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Pelvic Health Update: Exercise in Pregnancy, RED-S and Stools!

Therapy Live – Pelvic Health

CPD is something that the various lockdowns and Covid restrictions have impacted massively. As a Physiotherapist, I love to further my clinical knowledge and keep up to date on the latest research in order for me to enhance my practice and so when Therapy Live announced their Pelvic Health CPD course I signed up immediately. This online, day long course gave me opportunity to explore several different areas of Pelvic Health alongside MSK practice and I was so inspired that I wanted to share with you the standout points from the day.

Assessment of the Pelvic Floor

This was a really engaging and insightful talk from Elaine Miller (Pelvic Health Queen) about how we can assess the pelvic floor without having to do an internal exam, which many people can find quite daunting and may even deter them from seeking help.

After looking at the anatomy of the pelvic floor (which is often not addressed at all at Undergraduate Degree level), she spoke about all the other potential considerations and barriers to accessing help for issues with the Pelvic Floor. There is a lot of stigma and shame associated with Pelvic Floor Dysfunction and often an element of trauma involved to have caused the issue in the first place, an example of this being pregnancy and childbirth. It is an issue that can really take over someone’s headspace and become significantly debilitating in their everyday lives.

My favourite part of the session was when Elaine taught us all the position we should be in to open our bowels. It is important that we never strain when opening our bowels as this puts undue pressure on the pelvic floor. We want to be leant forwards slightly with our feet raised (on a stool) and as you open your bowels you want to “Moo”! Give it a go and see if you can feel a difference!

Another interesting aspect of this talk was looking at the overactive pelvic floor and this being often in younger women and girls. In younger ladies particularly we see “giggle incontinence” and frequently constipation is the root of the issue here. Other things to consider are impact sports, posture and breathing technique.

Relative Energy Deficiency in Sport (RED-S)

Another really fascinating talk was from Dr Nicky Keay on Relative Energy Deficiency in Sport. This topic is so huge and important particularly when it comes to a lot of the clients I see, that I will dedicate a full blog post to this in the near future. However it is something I wanted to cover in this summary too. RED-S concerns exercise endocrinology (think hormones) and looks at how this can affect performance.

The three aspects we look at are:

1. Training load

2. Nutritional intake

3. Recovery

Where there is an imbalance here, often around insufficient recovery and inadequate fuelling, the person is found in low energy availability and this prompts a hormonal response. The main consequences of this include things such as decreased performance in sport, impaired balance, loss of menstrual cycle in females, affects on peak bone mass and ultimately increased risk of injury; specifically fractures.

Implications and management of RED-S can be complex so look out for the full blog post dedicated to it in the future and if you are concerned about this in yourself please do get in touch!

Pregnancy Do’s and Don’ts

Being 29 weeks pregnant myself, this was one of the talks I was really drawn to. There remains a lot of stigma around exercising in pregnancy and women are seen as fragile and weak when pregnant, which is baffling really given they are growing another human being whilst going about their daily life! I am passionate about changing the narrative of how we view pregnant women, leaving behind the assumption that in pregnancy we need to exclusively rest and eat biscuits on the sofa with our feet up and instead providing women with the confidence and tools they need in order to continue an active lifestyle throughout pregnancy. Guidelines for exercise in pregnancy are very similar to that of the general adult population: 150 minutes of moderate intensity exercise with 2 resistance sessions per week. This is easier than you think to achieve with a daily walk and a couple of short Pilates sessions.

Some great tips I came away from this talk with were:


1. Stop if you feel uncomfortable! Listening to your body is key with exercising in pregnancy, and what might feel fine today may well not feel fine tomorrow.

2. Stay hydrated and cool.

3. Listen to your body and adapt as you need to! Running may become walking, full depth weighted squats may become 90 degree body weight squats, importantly you change the movements as and when is right for you.

4. Do what you enjoy! Exercise doesn’t have to mean going to the gym and sitting on a bike. Maybe you enjoy walking, Pilates or Yoga; it all adds up!

5. DO YOUR PELVIC FLOOR EXERCISES! My clients will know already how much I talk about this, but it is because it is so important. Your pelvic floor experiences such a prolonged period of increased load as your baby grows that it needs to be kept strong to support you.


1. Don’t bump the bump! Anything that poses risk to you banging your tummy should be avoided (think horse riding, rugby, netball etc)

2. Don’t lie on your back for prolonged periods after your first trimester

3. Don’t work at a vigorous intensity (so hard that you can’t maintain a conversation)

In summary, there is no evidence of harm to baby or to mum when exercising in the correct parameters for pregnancy and with benefits such as improved sleep, pain relief, increased health of baby and that brilliant mood boost, what’s not to love?

So there you have my whistle stop tour of all the excitement of the Pelvic Health course. I will be back soon with that RED-S blog as well as looking into barriers to exercise for women, but in the meantime I leave you with two tips: 1. Do your pelvic floor exercises and 2. Get a stool for when you poo!

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