In my pelvic health work, I hear “I’m not incontinent, I just leak a bit” multiple times a day from women at all ages and stages of life. Men might not like to admit it to anyone but they have problems too especially if they have a misbehaving prostate. Leaking anything (wee, poo, farts) unintentionally is abnormal. The clinical term for it is stress incontinence. This doesn’t mean you are stressed (although it tends to contribute), it means that the muscles that support your bladder, bowel and other pelvic organs are not strong enough to do their job under pressure. Pressure can mean coughing, sneezing, laughing, sex or exercise.
Unfortunately, the noise of pelvic health physios banging the drum about the importance of pelvic floor strength is still drowned out by the adverts for pads that promise a quick fix. Pads are, at best, a band-aid for a problem that can have far reaching consequences.
To quote the fabulous Elaine Miller, Comedienne and Pelvic Health physio “Wetting your pants won’t kill you (not even if you foolishly join in the mum’s race at the school sports day; “why did you just stop, mummy?”) but the secondary effects of it might”. If you wet yourself when you run or do body pump you don’t tend to keep going. Diseases of inactivity such as coronary heart disease are major causes of death in the UK. People with stress incontinence can withdraw from social activity through embarrassment, become depressed, suffer sexual dysfunction and even in the elderly, suffer hip fractures from rushing to the loo in the night.
This might sound like scaremongering but the statistics are as real as they are disturbing. 1 in 3 women suffer with incontinence and yet somehow it is still a taboo topic. It is accepted as a normal part of ageing or following childbirth. Women with continence problems need to understand that it is NOT normal and help is available. Things can and do improve with the correct advice, exercises and lifestyle changes.
So, what can we do? If you feel comfortable- tell someone. Ideally your local pelvic health physiotherapist or even your GP. They can help you to start taking steps to improve things. The more we talk and get these things out into the open, the less taboo they will become.
Pelvic floor exercises (sometimes called kegels) are a good place to start. There is good evidence that they improve the symptoms of stress incontinence. These are the most common questions ladies ask when I see them in the clinic:
“I’ve been doing kegels for years, they don’t make any difference”:
There is a common misconception that pelvic floor exercises are trying to pull up as if to stop yourself from weeing. That’s only ¼ of the story! ¾ of your pelvic floor muscles are actually around the back passage so effective contractions need to get both going. Sitting or lying down are the best positions to start this training in as gravity is reduced so gives the best chance of success!
Imagine you are in a crowded lift, you had a healthy bean filled supper last night and are desperate to fart. Breathe out slowly, as you do so, pull up around the back passage to hold the fart in. That is the back portion of the pelvic floor you should feel lifting. At the same time pull up through the vagina as if stopping the flow of wee. That is one contraction. Then relax completely. “Wink and zip” is another analogy- imagine the back passage winking as you zip up from tailbone to pubic bone.
To stop leaks, perform a contraction 10 times “fast” as in pull up/let go immediately. Then, pull up and HOLD for 10 seconds, relax. Repeat 10 times.
3 times a day of this whole routine is what research (and experience) tells us will reduce or eliminate symptoms of leaking. You may not be able to do it all immediately but work at the level you can to start and build it up.
Fancy cones, weights and electrical stimulators are all available and have their place but the best evidence is for the exercises described above. If you aren’t sure what is right for you, why not book in for an assessment – we love helping people to laugh and not leak!