Hypopressives - Episode Transcript

Helen

Hi, I'm Helen, and this is Why Mums Don't Jump: busting taboos about leaks and lumps after childbirth. All the stuff that happens to your pelvic floor that no one ever talks about - incontinence prolapse, pelvic pain. Problems that affect millions of women, one-in-three! I'm one of them. I have a prolapse. My pelvic organs fell out of place after the birth of my second child. And if you had told me back then that I would be speaking about this stuff out loud, I would have told you to give your head a wobble.

Hi, welcome back. We are at the end of season four. I know. When I set out to make Why Mums Don't Jump, I genuinely didn't think we'd get past season one. But once you start going on this, there's so much to talk about, as you know, and, yeah, now we're at the end of season four. And so much has happened over the past few weeks. I made my TV debut in the local news this week, which I did have to watch through my fingers. Yeah, but it's fine, it's all good. There's been newspaper coverage as well. That short film by the animation students at Falmouth University - which is a must watch, if you haven't already - it's like a minute and a half. Promise you'll love it. And obviously the massive thing that's happened, the launch of the book, which still feels like a dream. I've had the most amazing messages and reviews from women who've read it, saying the usual stuff - just knowing there's a whole community of women experiencing the same thing at the same time just helps immeasurably, doesn't it? And knowing that there is life beyond whatever issues are making things really hard right now, feeling more confident to seek help. One woman described how it made her laugh, cry and say, 'Ah, I see'. Which was a huge compliment. It's exactly what I wanted it to do. And, yeah, it's always just a privilege to hear from you all, so please do keep spreading the word and leave a review if you can spare a few minutes. It all really helps.

Today's episode: Hypopressives - no doubt you've come across them during a late night Google. That's where I first heard of them. I've never actually tried them, but anecdotally I've heard good things, especially when it comes to prolapse. They're not easy to describe, I don't think, but they're basically a series of breathing and posture exercises. They've been on my list of things to look at for a while, but I just wanted to be sure that I was comfortable exploring them because they're not currently a recommended treatment or certainly not in the UK. But I do get a lot of questions about them and I've asked around a bit and I think it's really interesting. And clearly it's working really well for some people. So I wanted to give you a flavour of what it's about and what the evidence is. So I've been speaking to a lovely woman, Alice Housman, who's a hypopressives trainer. Her background is in gynaecology nursing and she's currently working to publish some research about hypopressives. She's a mum. She also has prolapse and this is how it all started for her.

Alice

So after my third baby, I had a prolapse. He was a very unexpected home birth with my in laws present.

Helen

Oh, my goodness, that's a whole podcast in itself.

Alice

I know! I won't go into too many details, but they are so lovely. And it was fine. But I did think, oh, gosh, this doesn't feel great. And I didn't tear or anything, but in the next sort of few weeks, I thought, gosh, yeah, something's changed. And then just kind of waited for things to settle. And obviously you get that little bit of natural improvement. But after that, I was like, no, this is not good.

So my prolapse was actually very slightly external as well, so I had a constant bulge in my vagina and then it was kind of, in the evenings, it was kind of coming out a bit and it was really quite distressing. And my background is in gynae nursing, so I used to look after ladies having prolapse surgery and it had totally been on my wavelength, but not for me, in my 30s, with three children struggling to leave the house, struggling to go on a walk without having to nip behind a bush. I mean, we live in the country, so I could do that. But going into town, I just kind of became slightly like, well, just didn't really leave the house with the kids.

Helen

So you had incontinence symptoms, urinary symptoms as well as the bulge?

Alice

Yeah, more like really bladder irritation and, yeah, some stress incontinence as well. But the main thing was the bulging, the heaviness. I mean, my cycles, my periods, felt incredibly uncomfortable. Really quite unbearable for a couple of days. And I saw my GP and she was lovely, but she took one look at me and said, 'Well, just carry on with your pelvic floors and when you can't cope with it anymore, then I'll refer you for surgery'. And I was 34 at the time, so it was really at that stage, I did start googling and I kept looking on the internet and it was after about 18 months, I literally stumbled across hypopressives and it was a lady speaking about her own experience. And I read it and I was like, I've got to try this. And immediately, with kind of my NHS nursing head on, I thought, gosh, this isn't something that is recommended in the NHS. And kind of looked into that a bit and I thought, you know what? I don't care. I can't live like this. And so that kind of started me off on the journey and I actually then trained as a trainer. Never intended to teach, but had such good results. I was like, wow, more women should know that this is potentially an option to reduce their prolapse symptoms.

