At MFT we understand the importance of specialist and practitioners. As parents we all at some point have to rely on the advice of a specialist, sometimes for the most basic, and yet fundamental, needs of our babies. MFT Meets is a new blog series of interviews with people we find extraordinary.
This week's talk is with Clare Bourne, a force and advocate for women's pelvic health. Pelvic health for women is something so important, but also something that we easily ignore and put aside.
MY FOURTH TRIMESTER: Hi Clare!! Please tell me a bit about you and what you do and specialise in.
CLARE: My name is Clare Bourne and I am a pelvic health physiotherapist and Mum of 2 based in London. A pelvic health physiotherapist looks after women and men throughout their lives with any concerns regarding their pelvic floor and abdominal area. This may include incontinence, prolapse, pain and recovery after having a baby. My big passion is to work with women during pregnancy and postpartum to know how to stay active, care for they’re bodies and return to exercise safely, and navigate any new symptoms that might leave them feeling alone.
What made you become a pelvic health physio? What you do is so interesting and important – yet it’s something us women often put off as something we don’t have time to prioritise. Have you always been interested in pelvic health?
The honest answer is no, when I went into physiotherapy and started university at 18 I had no idea it even existed, and didn’t learn anything about it whilst at university. When I left university in 2019 there were not many jobs and as a junior physio you apply for a general job and then move around getting experience in lots of different specialisms. My first one happened to be pelvic health – initially I was terrified as I just felt I knew nothing, but I had the most amazing team whom I am still friends with them all now. They taught me everything I needed to know and I just loved it, I did a longer rotation than most do and then after a few years of doing other specialisms I came back to pelvic health and that is where I have stayed for 8 years now.
What’s so important about the pelvic health? Is there something like “good” pelvic health? How can you as a physio help women and new mothers? And do you help men too? (I know there’s some Dads amongst our subscribers!)
Pelvic health is so important because it really encompasses so many areas for women and men, often the very taboo symptoms and topics that we struggle to talk about. We are often educated more about other aspects of our health, like heart, bone, and now an increased awareness of mental health, which is amazing, but pelvic health still has a long way to go.
I don’t really think of it as good or bad, but I guess more of a continuum of ongoing care for ourselves, but essentially if we are having any symptoms, such as incontinence or prolapse or pain, then this is when we should reach out for help.
As a physio we support women and men throughout their lives, but a large focus is on caring for women during and after pregnancy as this time puts a lot of pressure on the pelvic floor and abdominals and therefore rehabilitation and support is key. We help women with pelvic, back, rib or hand pain during pregnancy, as well as if they are experiencing any incontinence or prolapse symptoms. Postpartum we support women with pelvic floor rehabilitation, especially those who have experienced tears or have symptoms of the bladder or bowels, prolapse or diastasis recti ( which is separation of the abdominal muscles) . On the NHS there is support for any women with symptoms via their GP or in some areas self-referral. Privately there are lots of physios providing postnatal checks, which are for anyone, even if they have no symptoms, to check how their body is after pregnancy and birth and make a plan of how to return to exercise safely and get back to what they love.
For men – yes they have a pelvic floor too. The more common symptoms for men are pelvic pain, erectile dysfunction, urgency or frequency of urination, or later in life if they have prostate cancer and their prostate removed most men will experience incontinence.
I can only speak for myself, but I definitely found my postnatal journey quite challenging (and still am in some way – lockdown I’m looking at you!) in everything from my own expectations on myself and society’s expectations on me.
When to be able to exercise, to have time, how to look and most importantly – how to feel about your entire world changing that first time. You have two kids - how has your own postnatal journey been?
Oh I hear you…..I think I would summarise with ‘an unexpected rollercoaster!’
After having my daughter 4 years ago I was diagnosed with a prolapse, which was my biggest fear really, and it really knocked my confidence. It took me a year to feel confident to exercise again and was a real journey to get back. I worked with an amazing holistic core restore coach who supported me and I got back to feeling really strong again before I got pregnant and had no prolapse symptoms.
