To wee or NOT to wee
Stress urinary incontinence (SUI) is the unintentional loss of urine. It can happen with activity such as running, jumping, coughing, sneezing or laughing.Any activity that increases your ‘intra-abdominal’ pressure more than the resting muscle tone of the pelvic floor muscle (PFM) will leak urine (weak PFM).
“I laughed so hard the tears ran down my legs” anonymous.
What causes it?
There are three types of incontinence, urge which is affected by bladder over activity, stress which is caused by a weak pelvic floor muscle (PFM) or a combination of the two which is called mixed incontinence. The most common form of incontinence I see today is SUI. It is caused by weakness in the PFM, this can cause the bladder to drop down into a position that prevents the urethra from closing completely. The result is a leakage of urine. The cause for the PFM weakness can be anything from child bearing (pregnancy) to low back pain, inactivity, obesity, injury to the pelvic region and commonly child birth. Back in 2015, Dr. Ciara Kelly, a well-known Dublin GP launched the Don’t Grin and Bear It campaign to draw awareness and give voice to this common, but rarely discussed, problem. She had some interesting statistics. 54% of Irish women suffer with a weak pelvic floor. One in two Irish women consider the topic taboo and don’t like to talk about it. In Kinsale, where I’m living, I find more and more women happy to discuss their incontinence issues and want to find the right exercises to help. The bad news is it is much more common in women than men. If you have it, you’ll know it, you’ll probably feel embarrassed, isolate yourself with work and social life and limit your exercise activity. The good news is, with simple specific exercises you can reverse your symptoms or prevent it from happening in the first place. I am happy to help and you can find simple Pilates beginner exercises online for exactly that, wildphysio.ie
Check out a two-minute tutorial with me on finding your pelvic neutral.
Pelvic Diamond. Your spirit level.
Pilates v’s Kegels?
Clinical Pilates, of most recent times has been shown in numerous studies and trails to strengthen pelvic floor and subsequently avoid SUI and/or surgical solutions. Unfortunately, women aren’t inclined to address PFM exercises, in my professional opinion it comes down to correct PFM education and time. This is very important, its women’s health and it should not be brushed under the carpet. One quick visit from a busy physiotherapist in hospital is NOT enough. Women need education and support in this area, it is a preventative measure and a reversible one too. Unfortunately, for women of our mothers era, prolapse was a common problem almost inevitably leading to surgery and not without complications.
Regardless of how we deliver, something quite large is coming out of our bodies through a relatively small hole or layers of abdominal tissue. Pregnancy and childbirth inevitably take a toll on our bodies.
A brief six-week check-up, a peek at the uterus, and a battery of feeding and depression questions seem entirely insufficient as our postpartum care. Culturally, we’ve come to accept that once the baby is born, the focus should be on the baby. This paradigm makes any sort of additional maternal care seem like a luxury.
Interestingly recently, of 361 Australian gym going women screened in a recent study nearly half (49.3 %) of participants reported SUI, many whom slight or moderate leakage. Less than 1 in 10 (9.7 %) of the women surveyed had heard about the causes of SUI or the exercise’s that would help. You are probably thinking right now, what about Kegel? Who was that? Arnold Kegel was an American gynaecologist born in 1894 he invented a pernieometer which could measure PFM strength. That is an age-old exercise of contract and relax of the PFM. Times have changed and more contemporary exercises (Pilates) has now surpassed Arnold. Pilates takes in body position, pelvic floor activation and builds on the endurance of the muscle. It focuses on breath and how the breath helps to increase ‘intra-abdominal’ pressure as you breath out. It is evidence based and has a much greater awareness around it than Arnold.
What are MY choices?
In my opinion, to wee or NOT to wee is a choice. If you rather a more ‘passive’ approach, and delegate this job to someone else you can hire a garment from Neuro-tech, the vital which is a wearable electrical stimulus garment recommended to be worn for 30 minutes a day, 5 times a week for 12 weeks for improvements. Or if you would consider yourself a helpless case, there is always surgery where gynaecologists mesh your bladder back to its original position under general anaesthetic. This was the preferred choice in the 80’s and 90’s when women were not educated and given a second option. There are options. The most empowering, enjoyable, active, accessible, affordable choice is something which you are in charge and does not involve electrical impulses or a knife.
In this diagram, you can see how the incorrect action is formed under run of the mill abdominal exercises, may actually- be putting more strain through a potentially weak muscle. The correct action is of pulling up through the pelvic floor on an exhalation as taught in Pilates effectively strengthens the PFM. One interesting piece of research in this area is a paper by Kari Bo (2004), summarising the evidence and developed three theories to explain the effectiveness of PFM/Pilates training for SUI:
1) women learn to consciously pre-contract the PFMs before and during increases in abdominal pressure (such as coughing, physical activity) to prevent leakage;
2) strength training builds up long-lasting muscle volume and thus provides structural support; and
3) abdominal muscle training indirectly strengthens the PFM.
Try lying down before watching my mini tutorial and see how easy it is to find a neutral pelvis and activate your PFM. Palpate your hip bones (ASIS) with the heel of your hands and bring your forefingers together to palpate your pubic bone, taking your hands into a pelvic diamond. Try to balance your pubic bone with your hip bones. Now, see can you find your neutral pelvis without palpating. Find it and then check again, what might feel like a neutral pelvis to you may not be yet.