 Fertility Facts Fertility Difficulties are complex and are important to sleuth out with the help of specialists (OBGYNs, both general and specialized), Urogynecologists (particularly for those with persistent pelvic pain), Other specialists (eg. if you have UC or CD, your Gastroenterologist or if you have RA or Lupus, your Rheumatologist) and your GP/NP. Fertility challenges are 40% due to the female partner + 40% due to the male partner + 20% of unknown/interactive (i.e. woman's allergic response to the man's sperm) issues. 1 in 6 couples in the UK sought fertility help in 2019. Over 80% of UK couples will conceive within 1 year of trying and a further 50% of the remaining will conceive within the second year. When we struggle with fertility, it's an often overlooked, challenging, difficult journey (ref: youtube channel of Lauren Mancell (https://celebratemuliebrity.com/2018/09/trauma-awareness-in-womens-health/). 30% of all pregnancies end up in miscarriage. A Woman's "Normal" Cycle
- luteal stage = holding, implanting, high progesterone (maintaining implantation) Know When You Ovulate and Track it Yourself Duration of cycle Ovulation day 22 day cycle day 6 - 10 24 day cycle day 8 - 12 26 day cycle day 10 - 14 28 day cycle day 12 - 16 36 day cycle day 20 - 24 32 day cycle day 26 - 30 Ovulation Information Mittelschmertz - a stabby kind of pain on one side of your lower pelvis when the egg is released. Your mucous is like egg white (stretchy, springy) and is more receptive to sperm, drying out a little after ovulation passes; the neck of your cervix is more open and welcoming. Your basal body temperature (taken first thing in the morning, prior to arising/warm drink) dips slightly at ovulation and rises slightly in the luteal stage. Keep a pen, paper (or phone tracker) and thermometer right beside your bed. Test and record your temperature daily and learn about how your body navigates the monthly-ish cycle. This is to create self-knowledge and to provide helpful information, not for complete focus. It's a "know thyself" moment. A BMI of >19 and <30 is the "golden window" for conception. Habits that help: no alcohol, no smoking, active lifestyle, manage diseases (Hep B/C/HIV), avoid occupational (chemical) exposures, wear loose-ish undies (especially the men), manage/address Endometriosis/PCOS/PID before/during fertility times, wait 3 - 13 mos. after coming off OCPs (the pill) while your body re-establishes its own natural hormonal cycles, avoid use of Ibuprofen (Advil, Motrin). Specific Dietary Recommendations: Mediterranean Diet, plant focused (at least 5 plants/day with a variety of up to 30 different plants per week), nutrient dense, organic/healthy protein sources that aren't processed, add Omega 3's that are algae based, look at your micronutrients (Folic Acid, B12, Zinc, Iodine, Vit D, Selenium, Iron with Vitamin C and without caffiene), Dairy should be high fat, Eliminate transfats, meat < 3x/week with fish > 1x/week, pass on alcohol + caffiene for both women and men, All the Dietary Recommendations equally affect both partners! Sleeping well/restoratively/consistently + Stress management/reduction are hugely important in themselves and need their own special focus! Daily exercise - some cardio, some strength, some flexibility, some restorative….."moderate physical activity" boosts conception success (including IVF) so think Goldilocks (not too little, not too much, just right). Get your hormonal profile checked if you're over 35 or not successfully pregnant within 1 year of trying and/or if you've had miscarriages (2+) to track/check your ovulation and/or have had 3 miscarriages. Egg Meets Sperm Facts Your egg is ready/fertile at 24 - 28 hours after you ovulate. Your sperm can be lively/ready to fertilize an egg for 5 days after being released in a hospitable environment. Find a Pelvic Physio trained in Fertility Support Manual Physiotherapy doubles IVF success rate (specifically myofascial + lymphatic + visceral) by improving the mobility/health of the implantation neighbourhood. Ongoing studies suggest the same result of these therapies for natural pregnancies. Addressing depression + anxiety is helpful. Studies recommend calming yoga (gentle hatha, restorative and/or yin) + Cognitive Behaviour Therapy + mindfulness practices + lifestyle changes to improve sense of self-efficacy and confidence. Consistency is the key, trying one new practice at a time for 4 - 6 weeks, 4 - 7 days/week before