Many women suffer urinary incontinence, but it’s not something we tend to talk about amongst our friends. If you have ever noticed a dribble in your undies … know that you are not alone!! If you have had a baby (vaginal or caesarian birth), you are far more likely to dribble in your pants than ever before – but don’t worry. Regular pelvic floor exercises and good bladder habits can make a great difference.
There are 2 kinds of incontinence: urgency and stress incontinence. Urgency is when you feel as though you are ‘bursting’ to empty your bladder. You really have to rush to get to the toilet, but when you get there, there’s not much volume.
Stress Incontinence is where you dribble a little urine when you sneeze, cough, jump or run with your kids. There are a number of strategies that we can put in place to help improve both of these.
Your pelvic floor is a sling of muscles that hold your internal organs in your abdomen. It is also the muscle that helps us hold onto urine if we think we are about to leak. Imagine trying to hold a 3L container of milk between your legs for 9 months (ie pregnancy) !!. There is a lot more weight than this while you are pregnant, but it’s a great ‘visual’ reminder about why your pelvic floor may need some extra attention through pregnancy and after your birth (irrespective of your type of birth).
Exercising your pelvic floor muscles is easy – the hard part is remembering to do them. Pretend to sit on the toilet and squeeze your muscles upward and inward. Some people say to pretend to stop the flow of urine (this is a great way to check that you are using the right muscles, but not a great habit to get into when you are on the toilet). Lift your pelvic muscles the from inside and aim to hold your contraction for up to 10seconds. This is an aim … initially try to do up to 10 contractions twice a day, and hold them for as long as you can (if 2-3 seconds is all you achieve – that’s a great start). Try not to over-do your exercises. When you can hold for 10 seconds, do more contractions throughout the day as you remember them.
There are 2 types of muscle fibres in your pelvic floor – the endurance fibres that help to hold for up to 10 seconds, and your fast twitch fibres. Once you can hold your pelvic floor muscle contractions for about 6 seconds, you can start exercising the fast twitch fibres as well. That simply means contracting faster – on-off-on-off-on-off … as well as remembering your holding exercises.
Lower tummy exercises (your inner corset of muscles) are also important as they help to stabilise your core (your middle). These muscles work in conjunction with your pelvic floor. Simply draw your belly button in (without holding your breath) and hold. This is a subtle movement that can be done with your pelvic floor exercises up to 3-4 times a day. A women’s health physiotherapist will be able to help you with all of these muscle groups and ensure that you are exercising them properly.
Good bladder and bowel habits are another important factor in pelvic floor muscle health. Bladder health can be improved by drinking 1.5-2L water per day. If you are not doing this already, increase your volume slowly. Try to reduce your intake of bladder stimulants such as caffeine, bubbly drinks and alcohol.
It is normal to pass urine 4-6 times per day and 0-2 times at night (depending on our age). Volumes are usually around 300-350mL, and we should be able to wait for 2-3 urges before we go to the toilet to pass urine. Our bowels should always be opened at our 1st urge.
Correct positioning on the toilet is something else to think about. There is a position of ‘least stress’ on our pelvic floor. Try to have your knees higher than your hips, bulge your belly out and breathe out at the same time to reduce strain. Your women’s health physio can also help you with this.
Avoiding or improving your incontinence starts now. Look after your pelvic floor with the strategies mentioned above, and if you are worried, pleas see a women’s health physio or GP who will assess your pelvic floor strength, help you do the exercises correctly, and put you on the road to a healthier pelvic floor (with less incontinence)!