sharing information about how exercise is used as medicine in our pear exercise physiology clinic.
WHAT IS PELVIC ORGAN PROLAPSE (POP)?
Almost one in five Australian women will be affected by pelvic organ prolapse (POP) during their lifetime. Many women may feel lost when it comes moving well, or returning to exercise with POP, but there are many ways to help return to movement that you enjoy whilst protecting your pelvic floor.
Whether you are a candidature for surgery, or during rehabilitation from surgery, exercise has an important role in reconnecting and strengthening your pelvic floor muscles and the musculature surrounding the pelvis.
WHAT IS POP?
POP is the displacement of a pelvic organ (bladder, bowel or uterus) onto the vaginal wall.
All of the pelvic organs are supported by a complex of muscles, ligaments, and fascia that attach to the bony anatomy of the pelvis. When these are weakened, those organs can decend.
Prolapse is common, fixable and managable.
WHAT CAUSES PELVIC FLOOR WEAKNESS?
WHAT ARE POP SYMPTOMS?
Prolapse can have a variety of symptoms, including :
Women can be hesistant to openly discuss these symptoms, but prolapse is very important to identify, and modify exercise to be performed safely.
If you think you may have prolapse, first seek guidance from your GP or Women’s Health Physiotherapist.
WHY IS EXERCISE IMPORTANT?
Exercise is important for your general health and fitness, and especially important for maintaining bone mineral density and mobility moving towards menopause.
Specific exercises for prolapse, including pelvic floor exercises, can help improve and manage prolapse symptoms and support your body, however certain exercises are contraindicated for prolapse – and can make things worse.
PELVIC FLOOR EXERCISES
- improve bladder and bowel control
- reduce the risk of prolapse
- improve recovery from childbirth, gynaecological surgery and prolapse
- increase sexual sensation and orgasmic potential
- increase social confidence and quality of life
Pelvic Floor exercises have their place to help improve motor control, strength and endurance of your pelvic floor, however a program of these exercises alone is not enough!
An Accredited Exercise Physiologist can help create an individualised exercise program for you, that is pelvic floor safe, may help elevate your prolapse symptoms, and that can transition you back to moving without fear, return to sport and support your to reach your personal fitness goals.
When would I see a Women's Health physio, and when would I see an Exercise Physiologist who works in Women's Health?
These are Q's we hear alot - so let us help!
The Continence Foundation of Australia has Accredited Exercise Physiologists (like us!), and Women's Health physiotherapists both listed as a go - to health professionals!
AEP's can develop an individual exercise program appropriate for your pelvic floor. You would see an AEP after you have been diagnosed with prolapse, incontinence or other women's health chronic disease like endometerosis. We can prescribe exercises to help strengthen, or relax your pelvic floor, make sure your posture and biomechanics (the way your body moves) is supportive to your pelvic floor. We help women take the next steps, after physio or surgery, to safely return to activity and sport.
A Women's Health physio (psst - not just any physio, must be a women's health or pelvic floor physio!!) hold post graduate qualifications specialising in pelvic floor. They can assess your pelvic floor function via an internal exam, and provide biofeedback using ultrasound. You would see a Women's Health physio for first steps rehabilitation and diagnosis of pelvic floor dysfunction.
What is Osteoporosis?
A skeletal disorder where bone strength becomes compromised due to faults of bone composition, metabolism and/or degeneration. The size, architecture and intrinsic material of bone should also be considered when determining bone strength and/or fracture risk. Osteoporosis is often referred as a “silent disease” as there are no signs or symptoms of the onset. Any bone can be affected but predominantly the spine, pelvis/hip, wrist and humerus are the main areas reported.
Osteoporosis is diagnosed by the measure of the bone mineral density captured by dual energy xray absorptiometry (DEXA) scan. A BMD T-score below -2.5 standard deviations = osteoporosis, a T-score between -1.0 to -2.5 = osteopenia (meaning low bone mass).
Why is exercise important for Osteoporosis?
Yet Again, Exercise is MEDICINE for managing OSTEOPOROSIS!