adding a second change. Remember small, consistent baby steps (1% change per week) is the best and most helpful, long-term approach. Weight management is vital for both partners so that BMI is stable between 19 and 30. Managing and stabilizing all chronic diseases including coeliac, endometriosis, adenomyosis and PCOS particularly. Cease smoking asap for both partners (refer to Alan Carr's "Easy Way to Stop Smoking" book). Addressing sleep disorders is vitally important as sleep is restorative and a key health factor. This means consistency with bed times, awakening times, cool room, warm feet, darkened windows, quiet or white noise, no blue light 1 - 2 hours prior to bedtime, no cell phone/ipad/laptop in the bedroom, warm bath/shower prior to bed, no snacks after 7 pm….make restorative sleep a priority. Identify and address all physical + emotional + relational stressors in your life. Craft a life that is calm, enjoyable, consistent and with comfort, predictability and joy. If you've had a miscarriage (or 2,3), you may feel loss and grief. It may help to speak with someone with whom you can be vulnerable and open. If you're able to be open and find support, it may help lift the veil of grief for you. IVF adds a whole new adventure/challenge. You may experience heightened anxiety when patience and care, sensitivity and support are what you need. Practicing daily/consistent mindfulness, breathing practices, progressive muscle relaxation and pelvic relaxation/release may be helpful. You may find that psychotherapy (particularly CBT) is an additional self care strategy. Biofeedback (self-taught or mindful training) to reduce stress hormones + improve sleep are recommended. Big self care, self compassion and calm are the bywords to repeat. Your individualized plan:
Property of Joanne Gailius, Full Circle Physiotherapy, Not to be copied without permission.
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 Inflammatory Bowel Disease (Ulcerative Colitis (UC) and Crohn's Disease (CD)) What does a pelvic physio have to offer someone who has IBD? Top Down (stress management + sleep challenges + microbiome support + exercise prescription + lifestyle factors + individualized concerns re: work/play/restoration/meaningful activities) Bottom Up (anal incontinence and/or constipation + bowel functional support/education) treatment, bladder + sexual + pelvic organ support + systemic challenges (skin, joint, eyes…) Focus: What's happening now? What is getting in the way of you enjoying your best, most meaningful life? Write your very unique list. All recent research says that lifestyle (more than medication or surgery) is the #1 most effective way to treat UC and CD or the combo. Facts About IBDs from 2015 - present research: Genetics?: Presence of IBDs has a genetic link, but there is no genetic link to the severity of the disease. Severity of both diseases is clearly linked to lifestyle/diet/smoking/stress management. These are modifiable factors and put you in the driver's seat. Stop smoking immediately (including second hand smoke) - Refer to Alan Carr's book on smoking cessation. Smoking is pro-inflammatory and your job is to reduce inflammation or "put out the fire". Reduce or stop alcohol consumption - 1 - 3x weekly of one beer, one x 5 oz. glass wine or 1 oz. alcohol. No stacking (never more than one at a time). Alcohol impedes a healthy gut microbiome and is pro- inflammatory as well! The Story of IBDs and Fibre? There is no evidence to support a low fibre diet for someone with IBD (most of the time). Fibre is protective for those with IBDs with a minimum of 27 gm fibre/day and preferably 35 - 50 gm fibre/day. It's very old, outdated advice to eat a low fibre diet. Why? - Fibre feeds your microbiome, helps control blood sugar, stabilizes body weight, helps immune regulation in your gut's T Regulator cells, maintains healthy gut barrier to reduce leaky gut, increases the mucous production to keep pathogenic bacteria off gut wall, helps excretion of excess hormones and supports your gut-brain axis (you think more clearly!). Proviso** - If you have a stricture or scar tissue limitations, you may need to eat low fibre until that is released surgically and/or with pelvic physio. Full Circle Physiotherapy and IBDs Page 2 How do you increase your fibre intake? - Low and slow is the motto. Choose one thing from the list below, see how your body responds over 2 - 3 weeks, then try the next. Keep what serves you.
