**Edit I wrote this blog back in February before NZ was set to Level Four**
Today I taught six beautiful women and the discussion of incontinence reared its head. The women I was teaching were all Mums, but incontinence isn’t limited to mothers. Children, Men, women, young or old, many people suffer with incontinence. Incontinence can be of the bladder or bowel, or both.
The fact that so many people suffer with incontinence makes you think that there would possibly be a wider conversation around it and less taboo.
At every supermarket there’s an aisle selling liners for men and women, I mean people are making a profit off your incontinence. A fixable problem, and if not entirely fixable then definitely a situation which is able to be improved. However ‘fixed’ or ‘improved’ doesn’t sell and our societal terror at talking about anything so personal or perceived to be embarrassing means we end up, (as we do so often) Isolated, embarrassed, scared and coping daily with a situation which need not be as bad as it is.
My kids are young enough that I have been to the trampoline park more than a few times in the last 10 months. A great place for Birthdays, Mum catch ups when you have toddlers, especially toddlers and babies, and somewhere safe, enclosed and providing coffee.
What strikes me so often in these environments is that it is often men jumping along with the kids, with Mums on the sidelines and, as one of my clients says if there’s a Birthday party at a trampoline park and she has to go she packs at least three pairs of knickers. She wasn’t trying to be dramatic or funny either, it was, for her, just a statement of fact.
So why are we so clueless when it comes to our own bodies? What is missing in our general consumption of information? Why aren’t we repairing ourselves?
Towards the end of pregnancy there are a large number of women who will be suffering from incontinence. It’s no surprise when you add in the weight of a baby, extra fluid, the lax ligaments and support, the pressure on to the bladder which all compound to make it incredibly difficult to escape without a little incontinence.
Then you push a baby out or maybe have all your stomach muscles and tissue sliced through to bring a beautiful wee human to the other side. Perhaps you tear, perhaps you have an episiotomy. Perhaps you develop a prolapse. If you’re lucky only one prolapse but it’s possible that you’ll be blessed with a combination of them.
A knowledge of how to engage your pelvic floor and beginning to connect back to it is key. For ‘normal populations’ (for the purpose of this blog read: those without any of the above conditions) we wouldn’t cue the engagement of the Pelvic floor, but for anyone rehabilitating, recovering, suffering and struggling with connection here it is vital that we do, as that is the way to get the correct muscles to fire and ensure that repair is happening and advancing. Once the Pelvic floor muscles and Transverse abdominal muscles engage without you having to think about them, and the symptoms stop then you probably don’t need to keep concentrating on them but until that point, you are going to have to continue thinking about engaging, remembering to engage, breathing to engage and adjusting your posture to engage and then thinking about it some more.
I took the family back to the UK when Maddie was 3.5 months old and remember walking around the airport at our stopover with her in the front pack and as I was walking thinking that I should practice engaging my Pelvic floor and I was so shocked that I could not hold on to any connection for a decent amount of time! It starts slowly and weight bearing, moving and also weight bearing and moving while you need the toilet make it even harder.
So what if you ignore it? You can’t be bothered, you don’t have the time, money, inclination? You see X Influencer on instagram back at bootcamp four weeks out, so if she can do it you can too, right? Wrong. You used to run half marathons so you’ll be fine, right? Wrong. You loved X exercise class so it’ll be fine to go back, right? You guessed it-no! It’s not that you never will be able to, of course you will! You will IF you honour your body, take modifications, listen to what your body is telling you and if you’re wetting yourself during an exercise class you need to take it easier.
If you were to return to high impact, weight bearing exercise before your pelvic floor is strong enough to support you, you could actually give yourself a condition that you didn’t have throughout pregnancy and childbirth.
We are seeing a worrying trend of women developing prolapses AFTER 6 weeks postpartum. Diastasis needs time to heal and restorative exercises to come back together without forward flexion, high impact and excessive work. We want to avoid exacerbating or creating; Prolapses Hernias, Piles, Back Pain, Disc Prolapses, diastasis and, of course incontinence.
Other than taking it slowly and following our “The Fourth’ guide, what can you do?
Did you know your Pelvic Floor, Diaphragm and Heart are all linked by the bodies myofascial slings? So when we breathe properly our diaphragm works as it is designed to which means we are more connected to our Pelvic floor, again allowing that to function at its optimum.
Breath, good posture, maintaining proper form when exercising, avoiding lifting heavy weights proper engagement (so not bracing, but drawing up to your potential and releasing fully too) as well as low impact centred work will do the repair work from the inside out.
Let’s not forget that there is more than one reason for incontinence, we have Stress Incontinence (SUI) eg. the aforementioned trampoline jumping, laughing, sneezing or exerting pressure on your pelvic floor. There is also ‘Urge” Incontinence, which is the sudden need to empty your bladder, even if you just went!
This can sometimes be our brains, rather than our bladders triggering our instant need to pee. If you think about our fast paced lifestyle and how we are always putting off going to the toilet while we are out and about, by the time we throw some kids into the mix (and we all know how much extra time that takes!) then what we can find is that we don’t heed our natural signs of needed to evacuate our bladders and keep the pressure building as we get on with our day to day, once the key is in the door the overwhelming need to pee arises and often we don’t make it to the bathroom. One of the tips we use for this is any exercise which will distract the brain, a good friend of mine who is a renowned Physio says he gets his clients to count back from 100 in 7’s. It takes so much brainpower that often it distracts us long enough to actually get to the toilet! However anything which challenges your brain so you can get there works.
We can also consciously or unconsciously create habitual incontinence, so for instance if we always go to the toilet before before leaving the house, we create a habit that we will always need to go to the toilet before we leave.
So let’s stop pretending that incontinence doesn’t happen. It does. There are Olympians suffering with incontinence, there are famous people who do and yes, for a time maybe you do too. What matters is that you don’t always have to suffer with incontinence, it doesn’t have to be a lifetime condition. So let’s start working smarter, not harder, looking after ourselves and allowing a safe space to let other women, and not just women, everyone, know it’s okay, and there are solutions available, you don’t have to live with incontinence.
If you ARE struggling, please seek help from a professional. I would recommend seeing your GP, a Physiotherapist trained in these areas, but ultimately ensure you feel listened to and supported. You do not have to suffer in silence.
Online resources we have found helpful related to this issue are the Continence Foundation of Australia and The Vagina Physio Blog.