Painful sex: how to use vaginal dilators to stretch your vagina

There is this myth going around in our society that it is “good to have a tight vagina” – but good for who exactly?! I’m asking you.

What if I was telling you that most of my clients consulting for painful sex issues present, in fact, a tight vagina, and it sure makes their sex life not pleasurable at all! Is that good? It sure ain’t.

There is a difference between having a healthy muscle tone in your vagina so you can have good sensation during sex, versus having a high tone and tight pelvic floor. Hypertonic pelvic floors are NEVER good and healthy – they can cause pain, incontinence, overactive bladders and so on. We want those tissues to breath, to allow stretch, to be dynamic, to move!

BUT HEY – that was not the point of my post actually. I wanted to tell you that if you feel like your vagina is so tight that penetration feels like sandpaper in your lady bits or like trying to fit a banana in a toothpaste tube, this video is for you.

This is for you, post partum mom who had vaginal tearing or episiotomy, or simply a challenging healing time, and now feels like sex is no longer the same and that there is not enough space down there.

This is for you, menopausal women who had no sex for years and just met a new partner, and discovers the sad reality of “use it or lose it”. Indeed, after a certain age, if we do not have sex very often, the vagina can actually shrink…! But hey, you can get it back!

This is for you, young woman in your 20s who has never been able to insert a tampon without pain, or never been able to have painfree sex ever since you became sexually active. You are actually starting to think that this may be how sex is supposed to be, and may start wondering why people even have sex.

PLEASE DO NOT ACCEPT PAINFUL SEX AS YOUR REALITY!

Return to running after birth: do you make the cut?

When should you return to running after delivery? There is so much controversy about this topic, and I thought I would share the updated 2019 guidelines to enlighten your decision making. Remember that these tests are only one part of the puzzle, and that a Pelvic Health PT assessment should also be part of it to make sure that you core and pelvic floor are ready for it too.

What’s the risk of going back to running without meeting those criterias?

You may put yourself at risk for permanent damage/injuries such as vaginal prolapse (when your bladder is descending into the vagina), or even pelvic/low back pain. Or you may get lucky and nothing will happen. But do you want to take that chance?

I have had clients who regretted not having been informed about holding off on high impact after birth, as they dealt with low back pain or vaginal heaviness for years after the fact… until they finally consulted with a pelvic health PT to address it. Believe me ladies, it is not worth the risk, especially if a few weeks of adequate exercises prescribed by a Pelvic Health PT can prevent those injuries.

Watch my 10-min video below to test where you’re at 🙂 

Also, if after going through these tests you feel like you make the cut, please ensure to go back to running very progressively – starting with some walk/run, flat course, short distances, slower speed, etc.  A pelvic health PT can guide you in the progression. You can find the updated guidelines at p.5 here for more details 🙂

Leaking urine: weak or tight pelvic floor?

Many people think that if they are leaking urine, they must necessarily have a weak pelvic floor. Starting from this assumption, they start doing Kegel exercises, and sometimes make their problems worse! Why is that?

In this video, I am drawing the distinction between a weak and a tight pelvic floor, and why Kegels can be harmful in some cases!

What to expect after your vaginal delivery?

One of the things I hear the most from my post partum moms is “No one told me this could happen..!”

Indeed, not many women are informed about what to expect in the pelvic area after baby is born. We spend soooo much time preparing for labour, birth and baby’s care. But once these adorable little humans are out of the uterus, it can be comforting to know what is normal and what’s not. No one needs an additional source of anxiety when trying to take care of a newborn, am I right..?

So here’s a list of the most common pelvic symptoms you may face after delivery:

1- Pain and soreness in the perineum

The perineum refers to the area between your vagina and anus. After all it’s been through, normal that it may feel sore and painful for a few days.

Your best friends will be: ice packs, sitz baths with witch hazel or calendula infusion, witch hazel pads, peri bottle to clean after urination & bowel movement, pain medication if needed. 