Walking, swimming, and cycling are great whole body/system activities however are not going to cut it for osteoporosis.
The mode of activity is extremely important as we need exercise that is OSTEOGENIC (bone producing).
Best evidence practice recommends:
However this intensity level of exercise maybe not be able to commence or completed right away as there are other personally factors that need to be considered first to determine if you are low, moderate or high risk level. Things to consider:
- Bone Mineral Density (BMD) T score.
- The age and fragility of the patient
- Height loss
- Has sarcopenia occurred
- Family history of osteoporosis
- Hormone status. i.e. early menopause
- Other co-morbidities, or disease that affect bone metabolism
- Long term use of certain pharmaceutical drugs
- Musculoskeletal health, any back pain or osteoarthritis
- History of falls
- History of fractures
- Poor biomechanics
- History of physical activity
- Dietary concerns: low vitamin D and calcium intake, excessive alcohol consumption
What are some exercises I should AVOID if I am high risk osteoporotic and are currently inactive?
Lifting techniques are vital for progressive resistance training, here at Pear Exercise Physiology we run a supervised osteoporosis class on Tuesday @ 6.30pm or pop in for one on one consult to perfect the technique and feel safe and confident within your exercise routine.
Beck, B., Daly, R., Singh, M. and Taaffe, D. (2017). Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis. Journal of Science and Medicine in Sport, 20(5), pp.438-445.
EXERCISE AND PCOS - THE FACTS
1. EXERCISE IMPROVES FERTILITY
Improvements in insuline and hormonal responses through exercise can significantly improve reproductive function in women with PCOS !
2. EXERCISING IN A WOMEN'S ONLY ENVIROMENT, OR WITH FRIENDS IS MORE SUCCESSFUL FOR LONG TERM ADHERENCE AND PSYCHOLOGICAL BENEFITS OF EXERCISE
Aim to find an aerobic or resistance based activity that fits within the confines of your daily routine, preferably in a supportive like minded enviroment. We work from Fernwood Fitness, which is a friendly women's only gym, with women from all backgrounds - some of whom are first time exercisers, others who are recovering from surgery, and others who are pregnant!
3. EXERCISE IS MEDICINE FOR PCOS
Longterm exercise maintenance will help improve the symptoms of PCOS as well as reduce the risk for developing diabetes - a chronic condition that PCOS sufferers have a much higher risk of developing.
Exercise will also help in reducing the risk of developing Gestational DIabetes during pregnancy for PCOS patients.
Have you been diagnosed with prolapse? It can be really scary, but exercise shouldn't be avoided, in fact it can HELP!
Managing your prolapse means
1. learning your anatomy
We always start by teaching our patients a little bit more about their diagnosis - where the pelvic organs sit, what exactly a prolapse means and where & how their pelvic floor works. Knowledge is power, and it helps things to become less confronting or scary when starting rehabilitation!
2. restoring good posture
Poor posture, like a slumping pelvis, rounded lower back, hollowed chest and forward head position is no good for your pelvic floor! By improving your posture, you will help your pelvic floor to function the way it should, and help the other muscules surrounding your pelvis like your glutes, abs and back to work better as well.
3. strengthening the musculature around your lower back, abdomen, diaphragm and glutes
Strong glutes, strong BUT FUNCTIONAL abs (that means not just sucking your stomach in !) good breathing and a strong back will all help in how you are able to perform movements, and maintain your Intra-abdominal pressure (the pressure that sits inside your abdomen). This will also help in managing your prolapse symptoms!
4. being mindful of your posture while sitting, standing, walking, running, lifting and carrying
Mums are very busy very active people - staying mindful of your postures whilst you perform your day to day activities can help in managing your prolapse. We will teach you strategies to help support and protect your pelvic floor in your day to day, as well as in the gym!
5. pelvic floor exercises!
Learning how to correctly activate, contract AND relax your pelvic floor, to help restore strength, endurance and function!
Interested to see how exercise can be used as medicine to help recover and manage your prolapse? Contact us via our website or call 0478116700.
WHAT IS PELVIC ORGAN PROLAPSE (POP)?