Fatigue - Fatigue is a functional concern for most people with IBDs, but especially women + younger + early stage + if you have pre-existing depression and/or anxiety. Research shows that the experience of IBD related fatigue is very similar to the fatigue people experience while having chemotherapy. Why? - IBD creates an inflammatory state in your body which is anxiety provoking, your gut-brain axis is wobbly (need microbiome support…..see all dietary suggestions above), treatments/surgery are taxing, depression/anxiety/loose stool may interrupt sleep. What can I do about it? - Calm your system/put out the IBD fire, develop a brilliant and varied microbiome, help your system to reduce medical/pharmaceutical/surgical needs by caring for yourself with healthy choices and consistency, then…Practice unwavering, consistent sleep hygiene (daily consistent bedtime and awaken times, safe/comfortable housing, cool room/warm feet, quiet/calm evening routine, no blue lights 1 - 2 hours prior to bedtime, covered windows, no evening snacks, cellphone not in bedroom (no texts/emails/calls during dedicated sleep time), write list for tomorrow on paper/phone and leave it in kitchen)….find what works for you and stick to it every single day/night! Personalized Exercise Programme Daily to 3x/week aerobic + resistance (weights or body resistance) boosts your immune system's response (but studies show that it didn't change bowel function). Aerobic exercise for 30 mins. x 5/week helps support your heart health, gives you a sense of calm (endorphin release) but can activate the bowel. Keep timing and fatigue in mind. Most folks with IBD choose early morning for their run/bike/swim. Calming exercise, like yin yoga and/or a regular gentle stretching routine can help reduce stress, anxiety and promote sleep. No surprise that this can be a lovely part of an evening time to promote sleep and calm the mind. Full Circle Physiotherapy and IBDs Page 3 Mental Health Considerations
Pelvic physios are trained in incontinence of bowel and/or bladder, bowel management (constipation et al.), sexual function/dysfunction, pelvic organ support, persistent pelvic pain and more. Any of these challenges may be within the experience of those who have IBDs. Prehab and rehabilitation from abdominal/pelvic surgeries, including ostomy surgeries, is part of our work as well (scar tissue release, tendomyofascial release, posture, abdominal/pelvic recruitment + strengthening + function and more). As a very specific example, the puborectalis muscle (a sling shaped muscle that wraps around and supports the anorectal canal) can become over-recruited and tight in some people with frequency/loose stool and functionally impedes the movement of the stool as it exits. It then looks like constipation, but is actually the opposite! A pelvic physio can help with manual therapy (releasing the muscle) and teaching you to accomplish this yourself with breath, positioning, your own hands/therawand…..even how/when you toilet. Assessment and treatment are yours to choose/guide. If you contact a pelvic physio, ask if they are trained in anorectal dysfunction prior to your appointment. And if you have any questions or concerns, please feel free to email me at jgphysio@shaw.ca and/or peruse my website: fullcirclephysiotherapy.ca. Property of Full Circle Physiotherapy  Strategies for Menstrual Health You'll have about 400 periods in your lifetime, so track them, learn about your experience and how to thrive before, during and after each cycle.
Try one idea at a time to learn what works best for you. You are unique as are your cycles. What looks like a good idea for me? Practical? Applicable? During, before or after my period begins?
Property of Full Circle Physiotherapy, updated July 2022, not to be copied without permission.  Kegels or Pelvic Floor Muscle Training (PFMT)by Sue Croft Physiotherapist | Jun 5, 2022 | Prolapse and pessaries, Urinary incontinence, Women's Health | 0 comments
There has been some recent bagging of Kegels (aka pelvic floor exercises) on Instagram and other important sources of life information and seeing as Influencers only need a good PR team and some sassy photos to extend their reach into the millions, I thought I’d post a very quick, short blog to put the alternative, supportive argument to not ditch Kegels before it was too late. In Australia, we actually don’t tend to use the term Kegels much but as this new trend is saying to Ditch Kegels, I am using that term in this blog. I am immediately stating my natural bias, that as a pelvic health physiotherapist, I have a strong evidence-based opinion on the value of actually seeking a pelvic health physiotherapy consultation to internally examine (with your consent) the status of your pelvic floor muscles and to validate what your best treatment programme might be to help your ‘pelvic floor distress’. The important thing to understand is that PF exercises or Kegels are just one part of a Big Apple Pie of treatment strategies. What that means is that addressing all components of a programme will lead to an excellent outcome for improving urinary leakage or bladder urgency or obstructed defaecation or faecal incontinence or pelvic organ prolapse or pelvic