Urinary incontinence is no laughing matter.

[As featured in Sheer Luxe]

Heard the one about the mother getting caught short after a particularly vociferous sneeze? Course you have. We’ve all been privy to stories of women who change their knickers three times a day, who leak water when they get out the bath or who loiter around the ladies’ aisle, furtively stockpiling incontinence pads. Heck, some of us don’t even try and hide it. My mum’s all-female pub quiz team are called The Tena Ladies. Oh, how we laugh (while furiously crossing our legs of course), but since when did wetting yourself become an accepted part of life after birth?

“I see so many women – even young girls in their 20s – who suffer from urinary incontinence and think it’s just part and parcel of having a baby,” says Emma Hunter from EH Physio in south east London. “For many, it’s only when symptoms start affecting their quality of life – pain during sex, loss of vaginal sensation and even pelvic organ prolapse – that they actually reach out to find a solution,” she continues. “It’s by no means too late, but most of the time there’s no need for it to get to that point.”

Pelvic floor muscle dysfunction affects as many as one in three women, rising to one in two after menopause *. It brings with it frustration, embarrassment and a loss of freedom. But it’s not all bad news. I’ve spent the last month getting the lowdown and it seems it’s never too late to teach your vagina new tricks.

The big squeeze.

No matter what kind of birth you had, the chances are that, postpartum, downstairs isn’t what it used to be. Pushing out a baby can be fairly brutal and in all too many cases your vagina takes the brunt. Long labours, back-to-back births, forceps, tears, episiotomies and 34 cm skulls (the average circumference of a new born’s head) can seriously take their toll. Even women who delivered via cesarean don’t always come out unscathed. The pressure of carrying a baby for nine months can have a pronounced effect on the pelvic floor ligaments that hold up your internal organs. And, on top of that, the pregnancy hormone relaxin, which softens and widens the cervix in preparation for childbirth, can dramatically loosen your undercarriage.

So, what’s the answer? It’s fairly simple. We should all be doing pelvic floor exercises. I think deep down (pun intended) we all know that. But are we doing them right? How many should we be doing? And, most importantly, can the wizard’s sleeve effect ever be reversed? I checked into EH Physio to get the inside scoop.

Buckle up ladies. We’re going in.

Waxing lyrical about your wayward vagina isn’t for everyone, but Emma Hunter is the perfect mix of informal professionalism and makes it seem like the most natural thing in the world, which of course it is. Down at her clinic, I tell her I have certain trust issues with my bladder and feel a low lying ‘heaviness’ when I go running. I also just think things could be a bit ‘perkier’ down there. Apparently there’s a very strong link between post natal pelvic floor weakness and a tummy gap (rectus diastasis abdominis), so the first thing Emma does is assess my posture, pelvis alignment and stomach muscles. She tells me that, when addressing pelvic floor muscle function, you need to take into consideration the whole of the abdominal/pelvic canister. Sure enough, mine is off-kilter. My sacroiliac joint has rotated so that I now have a very pronounced lumbar curve and my pelvis is out of alignment. Without these correctly in place, there’s a strong chance I won’t be able to do pelvic floor exercises properly.

Now for the latex gloves. The internal examination involves me lying on my back with my knees bent. First I have to clench my muscles as if I was trying to hold in wind, then zip them forward as though trying to hold in urine – all the while pulling up and inwards and still breathing. The mental image that springs to mind is trying to suck a piece of spaghetti up your vagina. Not that easy. No wonder my half-arsed clenches at traffic lights aren’t paying dividends. What I realise is that, though it’s a tad unusual to have a (professional) stranger’s fingers inside you feeling for internal muscles, it’s really the only way to pinpoint exactly what you’re doing up there.

Internal examinations are never a riot but Emma is extremely down to earth, patient and reassuring, especially when it comes to the rating part. That’s right, you get a rating on your ability from 1 – 5. 0 being no movement whatsoever and 5 being you should have your own circus act. To put this into context, if you go running, you should be at least a 4. I’m told to hang up my trainers for a while and swap stomach crunches for planks as they put less pressure on the pelvic floor but still strengthen the all-important transverse abdominals.** Emma then sends me on my way with a bespoke pelvic floor training programme, a stretch to keep my posture in line and some exercises aimed at strengthening my glute muscles, which apparently have a strong influence on your pelvic floor girdle. I’m so determined not to let her down, I vow to do them all religiously.