Pelvic Organ Prolapse (POP) is common, and can affect women young or old, most commonly post-natally. Almost one in five Australian women will need surgery for prolapse during their lifetime.
Every individual who has experienced prolapse may have different symptoms, but in general symptoms can include:
WHY IS EXERCISE IMPORTANT?
Exercise is important for your general health and fitness, and especially important for maintaining bone mineral density and mobility moving towards menopause. Specific exercise for prolapse can greatly improve and manage symptoms, however certain exercises are contraindicated for prolapse – and can make things worse.
An Accredited Exercise Physiologist can help create an individualised exercise program for you, that is pelvic floor safe and may improve your symptoms. AEPs can check you for diastasis recti, program safe individualised exercises and work alongside other allied health professionals including Women’s Health Physiotherapists, Psychologists and obstetricians/gynecologists. Working with an AEP can help transition you back to a full gym program safely and appropriately, to help you return to sport and reach your personal fitness goals.
WHAT TYPE OF EXERCISE IS BEST?
20 to 30 minutes of aerobic exercise three to five times a week (walking, cycling, swimming etc). Aerobic exercise helps your cardiovascular system, muscles, tendons and ligaments to stay strong and will also help you maintain to the correct weight (BMI) for your height and age.
Resistance training two to three times a week. Resistance training is fantastic for increasing your muscular strength, and integrating your core into more functional tasks. Strengthening your glute muscles, hamstrings, adductors, lower back and abdominals can all help in gaining and maintaining pelvic floor strength. Exercises such as squats, lunges, or seated dumbbell exercises can achieve this. Keep rep ranges high (12-15) and dumbbell weights lower to begin.
Pelvic Floor exercises (also known as ‘kegals’) also have their place to help improve motor control of pelvic floor, however a program of kegals alone will not improve your symptoms or your pelvic floor weakness.
An Accredited Exercise Physiologist like the AEP's at Pear Exercise Physiology can provide you with a program tailored to your own level of fitness, and assist you to correctly activate your pelvic floor through cueing, posture and good exercise technique.
THINGS TO CONSIDER?
Unfortunately, many women are left in the dark about how to safely return to exercise after hysterectomy.
There are some inappropriate abdominal exercises after hysterectomy that can increase the risk of injury to the pelvic floor (e.g. pelvic organ prolapse or hernia).
But we know how important exercise is – both for physical and mental health!
There are some exercises however that are better than others for recovering and returning to exercise after hysterectomy, and it is always best to seek the advice of an Exercise Physiologist to help rehabilitate and return to the activity you love to do – and protect your pelvic floor for the future.
What is a hysterectomy?A hysterectomy is an operation to remove the uterus – and depending on the type of hysterectomy being performed, accompanying organs such as the fallopian tubes, ovaries and cervix are often removed at the same time.
Most hysterectomies are performed to treat conditions such as fibroids (growths that form inside the uterus), endometriosis, adenomyosis, pelvic organ prolapse and cancer.
Hysterectomy is one of the most common types of elective surgeries for Australian women – but although this surgery is common it is important to remember that it is a major abdominal surgery that requires a period of rehabilitation afterwards!
Best exercises to start with after a hysterectomy:
First time back at the gym after surgery? Or looking to get started again at home?
The best exercise to start with is walking. Walking is fantastic functional exercise, and hill walking is a great way to challenge your cardiovascular fitness without risking injury to your pelvic floor.
It is also great to start to reconnect with your pelvic floor and core by performing some Pelvic Floor exercises (aka. Kegals) and core breathing. (psst….these exercises can be difficult to do, an Exercise Physiologist can help you!)
PELVIC FLOOR ELEVATORS
Always remember to relax your pelvic floor again – by letting it decend back to G floor, and allowing the doors to open. This should not be forceful – but just a relaxation.
Finally, some gentle stretches and mobility work will help get your body ready to move again. Some of our favourites are a seated glute stretch, seated hip flexor stretch and a wall side bend stretch.
Some exercises to avoid after hysterectomy are:
Immediately after surgery (within first 6 weeks post surgery) you may be advised to avoid lifting anything heavier than 4kg, and avoid prolonged standing.