pain – NOT just Kegels. Let’s briefly dive into what affects the pelvic floor muscle strength. The levator ani (pelvic floor) muscles are stretched by 1.5 to 3 times their normal length during a vaginal birth, depending on the size of the baby, the baby’s head circumference and the mother’s pelvic outlet. Structural damage can occur to the PF muscles by directly tearing the muscles partially or completely from their attachment on the pelvis (called levator avulsion), from micro-tearing within the muscles which can lead to overdistensibility of the muscles or nerve damage (by compression or traction) which causes temporary or permanent weakness of the muscles. Levator avulsion occurs in about 20% of all vaginal births and is strongly associated with: the age of the mother, (occurrence more than triples during the reproductive years from below 15% when the mother is aged 20 years, to over 50% at when aged 40 years) (1); long second stage of labour; posterior presentation of the baby; head circumference > 36cm(2); baby’s weight over 4kg and the use of forceps, but it can also happen in vaginal deliveries with no instruments. (3) A pelvic health physiotherapist can give you insight into the possible changes that have occurred to the muscles, but also encourage and focus on ways to regain strength through targeted strategies such as: education regarding the correct activation of the muscles, biofeedback, electrical stimulation to the muscles through a hand held machine, weighted cones and especially functional pelvic floor strength work through supervised exercise. Kegels or pelvic floor exercises can seem worthless or useless if you have sustained a significant injury from a vaginal birth because you can’t seem to make the muscles work and therefore Kegels lose credibilty if that is all that has been offered to the patient (who then may go on to become an Influencer). Pelvic floor muscle training (PFMT) is a well-researched treatment strategy which is one (important) aspect of any pelvic health management plan, but may be completely inappropriate as a “one treatment fits all” package – particularly if a woman’s main complaint is pelvic pain. In fact if you have pelvic pain, you may be asked to focus on relaxing your pelvic floor (and tummy) muscles and avoid Kegels until the pain has resolved. So what are ten quick points to pay attention to when performing Kegels or pelvic floor exercises? • Do not hold your breath at all. Learn to breathe normally as you do any exercise. This is very important. Learning to exhale on effort will protect your pelvic floor rather than holding your breath. • Do not try too hard at first and stop if you sense any pushing down or bulging around the vagina. Check this by feeling with your hand. This is called ‘bearing down’ and can make your prolapse or incontinence worse if you continue. • It’s all about the timing and endurance of the muscles not just strength. If you have had nerve damage or muscle avulsion then we cannot cure that at this point in time. So if your muscles are very weak, then it is imperative that you recruit and strengthen what is available to you at the correct time. • Use reminders for your exercise session: Perhaps use coloured stickers around the house to remind yourself, or when you clean your teeth, turn on the kettle or whenever you walk through a doorway. If you have poor sensation and difficulty in recruiting the muscles, then it is best to do your exercises in a quiet room, in a very focused way, so you are sure you are doing the exercises correctly. Using an image of the pelvic floor muscles will get your brain involved and remember you do not have to get on the floor to exercise these muscles! • Remember to brace or engage before effort. Gently draw in your pelvic floor muscles before and as you cough, sneeze, lift a weight (especially toddlers), get out of bed or a chair, and anything that is strenuous. It will become a life-long habit or ‘knack’. • Relaxation of your tummy and pelvic floor muscles is very important especially if you have any pelvic pain. Balance all tightening with plenty of relaxation. • Move so you decrease strains on your body. When getting out of bed move through your side; divide heavy loads into smaller parcels; be aware when picking up toddlers (especially in the early days after a new baby); and teach young children to be independent to minimize lifting them. • Regular pelvic floor muscle training is for life and can improve stress incontinence and severity of prolapse. Incorporate these exercises into your activities of daily living. • Allow time for improvement and ensure all strategies become life-time habits. • These strategies are for life! 3 monthly phone diary prompts to remind you of all those strategies. And NUMBER 10: Once you have sorted your bladder, bowel or prolapse issues consider having a review from a pelvic health physiotherapist yearly. This way you will get on to any deterioration in function early. References: (1) Dietz HP (2009). Pelvic Floor Assessment. Fetal and Maternal Medicine Review, 20(1), 49-66. 10.1017/S096553950900237X. (2) Rostaminia G, Peck J, Van Delft K, Thakar R, Sultan A, Shobeiri SA (2017) New measures for predicting birth related pelvic floor trauma Female Pelvic Med Reconstr Surg 22(5): 292-296 (3) Dietz HP (2013). Pelvic floor trauma in childbirth. Australian and New Zealand Journal of Obstetrics and Gynaecology, 53(3), 220-230. 10.1111/ajo.12059. (4) Sue Croft (2022) Pelvic Floor Essentials book  Find Your Own Body…..How to Feel Your Own Pelvic Movement
