Pelvic Floor exercises effective at treating incontinence
If you are suffering with urinary incontinence, you need to look at pelvic floor exercises and bladder training. You may have read previous articles about these exercises but if you had not taken previous research findings seriously, a July 2012 review by the American based Agency for Healthcare Research and Quality (AHRQ) should give you more reason to start pelvic floor (otherwise know kegel) exercises.
According to the review, about 25% of young women and 44% to 57% of middle-aged and postmenopausal women experience involuntary urine loss. Their findings show that age, pregnancy, childbirth, menopause, hysterectomy, and obesity put women at a higher risk of suffering from urinary incontinence.
Fortunately, there are several forms of treatment for women suffering from urinary incontinence. An independent team of investigators analysed 889 studies and prepared a comparative effectiveness review. The AHRQ review compared different treatments for urinary incontinence that included doing pelvic floor muscle (Kegel) exercises, bladder training; using medical devices, weight loss, medications and electrical stimulation, among others.
They found that “pelvic floor muscle training, combined with bladder training is effective for treating women with urinary incontinence without the risk of side effects. The drugs for urgency incontinence showed similar effectiveness. However, with some drugs, more women discontinued treatment due to bothersome side effects.”
Julie Goodyear talks about continence issues
Julie Goodyear has been causing havoc in the Celebrity Big Brother house.
“I sneeze, I pee,” she announced to fellow housemates, flicking away any embarrassment at suffering from urinary incontinence as if it were ash at the end of her trademark cigarette holder. In doing so she highlighted the millions of Britons who have poor bladder control.
It is estimated 14 million people in the UK have urinary incontinence and although it can occur at any time of life problems are most likely in middle age. One in five women over the age of 40 experience problems although men can also be affected, particularly if they have undergone prostate surgery.
However, as Julie, 70, has shown, there is no need to suffer in silence and there are many ways to deal with the problem.
Professor Linda Cardozo, an expert in urogynaecology at King’s College Hospital in London, says: “There is not one solution for everyone but there is help for absolutely everybody.”
There are four types of incontinence: stress, which causes leaks when you cough, sneeze or laugh; urgency, which is characterised by a sudden compelling need to pass urine; mixed, which is a combination of the two; and overflow, which occurs when the bladder overfills but there is no corresponding urge to urinate.
Childbirth increases the risk of problems. A Norwegian study published in the New England Journal Of Medicine found 10 per cent of childless women experience problems compared to 16 per cent of those who had children via caesarean and 21 per cent who had a vaginal delivery.
Other factors include loss of muscle tone as we age, obesity and lifestyle. Smokers like Julie are more likely to suffer because of their chronic cough. Constipation can also increase pressure on the bladder. White wine, champagne and caffeine-based drinks are the most irritating for the bladder but the fashion for downing copious amounts of water doesn’t help either.“Women often drink far more than they ought to. There is absolutely no need to drink all that sippy mineral water,” Professor Cardozo says.
“In a temperate climate the fluid intake recommended by renal physicians is 24mls per kilogram of body weight. For the average woman that would equate to 1,200 to 1,500mls a day.”
Diet versions of popular carbonated drinks are also more likely to cause problems than standard sugary ones. “The diet drinks are better for teeth and weight but they are not better for your bladder,” Professor Cardozo says.
Some forms of exercise are bad news. “Trampolining is about the worst, 70 per cent of women will leak when they are on a trampoline.” High-impact aerobics and weight training can also cause leaks but exercises to strengthen the pelvic floor, the sling of muscles which holds the bladder in place, will help reduce symptoms if you do them regularly. Professor Cardozo says pelvic toning devices may help, if only to identify the right muscles to flex and relax.
If in doubt ask your GP for a referral to a member of the Association of Chartered Physiotherapists in Women’s Health or search their website for a local one.
Incontinence specialists can offer distraction techniques such as sitting on the edge of a hard chair and other tips to minimise the risk of accidents.
If the problem is more troublesome you may be prescribed antimuscarinic drugs that suppress involuntary bladder contractions. A new class of drug which regulates nerve signals to the bladder will be available within a year or two.
