Don’t make me laugh (I might leak…) - The Pelvic Floor and Incontinence

Don’t make me laugh (I might leak…) - The Pelvic Floor and Incontinence

Let’s face it, it’s not something people want to admit to or talk about. 1 in 3 women have trouble with their waterworks. Pelvic floor weakness can affect men too, but it’s much more common, and tends to occur much earlier in women. That is not surprising - women hatch babies! But it DOESN’T have to be this way!

As Physios, we don’t often get asked by our patients about the pelvic floor, or problems that exist ‘down below’. We usually have to take the initiative to ask our patients directly to find this out. So here is some info we all need to know about the pelvic floor and incontinence (or wind!), not because you asked, but because we know you need it!! 

‘Waterworks problems’ tend to occur in three categories, and often co-exist.

• Stress Incontinence – leaking a bit (or farting -yikes) when you cough, sneeze, or lunge to catch a falling toddler
•  Urgency – you really feel like you need to pee. Like, really really! You think you will wet yourself if you don’t respond
• Frequency – aka micro-bladder. You visit the toilet A LOT. This may mean more than once during the night.

It is ultimately the pelvic floor that controls the chain reaction of events that are involved in bladder emptying, and at all other times, keeping everything closed up nice and tight. 

‘Normal’ bladder activity would generally involve:

• 4 to 6 trips to the toilet per day
• 1 toilet trip at night
•  dry knickers all of the time
• painless, comfortable peeing
•  the volume of at least a mug full of pee with each visit

Even if you rate as ‘normal’, keep reading. This could easily change as you get older, or have more kids!

So what goes wrong?

The pelvic floor muscles can become weakened by

•  Pregnancy
• Delivery
•  Age
• Constipation
• Chronic cough
• Hormone changes related to having a baby, hysterectomy or menopause
•  Drugs, eg some blood pressure meds, caffeine, alcohol
• History of bedwetting as a child – seems unfair doesn’t it!?

When the pelvic floor relaxes as we sit on the toilet, the bladder muscle squeezes out the pee. When the stream has finished, the pelvic floor kicks in again and shuts up shop. If there are issues with pelvic floor muscle strength though, the bladder emptying muscle can get mixed messages, and contract when it’s not supposed to (eg when you are out shopping and absolutely HAVE to go RIGHT NOW -  oh look, I only peed a teaspoon worth…). This is the ‘urgency’ we referred to at the start of the article.

If your pelvic floor is weak and you leak a bit when you strain (‘stress incontinence’), you can develop the tendency to go to the toilet more often, to ‘decrease the chance of a nasty accident’. Unfortunately all this does is reset your bladder’s expectation of fullness, and you get “gotta go” messages way more often. You generally then pee smaller amounts when you go. This is the ‘frequency’ aspect.

What is the solution?

Aha, the million dollar question! First you have to strengthen your pelvic floor, and second, you have to progressively ‘reset’ normal bladder function with a bladder training program. Want to know more??

To strengthen the pelvic floor you need to

•  Feel it working
• Find its limit
• Force the limit higher

To feel it working, sit reclined on pillows on the bed or floor, and pop a couple of your fingers just inside your vagina. Try to contract the muscles around your fingers – try different cues like ‘draw up your holes’, ‘avoid breaking wind’, or ‘squeeze Hubby’s willy’. If you can’t feel a contraction despite a few sessions of trying, you may need to see a Women’s Health Physiotherapist.

To find its limit, see how many 2 second contractions you can do, with 4 second rests in between. Don’t worry if its only 1 or 2!

To force the limit higher, do ‘your number’ of pelvic floor contractions multiple times a ay (eg on the ‘T’s – after you go to the toilet, stop at traffic lights, have a cup of tea). Then reassess your contractions on the bed, and use your new number to repeat multiple times a day. Don’t overdo it or get frustrated – the pelvic floor is like any other muscle and gets tried, and has good and bad days!

To retrain your bladder from frequency and urgency, first record a table of how often you go and what times, and approximately how much volume is produced at each pee.  Then, when you ‘gotta go’, WAIT! Wait for 5 minutes, distract yourself, hold your crutch, do whatever it takes. Once you can postpone every pee by 5 minutes, wait for 10!

If you are diligent with these exercises, there will be no option but improvement! One of the worst things we can do for ourselves, or our kids, is tell them to go pee ‘just in case’. This sets off bad bladder habits!

If you want to read more on this topic, I recommend a great book called ‘Women’s Waterworks –Curing Incontinence’, by Pauline Chiarelli. She has inspired much of this content!

Laughing is way too much fun – get started on your pelvic floor!!

Stay fit and have fun!

If you have any further questions about this article, email me: karen@physios-online.com

Karen Finnin
Musculoskeletal Physiotherapist
BAppSc(Physio),MMuscPhys