This is not to say you can never perform these types of exercises again, but that your body will require some recovery, rehabilitation and regain strength in your pelvic floor and core before your can return to this kind of high impact or heavy loaded work.
Finally, it is always best to start slowly when returning to the gym after major surgery, and if your exercise or activity goal is to return to high impact work like running or sport, seek the help of a professional like an Accredited Exercise Physiologist to help get you there safely and successfully!
Many clients I see are really keen to get back into shape and exercise after having baby, but steps should be taken to protect the pelvic floor and core prior to engaging in any high impact or high intensity exercise. As AEP’s we can help support new mothers regain their fitness and strength through safe, functional and effective training and rehabilitation.
Women who suffer from abdominal separation, are more likely to experience back-ache, hernias, pelvic girdle pain and pelvic floor dysfunction so it’s essential to rehab these muscles after pregnancy.
About diastasis recti (abdominal separation)
Some Stats and Figures
EXERCISES BEST TO AVOID
Crunches, sit-ups, planks, and some Pilates moves like straight leg lifts, basically anything that places strain and sheering force on the abdominals. These moves can cause widening of your diastasis, pressure and strain on your already weakened pelvic floor and lower back pain.
If you experience leaking whilst exercising after pregnancy, seek help from a women’s health exercise physiologist or a women’s health physiotherapist.
Incontinence is common – but not normal – and 100% treatable.
EXERCISES THAT ARE BEST TO DO
You can help to both protect and heal your diastasis aka abdominal separation through good nutrition, good posture and exercises to connect with your abdominals.
Eating protein and zinc rich foods, such as meat, fish, nuts, beans or eggs, and vitamin A rich foods like kale, broccoli, sweet potato can provide your body with the nutrients it requires to heal and repair. Eat plenty of fibre rich foods daily and drink an adequate amount of water to maintain healthy bowel habits – and don’t delay the urge to empty your bowels.
Being mindful of your posture (when you are nursing your baby, carrying other children or shopping etc) is also important in your recovery of your abdominal muscles. No matter how much fantastic work you are putting in at the gym, if you carry poor posture for the other 12 hours of the day, you will undo all your hard work!
5 great exercises that are appropriate for abdominal separation and pelvic floor safe for pregnancy and after birth!
Pssst - what is Belly Breathing?
Briefly, belly breathing is getting your pelvic floor, transverse abdominus, deep lower back muscles and diaphragm all moving together in sync. These 4 muscles make up your ‘core’.
Inhale – let your belly expand and pelvic floor relax
Exhale – gently draw up your pelvic floor and imaging drawing your two bony hip points at the front of your pelvis closer together.
This can take some guidance to get right but integral to learning to re integrate the pelvic floor and strengthen your core.
For help with abdominal separation, find your local Accredited Exercise Physiologist or Women’s Health Physiotherapist.
Esme Soan AEP
Pear Exercise Physiology: Pregnancy & Women's Health
What exactly is so good about exercise? At Pear Exercise Physiology, our mantra is Exercise is Medicine. Here are the ways exercise can improve your health:
You’ll lower your cancer risk. Regular exercise lowers the risk of breast cancer coming back, as well as reducing the risk of ever being diagnosed with breast cancer.
You’ll be able to maintain a healthy weight. Regular exercise can help you maintain a healthy weight by building muscle and burning fat. Overweight and obese women -- defined as having a BMI (body mass index) of over 25 -- have a higher risk of being diagnosed with breast cancer compared to women who maintain a healthy weight, especially after menopause. Being overweight also can increase the risk of the breast cancer coming back (recurrence) in women who have had the disease.
This higher risk is because fat cells make estrogen; extra fat cells mean more estrogen in the body and estrogen can make hormone-receptor- positive breast cancers develop and grow.
You may have fewer and less severe side effects from treatment.
Research suggests that exercise can:
- ease nausea during chemotherapy
- improve blood flow to the legs, reducing the risk of blood clots
- ease constipation by stimulating digestion and elimination systems - rev up your sex drive and increase your energy
- ease fatigue caused by radiation and/or chemotherapy
You’ll have more energy. Fatigue is a side effect that many women have during and after treatment for breast cancer. Regular exercise can boost your endurance and help your heart and lungs work more efficiently, both of which give you more energy for the work you do each day.
