 A levator avulsion is where part of the pelvic floor muscles are pulled off the pubic bone. This can affect between 10-35% of women following their first delivery.
The loss of this support can make your pelvic floor weaker, enlarge the opening of the vagina and increase the likelihood of prolapse. A levator injury is not repaired, but if you have been diagnosed with one it makes it even more important to strengthen the intact pelvic muscles - to provide as much support as possible to the pelvic organs. Levator injuries are often not diagnosed immediately but may be picked up by your physiotherapist or gynaecologist during a pelvic examination.
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 I use this analogy all the time in clinic to help patients understand the importance of managing their pressure to help improve core/pelvic floor symptoms. Pelvic floor symptoms such as prolapse and incontinence tend to be worse in high pressure situations, when the crisp packet (the core) is overwhelmed.
Breathing is an easy way to reduce pressure. If we exhale rather than hold our breath on exertion, there is less pressure being held "in the crisp packet" that has to be managed by the core muscles. If you have symptoms on a particular activity - such as running/HIIT or cross fit, see your local women's health physio. They will be able to modify your activity to better manage the pressure you are producing with that activity.  There seems to be concern amongst those who have a diastasis that gap size determines whether they have recovered . Whilst gap width is something we assess in clinic, there are more important aspects of diastasis that need to be assessed:
1) How much tension you can generate across the gap during load? For example: during an abdominal curl up. If you put your finger on the gap whilst performing a curl and you feel it’s tense/firm, that’s a good sign 👍. It shows the abdominals are engaging ok. If it is very soft, some more rehab is needed. 2)Is there doming/bulging on functional activities? I have seen women with a very small gap who have significant doming during high level activities, and those who have a bigger gap that don’t dome at all. That’s why assessment is so important. You shouldn’t be frightened to exercise - a Physio can give you very specific guidance about what activities you can do (and I bet they say you can do more than you expect). The key is modification. 3) How is the rest of the core performing? It's important not to just look at one element of core function because every woman should be treated holistically. If someone has a pelvic floor issue as well as diastasis, this should be assessed too. It is possible to kill two birds with one stone when setting up a rehab programme; two core issues can be treated together.  Are you unsure where to go for help postnatally? Are you experiencing symptoms but are unsure what treatment is available? A women's health physio is ready to help you. In most cases, conservative physiotherapy management is effective in dealing with common issues such as diastasis, incontinence, pelvic pain/back pain and prolapse. Use this flow chart to see how pelvic floor therapy can help you!
 Women's health physios do not just teach kegels! And this list is not exhaustive. These are just some of the most common problems I see in my clinic each week.
You can get a referral via your GP for NHS physio or there is a large private network of physios in the UK, which accept self referral. You can book an appointment with our clinic by clicking here  Just a few minutes of massage a day can make all the difference to your scar healing.
Massage helps to: Break down unnecessary scar adhesions Reduce scar sensitivity Improve the mobility of the skin Reduce scar related pain These are simple techniques that can be easily implemented by someone who has a c-section scar. If you do not think you scar is improving or you are finding it painful, book in to see a physiotherapist.  I was prompted to share this post because I've had a really nasty bout of coccyx pain recently. However - I've utilised some of these strategies and it's now resolved!
1. Offloading the tailbone is important during sitting. You can buy lots of different ring cushions on amazon but I find the blow up travel neck pillows have worked a treat for me! 2. The pelvic floor can often aggravate or contribute to tailbone pain so pelvic floor stretches can be very helpful in relieving symptoms. 3. Manual therapy doesn't work for everyone but when it does it's great! I then give patients a way of self treating at home. 4. You can try heat or ice, whichever gives relief. I definitely prefer warmth but see what works for you. 5. The coccyx is part of the spine so low back problems can also contribute to tailbone pain. Therefore it is important the spine as a whole is moving freely. Incorporate some spinal mobility exercises into your daily exercise programme. 6. Make sure you are not sitting in a slouched position because this loads the coccyx and can irritate it further. Make sure you're are sitting on your sitting bones (the bony bits in your bottom), not your tailbone! 
If your pelvic floor rehab doesn't include some kind of glute strengthening, now is the time to get started! Strong glutes allow your pelvic floor to focus on what it's best at - supporting your pelvic organs and keeping you continent!
 I was delighted to produce this infographic for the POGP journal to support Christien Bird's presentation at the POGP conference last year.
The presentation by Christien covered many different aspects of menopause management but the three key elements that all women need are good sleep, good diet and regular exercise. There is lots of confusing information out there, especially about diet in menopause. But the take home from the presentation was this: Manage your blood sugar levels. The easiest way to do this is through eating a combination of protein and complex carbohydrates. There is a tendency for women to "go to the mat" in the peri/post menopausal years. Whilst there are lots of benefits to doing lower impact mat based exercise, the benefits or doing a mixture of exercise types (including resistance and higher impact) are incredibly important for optimising muscle mass and bone density. Variety is key!  The boat in the dock theory (Delancey et al) is a way of illustrating the relationship between the pelvic organs (the boat) pelvic floor (sea), ligaments (ropes) and prolapse.
A weak pelvic floor doesn't cause a prolapse. But over time not having that support puts more strain on the other support systems, which in turn can cause more stretching or damage to the support system. The best approach is to always maintain a strong pelvic floor. If you then stretch or injure any of the connective tissue supports (eg through pregnancy or childbirth), you've still got some solid muscular support. If you've already gott a prolapse and haven't had any pelvic floor strengthening, hopefully you can see from this image why it's so important! |
AuthorClaire is a women's health and sports Physiotherapist. She is the owner of Spring Physio and is based in East Sussex. Archives
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