By the time your were about 3 years old you were potty trained. You had mastered the independence of using the toilet and further conversation about toileting and your urinary system in general rapidly declined and ultimately stopped by about age 4 or 5. No one talks to us about normal patterns around urination once we graduate to big girl panties. We carry on without little thought or concern about urination throughout childhood and into adulthood. Some of us are lucky enough to never have to think about it again, but for millions of women around the world there comes a time when urinary incontinence reappears.
When this happens, most women do not talk about it and simply find a bandaid. After all, it's pretty easy to place a pad in your panties and carry on like nothing abnormal is occurring. Who wants to talk about dribbling urine in their underwear over mom's night out cocktails? There are so many more socially acceptable things to discuss during your precious time without kids! This mindset is why so many women wait an average of 8 years without treating the completely curable problem of urinary incontinence. It's embarrassing and easily covered up! However, it also causes undesired changes in routines and habits that can add to anxiety, stress, social withdrawal, and even result in institutionalization. According to the book "The Bathroom Key" by Kathryn Kassai and Kim Perelli "urinary incontinence is a leading cause of nursing home placement in elderly women."
Urinary incontinence is any amount of leaking of urine when not on the toilet. There are 2 main types of urinary incontinence: stress and urge.
Stress incontinence is when you have leaking of urine during activity such as walking, jumping, standing up, lifting or sneezing. This type is a physiological problem related to weak pelvic floor muscles. Urge incontinence is when you have leaking of urine on the way to the bathroom or in association with an urge to urinate. Urge incontinence is both a physiological and psychological problem. The bladder has lost it's ability to regulate urges and the pelvic floor muscles are weak. Both types of incontinence can occur together and this is called mixed incontinence, which is very common. Whether you have stress, urge or mixed incontinence it is curable with pelvic floor occupational therapy offered by Windward Maternal Wellness.
We should all recognize that no degree of urinary incontinence is normal. Not during pregnancy. Not after childbirth. Not after menopause. Not ever. Seeking out professional treatment is the best way to find a resolution to your incontinence and here are a few things you can do at home.
1. Identify if you have stress, urge or mixed incontinence based on the description I provided above. Once you know what you have, you can better direct your efforts to reduce incontinent episodes.
2. Since both types usually involve weak pelvic floor musculature, I recommend making sure you can identify contraction and relaxation of your pelvic floor through the use of Kegels. Many women with incontinence have difficulty completing a full range of motion Kegel. This means completely contracting and relaxing the pelvic floor muscles. Here are 2 ways to "find" your Kegel or pelvic floor muscles:
-"Stop test"- when you sit on the toilet to urinate, try to stop your flow mid-stream then allow it to resume as usual. You must activate your pelvic floor muscles to stop or slow the urination. Be aware that this should not be done regularly during urination as it can lead to other problems. Simply use it as a diagnostic test for yourself.
-Holding in gas (or urine)- most of us do not want to pass gas when in the presence of others. To prevent the passage of gas, you must contract your pelvic floor muscles. Many of us do this almost automatically, but to better identify the sensation of your pelvic floor muscles, I ask my client's to contract their anus as if they are preventing the passage of gas. Even better, is if you can contract your pelvic floor muscles as if you are trying to prevent the passage of urine and gas at the same time.
Once you have mapped in your mind the sensation of the contraction and relaxation of your pelvic floor muscle, you are one step closer to reducing urinary incontinence. However, if this was difficult keep practicing or reach out to a pelvic floor occupational therapist.
3. For urge incontinence I recommend keeping a bladder diary. Record how many times you urinate in 24 hours for a 1-2 weeks. You should be somewhere between 6-8x per day, but most women with incontinence are much higher. Without concern for nighttime urination patterns, begin to try to stretch your daytime episodes of urination further apart by using these strategies:
-Reduce your intake of caffeine, citrus, alcohol and spicy food, which are all bladder irritants and can increase your urge to urinate unnecessarily.
-When you feel an urge to urinate, sit down and complete 3-5 SLOW Kegel exercises. Squeezing your pelvic floor muscle up as you exhale. Often this can delay the need to use the toilet by 10-15min or more.
4. For stress incontinence, I recommend learning how to link your breath with your Kegel contraction. Laying on your back with your hands on your stomach, take an inhalation and allow your stomach to rise and pelvic floor to be relaxed. With your exhalation, draw your stomach muscles inward and up toward your head, while also drawing or contracting your pelvic floor muscles up. Do this exercise 10x holding each upward contraction for 2-3seconds before relaxing completely. You can progress this same exercise from laying down to sitting and standing as you begin to feel the sensation strengthen.
As with any health condition it is often best to seek out professional evaluation, support and treatment. Windward Maternal Wellness offers pelvic floor rehabilitation in the comfort of your home. Reach out to us today to design a personalized treatment plan that will end your need for planning your day based on the accessibility of a bathroom, wearing only black or avoiding exercise that you deserve to do without leaking! Urinary incontinence is curable and we can help!
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Hilary Valentine, Owner of Windward Maternal Wellness
I was born and raised in Massachusetts but I have called Oahu my home for the past 14 years. I live with my family in Kailua, including my husband, Jason, my daughters, Victoria and Gwendolyn and my parents, Nanette and Geoff. This blog is intended to shine light on both my work as a women's health occupational therapist and postpartum doula, my personal views on lifestyle topics such as parenting and women's health as well as a resource for education on topics relevant to the clients I serve. I welcome any and all comments and feedback! Mahalo!