Six weeks on and two visits to the clinic later, what have I learnt? Firstly that pelvic floor exercises are not a quick fix. I’ve made significant progress and I’m running again – albeit shorter distances than before – but I haven’t reached the heady heights of a 5 star rating yet. These things take time though and, considering my second child has just turned four, I’ve got some serious time to make up for. Anyone embarking on a programme like this should remember it’s crucial to continue, even if initially you don’t notice any difference. Most women feel a marked improvement within three to five months. To help you remember to do the exercises (for some, the hardest part), there’s now an app. Squeezy is NHS produced, backed by physios and a godsend. It guides and reminds you, plots your progress and has tips, diagrams and a Q&A section. Think of it as a personal trainer, but this one doesn’t shout and is only interested in your nether regions.

Top tips: 

  • Make sure you’re activating the whole of your pelvic floor, not just the front section. The diagram below shows the pelvic floor muscles as they circle around the openings of the urethra, vagina and anus. You need to be activating all three elements of that figure of eight pattern, not just the front part. 
  • Start off doing your exercises when lying down or sitting (so you’re not working against gravity), then progress to standing as you improve. It’s very important to completely relax your pelvic floor after each squeeze.
  • According to guidelines, pelvic floor muscle training programmes should comprise at least eight pelvic floor contractions, performed three times per day (NICE 2013).
  • Constipation is a major cause of poor bladder control and straining can actually lead to a prolapse (when the pelvic organs drop into the path of the vagina). Keep everything moving internally with a good, clean diet made up of plenty of fruit, fibre and vegetables. You can help by adding psyllium husks to smoothies, squatting for 30 seconds before you go to the toilet (it helps line everything up) and drinking lots of water (three litres if you exercise regularly).
  • Speaking of prolapses, pelvic floor exercises can be a great first line therapy when it comes to managing the symptoms and, in certain cases, can avoid the need for surgery.
  • Train your bladder to wait longer between toilet visits – the ideal time is roughly three hours. A good wee should last around 15 seconds. Cut down on caffeine (it’s a diuretic) and try not to go ‘just in case’, it makes for a lazy bladder.
  • Try to avoid carrying heavy objects. If unavoidable make sure you pull up your pelvic floor before and during. Likewise, If you feel a cough/sneeze coming on, squeeze your pelvic floor muscles in preparation.
  • Young, old, kids in tow or not, if you’re in any doubt about your pelvic floor status quo, find a women’s health physio or talk to your GP who can refer you to a urogynecologist. Please don’t pretend it’s not happening, because ignoring it won’t make it go away.
  • And if the last point didn’t resonate, maybe this one will. Pelvic floor exercises can heighten arousal during sex, give you mind-blowing orgasms, improve blood circulation and increase vaginal tone. Yeah, now you’re clenching.

Emma Hunter is the founder of EH Physio in East Dulwich www.ehphysio.com 07856 203 980. Check out her Women’s Health Page for more information and for details of the next Women’s Health Workshop (February 24th 2016), which is a two hour session – open to ALL women – that focuses on pelvic floor rehabilitation training, exercises to manage and prevent pelvic organ prolapse and urinary incontinence, as well as advice on core muscle strengthening and posture correction.

*Chief Medical Officer Annual Report, 2014: Women’s Health.

** Planks are not recommended for anyone with a tummy gap. If in doubt ask a professional before embarking on a new exercise regime.



Quick Start Pelvic Floor Exercise Programme:
You need to practise long and short squeezes to strengthen the different types of muscle fibres within your pelvic floor. Long squeezes engage your slow twitch muscles and are good for endurance, such as running. They’re also the muscles that you need to be working if you have signs of a prolapse. The short squeezes train your fast twitch muscles and are good for stress incontinence – ie. when you sneeze, cough or laugh.


Long squeezes:
Aim to complete 10 long squeezes for 10 seconds, three times a day.

Short squeezes:
Aim to do 10 short squeezes, three times a day.



 

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