Helen

It's a funny one, isn't it? So you're coming it from the nursing side of things and you're thinking, I've never heard of this before. And I was coming at it from the journalism side of things and I'm a natural cynic anyway, and you go into that Google mode, don't you? You start looking at all these things and then there's some things you definitely park in the kind of that's-a-lot-of-nonsense category and then there's the stuff that's kind of officially recommended. And then, yeah, for me, hypopressives is something that was kind of in the middle. I was a bit like, kind of need-to-know-more-about-this pile. And then just because of everything that's happened - and I've been able to manage my prolapses symptoms through exercise and pelvic loor exercise and stuff, and I also, we'll get into this, but I get the sense that it's quite a commitment as well to learn hypopressives and to keep them up. So I guess this is really the first time that I've had a proper conversation with someone about them. I get messages from people quite often asking me what they are and what it means and everything. So hopefully we can answer a few of those questions. So, generally speaking. Tell me more about hypopressives. Where have they come from? What's the theory behind them? What do they look like?

Alice

Yeah, so it was originally developed in Spain by a physiotherapist called Marcel Caufriez, and he was working with postnatal women and observing that when they did normal core exercises, their prolapse symptoms were getting worse. And so he developed this. It's essentially like a low pressure exercise technique where you basically create a vacuum in the tummy and the pelvic area and use different poses to retrain the core and the pelvic floor to work more automatically in the background. So we're working on that kind of autonomic side, that reflex activity, which actually, in terms of core and pelvic floor, it's the majority of how those muscles are working anyway. So that's where it started. It's sort of since been developed into fitness techniques and there are different ways you can learn it. And there are different nuances of the breath work as well, which I didn't actually really know about until I started doing my own research into it. But there are definitely ways you can do it to get better results from a pelvic health side, which, yes, is good to know. It's a good thing to know.

Helen

I've seen videos and pictures of people doing it and it looks a bit like - I might be totally wrong - like when you see weightlifters or bodybuilders posing for contests and they have the really concaved tummy, they breathe in right underneath their ribs and when I've seen people do it, it's kind of like you do that and then I see them doing kind of like yoga poses around that.

Alice

I think as a technique, I think it is quite widely misunderstood, primarily because when you look at it, it looks really weird and it looks like you're pulling in your stomach. And I know that if I was looking at it from a pelvic health perspective, if I was working in pelvic health, I'd be like, what has that got to do with improving prolapse and incontinence? Because essentially you don't want to be sucking in your upper abs. You don't want to be I mean, it just looks weird. But actually what we're doing is because we're reducing pressure, the vacuum that it creates is actually completely involuntary. So you exhale, so it feels like a normal exhale. You hold your breath, you pause, and then when you stretch your rib sideways, basically the deep core muscles contract and kind of move up and the pelvic floor follows and it follows synergistically with the diaphragm as the diaphragm moves up and it kind of umbrellas and the pelvic floor moves. And we know that the pelvic floor mirrors the movement of the diaphragm. So it's a really amazing way of accessing the pelvic floor through breath, and releasing and toning and getting the core to function more as a unit. But yeah, it looks weird and I think it's very misunderstood, but I think we've not really tapped into it in this country and it's exciting, I think.

Helen

Yeah, I just welcome anything where we can explore new techniques or ways to help people. Why not? If it's not going to do you any harm, there are different things to try.

When you first tried it, what was that like for you? How did you get your head around it? Did you just get it straight away? Because it does sound complicated and I'm not going to lie, I did try the other day when I knew we were going to have a chat. I did stand in front of the mirror and try, have some random try. It didn't go particularly well. What was your experience like?