Botox and other forms of botulinum A toxins are another option: injected into the wall of the bladder they can prevent for up to a year the muscle spasms which trigger leaks.
Surgical solutions involve slings to support the bladder, procedures to lift the neck of the bladder or placing a tape under the urethra which blocks urine if the pelvic floor drops. “It works like a hosepipe when kinked,” Professor Cardozo explains.
“The most important thing to remember is there is help available. Urinary incontinence is no longer such a taboo because there are so many high profile people who have now admitted to having problems.”
Two simple ways to tackle incontinence
There is no reason why anyone should have to feel embarrassed about incontinence, but it continues to be a common chronic health condition that diminishes quality of life.
Many women experience urinary incontinence for the first time during or after pregnancy. The physical changes of pregnancy, along with the stresses put on the pelvic floor, can cause urine leakage with exertion, coughing or sneezing. For many women, this problem resolves within several months postpartum. However, without treatment, some women may continue to have a chronic incontinence issues for life.
There are two main types of urinary incontinence, listed below. Some women develop a mix of the two.
Causes:
-A weak pelvic floor.
-Urethral sphincter dysfunction.
Women who have stress incontinence experience urine leakage when pressure is put on the bladder during laughing, coughing, sneezing, or with exercise.
Causes:
-Pregnancy or pelvic surgery such as C-section.
-Injury to pelvic area.
-Diseases such as diabetes, stroke, MS or other neurological conditions.
This condition is more commonly called ”overactive bladder.” Urge incontinence occurs when there is nerve dysfunction that causes bladder contractions outside of normal urination. Women with urge incontinence find that they have episodes where they experience an extremely strong and immediate need to urinate. The bladder contractions can make it difficult to make it to a bathroom.
Treatment
The first line of treatment is to strengthen the pelvic floor to help provide greater support and control. The pelvic floor muscles play an important role throughout a woman’s life in maintaining proper alignment of the spine and support and function of the pelvic organs. The muscles of the pelvic floor span from the pubic bone to tailbone, forming a figure eight around the urethra, vagina and anus. Weak pelvic muscles result in sagging and loss of support of the pelvic organs, and can lead to incontinence problems if not corrected.
Pelvic floor exercises (sometimes called “Kegel” exercises) are a great way to strengthen these muscles and are simple to perform, but require that you first identify how to correctly contract the pelvic floor muscles. One method for locating the pelvic floor muscles is to note the area that contracts when you stop urinating. The muscles responsible for stopping urine flow are the pelvic floor muscles. You can use the urine stop-and-start test when initially learning how to locate and isolate the muscle group.
Pelvic Floor Exercises
Two or three times a day, do 5-10 repetitions of each exercise listed below. Build up to two times a day of 25-50 repetitions of each exercise. If your pelvic floor muscles fatigue quickly, do fewer repetitions each time, but increase the frequency throughout the day.
Quick Flicks:
Contract your pelvic floor muscles quickly and release.
Elevator:
Slowly contract your pelvic floor muscles (think of lifting up like an elevator moving up floors), progressively increasing your contraction, and then slowly releasing back down. You can increase the effectiveness of this exercise by holding for five seconds at the top of the contraction.
Your abdomen, buttocks, and thighs should not be tensed when doing these exercises. Lie, sit, or stand with your legs slightly apart so you can isolate the correct area. No one will be able to tell that you are doing these exercises, so you can do them anywhere. It’s helpful to give yourself a ”cue” to do your exercises; for example, try to remind yourself to do them while brushing your teeth or driving to work. You should contract your pelvic floor muscles each time you lift something, laugh, sneeze, or cough to provide support and prevent further weakening.
Increasing pelvic floor strength is helpful for reducing stress incontinence, and the exercises can be part of the treatment for those with ”overactive bladder” or urge incontinence issues.
In addition, those with urge incontinence can improve the condition with the following bladder-retraining program:
1. When you feel a strong bladder urge, stop and stand (or preferably sit) very still.
2. Squeeze your pelvic floor muscles 5-6 times to prevent leaking.
3. Relax by taking a deep breath and exhaling several times until the urge reduces.
4. Slowly walk to the bathroom. If the urge suddenly becomes strong again, go back through the steps to regain control and retrain your bladder response.
