Some studies suggest that 9 out of 10 women will suffer some form of incontinence in their lifetime. For many it is an embarrassing and life altering daily trauma. Still a taboo subject for most this common and under-treated symptom is a common cause of relationship break-downs, reduction in physical activity and sport and will even limit laughter with friends. One of the biggest and most incorrect assumptions is that it is just a normal part of the ageing process; something that is par for the course. It is not.
The incidence of urinary incontinence in women increases during and after pregnancy, but it is not limited to this demographic. Often we will laugh about it to try to make light of the situation, but I want to promote a shift in society, to increase awareness and ultimately help as many people as possible to throw away the pads!
Whether you just leak a bit with exercise or a sneeze, or if leakage is a part of daily life, the following information has been collated to give you the confidence to start improving your symptoms today.
The female pelvic floor is made up of a group of muscles, the same as any other muscles in your body. They act as a sling and connect from the bone at the front of your pelvis to the coccyx at the back of your pelvis. They work with the muscles that connect to your outer thighs. Together they support your pelvic organs and keep you continent. Unlike the male pelvic floor, females have three openings in their pelvic floor, which makes it inherently weaker and more prone to pelvic organ prolapse. Pregnancies and deliveries, constipation, chronic coughing and heavy lifting, pushing and pulling will all put extra pressure on the muscles.
Pelvic floor exercises are often prescribed for ladies with continence issues. Depending what you read you will see a variety of suggestions and tips for how to perform them. In my opinion, one of the most important things to remember is that you are trying to build muscle. You need to think 'body builder'. Occasionally remembering to do a couple of squeezes, then getting distracted and doing something else, is not going to get you very far. You will need to complete the exercises daily, to muscle exhaustion, to notice any change in symptoms. The good news is that it will not take very long to complete them each day, probably just five minutes.
Lie on your back with your knees slightly bent. Squeeze your pelvic floor by imagining that you are trying to stop yourself from doing a pee or poo. You should not be using your buttocks, sucking in your stomach or holding your breath.
Count how long you can hold the contraction for in seconds and note it down. Wait for a few seconds and then try and hold for the same amount of time again.
Repeat this until you physically can't do any more and note down how many times you managed it.
Now try some quick contractions, pull in quickly then let go straight away. See how many you can do in a row and make a note of it.
You have now completed your pelvic floor 'fitness test'. This will be used as the baseline for your exercises.
Each time you complete your exercises (aim for once per day) try to beat your score by one. For example try to hold for one extra second, one extra contraction and an extra quick one. As soon as you are able to do so then increase it again, and so on. This way you will build muscle quickly.
Another way to make the exercises harder is to change the position that you do them in. From lying on your back, progress to sitting, then standing, then standing with legs apart.
You may have tried pelvic floor exercises and not noticed any improvement. One possible cause of this may be that you have an issue somewhere else in your body that is increasing the pressure on your pelvic floor. A common place for this is in your thorax or chest. This commonly occurs in pregnancy and after childbirth, for a variety of reasons. A good exercise to try is use your breathing to try to stretch out the muscles that surround your chest. A great position for this is something called 'Child's pose'. On a bed or the floor get on to your hands and knees. Keeping your hands in place try to sit your bottom back towards your heels. Keep your head in line and keep your neck relaxed. Go as far as you can comfortably and you should feel a gentle stretch in your back and under your arms. Keep in this position and take a deep breath. Repeat the deep breath six times whilst staying in the position, but take normal breaths in between to stop yourself getting dizzy. Complete this stretch before your pelvic floor exercises, and before and after any exercise classes or physical training.
One last thing to try is to make sure that you don't get constipated.
You can help yourself by:
- Drinking 1.5-2 litres of fluid per day
- Eating 4 dried prunes per day (or apricots)
- Using a tablespoon of ground linseeds per day (on cereal, salads, in soup or smoothies)
- Getting a minimum of 30 minutes of exercise daily (walking is fine).
If you have tried all of the above, have difficulty managing your bowels and or still have symptoms then please book in for an appointment. Urinary incontinence is treatable and doesn't take long to improve. It is never too late!