Alice

I am actually quite uncoordinated, so I found it incredibly difficult to work out what my body was doing, because my posture was really off anyway. And the breath work - I was very, very stiff in my rib cage. But when I started practising every day, I did get it quite quickly after that and within three to four months, my symptoms had basically reduced to the point where they were pretty much nonexistent and it felt pretty miraculous. I went on to really develop the rib stretch and things after my training, but even the breathing and the release of the diaphragm seemed to just have a positive effect on things like the pelvic congestion I was experiencing, and that heaviness. It took a while to get it. I mean, I think now when I teach it now, I've taught hundreds of women, I've got a step by step guide that I follow, and it's really effective. Most people get it within about five to ten minutes, and actually then they practise and they get better at it pretty quickly.

Helen

And the idea is that you practise every day, right?

Alice

So I would recommend you do about five or six days a week, about 15 minutes. So most of my ladies will do Monday to Friday, 15 minutes when they wake up in the morning. And for the benefits that they get, it's kind of like a no brainer, because you hit posture, core, pelvic floor, you decongest the pelvic area. It's very relaxing. It's a very mindful technique. So it's kind of really calming for the nervous system. And it feels great. It's an exercise, and you're moving your body, and with all the benefits that come with it, it's really fantastic.

Helen

And bear with me because, like I said, this is really the first time I've really kind of thought about it. Just in layman's terms, how would you describe what that ten or fifteen minutes looks like? I mean, I know I gave a terrible description of a bodybuilder, but if there was a video of someone doing it, what would it look like?

Alice

Okay, so, for example, you'd be lying on the floor with your feet flat on the floor, knees bent up, and you would pop your hands around your ribcage, fingers at the front, thumbs to the back, and you just breathe in and out three times. So the in breath is through your nose for three, the exhale is slightly slower, so we're not trying to exhale out more than we've breathed in. And you do the in and the out three times. Then you hold your breath out, pause, slowly stretch your ribs sideways towards your hands. And that creates the vacuum. You basically don't want to over exhale. You don't want to kind of transfer positive pressure to the pelvic area, which is a mistake I see a lot. And I think that's where people can kind of be like, oh, I got some improvements, but not really that very much. The technique does need to be kind of really good with the breathing.

Helen

Okay, all right. So it is looking maybe like a little bit like yoga, a little bit like Pilates, but there's just different breathing happening.

Alice

Yeah so you start off on the floor, and then we start to introduce standing poses, kneeling, quadruped, sort of all four, sitting poses. Lunges, we've got bridge, different kind that work more up the front line of the body to activate more and lift through the bladder. And then ones that kind of release more through the back of the pelvic floor and also improve glute strength and things like that, which is so important for pelvic health. So it combines so much stuff that is beneficial. I think that's why it works so well, really.

Helen

And would you be doing this alongside other things as well, like diet and watching your constipation and maybe pelvic floor exercises as well?

Alice

So definitely avoiding constipation, drinking plenty of water, feet on a stool, that kind of stuff. Pelvic floor exercises, yeah for some women, they can do it alongside it. I have to admit, for a lot of the women that come and see me, they've already worked with really good professionals. They've done their pelvic floors, they've done the whole thing, and they're kind of like, I need something else now. So a lot of them have stopped, or they sort of do a little bit of both and then they phase it out when they get better benefits from the hypopressives. So it really depends on who we're working with. And it's very, very tailored, because pelvic floor exercise have got their place, and I think it's really about the individual and what they need.

Helen

So the key question, I suppose, for everyone with all of these things is what is the evidence that it works? Because I had a little look just before we chatted, and I think, as things stand, it's not recommended in the clinical guidelines, as you said, which doesn't necessarily mean it doesn't work, but just that the evidence base isn't there for NICE to recommend it, or at least it's not there yet. And I think I read, to date, there's no evidence that other exercise programmes beyond pelvic floor muscle training are more effective for prolapse. But again, it's all just emerging, isn't it? And I know that you're working on a paper yourself, so as far as you are aware, what's the evidence that they are effective?

Alice

Yeah, so I think there's a couple of things that have been done in terms of the research - there's nothing actually that's been done in the UK yet, which is crazy, thinking about it's been around 40 years and the anecdotal evidence is strong - so there's international studies, which they are good, but they're not very rigorous. So there's actually a really good RCT, randomised control trial that was done in 2020.