2- Painful bowel movement, hemorrhoids, blood in stool, constipation

Again, depending on how your birth went (pushing time, baby’s position, baby’s size, use of forceps or vacuum, tearing, etc…), your rectum area may have taken a hit in the process. Totally normal to have some of these symptoms for the first few weeks.

Your best friends will be: anurex (cooling device for the rectum – available to purchase at my clinic), stool softeners, squatty potty (to have a more optimal position on the toilet), ointment (ask your doctor), donut cushion. For constipation: water, fibre & magnesium supplements. For more detailed info about this topic, read my post about bowel health!

3- Difficulty to hold urine, stool or gas

That is to be expected to a certain degree for the first 2 months after baby. You may feel urine coming out with laughing, sneezing or coughing, or even on the way to the bathroom, or at random times. You may feel like you cannot hold gas anymore, and that you have to rush to the bathroom to make it on time when you need to have a bowel movement. These symptoms can be quite embarrassing to deal with, but they should slowly get better over time. Starting on your pelvic floor exercises a few days after birth should speed up your recovery. After 8 weeks, it is not normal to still present these symptoms and you should definitely consult a Pelvic Health PT if that’s the case.

Your best friends will be: pads specifically made for incontinence (such as Poise) – they breath better than menstrual pads and will be less irritant for your skin

4- Vaginal heaviness / feeling that something is falling out of your vagina

For the first few weeks after birth, you may feel like your organs are falling out of your vagina if you stay on your feet too long or go for a walk. My suggestion is to:

  • Try and avoid activities that trigger heaviness, and ask your pelvic health PT about how to modify your activities to reduce pressure on your pelvis
  • Address any constipation issues – straining on the toilet is a major risk factor for prolapse
  • Avoid lifting more than your baby weight for 4-6 weeks – split your loads (ex: grocery bags, wet laundry baskets) and use your support network for domestic tasks
  • For families with toddlers: try and explain that mommy can only give hugs while sitting for now, and find creative ways to make them more independent to get into bed / vehicles so you do not have to lift them too often (ex: monkey ropes, ladders, stool to climb onto the bed). If you make it fun and interesting, they are more likely to collaborate 🙂
  •  Spend 5-10 min with your pelvis elevated when you present heaviness sensations (ex: lying on the floor with calves on the sofa or a chair, and a few cushions under your pelvis to elevate it)

Your best friends will be: anti-gravity pose (calves on a stool with pelvis elevated) or horizontal position when symptoms occur, pacing yourself to avoid triggering symptoms, squatty potty, stool softeners, support network to reduce domestic tasks

5- Intercourse may not happen @ 6 weeks postpartum

OK: first, most couples return to intercourse between 3-6 months after baby is born – those are just the statistics. The famous “6-weeks green light” from the doctor can be quite a source of anxiety for many women, actually. Indeed, some moms feel the pressure to get back to sex ASAP, when in fact they still have lots of healing to do, both physically and emotionally especially if they have experienced birth trauma.

Not to mention that moms may feel exhausted, overwhelmed, anxious or depressed. They may have a low libido, sore nipples, and vaginal dryness from breastfeeding. On top of that, they are figuring out their new role as a mother, their new routine, how to care for their baby, how to heal their body, etc. They are learning to take care of their postpartum body, but they may not feel super sexy while they are figuring it out. How are they supposed to want sex in these conditions?

Now – you have worked up the courage to try intercourse again. You were seeking that connection with your partner and you were also curious to know how it would feel like, especially that your doctor told you that your tear was healed. However, a well healed tear does not necessarily translate in a pain free tear. Some women may have no pain with sex at all after a 2nd degree tear, and some others will barely be able to tolerate penetration after a 1st degree tear. Why is that? Because no one heals the same – some people will have more scar adhesions than others, reducing the mobility of their tissues (which causes pain). Other will have tight pelvic floor muscles as a result of their birth, and this can cause pain too.

