I am going to start with a pretty shocking statistic; one in three women and one in nine men wet themselves. Given the stigma and shame that accompany incontinence, it is likely that the figures are actually much higher. Somewhere between 1 in 10 and 1 in 20 people have problems with bowel control. Incontinence is common, but it is not normal.
The pelvic floor muscles are a sling of muscles forming the base of a group of muscles commonly referred to as the core. They play an important role in supporting the pelvic organs, bladder and bowel control and sexual function in both male and female bodies. Check out Pelvic Floor First (“Follow” link below) for more details on the anatomy.
Most people with symptoms have a mixed picture of urge and stress incontinence.
Stress incontinence is when you leak urine when you cough, sneeze or laugh. Often people with stress incontinence stop exercising and reduce their fluid intake to manage their symptoms and they go to the toilet more often “just in case” which, in turn, can cause further problems.
Urge incontinence is when you cannot wait 2 to 4 hours before emptying your bladder from the time that you first feel the need to go. This is the classic “key in the door” situation; you are used to going to the toilet as soon as you come home and you become conditioned so that as soon as you reach for your key, you leak urine.
You can work on behavioural cues (eg holding on for a very short time when you get home) to train your body and, for some patients, medication can be helpful. In menopause, decreased oestrogen can cause urge incontinence, even if you have not had any issues previously.
Simple lifestyle measures are often really helpful:
- cut down on caffeine and alcohol, as both irritate the bladder;
- maintain a healthy weight, so as not to exert additional pressure on your pelvic floor;
- don’t regularly go to the loo “just in case” as this will reduce your bladder’s capacity over time;
- eat plenty of fresh fruit and vegetables and stay well hydrated to avoid constipation and the additional pressure of straining.
Despite the fact that there is good evidence that pelvic floor exercises can help the majority of people with incontinence, it is estimated that only one in four women seek help for incontinence and it takes them an average of seven years to do so.
In the video below (“Watch this”), a pelvic health expert talks you through how to do your pelvic floor exercises – you need to do a long hold and short squeezes whilst continuing to breathe. In both cases you need to relax your pelvic floor muscles completely between squeezes. If you don’t see an improvement after doing your exercises consistently for 12 weeks, then see your GP for a referral to a specialist.
Incontinence is more common than hayfever or athlete’s foot but we remain embarrassed about it, despite the fact there are simple measures we can take which have been proven to help significantly.
In later life, continence is the greatest indicator of quality of life. It’s never too late to seek help.
I am sharing some of my favourite resources, if you would like to delve deeper.
I simply couldn’t write this blog without referencing the utterly brilliant Elaine Miller aka “the Fanny Physio” – she is a fantastic advocate for pelvic floor health and the value of doing your exercises regularly. She is also a stand up comedian.
A very funny, honest and informative read, tackling the taboo of incontinence following childbirth, written by a physiotherapist.
Pelvic health is just as important for male-bodied people too; this podcast covers some of the common issues encountered in male bodies. Dr Susie G (the guest) has her own podcast series if you want to learn more.
Download the award winning NHS Squeezy app for reminders (we all need reminders!) to do your exercises as well as great resources.
Pelvic Floor First on YouTube – lots of short, very informative videos on pelvic health for men and women
If you would like any further information or resources, or have any suggestions on how I could improve this blog, please let me know.
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