water and then put a finger over the top of the other end, we create a closed pressure system. When we lift the straw out of the glass, some of the water stays in the straw. The water remains in the straw until we lift the finger off the top, breaking the seal on the pressure system and all the water runs out the bottom.
Our bodies should be a closed pressure system (the straw in the glass). Diastasis recti is like a hole in the side of the straw. It breaks the seal of the pressure system and the result is that women often leak. This is such a good analogy and blends well to the other pieces of our discussion to try to create and maintain a balance of the muscular structure (straw) and the pressure system (water). That change in the pressure and muscular system balance created by the diastasis can also contribute to pelvic organ prolapse, constipation, etc. too!
Jen: Studies show 30-50% of women experience incontinence issues after having a baby. Some women may experience this when they run, some when they sneeze or laugh. There are varying severities…. Is any incontinence considered normal?
Julie: Short answer – NO! Longer answer is we have “normalized” leaks because they are SO common. This is tragic, and women need to demand more, expect more, and understand there is more!
Jen: What does incontinence tell you about a woman’s body?
Julie: The deep system of muscles and pressures we’ve been discussing, our ‘core’ is the same system that helps us control our continence. So to me incontinence is just one of many signs that the system is not balanced. For some the imbalance shows up as a faulty breathing pattern, inefficient movement, balance issues, or an ache or pain. We are growing in our acknowledgement that incontinence is just evidence of a faulty system, instead of our classic understanding that it is just a weak pelvic floor. If we look at it that way, we can also start to remove the stigma and silence around leaks. This also helps to explain why teen girls, women who have never had children and men struggle with incontinence too.
Jen: What do recommend for preventing and/or rehabilitating a damaged pelvic floor?
Julie: Similar to how we would treat diastasis recti, this is a multi-factorial issue not just a tummy muscle issue. A pelvic floor needs rehabilitation as a part of the SYSTEM that controls continence or supports and restores a prolapse. This is a switch in messaging to women. We have always been told that the pelvic floor acts alone to control continence, so addressing it with Kegels has been the only solution offered. I am suggesting something different. Use it in conjunction with the team of muscles it works with (diaphragm and TA) in a coordinated way as the foundation for movements and exercise.
The pelvic floor actually rises and lowers with the rhythm of the diaphragm. It moves! On inhale it lowers, and on exhale it rises. I like to think of this coordinated interaction as a Piston. When we use the system in this way we are training the pelvic floor to move up and down, to bounce and absorb impact in running and athletics. We are training the pelvic floor to respond to the pressure in the abdomen, not be overwhelmed by it causing a leak or pressure or a prolapse.
We have talked about alignment already, but alignment or form in exercise and every day life is a big piece of creating the availability of the pelvic floor and its teammates to do their job well. We are growing in our understanding of how alignment also helps to modulate the pressures in the abdomen during activities and fitness. More tips on this are here.
If women are interested in a program to help pull all these pieces together, I created a self-paced program designed for specifically for women available as an online course or DVD through my website. The focus of the DVD/online course is on incontinence through restoring the coordination of that deep core system, but because the same system helps restore the deep core it helps heal a diastasis (3+ or smaller) as well. In addition, I had great feedback from women with pelvic pain who have used it as a starting point to help learn to return to activity and gentle exercise. We recently published an exploratory research study on the program, and in 3 weeks 85% of the women experienced an improvement in their incontinence! You can read more details from the study here.
Find a physiotherapist in your area:
Check out Julie’s online course:
Julie offers a self-paced video series offering the latest concepts, exercises, movement strategies and body awareness tips for rehabilitating your pelvic floor, minimal to moderate prolapse, diastasis recti, and pelvic pain. The skills learned in this course can easily be integrated into your day.
Time: 1.5 hours, divided into six brief segments.
Price: $29.95 USD
Click here to find out more
Fix Me After Pregnancy Series
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