More than 40% of women experience pelvic floor problems. Although extremely common, this is not normal and doesn’t need to be accepted as a way of life.
Given that the pelvic floor is a group of muscles, like any other muscles in the body, they are highly adaptive to training, so quite responsive to Physiotherapy resulting in improved pelvic floor control and function.
ONE: Understand Normal Bladder Function
Normal Bladder Function
When we drink fluid, after it enters the bloodstream it moved to our kidneys where it converted to urine. It then moves down to the bladder via two tubes called the ‘ureters’ where the urine is stored.
Normal Bladder Sensation
As urine enters the bladder, the wall of your bladder (the detrusor muscle) expands. It is the stretch of the bladder wall that gives us a gradually increasing urge to pass urine. Usually 150-200mls of urine is required to feel a sensation of urine in your bladder. By approximately ~400-500ml, most people will feel a reasonably strong urge to go to the toilet.
TWO: Understand Incontinence
Stress Urinary Incontinence
Stress Urinary Incontinence is the involuntary loss of urine with times of increased pressure within the abdomen. This may include coughing, sneezing, laughing, running, jumping etc
Urge Urinary Incontinence
Urge Urinary Incontinence is the loss of bladder control that specifically occurs when someone has a strong sensation of needing to pass urine and is trying to get to the toilet
THREE: Understand Pelvic Floor Muscles
The pelvic floor is a group of muscles that make a sling running across the base of the pelvis. This sling surrounds the urethra (the thin tube via which urine passes)
The pelvic floor muscles (PFM) are responsible for:
- Supporting pelvic organs
- Controlling continence
- Urination, defecation, childbirth and sexual activity
A ‘squeeze and lift of the PFM has two functions:
- Tightening the PFM squeezes the urethra closed which stops urine from passing through
- Tightening the PFM sends a message to the bladder telling it to ‘stay relaxed’ so that it can continue to fill with urine
FOUR: The ‘Knack’
Activating Pelvic Floor Muscles
When tightening the PFM you should feel a ‘squeeze’ sensation as well as a ‘lifting sensation upwards.
Cues that can be helpful:
- “Tighten around your bum hole”
- “Imagine you are mid-stream on the toilet and you want to stop that flow
- “You have a tummy full of gas and you don’t want to let it out
Before you’re about to cough/sneeze/laugh (or anything that generally will cause leakage), squeeze and lift you pelvic floor muscles. This will help counteract the increase in intra-abdominal pressure caused by the action and help prevent any leakage.
FIVE: Bladder Relaxation Reflexes
Pressure on the front of your genital region
The pudendal nerve sends messages from the genital region to an area of the spinal cord that also receives messages from the bladder
- Press upward on your genital region with your hand
- Sit on the heel of your foot to provide pressure at the front of the vagina
- Sit on the corner of a table or on an arm chair
Standing on your toes or curling/clawing your toes into your shoes
The posterior tibial nerve which runs from the spinal cord down the back of your leg and under your foot also overlaps with the bladder nerves
- Sit down and curl your toes in your shoes/grip the carpet bare foot
- Rise up onto your tippy toes, tensing your calf muscles
Counting backwards by 7’s / distracting yourself by making a shopping list
The Pre-Frontal Cortex is the part of the brain that helps relax the bladder. This front area is also responsible for organisational tasks, lists based activities etc. The panic we feel with the urgency to go to the toilet causes us to switch off the frontal area and move to the emotional part of the brain.
- Concentrate on something difficult that involves numbers, lists, order of tasks etc
SIX: Lifestyle and Diet Modification
- Alter the total daily amount of fluid consumed. ‘Too much fluid’ can cause the kidneys to produce urine at a very fast rate, increasing the chance of a bladder spasm. ‘Too little fluid’ can cause your urine to be very concentrated which will irritate the bladder wall and cause spasm.
- Alter how you consume your fluid throughout the day. Drinking a large volume in a short amount of time will encourage the bladder to suddenly fill quickly. It is recommended to space your fluid intake throughout the day.
- Reduce caffeine intake. Caffeine which is found in coffee, tea, sport drinks and soft drinks can cause bladder spasms to be stronger and occur with smaller bladder volumes in some people. Reducing caffeine may reduce your urge incontinence symptoms
- Reduce use of artificial sweeteners. Artificial sweeteners found in diet food and drinks are also common bladder irritants for some people. Reducing your intake can reduce your urgency and leakage.