Helen

Which is like the gold standard of research, isn't it? Because it compares two groups against each other.

Alice

Exactly. And that was Navarro-Brazález and their team, and basically they looked at Pelvic for exercises, pelvic floor exercises and hypopressives, and then hypopressives on their own. They compared all these three groups. It was about 100 women, 30 in each group. It's a very good study and everybody improved and there was no significant difference between the groups. So that's really good. But I still think in the pelvic health community, they don't just want one paper. So, for me, I'm looking at that, thinking, well, that's good evidence and it is a good paper. But I think this is a thing in women's health, there's a lot of things that need more research and I think women are like, I don't want to wait till the research is out there. I can see it's helping women. And this is one of the reasons why I started collecting my own data, partly because I felt a little bit uncomfortable offering something that wasn't offered in the NHS. I'm NHS born and bred, and so I thought from the word go, I did before and after screens, and I really didn't think I would find the kind of positive data that I had. I thought maybe 50% of women would benefit, maybe even 25, even if it was one in ten. And through doing that, it's been so eye opening, because generally the chat in the pelvic health community is 'hypopressives help women with prolapse'. But I'm like, but if you've got a grade two prolapse, is that going to help you? Is it going to help a lady with a triple prolapse? And one of those is a grade three? So through doing this research, I've actually been able to really understand the technique more and which women are benefiting and how much as well. So I've really enjoyed, actually, being geeky with the research side of it. But it's hard as well when something - you think people are looking at you as well. And it's like, I want to be really responsible in the field I'm working in, because it's not in the NHS and I want to give women all the information they need to make an informed decision about whether or not they want to try this programme, because it is one-to-one and it is an investment. But I think for the women that we've worked with, it has been worthwhile.

Helen

So what have you found with your women, then? I don't think you gave a figure for the sort of success rates that you found?

Alice

I'm working to publish - it was going to be a case series, but now it's actually bigger - so it's 74 women. They're aged in their twenties to sixties. The average is 40. And we literally did a before and after screen. So it was myself and one of my coaches, Emily, that worked with me in the latter stages of this.

Helen

And by screening, we mean a questionnaire?

Alice

A questionnaire. So they're doing a questionnaire. It's the Pelvic Organ Prolapse Symptom Score. So you've got seven questions. And then we do ask some additional questions on quality of life and they will literally say how they are over the last four weeks, and then at the end, they'll do exactly the same. And then we've looked at the difference between that, and what we found is that out of 74 women, they've all improved. We actually had to exclude women who didn't have a diagnosed prolapse, were just coming for incontinence, had had previous surgery, those kind of things. So everyone in this study has been properly diagnosed, has worked with a women's health physio and they're just coming to us afterwards. And the average improvement is huge. It's an 85% average improvement for these women on just their symptoms. They all have a single, a double or a triple prolapse. So these aren't women with minimal symptoms. And the exciting evidence, I think this is the most exciting thing, is that we have found no significant difference with age, stage of prolapse and numbers of prolapse. So if someone comes to me to do the programme, I can say to them, whatever prolapse they've got, you've got as good a chances getting good improvements as anybody else who we've worked with on the programme, and I think really shows that hypopressives does something in our bodies that really helps prolapse. Whether or not you've had it for two years, four years, five years, whether it's really bad or actually it's quite mild.

Helen

How do you think it works? Is it a combination of posture and breathing and balancing, in combination with, as you say, that sort of vacuum, or potentially vacuum effect? I guess it's still all theoretical, right, or is it? I don't know.

Alice

Yes, they've actually done some research papers looking at how it actually works. So one of them found that during the vacuum breath, the bladder actually moves up. So during the vacuum breath, it moves up. It's not to say it stays there. But there is a ligament that goes from the top of the bladder into the back of the belly button. It's a ligament-like structure and every time you do a vacuum, that draws up. Now, women with bladder prolapse, yeah, they do very, very well. So do my ladies rectocele, but it's nice to see that lift on ultrasound. They've also looked at research to show it does activate the deep trunk muscles and it does improve posture. And in terms of the other things, there's research to show that it improves body image, that it improves pelvic floor tone, levator ani thickness, and obviously incontinence and stress incontinence and all those things. But I actually think a lot of the work that we do is through balancing the pelvic floor, exactly what you're saying. I think areas of tension, areas of tightness, getting the pelvic floor moving with the diaphragm reminding the pelvic floor is supposed to be doing, essentially, and that synergistic movement there. But also, I think when our pelvic floors are tight, they're not functioning well, they are inhibited. And I think hypopressives can just offer this way of just keeping the pelvic floor moving and in a really natural way and creating that lift, which I think can be so important for prolapse.