Second time around well lockdown hit when I had a 10 week old and a toddler at home and with a medical husband there was just no time for me really – but I was much more confident to return to exercise quicker and use it as part of my rehabilitation. It has been very stop-start this year as well it has been a bit mad, and a year on I am starting to find a bit for time for me. But yes I am not back to pre baby weight or as strong, and that is ok. There is so exact timescale and being kind and gentle with ourselves has got to come first.
Let’s talk all things pelvic girdle pain in pregnancy. PGP is something that can get quite hardcore!
What is it, and how can we help to prevent it? If it’s there – does it always have to remain the same or can we make the pain go away?
Pelvic girdle pain (PGP) can be so debilitating and around 1 in 5 women suffer during pregnancy. A big problem is that women don’t access help early on due to lack of awareness amongst healthcare professionals and women that there is even help available. It is pain experienced during pregnancy, anywhere around the pelvis, and often felt on walking or standing on one leg or doing the stairs etc. It is treatable and can go away, but seeing a pelvic health physio early on to understand why you are experiencing it and a treatment plan is the key.
What is good to keep in mind when returning to exercise after having given birth?
❤️🩹 Wound healing – have you had any infections or delay to healing
🏋️♀️ Pelvic floor strength – everyone needs to rehabilitate their pelvic floor after birth
⏰ Returning to impact – generally the earliest this is advised would be 12 weeks, and probably for most women a more accurate timescale is around 6 months
🧩 Abdominal muscles – for most the separation that occurs between the muscles resolves, for some it remains and support is needed. However it is important to know that strengthening all the muscles of the tummy is key during the postpartum period.
🥱 Fatigue – we are tired and demanding a lot of our bodies physically day to day anyway so just remember this when also factoring in exercise
🍊 Nutrition – lots of mums are also breastfeeding and though it is fine to exercise when you breastfeed we need to ensure our food and drink meets our body’s requirements
Many women still find some things really embarrassing to ask (I know I’ve been one of them!). What are some common questions you get?
It can be so hard to talk about these topics but once we open up and know we are not alone then it can really help. These are just some of the things I hear from women:
🟠 Does anyone else have pain with sex?
🟠 I feel like something is falling out of me
🟠 I keep doing vaginal farts when exercising
🟠 I wet myself when I run so I wear black leggings
🟠 I don’t feel sexy now I have a prolapse
🟠 I feel like I failed because I didn’t have a vaginal birth
🟠 I can’t hold my wind in anymore
🟠 Is it normal to find sex painful?
My biggest tip for anyone experiencing prolapse symptoms is – The first rule of prolapse is: "Don’t Google Prolapse"...
How has the pandemic changed the way you help women? Do you treat lots of women postnatally?
The pandemic has opened up a new virtual world, and I think it has challenged our way of treating. I still feel that face to face is the most powerful and examining the pelvic floor is always so beneficial, but the power of education is very clear. I treat a lot of women postnatally, the majority of the women I treat are postnatal at the moment actually, and I am loving seeing more women wanting to know more and being proactive in their recovery.
Cheesy but have to ask - what do you love most about what you do?
Empowering women to do what they love and have a safe place to talk about some of the hardest and most embarrassing things they may face.
Your top 5 pelvic health tips?
🤸 Do your pelvic floor exercises regularly
🧘 Make sure you relax and let the pelvic floor go and not only focus on squeezing
💙 Take care of your bowels, don’t strain to open your bowels and use a little stool under your feet
🎙️ If something feels right – speak to someone about it
🤕 Incontinence, painful sex or prolapse symptoms (heaviness or dragging) are not just ‘part of being a mum’, they are treatable so please do seek help if you need it.
Last but not least. What emoji do you feel like at the moment and why?
😅 - very happy, juggling lots!!
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