Symptom Remedies
Kegels: Essential Exercises for Mamas on Bed Rest
February 16th, 2010
Most women have heard of Kegels and at one time or another have been advised to perform Kegel exercises. But in my experience as a woman’s health professional, I find that many women have no idea what muscles are involved in Kegel exercises and as a result have no idea how to perform one properly. So I offer here a short review.
Kegels are essential exercises for all women, but especially for pregnant women on prescribed bed rest. Mamas on bed rest, with their prolonged inactivity and growing uteri are at increased risk of weakened pelvic floor muscles which will be further stretched and potentially weakened if they vaginally deliver their babies. The results can be urinary incontinence (involuntary loss of urine with coughing, laughing, sneezing), organ prolapse (bladder, uterine or rectal prolapse (bulging or protrusion of the bladder, uterus or rectum through their respective openings to the outside), or decreased sexual sensation due to the lax musculature. But I don’t want to get ahead of myself here. Let me start with the basics and work forward.
Dr. Arnold Kegel developed “Kegel” exercises to help women strengthen the pelvic floor muscles following pregnancy.
Dr. Kegel noted that women frequently became incontinent following pregnancy and found that if they could strengthen the pubococcygeus “PC” muscle (the muscle that is suspended along the pelvic floor like a hammock and holding all of the pelvic organs in place), they could often improve or reverse urinary incontinence as well as bladder, uterine or rectal prolapse. He started teaching his patients how to contract the PC muscle and Kegels were born
So how is a Kegel done? First, you have to be sure that you are working the proper muscles. If you are squeezing and releasing your buttocks, you are probably not working your pelvic floor muscles-at least not effectively. You can be sure you are working the pelvic floor muscles:
- By stopping the flow of urine while urinating. While this is a good way to get to know the pelvic floor muscles and what they feel like when contracted, do not stop the flow of urine ROUTINELY as a way to strengthen the pelvic floor muscles. This practice will actually weaken the muscles and cause or worsen urinary incontinence.
- You can look at your perineum and watch as you contract the muscles. If you are performing the exercises correctly, you will see the anus “wink” the perineum move up and down and the clitoris “nod” (thanks to Desiree Andrews of Prepforbirth.com for these great visuals!). This is a great way to see and learn which muscles are working. You can place a mirror on the floor and squat over it to see the muscles or hold a mirror between your legs. However, if you’re pregnant, it may be hard to hold the mirror between your legs and see and this is really hard of you are on bed rest. But for non-pregnant women, this is a good way to start learning how to Kegel.
- You can feel for muscle contractions by placing a finger or two into your vagina and then contracting the pelvic floor muscles around your fingers. Again, once you know which muscles to contract, you can effectively perform Kegels.
- There are devices that one can use to help stimulate the PC muscles. Physical therapists often use such devices when teaching clients how to do Kegels. Additionally, one can buy such devices and learn to Kegel using the devices.
Now once you get the basic muscle contractions down, you can then move on to some “advanced” Kegeling.
Squeeze, Hold, Release : This is just as it states. Squeeze your PC muscle, hold for a few seconds and release.
Elevators: This is an increasing contraction and likened to making floor stops while on an elevator. You begin by lightly contracting your pelvic PC muscle. After about 2-4 seconds, increase the contraction further pulling up the PC muscle. Hold for another 2-4 seconds and then tighten the contraction again. Hold for 2-4 seconds and then release. A variation is to gradually release the contractions holding for 2-4 seconds as the “elevator goes down.”
Quick Bursts: These are just what they say, quick contractions. You quickly contract the PC muscle, say 10 times. Rest for a brief moment and then repeat the series. This should be done several times over the course of about 5 minutes.
Some people recommend that women “Kegel” approximately 20o times a day-performing a variety of contractions. If you Kegel regularly, say 3-4 times a day performing 10 or more Kegels at a time, you will strengthen the PC muscle. But as the saying goes, the more you work a muscle, the stronger it becomes. So if you want to keep your PC muscle strong and have a strong pelvic floor, Kegel often, several times a day and in various situations so that you not only develop pelvic floor muscle strength, but also muscle control which can help prevent incontinence and enhance sexual pleasure.
Note: Second image courtesy of www.menstruation.com.au
Cold Remedies for Mamas on Bed Rest
December 11th, 2009I think I’m getting a cold. The other day I was teaching a fitness class, bent over and nearly fell on my face. My head got that “full” feeling and I thought, “Oh no, not now!” I have been feeling tired and have been burning the candle at both ends to get everything done for the holidays before my kids get out of school for winter break. I suppose I may have over done it a bit.
