Many of you will be reading this, because you want to find out how to stop this embarrassing problem, as it is easier to read privately online rather than talk to your friends about it. That is fine, if what you read here helps just one of you, then let’s read on.
Pelvic floor issues can often be the butt of a joke, or something we all laugh about – but it is no laughing matter when it starts to affect your life – from choosing where to visit in case there are no toilets, refusing drinks in case of needing the toilet, not going on journeys for more than 2 hours in case of toilets, not exercising, or wearing extra protection when running etc, etc, etc.
There are many reasons for “leaks” in the lower department – childbirth, age, menopause are some of the more common ones. They can be tagged in the following ways:
This type of leak tends to happen when we laugh too much, cough or sneeze, run, jump or even getting up out of a chair. It can be a small amount that leaks, but this is frustrating, embarrassing, damp, inconvenient and we wonder if we smell a bit…
This type of leaks comes about because the muscles of the pelvic floor, that hold things in place, become weaker. We are not taught (as in other countries) about how to train and activate the floor, because after all, it is a muscle, and we can train in, and so we normalise this issue and think it is something that happens to many people. Training your pelvic floor is a very specific, but an accessible form of training that you can introduce into your daily life or weekly workout – see more details at the end of this section.
Urge Incontinence AKA “key in the door”:
This type of leak is more like a flood that happens as our brains see the toilet - we know we are safe, and the muscles start to contract and squeeze the liquid out – which unfortunately can happen before we have sat down on the loo. Often coined “key in the door” as it can be the case that you are all ok, but as soon as you see the toilet, you want to wee, or as soon as you get to the “safety” of your home, you can let go of your bladder.
There is a small muscle called the “detrusor” muscle that is responsible for contracting around the bladder to press the urine out – a useful thing – but when we psychologically “see” the area that we can “let go”, then the muscle starts to work before we have had time to drop the trousers….it is not a useful thing at all.
This type of leakage tends to be more severe and often can soak through your clothing. As it is a nervous system response, we need to work to control the “urge” and remain calm until we are ready to let go. One of the more bizarre, but surprisingly successful tips, is to walk away from the toilet, so that you can fool your brain into believing that you are not there yet – thus giving you time to undo the zip and buttons…
Oh, how I wish there was a better word for this, but it says the exact right word. This is the end bit of dribble after you have finished or before you start. You may have gone for a wee, stand up, and then dribble, or for those who are standing up, then it happens once you think you have finished. This leads to uncomfortable dampness, and irritation and is often caused by the natural aging process where muscles become weaker, and therefore less able to “shut the door” firmly.
At the end of the tube from the bladder, we have a valve shaped organ that opens and closes – general muscle weakness can make this valve less efficient, but as it is muscular, we can work to train this muscle – and this is separate and different to training the deep pelvic floor muscles. I can’t promise you it is an easy muscle to train, but if this is a bit issue, then you may well be motivated to put the effort in.
"More than" Incontinence:
Yes, you may look at this list and think, I have more than one of these issues….this is normal, and you should not be concerned.
Pelvic Floor training (PFT)
Much has been written about the value of teaching people how to exercise and improve the strength of the pelvic floor muscles – from Kegels, to physio therapy, yoga, Pilates and even surgery.
The ethos is to learn how to contract these muscles either whilst doing other exercises – e.g., the bridge – or to focus on contracting them specifically. There is value in both – and I would recommend doing both if you can. Selecting to do PF only helps you to focus on the “how” to do it, but it can be tiring to do for anything longer than a few minutes and therefore it is worth adding the squeeze in when doing your normal exercises if you can.
The easiest way to start to think about doing this is to sit upright on a chair, with your feet on the floor. Start by thinking how you contract your muscles to stop yourself breaking wind, then think about how you contract your muscles when you want to go for a wee – you should be able to feel these muscles lift a little away from the chair – but your buttocks or your legs should not move at all. Now do both of these together, so that you feel the whole floor area contract, but no movement in legs and buttocks again please. You might find some small pulling in of your lower abs, as if you are doing up your tight trousers, but try not to over squeeze the stomach.
Once you have got used to this contraction – doing this whilst doing the bridge has shown to be very effective and I recommend this as a good starting place to keep remembering to do this during this exercise. You can also do this before doing any abdominal work – and especially so if you have any prolapse.
Learning to do what is known as “Hypopressive breathing” also helps (and especially prolapse). And you can learn to do this by taking a deep breath in, breathe out and draw your abdominal muscles in, then keeping the abdominal muscles tight, take another breath in – you ought to feel the PF muscles draw up towards the abdominal area.
Why posture matters:
In addition to the PF activation sequence, it is also important to consider how else we might be contributing to the strain that is placed on the PF – and one of these can be your posture.
If you think of your pelvis or hip area as a big fruit bowl, with your abdominal contents sitting in the “bowl” you can see that there is a lot of weight to be held within this area. There are ligaments and muscle to help us do this – and it is those that we need to keep strong and flexible to make sure that we do not cause any further pressure or strain on the PF that is already weak. There are three areas that we need to look at – together these are called the “lumbo pelvic area” and consist of the following parts:
o The pelvis
o The lumbar spine
o The hip bones
o Each of these areas have attachment points for the PF muscles and are key to aligning the pelvis in its least “stressful” position.
We know that it is more difficult to learn and perform your PF activation sequence when your posture is out of alignment
We also know that in incontinent women, the urethra length is shorter, which affects its ability to contract properly - the change in the length of the urethra (tube your urine comes down) is linked to poor posture, or a “slumped” position.
For those of you who find this a problem when running, then postural work can help improve stride length and heel strike, which in turn should help reduce the amount of pressure on the PF during the running phases. Fatigue is often associated with symptoms of stress incontinence, so any work to help reduce fatigue with improved muscular endurance should be encouraged. Do not give up running if you are suffering from stress incontinence - but include additional postural training and look to shorten your running sessions into blocks of activity with rest in between to reduce fatigue.
Menopause has a direct effect not only on the muscle of the urethra, making the muscle thinner and less able to contract with force, but also on bone density which can lead to greater postural changes. Bone loading and strength training are super important to include as we age to help us remain upright and toned.
To work posture, we need to balance the front, back and stabilise the side of the body:
Think about including the following exercises into your programme to improve your posture – always remember to warm up and cool down after exercise. Please remember to modify the exercises for any particular back pain or other injuries.
Before each exercise, try to activate the PF without doing any other contraction.
Standing side and rear leg lifts – including squats if appropriate.
If you have no back problems, then please include more squats
Dead Bug – leading onto Single Leg Stretch
McGill Sit-up No 6
Side Leg Lying
Side Hip Lift
Glute squeeze (on front)
Bird Dog or Pilates Table Top Single Leg stretch
Hip stretches side and front
There are many brilliant physios out there who can help you individually, nevertheless, you too can help yourself with some daily practice – and reading articles like this might remind you about this exercise protocol. I will be delivering an online programme on this later this summer and will let you know all about it – in the meantime, practice the sitting contraction, then practice each time to you your Pilates, and try to master the Hypopressive breathing technique.
Don’t let your pelvic floor issues hold back your fitness – add them to your fitness goals too!
Good Luck !
I have a short video that you can watch showing you how to include this activation in your exercises - scroll to the bottom of the On demand Video page to gain access