Bottom line is: painful sex after birth is a thing! A very common thing, but it does not mean that you should accept it as your new reality. There are so many things we can do to help you, so please do not suffer through and consult 🙂

Your best friends will be: lubricant, Book “Reviving your Sex life after Childbirth” from Kathe Wallace – she shows great massage techniques to help with scars, pelvic health PT consult, Sofia Fortin from the Happy Vagina Project & her Sex After Kids masterclass

I hope I did not scare you with this post – but I just wanted to let you know that these issues are super common after birth, so don’t panic if they happen to you. But most of all, I want you to know that Pelvic Health Physiotherapists ARE YOUR BEST FRIENDS for your postpartum recovery. They will carefully listen to your birth story, let you cry if you need to cry, let you share your concerns without discrediting them. They will ask you all about your urinary, bowel, pelvic pain & sex symptoms, and they will make a plan with you. They will guide you through your recovery, so you are not alone.

You are not alone, mamma, and you deserve the best.

xx

Sophie

 

 

 

Bladder health 101

As any part of your body, your bladder can become unhealthy if you don’t take good care of it. That’s when people start consulting me for overactive bladder issues (going to the bathroom too frequently), urinary urgency, incontinence and so on.

What can you do to keep your bladder healthy? Here’s a few pro tips!

1- Stop going to the bathroom “just in case”: there is a muscle around your bladder, the detrusor, and if that muscle does not get stretched enough because you are constantly emptying your bladder before it’s full, this muscle can become stiff overtime! Start listening to your bladder signals to maintain a good bladder capacity – it will tell you when you need to go, no need to anticipate it 😉 This is also valid for any parent who may be encouraging their kids to go to the bathroom just in case – I tell ya, these kids will be in my office for overactive bladder issues when they grow older! It’s okay to do it for a “one off” before a long car trip, but in the day to day, try and teach them to listen to their bladder signals 🙂

2- Stay hydrated: to provide your bladder with a healthy, non irritant environment. What does that mean exactly to “drink enough water”? If you look at your urine colour, it should be pale yellow – not dark (exception is made for the first pee of the morning). The darker your urine, the more irritant for your bladder, which can in turn creates symptoms like urinary urgency (that unbearable sudden feeling that you need to go to the bathroom right now and you can’t postpone it!)

3- Be aware of bladder irritants in your diet: coffee, carbonated drinks, sugar, spicy & acidic food,  alcohol can all be triggers for urinary urgency and frequency, as they are considered bladder irritants. If you suffer from these symptoms, try to eliminate one item at a time for a few weeks to observe the effect on your symptoms. If you don’t have symptoms, just make sure to keep a healthy balance in your diet so you do not develop symptoms in the future.

4- Avoid straining while urinating: I know sometimes it is tempting when you are in a rush to try and  push your urine out through holding your breath. But all this extra force on your bladder can be damageable over time and lead to a bladder prolapse (when the bladder starts descending into the vaginal canal). Instead, take a few extra seconds to let your bladder empty on its own as you release your pelvic floor muscles. To do so, visualize the blooming of your vagina and release all the muscles around your vagina and urethra. You can do a gentle contraction of your pelvic floor muscles once the last few drops have gone through, in order to close the urethral sphincter properly – this is super helpful especially if you have symptoms of urine dripping while standing from the toilet. If you have no clue of what I am talking about by contracting and releasing your pelvic floor, consult with a Pelvic Health physio, or watch my video:

5- Do not hold urine for too long: meaning more than 3-4h between voids (depending on your liquid consumption). As much as it is not recommended to go to the bathroom too often, there is also a limit to what your bladder can hold! It is definitely not a good idea to hold your urine for too long – indeed, it can lead to pelvic floor muscle tensions and fatigue (as you will have to contract your pelvic floor in order to hold your bladder for that long…). This can lead to pelvic floor dysfunctions in the long run! So if you are a nurse or any worker on a the road who do not have easy access to a washroom, time yourself or put an alarm or something if you tend to forget to empty your bladder!

Hope this helps!!!

Sophie

 

 

3 key elements to have your pelvis on your side for labour & delivery

Your best friend just signed up for a full marathon in 9 months.
42 km!!! 
You are impressed, especially that she has never run before!

