Friday, 2 June 2017

What? There are 3 different ways I can wet my plants?

            I saw a saying on a billboard somewhere that said, “I laughed so hard I wet my plants.” Although it was meant in a humourous way, individuals whom experience incontinence do not find it to be a laughing matter in most cases. Why is incontinence not a laughing matter? Because incontinence is the involuntary loss of urine, meaning you had no control.
          In Canada based on the Canadian Continence Foundation numbers, approximately 3.3 million Canadians have incontinence (1). I’ve read estimates in various studies saying 1 in 3 or 1 in 4 women will experience incontinence in their lifetime and 1 in 9 men. If it is so common, why aren’t more people talking about it and most importantly seeking treatment for it?
         I believe it is because media and even some healthcare providers have normalized incontinence as normal after giving birth and something that comes with age. Just because something is common, does not mean it is normal. There is a shift happening currently where more celebrities and healthcare providers are working really hard to spread the word about pelvic health. I am just one of those people trying to educate others.
Okay so, what’s this about 3 different ways I can lose urine?
            Well, there are 3 types of incontinence that are the most common, stress incontinence, urge incontinence and mixed incontinence.
Stress incontinence: the loss of urine associated with increases in abdominal pressure, such as coughing, sneezing, laughing, lifting, running and high impact exercises.
Urge incontinence: is when you get the sudden urge to go pee and you rush to the bathroom but don’t make it.
Mixed Incontinence is a combination of stress and urge incontinence.
What can I do about it?
Very good question. Most women are familiar with the term “kegels” which are basically pelvic floor contractions. But are they enough? And are they right? I want to take the time now to clear up a few things.
            Yes Kegels can be helpful if they are performed correctly. Many women “think” they are performing them correctly but I often see in my practice that they are also contracting compensatory muscles such as the abs, inner thighs or buttock. I also see clients whom are contracting more strongly around the anus, which is great for keeping control of stool but are under-utilizing the muscles around the urethra where the urine comes out. So if you are thinking about trying kegels at home, I strongly encourage you to find a pelvic health physiotherapist near you to ensure kegels are right for you and that you are performing them correctly.
           Now, its important for me to note that “kegels” are not for everyone! In some cases can make your symptoms worse. I see more often than not pelvic floor tightness that leads to weakness. In these cases learning to relax the pelvic floor muscles helps to optimize strength because the muscles can actually move through their full range of motion. So if you are performing kegels and are not getting better it can be because a) you’re not doing them correctly b) you actually have tightness in the pelvic floor or c) lack of coordination with other muscles.
           Lastly I wanted to clear up that incontinence is not just something pregnant women get. Several studies have been conducted showing young female athletes get incontinence too. One study found the highest percentage of incontinence among young women is in gymnastics and track and field (2, 3). This is another discussion that healthcare providers are trying to educate coaches, parents and athletes about, incontinence in sports. It is more common than previously thought and again common but not normal.
           Other risk factors aside from pregnancy for developing incontinence are obesity, surgery, strenuous work or exercise, constipation, straining with bowel movements, chronic coughing and older age (4).
           What about age? A large study of 34,815 women out of Norway found, 10% of women had incontinence between the ages 20-24, 14% 25-29, 18% 30-34, 21% 35-39, 24% 40-44, 28% 45-49 and 30% 50-54 years old (5). Although the percentage of women experiencing incontinence does increase with age, younger women experience it too.
           I hope you found this article informative about incontinence and that it cleared up some misconceptions. So ladies and gentleman if you have incontinence, please find a therapist whom is trained in pelvic health and can perform internal exams so that they can help you. To find a therapist close to you, visit www.pelvichealthsolutions.ca
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The Pelvic Health Lady

References:
1.        Canadian Continence Foundation, accessed n Feb 4, 2017 from http://www.canadiancontinence.ca/EN/what-is-urinary-incontinence.php
2.        Nygaard et al. 1994. Urinary incontinence in elite nulliparous athletes. Obstet Gynecol 84: 183-187.
3.        Nygaard, IE. Does prolonged high-impact activity contribute to later urinary incontinence? A retrospective cohort study of female Olympians. Obstet Gynecol 90: 718-722.
4.        Bø, Kari. 2004. Urinary Incontinence, pelvic floor dysfunction, exercise and sport. Sports Med 34(7): 451-464.

5.        Hannestad et al. 2000. A community based epidemiological survey of female urinary incontinence: The Norwegian EPINCONT Study. Jorunal of Clinical Epidemiology 53: 1150-1157.

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