You’ll have better mobility. Scar tissue that forms after breast cancer surgery, reconstruction, or radiation can lead to your arm and shoulder muscles feeling tight. Over time, careful stretching exercises can improve any range of motion issues you may have in your arm and shoulder.
You’ll have more muscle and be stronger. As most people age, they tend to lose muscle and gain fat. Chemotherapy and hormonal therapy medicines can throw you into sudden menopause, which also can cause muscle mass to decrease.
You’ll keep your bones healthy. As you age, you lose bone mass. If you’ve been diagnosed with breast cancer, maintaining healthy bones is especially important for you. Research shows that some breast cancer treatments can lead to bone loss.
You’ll feel better about yourself. A breast cancer diagnosis can leave some women feeling scared, depressed, and anxious. Exercise can help lift your spirits, keep depression at bay, and boost your self- esteem. Physical activity triggers the release of brain chemicals such as endorphins that can make you feel happier and more relaxed.
You’ll sleep better. If you struggle with insomnia or wake up a lot at night, regular exercise can help you fall asleep faster and sleep more deeply.
You’ll make friends. All participants in our Pinkmoves classes have experienced breast cancer or gynae cancer. We have fun, laugh and support each other in the Pinkmoves group, under the guidance of an Accredited Exercise Physiologist.
What is polycystic ovary syndrome?
Polycystic ovary syndrome is a hormonal disorder. It is also known by its abbreviated name PCOS and sometimes as polycystic ovarian syndrome. PCOS is quite common, affecting between 12-18% of women of reproductive age and up to 21% of women in some high-risk groups, such as Indigenous women.
PCOS can be a complex condition to identify because there are several symptoms and not all of them are required to be present for a diagnosis of PCOS. Also, very few women with PCOS have the same set of symptoms.
What are the signs & symptoms of PCOS?
Many of the symptoms of PCOS are caused by high levels of androgens in the body. Androgens are also called ‘male’ hormones, the main one being testosterone. Even though they are called ‘male’ hormones, all women have androgens; they are necessary for good health. However, in women with PCOS the levels of androgens are too high, affecting ovulation (release of an egg from the ovary), periods and other body systems.
Symptoms of PCOS may affect these body systems and cause these symptoms:
Periods & fertility
No periods, or periods that are:
Multiple cysts on the ovaries
Difficulty becoming pregnant
Hair, skin & weight
Excess facial and/or body hair
Acne on the face and/or body
Scalp hair loss
Darkened skin patches
Easy weight gain
Mental & emotional health, sleep
Sleep apnoea (a sleep disorder in which abnormal pauses of breathing occur during sleep)
PCOS symptoms can be different from woman to woman. Some women will have only some of these symptoms, whereas others will have all of them. In some women, symptoms may be mild, while other women’s symptoms may be severe in nature.
How do you know if you have PCOS?
If you think you may have PCOS, you need to see your doctor and discuss your symptoms and medical history with them. Don’t rely solely on online information and ‘self-diagnose’ without seeking help.
A diagnosis of polycystic ovary syndrome can be made when at least two out of these three criteria are met:
Your doctor may use some tests for PCOS to exclude other conditions and make sure you have the correct diagnosis.
Tests for PCOS can include blood tests, to check your hormone levels and assess your risk of developing heart disease and diabetes, and ultrasound, to see whether there are any cysts on your ovaries and whether an ovary is enlarged. An ultrasound can also assess whether your womb lining is normal, as in some women with PCOS there can be abnormal thickening of the womb lining.
Apart from fertility problems, PCOS is also linked to chronic health issues such as heart disease and diabetes. That is why it’s important that your symptoms get the attention they need, so you can be the healthiest you can be.
Management of PCOS
There are a number of ways to manage the symptoms and impact of PCOS. The keys to managing PCOS successfully include:
Published with the permission of Jean Hailes for Women's Health
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