I hated being sick when I was pregnant and with each pregnancy I got at least one cold. Because of the stress of pregnancy on the immune system, pregnant women are at greater risk for contracting various cold and flu viruses. In this era of H1N1 it’s hard to know just what to do if you get sick. Many obstetricians allow pregnant mamas to take a few over the counter cold remedies; Tylenol, Sudafed and Benadryl are commonly regarded by obstetricians as safe to take. But if you are on bed rest, sometimes the recommendations are different-especially if you are taking medications for diabetes, high blood pressure or to halt preterm labor. Because of drug to drug interactions, if you are taking medications for any one of the aforementioned conditions or for some other reason, you need to be especially careful and consult with your obstetrician or midwife before taking ANY over the counter could products.
When viruses strike during pregnancy, it can be helpful to employ some of the “old timey” remedies that our mothers and grandmothers may have used to relieve the symptoms. Most of these remedies come from items in your pantry and are safe to use in pregnancy. But always check with your obstetrician or midwife to be sure.
Congestion
Vicks Vapor Rub (For chest): Apply a warm towel or hot water bottle over your chest after application to help relieve chest congestion and tightness.
Saline Nasal Washes: Saline nasal sprays are an excellent and safe way to clear congested (and runny) nasal 
passages. If you want to help clear the sinuses, use a Neti pot or other nasal irrigation system in combination with the saline. Saline solutions are easily made with 8 oz of warm water and 1/4 tsp of non-iodized salt.
Vaporizer/Humidifier: Many people recommend cool mist humidifiers, but I found that when I am sick I am typically cold and prefer a warm mist humidifier. I suppose that this is a personal preference but you may want to ask your doctor or pharmacist if you are undecided.
Sore Throat
Tea: Tea is far and away my favorite thing to relieve a sore throat. I like to make tea as hot as I can stand it and sip it. Of course when you are pregnant, you want to avoid caffeinated teas as the caffeine will cross the placenta and babies don’t clear caffeine as easily as we do. Non-herbal teas such as Green and Black teas contain caffeine. Depending on your situation, your OB or midwife may not want you to have caffeine so you may need to avoid these and other caffeinated teas. If you are unsure, ask before consuming these teas.
According to the American Pregnancy Association, many herbal teas and most commercial herb teas (Celestial seasonings teas for example) are safe during pregnancy. Many herbalists and midwives may disagree so if you have questions, definitely consult with an experienced herbalist. However, the American Pregnancy Association advises caution with the following herbs:
Dandelion-Insufficient, reliable information exists regarding safety in pregnancy
Chamomile-Insufficient, reliable information exists regarding safety in pregnancy
Nettles-Natural Medicines Database gives nettles a rating of Likely Unsafe , even though it is used in countless pregnancy teas and recommended by most midwives and herbalists.
Rosehips-Insufficient, reliable information exists regarding safety during pregnancy
Alfalfa-Possibly unsafe
Yellow Dock-Possibly unsafe
For more information, visit the American Pregnancy Association Website, www.americanpregnancy.org.
Saline Gargles
This ancient remedy is still very effective at relieving a sore throat. Place about one teaspoon of regular table salt in about 2 cups of warm water. Gargle as needed. The good thing about this is that you can do it as often as you like.
Cough
Honey-I recently learned from some pediatricians that a teaspoon of honey taken every few hours can alleviate
coughs. No one seemed too sure about the mechanism, but I would imagine that the honey coats the throat and may relieve the cough reflex. No proof here, just a thought on my part. When viruses strike during pregnancy, it can be helpful to employ some of the “old timey” remedies that our mothers and grandmothers may have used. Most of these remedies come from items in your pantry and are safe to use in pregnancy. But always check with your obstetrician or midwife to be sure.
Vick Vapor Rub-This is by far the most “out there” remedy that I had heard, but I tried it myself last year and it did allow me to sleep. You apply Vicks Vapor Rub to the soles of your feet and then put on thick socks and climb into bed. Now I don’t know why it’s effective; perhaps the socks help the Vicks to be absorbed into the soles of the feet and then the effects travel all over the body. I really can’t explain this and wouldn’t have believed it if I hadn’t tried it and had it work. While it may not be effective, it is something you can try that won’t harm you or your baby.
Now remember, these are a combination of “wives tales” and old time home remedies and while some may scoff at them, some are effective. Likewise, since home remedies can be effective and are essentially using products “off label”, you should check with your OB or midwife before using them. But in most cases, they are far less toxic than some of the over the counter and prescription remedies (and often far less potent) and may provide some much needed relief.
Is Complete Bed Rest Best?