Additional treatments can range from biofeedback and behavior interventions to medications and surgery. The key for effectively treating an incontinence problem is proper diagnosis and follow-up with a healthcare provider who is trained to treat this condition.
Remember, if you suffer from incontinence, you are not alone! It is an easily solvable and common problem that you don’t need to feel ashamed of.
Survey shows benefit of Pelvic Floor Exercises for Urinary Incontinence
A July 2012 review by the American based Agency for Healthcare Research and Quality (AHRQ) should give you more reason to start pelvic floor (otherwise known as kegel) exercises.
According to the review, about 25% of young women and 44% to 57% of middle-aged and postmenopausal women experience involuntary urine loss. Their findings show that age, pregnancy, childbirth, menopause, hysterectomy, and obesity put women at a higher risk of suffering from urinary incontinence. Fortunately, there are several forms of treatment for women suffering from urinary incontinence.
An independent team of investigators analysed 889 studies and prepared a comparative effectiveness review. The AHRQ review compared different treatments for urinary incontinence that included doing pelvic floor muscle (Kegel) exercises, bladder training; using medical devices, weight loss, medications and electrical stimulation, among others.
They found that “pelvic floor muscle training, combined with bladder training is effective for treating women with urinary incontinence without the risk of side effects. The drugs for urgency incontinence showed similar effectiveness. However, with some drugs, more women discontinued treatment due to bothersome side effects.”
Some information to help solve incontinence worries
Urinary incontinence is more common than reported. Regrettably, many people suffer in silence and restrict their daily activities. Yet incontinence is often easily managed and treated, indeed, experts have shown that nearly 80% of people with poor bladder control can be cured or improve.
Bladder control is a problem for women and men, and some young people. Experts estimate that four out of five incontinence patients are women — especially those who have had pregnancies or who are elderly.
Urine leakage is the symptom of a medical problem. Diabetes, strokes or Parkinson’s can damage nerves. A bladder infection or irritation (like a kidney stone) can scar the urethra (the tube that moves urine from the bladder). Childbirth can weaken muscles, stretch tendons, or damage nerves. Drugs like diuretics can increase bladder activity. It can be hard to get to a toilet if severe arthritis slows walking, or if medication makes a person confused or sleepy. Lower estrogen during menopause can weaken the vaginal canal.
There are several types of incontinence. Stress incontinence occurs when pressure on the bladder causes a loss of control and leakage. This often occurs when a person sneezes, laughs, falls, runs, exercises or lifts a heavy object. Urge incontinence is different; the bladder becomes overactive, perhaps from a spasm. The sudden urge to go makes a person rush to the toilet. Overflow incontinence can occur when the bladder will not empty and urine builds. Something might prevent the bladder from emptying, such as constipation, an enlarged prostate, or scar tissue.
Pelvic surgery and trauma can affect the nerves, muscles, and structure of the pelvic area.
For women, the trauma of childbirth and carrying a baby can reduce support of pelvic organs, affect the bladder, and injure nerves. After a pregnancy, weak muscles can also cause the bladder or uterus to drop out of place and bulge into the vaginal canal or press down on the rectum.
For men, especially older men, an enlarged prostate or prostate surgery can weaken muscles or cause nerve damage. The surgeon might widen a passage for urine or use techniques to shrink an enlarged prostate gland. Men can need surgery for prostate cancer. At times, surgery results in complications such as impotence or incontinence
There are many urological tests that can help specialists learn the specific problem or problems causing leakage. Urodynamics tests are helpful to see how efficiently a bladder fills and empties.
However, don’t assume that incontinence is a problem that you must just accept.
Don’t be embarrassed to get help. Specialists (urologists for men and women, or urogynecologists for women) can do tests to pinpoint medical problems. Finfing the right solution depends on identifying the real problem.
Don’t be afraid to be honest with your doctor or nurse, give a complete history so they have all the information to make a correct diagnosis. Don’t be surpised to be asked for a physical examination and to provide a urine sample.