Learning to feel our own discreet, hidden away pelvic floors is a thing! We can do it from the outside with our clever hands and brains, breath and movement. It's our brilliant and amazing bodies finding how to move with ease, support our organs, breathe in many different ways, manage pressures inside our bodies and in daily life. All of it! It's super simple and here's how. Start by standing up and reaching down with your long, middle finger to feel your very own anus from the outside; the "external anal sphincter" is her full name. Studies show us that feeling with your mind's eye and with your finger is the best indication of the activation and release of your pelvic floor. You can use both hands or just one hand (which is easier). Hold your middle finger on your anus and let your index and fourth finger rest on either side of your anus. They're helping you feel the action! Now…the action:
Would you like a different view/feel/idea? Let your finger go a little north of your anus and rest on your tailbone or coccyx. It's the tiny triangular bone at the base of your spine; it's an attachment point to your anus and other pelvic floor muscles. See the tiny bone angulated forward on the picture? It has a big role in pelvic muscle function! Now….the action:
Homework….ask yourself:
 Pelvic Pain conditions are so common.....1 in 10 Canadian women have endometriosis, 1 in 10 Canadian women have always experience painful sex (primary dyspareunia).....and that's just the tip of the pelvic pain iceberg. There's painful urination, postpartum vestibulodynia, postmenopausal genitourinary syndrome, evacuation disorders of the bowel, proctalgia fugax......many, many more.
But there is a commonality in many pelvic pain syndromes (with the HUGE proviso of "please see a pelvic physio, get diagnosed and proceed with a bespoke programme) that are summarized in this self care document. Self Care for Pelvic Pain Conditions Mar 2022 Goal: enjoy life's activities that stay as sub-threat (no grizzly at the door), non-nociceptive (always staying pain free), fun (laughter, silliness and joy) and fulfilling function (meaningful work, play, restorative activities). Where we start: You are normal. You're not broken. Everyone is different. You are unique. Where we're going: You're in the drivers seat; you're in control. The pain is happening to you (yes), but you can control the volume and choose your response (YES). Pain is part of life (inevitable) but suffering is optional (you can change the story of the pain you've experienced). How we do this: We help you learn to calm your pain response. Firstly, you calm the pain response down, then you build yourself up. Self Compassion takes three roads:
Control your thoughts:
**Specifically effective in reducing pelvic pain as the pelvic floor muscles + jaw muscles are the first and most active muscles to respond to anxiety or stress or fear or pain (or all)** 3 Good Things Practice: write down the 3 good things that happened today (Keep it simple: You woke up safe and warm in your bed, You had coffee, You can take time to write 3 things down) within 3 minutes Movement: Balance out your movement and rest, leaning towards shorter more frequent rests and consistent, happy, gentle, calm movement through your day
Food You Eat/Nutrition: evidence based food choices to reduce inflammation and influence pelvic pain, All evidence points to a healthy, whole food, organic, plant based diet ("Real food, Mostly plants, Not too much").
Self medication with opiods, alcohol, cannabis - have a look at your short term use and long term goals….do they match up happily? Are there other options that are non-medicative, non-addicting, narcotic-free? Yoga: classes at The Yoga Room with Barb Minichiello, Gail Thompson or Stephanie Derraugh and/or online with Shelly Prosko, Part A for quieting, Part B for activating on Vimeo (clientdiscount10 for 10% discount) **Twice weekly for one hour over 6 weeks is effective in reducing pelvic pain on long-term studies** **Three poses specifically help: Legs up the wall, reclining bound angle (fish), Savasana (corpse)** Sleep: good, consistent sleep reduces your pain perception and improves your pain resilience, ask for sleep hygiene handout/help. Skin Support:
Do a monthly vulvar and vaginal assessment with a hand mirror (ask for the handout) of your skin condition, your movement with breath, bearing down and closing/lifting. **Property of Full Circle Physiotherapy, not to be reproduced without permission** Joanne Gailius, BSR, PT/OT Physiotherapist Full Circle Physiotherapy C2 - 1204 NW Blvd. Creston, BC Ph 250-254-3494 Fax 1-855-655-5281 jgphysio@shaw.ca How to Fully and Completely Empty Your Bladder or How to Void Well (pee, tinkle, wee, widdle, micturate, go to the loo……) First, what is normal, healthy voiding for an adult woman or man? Think about each of these statements and ask yourself, "Does this describe me?"