Helen

And then is it something that you have to then carry on? I mean, it's not like you do it for six weeks, then you're done, you're off, you're back to how you were before. Is it like with all these things. It's something you have to maintain?

Alice

Yeah, you do want to maintain it. I do 15 minutes a day. I wake up, make myself a cup of tea, and I do 15 minutes. I actually use my own YouTube videos to follow because I really enjoy doing it - it's part of the incentive of doing my YouTube channel as well, because I didn't have anything else to follow. But it's nice to have that mix and variety. 15 minutes a day, and it is really working towards it being a skill for life. But also, I'm just so grateful. I used to get really emotional when I look back at how my life was with prolapse, and now I'm just like, I can literally...15 minutes a day. I'm pretty much asymptomatic all the time. I don't even think about it, whereas it was in my head all the time. I was just obsessed by it. I was so distressed. I know you've been there. It just takes over, doesn't it?

Helen

I was going to ask, what was that transition like from being in that headspace? We try different things, don't we? And sometimes they work and sometimes they don't. When did you allow yourself to acknowledge that, hey, this is actually making a real significant difference?

Alice

Yeah, I mean, I think it was in the first sort of three to four months that the bulge went, and it's never come back. And I don't have any bulging in my vagina anymore. I think it was moving on to doing harder poses, where actually, although I was really, really good at sort of the four month stage, I did find I'd kind of get random days that would be really bad and I'd be like, Why is that? But now that's sort of all plateaued off and I just don't get that fluctuation anymore. And I think a lot of that is to do with adding in some of the harder poses, some of the more whole-body and some body strength training as well, which has really tipped me into being just so much better than even then. And I was thrilled with my results of four months.

Helen

And it's like, with a lot of these things, we're not saying that if you were to stand in an ultrasound machine or whatever - whatever you do in an ultrasound machine -,things are not going to be as they were before you had kids, necessarily. It doesn't mean to say, that anatomically, everything is back to as it was. But the key thing, I think, correct me if I'm wrong, is the symptoms, right? Your symptoms and your quality of life - that changes and that's what then changes your life?

Alice

Exactly. And I think the aim of any treatment, I know that the NICE guidelines around pelvic health improvements, it's all about it's all about symptom improvement. It's all about what is a woman experiencing and how can we improve her quality of life? And that's where it starts and finishes. That is it. That's why we do what we do. Everybody who works in pelvic health, that's what you're aiming to do, isn't it.

Helen

Thanks so much to Alice for that and I hope it was a helpful conversation for you. As ever, none of it is intended as medical advice, so please seek out your own professional help. If you want to know more about hypopressives, I'll add some links to the show notes, as well as Alice's website. On Instagram you can find her @hypopressives_with_alice and I'd love to hear from anyone who's tried hypopressives. How did you get on? Find me on social media or drop me an email, let me know. And that's it for season four and I'm not sure what comes next for me. I'm open to all ideas. I think that this has very much been a passion project for me, which kind of snowballed, and I'm really lucky that I've been in a position to roll with that. But it's a huge commitment and I need to work out how I might sustain that. So all ideas are welcome. And don't forget that you can support the podcast at buymeaccoffee.com/whymumsdontjump. It can be completely anonymous, if you prefer. Thank you to everyone who's done that so far, because it really helps with hosting fees and so on and so forth. So that's it. Thanks to you, and to all of the brilliant guests who have shared their stories and their expertise over the course of the last few weeks. You're amazing! You've been listening to Why Mums Don't Jump with me, Helen Ledwick.

You can find me on social media @whymumsdontjump, where I'll keep you up to date with what's happening, or online at whymsdontjump.com. Bye for now.