by Nelly Faghani, Registered Physiotherapist
Pelvic Health Solutions
It has been proven that exercise—running especially—has health benefits well beyond any pill a doctor could prescribe. Sadly, women often stop exercising as a result of bladder leakage, also called incontinence. They feel embarrassed and suffer in silence, thinking the condition can’t be treated or that it is a “normal” part of aging.
Starting the Conversation
Ladies, let’s break the silence. Incontinence is common, but it is not normal. There are simple, low-cost, real-time, non-surgical solutions that women need to know about. For starters, many don’t understand the meaning of the word “incontinence”. Let’s demystify the medical jargon. Stress incontinence is a small “spurt” of urine that occurs when you cough, laugh, sneeze or do physical activity (such as running). Urge incontinence (also known as overactive bladder syndrome) is the sudden loss of bladder control just after an overwhelming urge to go pee. Mixed incontinence is when women suffer from both.
The Pelvic Floor
American gynecologist Dr. Arnold Kegel brought the world’s attention to the group of muscles called the pelvic floor that are like a hammock or sling, supporting the bladder, uterus, prostate and rectum. Dr. Kegel noted that a woman’s pelvic floor muscles were weakened by childbirth and prescribed his famous “Kegel exercises” to women as a non-surgical treatment. Frustration with doing Kegels, uncertainty of how to do them properly, or not seeing results has left many of us feeling hopeless, so we just keep wearing pads or stop exercising altogether.
Guidelines for Kegels
When the pelvic floor muscles are weak, they need to be strengthened through a structured strengthening program. This doesn’t mean doing a few Kegels at the kitchen sink or at a stoplight and, contrary to what many women are told, you should never do these exercises by stopping your urine mid-stream. An extreme approach that suggests doing 1000 reps a day has no basis in exercise science either. Start by following the same rules you do when doing weight training at the gym: 3 sets of 10 repetitions daily for about 12 weeks. You can do them daily because, unlike weight training at the gym, you don’t add weights to increase the effort. So, daily exercise is safe until those annoying leaks stop.
How do you know that you’re doing them correctly? The best way to know for sure is to see a professional, like a physiotherapist, who has the appropriate training to confirm you are doing the exercises properly. They’ll do an internal exam to assess the state of the muscles and let you know how well you’re doing your Kegels. Research shows that strengthening pelvic floor muscles with the guidance of a pelvic health physiotherapist has an effectiveness rate of 80%.
Pessaries are another great tool for managing incontinence. Until now, all pessaries had to be fitted and inserted by a medical professional. A self-fitting pessary, specifically for stress incontinence, was recently launched. The uresta® pessary is designed for comfort, safety and ease of use. It can be used all day or only for the activities that cause leaks, and can be a safe, low-cost solution for women who don’t respond to exercise or who can’t access a pelvic health physiotherapist.
Surgery is for the 20% of women who can’t improve their symptoms with strength training or the use of a pessary alone. Surgery should be approached cautiously based on the latest available evidence.
Female runners may also have the opposite problem of tight pelvic floor muscles. By nature of their sport, runners develop tight hip, low back and pelvic floor muscles. In these cases, doing Kegels may worsen the problem. These women should consult a pelvic floor physiotherapist to assess if they have tension in these muscles before starting Kegels or inserting a self-fitting pessary. Symptoms of this type of tension would be mixed incontinence, overactive bladder, pain with intercourse, or generalized pain in the pelvic region or hips.
Start the conversation with your girlfriends, your doctor, your pelvic health physiotherapist or your nurse practitioner. You are not alone! Don’t let embarrassment stop you from doing the sport you love.