Now…..when you arrive at the toilet, there are some tricks to keep in mind.
Joanne Gailius, BSR, PT/OT Physiotherapist Full Circle Physiotherapy C2 - 1204 NW Blvd. Creston, BC Ph 250-254-3494 Fax 1-855-655-5281 jgphysio@shaw.ca Mar 2020  Topic of the week at Full Circle.......post menopausal women in their 60s, 70s and 80s
working hard, busy harvesting in this agricultural valley and frustrated! In pain! Pushing too hard! Not coping, not sleeping, not restoring. This blog is a loving reminder that after our bodies are no longer supported by estrogen, we aren't as physically strong as we once were BUT even moreso, our endurance will have waned somewhat. There are some habits that will bring us joy in doing those meaningful work, rest and play. Here are my suggestions: 1. Jot down your list in pencil, then prioritize. What 3 job actually need doing today? Which ones could wait until tomorrow or tomorrow's tomorrow? 2. Know when you have the most physical, emotional and relational energy. Match the job to the time with some cleverness. 3. Stay ahead of your endurance dips. Plan a wise, intentional, constructive 15 minute rest mid or late morning and repeat that in the afternoon. Don't wait until you're at the over and out stage! You'll know that you're becoming brilliant at this when you feel pretty lively in the early evening and have the energy to enjoy some fresh activities when the sun is going down. 4. Support your sleep. Get boringly attentive to the same time, the same place, the same room, fresh air, warm bed, comfortable sleeping duds, no tech in the room (use a non-cellphone alarm)......think of when you were desperately trying to get your babes to bed and treat yourself with the same brilliant sleep support. 5. If you enjoy a daily glass of wine, have it at lunch rather than dinner or evening. Wine can create a pancreas-induced awakening in the wee hours. 6. Awaken with energy......you'll know that you're doing all of the above well when you awaken with energy, not ache and pain and dread. 7. Go for a walk. Those big muscles that move you through space (your gluts) are made for the job. Enjoy a walk daily. Breathe in deeply and stand tall at each telephone pole that you pass, letting your arms swing with each step. Enjoy the freedom of movement, the place that we get to live and the beauty of the onset of autumn. 8. Make time for something that you truly enjoy. Knitting? Reading? T'ai Chi? A phonecall with someone that you miss? An email or an old fashioned letter? 9. Most Importantly - Know your priorities, moderate your expectations and have respect for your age and stage. You're one of the lucky ones who is here with all the wisdom that the years have brought. Some self-compassion and self-care (not just self-soothing.....a pedicure and manicure are wonderful, but self care is the practice of employing daily habits that provide you with optimum health and joy) go a long way. Take care of yourself.  As the days are shortening, the evenings are having a sense of chill and we're harvesting tomatoes and peppers.....we begin to see the glimmers of summer's end. "Unprecedented" describes the summer of 2020 in every way. It's been a summer of constant change, resiliency developed, losses noted and a deeper sense of home for so many of us. No traveling? You've stayed home, found your place, your town, your city. Not visiting restaurants? You've cooked at home more, enjoyed takeout, eating in the park, shared meals with family more often. Not going to the gym, pool or ice rink? You've walked, biked or just rested. Or???