October 16th, 2009Recently someone made the comment that high risk pregnant women should not engage in any sort of physical activity while on prescribed bed rest. I cannot disagree more vehemently! When a pregnant woman is placed on bed rest, not only is she at risk for the usual complications of pregnancy (in addition to the particular risks that landed her on bed rest in the first place!) she then adds an increased risk for deep venous thrombosis (DVT) and embolism, pulmonary complications an muscle atrophy (wasting and loss of strength). This is why I produced Bedrest Fitness, a series of exercises pregnant women can do while on prescribed bed rest.
Numerous research studies have documented that prolonged inactivity is detrimental to health. For this reason, when a person has heart bypass surgery, as soon as they are taken off the ventilator and are breathing on their own, nurses are instructed to get them out of bed and into a chair. This sometimes occurs within in hours of open heart surgery! But the sooner patients sit in an upright position, the sooner they will begin reusing their muscles, taking deep breaths and recovering. The same thing happens for orthopedic patients. Once a hip or knee is replaced, within hours to days, physical therapists begin moving the new joint to aid in healing, range of motion and optimum utilization. Early movemtner lowers the risk of venous blood pooling in the legs , blood clot formation, embolisms (blood clots that dislodge and travel to other areas of the body), pulmonary (lung) collapse, fluid in the lungs and the development of pneumonia. So given these examples (and there are many more such as cancer patients and other surgical patients) doesn’t it seem strange that we tell pregnant women to go sit/lie down for weeks to months at a time???
I am sure that opponents and naysayers will chide me by saying, “Well then YOU take responsibility when a woman loses her baby!” I think that we can all agree that no one wants a pregnant woman to lose her baby (or babies as the the case may be). But I think that it behooves all of us, especially in this era of health care reform, to re-examine how we manage high risk pregnant women and to really ask ourselves, is complete bed rest really best?
In some cases, bed rest really is the answer. If a woman is actively bleeding from her vagina, experiencing contractions indicative of preterm labor or has severe high blood pressure and is at risk of pre-eclampsia then yes, bed rest is indicated and I think that inpatient hospital care is best in these settings. But once the bleeding stops, the contractions stop and her blood pressure is closer to the normal range is it still necessary to completely restrict a woman’s activities? Is it best to send her home without medical supervision? Is it in her and her baby’s best interest for her to remain immobile and inactive?
Researchers are just beginning to look at how high risk pregnant women are managed and are beginning to realize that perhaps restricted activity and modified bed rest are better options. If a woman is able to be up out of bed but sitting with her feet up she can work from home and engage in family activities. But some people still argue this isn’t enough, especially in the case of the incompetent cervix. They argue that the gravitational pull downward requires that a women stay reclined in bed. Again, this may not be the case.
The September 2009 American Journal of Obstetrics and Gynecology published a study, “Prediction of spontaneous preterm birth in asymptomatic twin pregnancies with the use of combined fetal fibronectin (fFn) test and cervical length”. Now first let’s qualify their findings by saying that the mothers in this study were in fact having twins but they were not otherwise high risk, i.e. they didn’t have incompetent cervices. The researchers found that in 155 twin pregnancies examined between 22 and 32 weeks gestation,
- A positive fFN test or a cervical length of <20mm increased the risk of spontaneous preterm birth at <37,<34,<32, <30 and <28 weeks gestation.
- The combination of a positive fFN test result and cervical length <20mm had a significantly higher positive predictive value for delivery at all gestational ages than either test alone.
- A positive fFN test result was a stronger predictor of spontaneous preterm birth than a short cervical length alone.
Although this is one test and on a fairly small, very specific population, we can’t ignore the potential indications. To date many women with multiple pregnancies are placed on bed rest to prolong gestation-regardless if they are having symptoms of preterm labor or other complications. While most mothers of multiples often lower their activity levels later in pregnancy out of necessity, those who wish to remain “restricted” but not “bedridden” may now have a way to determine their risk and potentially avoid bed rest.
Likewise, incompetent cervix is one of the most common reasons women are placed on prescribed bed rest. If a pregnant woman with an incompetent cervix can have a cerclage (sugical stitch placed around the cervix) and if the cervix is not effacing (thinning and shrinking), the fFN test may be used to establish which mothers actually need to be on bed rest because preterm labor is highly probable and which mothers may be able to be on modified bed rest, “house arrest” or simple modified/restricted activity.
Truly more research must be done in this area, but it is exciting to see that people are actually doing work for us high risk mamas. Maybe one day, we’ll be better able to tell who really needs to be on bed rest and who does not.
Mamas on bed rest, if you want to keep moving, try Bedrest Fitness! It’s simple yet effective at helping maintain muscle strength and mobililty. see a clip at www.mamasonbedrest.com.