– So how are you preparing for your running event? you ask her.
– I don’t know. I’ll just go with the flow and see what happens I guess!

This story does not make sense, doesn’t it?

Why do we think it makes sense then when it comes to pregnant women approaching delivery then?

…when birthing a baby is the most physically challenging event a woman will ever go through?

In this 20-min webinar, you will learn
3 key elements
to have your pelvis on your side
during labour & delivery

Doing your Kegels right: pro tips!

“I have been doing Kegels but I am not sure if I do it right, so I would like you to check…” – so many women consulting me…!!! 

I don’t blame you ladies. Before taking my first Pelvic Health PT education course, I did not know either… Isn’t it crazy that we are not educated about pelvic health in school as early as teen age? Knowing how to contract and release your pelvic floor is such an important part of maintaining good pelvic health as a woman! It can be a game changer in your sex life, it can avoid embarrassing urine leakage symptoms, it keeps your your bowel & bladder health on the ball, it provides stability to your pelvis & low back… It is extremely connected to so many functions!! But still, we barely know these muscles even exist, let alone how to exercise them…!

If you want to get my pro tips to learn how to contract & release your pelvic floor (aside from the typical “try to stop your flow of urine” exercise that many women were told to do but is so unhealthy for your bladder!!), this video is for you! 

Exercise to stop leaking when you sneeze or cough!

“I want to stop peeing my pants every time I sneeze or cough” is one of the most common reasons of consultation I hear in my clinic. Clients often develop the strategy of crossing their legs to compensate for the poor pelvic floor muscles who just got a little lazy after childbirth or menopause.

Here is a simple exercise you can practice to start re-educating that reflex called “The Knack”. The Knack is a pelvic floor contraction before any increase in intra-abdominal pressure (such as when you sneeze, cough or laugh hard). It normally happens naturally without thinking about it, but when the pelvic floor does not work properly following hormonal changes or pelvic trauma, this reflex can be lost.

But hey!! Don’t worry, there’s something you can do!! Try this out:

Do’s & dont’s for core workouts

You have been told that some core workouts are better than others during & after pregnancy but you’re not sure what that means? Watch this!

PS: This also applies to anyone doing core workouts to protect your back and avoid injuries!! But moms are just more vulnerable to injuries because of their overstretch core from baby growing in the abdomen!

My top 5 recommendations for an A1 gut health!

Pooping is such an essential body feature. Actually, if you don’t poop, you die… Does that convince you? In my intake form for my clients, I always ask about presence of constipation, because it is totally part of the big picture when we talk about pelvic health. For example, constipation leads to straining, which in turn increases your chances of developing a pelvic organ prolapse (when your bladder is falling out of your vagina!). Having a rectum full of hard stool can also push on your bladder and create urgency and frequency (going to the bathroom too often).

I would have many more reasons to advocate for a great bowel health, but let’s get to the point here. Don’t you think there is something so satisfying about having a nice long sausage-like stool that just slips right out of your bum? I never heard of anyone being stocked about straining to push those hard nuggets out that come along with constipation. I guess this is not something we normally discuss on a Friday night with friends, to be fair…!! But I’m sure you know what I’m talking about, right..?

OK so let’s go ahead with my 5 top recommendations for healthy pooping!

1- Stay hydrated

The best way to assess hydration is to look at your urine colour. If it’s pale yellow, you are good. Darker urine is okay for the first pee in the morning, but throughout the day it should be pale.

Stay away from recommendations such as “everyone should be drinking 8 glasses of water a day” – everyone’s needs are different. A breastfeeding mom will have lots of water coming out of her body from feeding her baby, therefore will need to drink more. Same with someone who exercise a lot, or has a very salty diet.

Your urine colour is a much better gauge to dictate how much water you should be drinking, rather than relying on a general recommendation.

2- Eat enough fibres

Again, that may look different from a person to another. My philosophy is: fix your water intake first, and see what happens with your stool – if it does not fix your constipation problem, then try increasing fibre intake. We want to target a stool that looks like #4 on the Bristol Stool Chart – like a sausage or snake, smooth and soft, with no cracks.