Interesting times. This is a short blog, a simple nudge to check in and take care of yourself. Check in with the human in the mirror. Notice how you're feeling, how you're thinking, how your body is responding to today and all it has brought to you. You don't have to begin to journal or meditate. Checking in with your one and only home, the body you inhabit is a gift to yourself. Our body "keeps the score", noticing all the experiences, interactions, life habits that we experience every day. Are you holding tension in your shoulders? neck? pelvic floor? hips? feet? What would it feel like to let that go? Maybe tighten up your tight area more....more..........more. Then release! Is that different? Is your posture restfully letting gravity pass through you when you're standing up? Or are you a "bum tucker", "chin poker" or "sloucher"? Begin at your sit bones (in standing).....rock them back and forth with your breath, then let them release just when they're pointing straight to the ground. Feel them! They're an amazing pair of dense, thick, strong bone that is the centre of your pelvic floor and your sitting destination in the chair. Hold that. Then lift your sternum (breast bone) up to the sky. You'll feel your braband lift off your front ribs, your mid spine activate right where your bra does up, your shoulders rock back and settle and feel an urge to take a brilliant, nutritious deep breath! Hold that. Finally, tuck in your chin towards the back of your head, not tipping forward, simply making a wee double chin. You might feel an urge to clear your throat or swallow. Hold that. Now notice how that feels. Look forward. Feel tall and strong. Really Strong!!! Gravity is passing directly through you, through the curves of your spine that provide you with spring-like responses to movement, through your strong, dense cortical bone and your balance will be dynamic and spunky. There is no perfect posture. Each of us is built differently, has had different experiences in life and does different things with our body each day. But you can enjoy ease in your body by taking time to check in and find ease-filled, gravity-enhanced, respiration-supported posture and movement through your day. When you notice that life feels heavy, that losses feel cumulative and "life as it was" feels distant, find your strong posture, your gravity defying self. Breathe fully. Balance well, Stand and walk with ease.  The second chapter on men's pelvic stories is a more specific look at how men (and those who love them) can work through pelvic challenges, focusing on prostate cancer, surgery and treatment. The first chapter talked about the pelvic problems that a man may face. The good news is that with pelvic physiotherapy and a solid commitment to follow through with the work at home both before and after surgery and treatment, complete resolution of both leakage and impotence is possible. Each man will have varying severity and duration of these physical side effects and they can lead to a much reduced quality of life. You can rewrite your story with help.
The protocol that is described here leans heavily on the brilliant work of Jo Milios in Australia, a pelvic physio devoted to men's pelvic health and aided by over 3000 men who have had radical prostatectomies. Men who followed this protocol had much less leakage, much reduced duration of leakage and a much improved quality of life throughout their recovery time. Even more convincing is the statistic that 1 in 6 men had no leakage whatsoever! For 4 - 6 weeks prior to surgery and resuming immediately after surgery, men are taught the following protocol: six times daily, in a standing position, two exercises are performed. The first is 10 fast twitch (or speed 'ems) maximal (full on!) contractions and releases. These are followed by 10 slow twitch (endurance building or hold 'ems) contractions, holding each for 10 seconds with a 10 second relaxation time between each contraction. It's important to find "the right muscles". Try this: squeeze the front passage as if you're stopping the flow of urine, then lift your testes and retract the penis. Doing these exercises in standing is important as this is the position in which most men leak. With your pelvic physio, you'll learn awareness of which muscles activate correctly, then how to release fully and more! The importance of "pre-hab" or beginning training prior to surgery can't be reinforced enough. The time between biopsy/diagnosis and surgery is a time to begin learning about your pelvic function, strengthening and releasing. Bladder control (voiding with control and fully 6 - 8 x daily or learning to do so) and a happy bowel really make a difference as you head into the choppy waters of surgery and treatment. Jo's research has shown that men respond very well to the improved physical control of their waterworks and sexual function with this help, but additionally they are emotionally and relationally so much stronger! Her goal is to improve the quality of life for all undergoing prostate cancer diagnosis, surgery and treatment. Let's get specific....one appointment for assessment/training is sufficient to help you begin. Palpation can be done externally in most cases. Your important three muscles that control your urine, the trio that you need to learn to turn on and off and strengthen are called the external urethral sphincter + bulbocavernosus + puborectalis. Sometimes that pesky external anal sphincter gets dominant and you need to learn to teach it to quiet down. Once you've found these muscles, you'll move onto working in synergies, becoming powerful (for coughing and sneezing), strong (for sit to stand and lifting), having endurance (for standing and walking), improving the quality of contraction/lifting of the pelvic floor as well as improving release/relaxation in order to support the next contraction. The toughest bit? Fatigue. Standing upright will fatigue the system and that fatigue may worsen as the day progresses, causing leakage to occur. Many men will have overactive muscles that need to learn to release and NOT exercise at first (called pelvic downtraining), some men will vary |
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