Do you leak urine when you cough, laugh, sneeze or lift a heavy weight? You are not alone: about 1 in 3 women suffer from stress incontinence which can be caused by, amongst other things, weak pelvic floor muscles.
As with many common musculoskeletal problems, we can trace the cause back to the fact that humans evolved to walk on four legs. By standing upright on two legs, our pelvic floor muscles are not only responsible for aiding defecation, urination and birth but also must act take on weight- bearing duties.
In effect, the pelvic floor muscle has become a large hammock of muscle cradling the bladder.
When you laugh, cough or lift a heavy weight, our pelvic floor muscles naturally squeeze together to keep the bladder outlet closed. Aging, excess weight, pregnancy and labour can all weaken a woman’s pelvic floor muscle which can lead to the escape of urine at unwanted moments.
Women who have long labours, big babies or forceps deliveries are at particular risk. Studies have shown that nearly 40 per cent of women experience incontinence following having children and many are too embarrassed to seek help. Other women sufferers consider stress incontinence to be ‘normal’, mistakenly believing that it is just something to be put up with.
Many factors, other than pelvic floor problems, can contribute to incontinence including bladder infections, hormonal changes during the menopause, problems with the urinary tract, nervous system conditions, constipation, medication, smokers cough, high caffeine intake or simply being in the habit of emptying your bladder too infrequently or too often.
Please don’t suffer in silence: if you experiencing leaks talk to your GP to confirm why this has occurred and to rule out any contributing medical conditions. Then ask his or her advice on the best way of dealing with your level and type of incontinence.
Whilst no method of dealing with stress incontinence is 100 per cent effective, including drugs and surgery, there are several noninvasive self-help steps that you can take. Incontinence nurse specialists may help you with dietary changes or even ‘bladder training’ which involves only urinating at set times with the gaps between urination gradually increased.
Some women have found that wearing a medical device internally (rather like a silicon tampon) pushes the vaginal wall against the bladder outlet thus helping to keep the urethra closed. One brand of these devices is the Incostress (see www.incostress.com for more information).
Whether you already experience stress incontinence or you want to help avoid developing it, it’s important that you get in the habit of strengthening and toning your pelvic floor muscles. You will have probably heard of pelvic floor muscle (PFM) exercises or Kegel exercises before…but how many of you do them on a regular basis?
Here’s a recap for you. It’s quite tricky to perform PFM exercises correctly. You can check for yourself by placing your finger in your vagina and squeezing around it. When you feel pressure around your finger, you are using the correct muscle. Try to keep everything relaxed except the muscles right around the vagina.
Another way to check: next time you are urinating practise stopping and starting the flow of urine by contracting your muscles. This is also a good way to monitor the effect of your PFM exercises – you should find this test gets easier as you build up muscle tone.
You may find it easier initially to practise PFM exercises lying down with your knees bent and together. To work the muscle harder, have your knees apart. Contract your PFM for a count of four and then relax for a count of four. Repeat this for 5 minutes twice a day. Do not bear down or squeeze your thigh, back or abdominal muscles. Breathe slowly and deeply.
As your PFM muscle gets stronger, you can do the exercises sitting down or standing and you can double the amount of time you contract the muscle. Bring
in some variation by contracting your PFM for 5 to 10 seconds or by contracting and releasing in rapid succession. You could also try coughing whilst holding the muscle contracted.
Some women find it easier to practise these exercises using vaginal cones. These are of differing weights and are available from chemists. If you do not notice any improvement after three months of daily PFM exercises then you should return to your GP.
A further option is to use a special tens machine at home. These units involve using a very mild electric current to internally stimulate the PFM. This involves a pins-and-needles or tingling sensation but no pain. You should only use these after advice from a healthcare specialist.
Further information: Continence Foundation helpline 0845 345 0165; www.continence-foundation.org.uk