Improving your pelvic floor muscle function can greatly improve and prevent such issues because it has a direct role in both supporting and controlling the bladder and bowel.
Here are a few day to day tips to optimise your pelvic floor and bladder health:
1. Practice your pelvic floor exercises; See how many repetitions of short (1 second) and long contractions (aiming for 10 seconds) you can do. Practice this three times a day Try using different cues such as;
'draw your coccyx towards your pubic bone'
'imagine you are trying to stop passing urine'
'imagine you are trying to stop passing wind'
'try and draw a tampon up inside your vagina'
Make sure you aren't holding your breath! If you find this hard not to do then count or talk out loud or focus on exhaling as you squeeze.
2. Drink between 1500-2000 mls a day (if you are breastfeeding, completing vigorous exercise or perspiring a lot you may require more)
3. When going for a wee it should ideally be over 300 mls (get an old plastic jug and measure!)
4. You should go for a wee between 6-8 times over 24 hours. It is not normal to go every 30 minutes!
If you find you are going to the toilet frequently with small volumes you may need to get the pelvic floor stronger and practice 'deferring the urge' with bladder retraining techniques. The pelvic floor acts as an inhibitor to the bladder. Some call it the gatekeeper to the bladder! To improve your bladders capacity and ability to hold for longer, start by practising deferring urges at home (somewhere you know you can get to the toilet if you need to) by holding long gentle contractions of your pelvic floor. Also try to keep calm as anxiety can only make the urge feel stronger! Easier said than done I know, but sticking with bladder retraining techniques can work.
5. DO NOT practice stopping passing urine when you are actually going to the toilet. This can lead to bladder irritation.
6. Do you hover on public toilets? DON'T! This can inhibit your pelvic floor from completely relaxing to allow you to go for a wee and can lead to incomplete emptying meaning you might feel you need to go more frequently. Put down some tissues or carry wipes instead!
7. When going for a wee sit with your feet flat on the floor and lean forwards with your elbows on your knees, this helps to position your bladder and urethra opmtimally to empty.
8. Do you go to the toilet 'just in case'? DON'T! If you are going out the door but have only been to the toilet 30 minutes ago do not go again if you don't feel you need to! This can lead to a reduction in your bladders ability to store urine and can then lead to frequency and urgency issues.
9. What colour is your wee? Urine should be clear enough for you to read a newspaper through in the bottom of the toilet pan. If it is cloudy, yellow-dark yellow, contains blood or has a strong odour you should seek medical help. You may have a lower urinary tract infection or something else requiring assessment and treatment.
9. Do you live off that hot cuppa to get you through the day? Alcohol and caffeine can be an irritant to the bladder as well as a diuretic meaning you may need to go more urgently. Try to limit your tea, coffee, cola and alcohol intake, however if you are suffering with urgency or urge incontinence you may want to consider cutting this out. Water, herbal teas and decaff tea and coffee can be good replacements.
10. If you are suffering with any bladder urgency, frequency or incontinence symptoms make sure to visit a Women's Health Physiotherapist. They can review your pelvic floor function and assess your bladder habits and diary and make changes to minimise and manage these symptoms which can be life changing.
I hope this information helps you to be proactive in your bladder health. Some of the above are things you may not think to think about because they can be just 'your normal', and toileting habits aren't typical dinner table conversation so you may not be aware of what is 'normal' and what isn't. If you have any questions just ask or book yourself in for an appointment.
Until next time,
The Powder Room Physio
BBC News recently highlighted that nearly one in 10 British women suffer from painful sex, however little is still known about how much Women's Health Physiotherapists can help treat and relieve these symptoms.
The recent survey of nearly 7,000 sexually active women aged 16 to 74, in BJOG: An International Journal of Obstetrics and Gynaecology, suggests this medical problem - called dyspareunia - is common and affects women of all ages. The survey results highlight that many find the subject embarrassing and taboo which acts as a barrier to seeking help. Despite the recognition of the problem in the media, there is little mention of how us Women's Health or Pelvic Floor Specialist Physiotherapists can help. As a consequence the Pelvic, Obstetric and Gynaecology Physiotherapy Association (POGP) is running a 'Pucker up your Pelvic Floor' Campaign for the month of February to try and signpost women and men for sexual dysfunction this valentines day.
Painful sex is particularly reported amongst ladies in their late 50's and 60's which can be linked to menopausal changes and vaginal dryness issues. Followed by young sexually active ladies. I for one can vouch for dyspareunia issues for the first six months postnatally (for those of you that know me, sorry for the over sharing but I wouldn't be doing my job fully if I didn't acknowledge this!) After having a kiwi suction delivery requiring an episiotomy I bruised horrendously which caused me to sit down consciously and tentatively for at least 6 weeks followed by months of cautious touch and tenderness. Thankfully I can say that things have healed well and any discomfort has been relieved, but had I not 'physioed' myself and applied all the advice, exercises and treatment I would give to a client in a similar position things may be very different now.
Painful sex was seen to be strongly associated with vaginal dryness, feeling anxious about sex and lack of enjoyment of sex. Vaginal dryness is a common byproduct of the menopause but it is also apparent in the early months postnatally related to hormonal level changes and breastfeeding. There are many other emotional, psychological and physical factors contributing to painful sex which can be complex to treat.
People may associate pelvic floor exercises (kegals) with prevention of incontinence but may not know that strengthening, toning and knowing how to relax the pelvic floor muscles has an impact on sexual enjoyment and performance too. A condition called vaginismus can develop as a consequence of a vicious cycle of experiencing pain (i.e from childbirth and healing tissues), anxiety and fear, causing tension in your body including the pelvic floor muscles which causes tightening around the vagina and pain during intercourse.
Pelvic Health and Women's Health Physiotherapists specialise in completing assessments and examinations of the pelvic floor to help you understand what your pelvic floor is doing and if it is contributing to your symptoms. It is very common for you to not know what your pelvic floor muscles are doing, this is partly related to the fact that you cannot see them in action like you can with your biceps on an arm curl. Therefore, if you are in doubt, don't delay and seek a Women's Health Physiotherapists advice. You can download a free pelvic floor exercise booklet from the POGP website http://pogp.csp.org.uk/publications.
For the month of February The Powder Room Physio is offering 10% discount on purchase of a Mummy MOT postnatal assessment gift certificate. If you are suffering from pain during sex, regardless if you had your child 6 weeks ago or 6 years ago then contact The Powder for more information: firstname.lastname@example.org, 07734455184.
For more information on how you can get involved in the Pucker up campaign, visit: http://pogp.csp.org.uk/news/2017/01/31/pucker-your-pelvic-floor-pogp-campaign-february-2017