If you suffer from incontinence you know how debilitating it can be. It can often interfere with our normal activities of daily living as well as social life. Even leaving the house can become difficult and often require significant planning as to where public toilets can be found in case of an emergency.
For more information about what incontinence is and the different types see our blog: Prevention and Management of Incontinence (as published in the Great Health Guide) posted on 22 March 2016.
So what can be done about this issue? The first step is to identify the cause. Your doctor will refer you for necessary tests to rule out any serious pathology. Testing also usually involves getting a diagnostic ultrasound which will show whether you have a prolapse and if yes what degree it is.
The next step is treatment. According to the American Family Physician journal “Bladder retraining and pelvic floor muscle exercises are first-line treatments for persons without cognitive impairment who present with urge incontinence… Pelvic floor muscle exercises are considered first-line treatment for stress incontinence”[1].
In order to make sure that the exercises work for you a specific, comprehensive system needs to be implemented by your women’s health physiotherapist. This involves the following:
1. Using Real Time Ultrasound to assess your core muscles
The term “core” is probably one of the most overused words in the health and fitness industry. Unfortunately it is often used incorrectly, leading to the belief that the core only involves the stomach muscles. Let’s clarify this common misconception. Our core muscles are in fact the muscles which support our spine and all the joints, which means that there are core muscles of the lower stomach and back, hips, knees, shoulders etc. In relation to pelvic floor exercises, however, we are referring to the deep stomach and lower back muscles.
By using Real Time Ultrasound both you and the physiotherapist will be able to see on the screen how the core muscles work. Your physiotherapist will teach you how to activate these muscles and seeing this contraction on the screen will ensure that you are engaging them correctly.
It’s important to realise that the core muscles and the pelvic floor muscles share the same nerve supply, hence by engaging the core you are already starting to work your pelvic floor muscles. This is the first step in managing incontinence.
2. Using Real Time Ultrasound to assess your pelvic floor muscles
The next step is specifically training your pelvic floor muscles, once again using Real Time Ultrasound. In our practice we see over and over patients performing pelvic floor exercises incorrectly. The most common mistakes are:
- Bearing down instead of lifting the pelvic floor
- Engaging superficial muscles, such as the buttocks, instead of the pelvic floor
- Holding the breath while performing the exercises
This is why it’s crucial to use Real Time Ultrasound. Just like with core training discussed above both you and your physiotherapist will see on the screen how your pelvic floor muscles are working. If you are bearing down instead of lifting this will become evident straight away. Your physiotherapist will then be able to correct your technique, making sure that you are carrying out the action correctly.
Your physiotherapist will also check to make sure that you are not holding your breath, as this creates more pressure on the pelvic floor, only exacerbating the problem. It’s also important that your physiotherapist feels your buttock muscles to ensure that you are not engaging them.
Initially the exercises will be done in lying down as this is the easiest position. As you improve they will progress to sitting, then standing; the final step is functional exercises, such as engaging the pelvic floor muscles while squatting. This type of progression will make it easier for your pelvic floor muscles to switch on whenever you need them, e.g. when you walk, laugh, lift something etc. Prior to moving on to each new step it’s crucial that your physiotherapist reassesses the pelvic floor muscles using Real Time Ultrasound to make sure that you are still engaging the muscles correctly.
Your physiotherapist will provide you with specific home exercises each time. In order to achieve the best results you should aim to perform the exercises three times per day and do three sets of each exercise. While this may sound like a lot, in reality each set only takes approximately two minutes.It is certainly worth the effort when we are talking about managing and treating incontinence.
One of the best types of exercises for pelvic floor muscle strengthening, particularly once you are in the functional stage of training, is Clinical Pilates. Your physiotherapist will incorporate the pelvic floor exercises into your Clinical Pilates program, making sure that you do sufficient number of repetitions during each session.
Besides exercises there are a number of lifestyle changes which often need to be made in order to achieve the best results. Did you know, for instance, that your diet and certain daily habits can have a significant impact on incontinence? Here are some interesting facts:
- Water does not irritate the bladder, however coffee, alcohol and some other beverages do
- You should aim for 1.5-2L of water daily, however try not to drink too much before going to bed and drink small quantities often rather than having a full glass at once
- Getting sufficient amount of fibre in your diet, specifically from raw, unprocessed fruits and vegetables, can greatly help with incontinence
- You should aim for 2-3 servings of raw fruit and 5 servings of raw vegetables daily
- Going to the toilet “just in case” can actually result in weaker, less functional pelvic floor muscles
[1] Hersh L, Salzman B. Clinical management of urinary incontinence in women. Am Fam Physician 2013; 87 (9): 634-640