So first thing guys: LOOK AT YOUR STOOL BEFORE FLUSHING! Obviously, I’m assuming that you are pooping in a toilet and not in an outhouse (which is an unfair assumption especially in the Yukon where many people live in a dry cabin…!) But please if you can, do it!

For the longest time I had the Bristol chart by my toilet at my house and my roommates were making fun of me for it. But I wanted to bring awareness in the household and it worked!! Soon enough, people started saying “Hey I had a #4!!” with so much pride – it made me so happy!! #pelvicfloormafia

But coming back on fibre intake – if you see that even with proper hydration, you are still struggling with a #1 or #2 type of stool, you should look at increasing your fibre intake. Some easy ways are:

  • Adding 2 tbs of ground flax seeds to your breakfast (in your oatmeal, smoothie, yogurt, or simply mix it with hot water – not the best taste though..!) – they need to be ground otherwise it go straight through your body without doing anything for your guts!
  • Prepare some celery sticks snacks for the week  – if you are not a fan of the taste, add a dip or hummus to make it tastier!
  • Snack on dry fruits such as prunes, or fresh fruits like berries

There are many other ways to increase your fibre intake – a naturopath or dietician would be the best professional to guide you through this if you need more assistance. One important thing to mention with increasing fibre intake is that you should also increase water consumption proportionally, especially if the food item you chose does not contain water. For example, celery already has water content, whereas seeds do not. So if you choose to eat more seeds, you should also increase water intake to balance that out, otherwise you will get more constipated…!

 

3- Squat to poop!

If you have never watched the Squatty Potty advertising, this will convince you!!

Basically, when you sit on a regular toilet without squatting, you are anatomically setting yourself for a harder time during your bowel movement. If you are already a bit constipated, having your knees higher up versus down can make the world of a difference!

 

 

 

 

 

4- Relax your pelvic floor muscles!

The pelvic floor muscles are the ones around your urethra, vagina & anus. If you pretend to pick a berry with your anus and pull it up, you are contracting your pelvic floor and closing your anal sphincter. Now pretend to let go the berry and bring it back down, you are releasing and opening the anal sphincter. While pooping, you want to let the berry go, not pick it up!

If those instructions seem very foreign to you and you have no awareness whatsoever of what is going on in this area, go see a Pelvic Health Physiotherapist so they can assess your pelvic floor to optimize elimination!

5- Breath!

You would be surprised how many people hold their breath and tuck their belly in while having a bowel movement. Actually – that was me before becoming a Pelvic Health PT!!!  And even now, I need to be so mindful about not going back to those bad habits, and keep breathing properly & let my abdomen relax while having a bowel movement. All the pressure you are adding onto your rectum and intestine while holding your breath and clenching your abs is definitely not helping for your stool to come out. It is rather squeezing everything and restricting the motion of your stool.

Image result for breathing

So when you are about to have a bowel movement, squat, release your belly, unclench your abs, and start breathing in through your nose, out through your mouth. Your abdomen should be rising and falling with your breathing, very passively, and this nice rythme will help moving the stool along.

 

 

 

 

 

OK now I realize that I said 5 tips but I actually have 6… Is that okay?

There is a super cool intestinal massage you can do to trigger a bowel movement. It is recommended say if you have not had a bowel movement that day and you would like to trigger it, or else you are bloated or feel intestinal cramping. It helps moving things along. Normally, you should feel a signal to go for a bowel movement within 15-20 minutes after doing it. I recommend this massage after a meal to benefit of the great digestive enzymes that are naturally secreted after eating.

The best thing: I made a video to demonstrate it!!!

I hope this was helpful!!! Don’t forget that gut health has so many components and it is hard to summarize it in 5 recommendations. There are many other things that will affect gut health such as stress level, diet, level of activity, medication & medical conditions, to name a few. But I think if you apply those tips to cover the basics, you will have a head start on many people… !!

Thanks for reading!

Sophie