Stress incontinence is caused by a weakness of the pelvic-floor muscles supporting the bladder.
The pelvic floor muscles form a hammock that is connected at the front to the pubic bone and at the back to the coccyx (tailbone). The genitals (vagina), urethra (tube carrying urine from the bladder) and rectum pass through the hammock dividing the muscle fibres.
Because we seldom use these muscles, they become weak and unable to effectively do their job in supporting the bladder neck - helping to keep it tight and leak-proof. We particularly need these muscles to be strong when a rise in pressure occurs - when we cough, laugh, sneeze, run, jump, and so on. If you were to watch this activity on video you would see that, as you cough there is a downward pressure through the abdominal wall onto the bladder; this increase in pressure forces the urine through the weakenend muscle which should close the urethra tight.
| Symptoms - Repeated loss of small amounts of urine on laughing, sneezing and coughing etc.
- Damp underwear or pads
- Irritation of the skin around the genital area
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The sensation of something inside dragging downwards is the serious sign of a more complicated condition, a uterine prolapse. In some people, lower back pain may also be experienced. These symptoms may become apparent gradually or after an activity such as heavy lifting. Your GP must be consulted.
It is essential for ladies in particular to get into the habit of exercising these muscles several times a day.
Risk factors
Having babies
It is now known that by having more than 3 babies at a weight greater than 4kg (8lbs), significant damage will occur to the pelvic floor. If you have ignored the advice to do pelvic floor exercises it is likely that you will experience leakages. However, it is never too late to start.
Overweight
Carrying excess weight will increase the pressure on the bladder. If the pelvic floor muscles are weak the additional pressure may be enough to make incontinence more likely.
Menopause
You may also find during or after the menopause that your control is not as good as it used to be because of the change in oestrogen levels.
What will my GP do?
Initially your GP may refer you to the physiotherapist who will assess the strength of your pelvic floor muscles. This generally will involve a digital vaginal assessment and the use of a perineometer to measure the strength of your ability to squeeze - and to teach pelvic floor exercises.
If your GP has found that you have a prolapse - known also as a cystocele when the bladder bulges into the vagina, or a rectocele when the bowel bulges into the vagina - he will refer you to either a gynaecologist or a urologist who has a specialist interest in incontinence.
If the prolapse is found to be synonymous with the incontinence then a surgical repair will be necessary.
| Pelvic floor exercise regime
1. Sit comfortably with feet touching the floor, legs slightly apart. Lean forward and rest elbows on thighs. This relaxing position will ensure you do not tighten your buttocks or abdominal muscles while exercising the pelvic floor muscles.
2. Tighten and pull up the muscle around the anus, hold to the count of 3 or 4 and relax to the count of 3 or 4.
3. Now concentrate on the vagina and draw the muscle upwards and inwards and hold to the count of 3 or 4 then relax to the count of 3 or 4.
4. Repeat this drawing up and relaxing to the count of 3 or 4 with both parts of the muscle as often in an hour as you can without tiring it, that is without it aching. The total in a day should be between 50 and 120. A guideline is to do 5-10 each exercise session, gradually increasing the 'hold' times. |
When you are confident that you are doing these exercises correctly you will be able to do them whilst standing, lying or sitting. In fact you can carry out the exercises ANYTIME, ANYWHERE.
The best time to exercise is during intercourse as then you can get positive feedback - and know that you are using your muscles correctly! It should also now totally enhance sexual enjoyment for both partners.
If leakage (urine) occurs during intercourse, doing pelvic floor exercises will help to prevent and improve the leakage. However it is important to have a vaginal examination to exclude prolapse - or descent of the cervix or uterus.
20/05/2009