Look for habits that you can change to manage leakage. Some people improve by avoiding caffeine, alcohol and certain drugs, and by limiting fluids at night before bedtime. A diet of fruits, vegetables and whole grains can reduce constipation. Drink enough fluids in the daytime to avoid urinary tract infections and constipation.
If you weigh too much, lose weight. A large belly puts pressure on the pelvic muscles. Excess weight can cause both stress and urge incontinence.
For urge incontinence, create a regular schedule to empty your bladder, starting at every two hours. Over time, you can increase the time between trips to the bathroom. This schedule can retrain your bladder to control urges.
Regardless of your age or sex, force yourself to do Pelvic Floor (Kegel) exercises. They can strengthen muscles to support the bladder and control leakage. Don’t just blame old age or being out of shape for your poor bladder control.
If you are a young woman, start doing Kegel exercises before getting pregnant. Strong pelvic muscles will serve you throughout your life and could make the effects of childbirth less difficult.
If a treatment does not work well for you, don’t be afraid to ask for another option and remember that there are many ways to manage incontinence alongside incontinence pads and incontinence pants.
Pelvic Floor Exercises Prevent Incontinence
A 12-week exercise program, including pelvic floor muscle training (other wise known as Pelvic Floor Exercises), during pregnancy can help prevent and treat urinary incontinence in late pregnancy, according to research published online July 17 in BJOG: An International Journal of Obstetrics and Gynaecology.
Signe N. Stafne, P.T., of the Norwegian University of Science and Technology in Trondheim, and colleagues conducted a randomized controlled trial involving 855 pregnant women who were randomly allocated to either an intervention comprising a 12-week once-weekly physical therapist-led group exercise session, including PFMT, conducted between weeks 20 and 36 of gestation, or regular antenatal care.
The researchers found that 11 percent of women in the intervention group reported any weekly urinary incontinence, compared to 19 percent of controls (P = 0.004). Three percent of women in the intervention group reported fecal incontinence compared with 5 percent of controls, but the difference did not reach statistical significance (P = 0.18).
“The results from the present trial indicate that pregnant women should do pelvic floor muscle training to prevent and treat urinary incontinence in late pregnancy. Thorough instruction in correct pelvic floor muscle contraction and pelvic floor muscle training is important, and specific pelvic floor muscle exercises should be included in exercise classes for pregnant women,” the authors write. “Any possible long-term effects on urinary incontinence and the preventive effect of pelvic floor muscle training on anal incontinence should be explored further.”
Some answers to common questions about Incontinence
Do women have incontinence more often than men?
Unfortunately for women, yes. Urinary incontinence often occurs because of problems or weaknesses in muscles, support mechanisms and nerves that help to hold or release urine. Pregnancy and delivery, body changes associated with menopause and the way a woman’s female urinary tract is structured are among factors that contribute to twice as many women having incontinence problems. What’s important to know is that you don’t have to live your life wearing pads or being embarrassed by leakage. Incontinence is treatable at all ages.
Do symptoms differ for women?
The most common type of Urinary Incontinence for women is stress incontinence where coughing, laughing, sneezing, or other movements put pressure on the weakened bladder structure or surrounding muscles, resulting in urine leaks. With urge incontinence, women suddenly feel an uncontrollable urge to urinate and leak without control. Something as simple as hearing the sound of running water may be enough to prompt the release of urine. Mixed incontinence, a combination of stress and urge incontinence, also occurs much more frequently in women.
How is incontinence treated?
Significant progress has been made in treating incontinence effectively. Make an appointment with your Healthcare professional for an exam that will identify what type of incontinence you have. The doctor also will determine if you have underlying medical conditions that can cause incontinence.
Common medical reasons include pelvic growths, blockages and vaginal or bladder prolapses. Some medications also can contribute to the problem, so bring a list of all meds you take when you go to your appointment.
Depending on the type and extent of your problem, you may be referred for a course of treatment. This may include behavioral therapies such as fluid management, pelvic floor strengthening, bladder retraining, bulking agent injections, biofeedback or nerve stimulation (neuromodulation).
Finding the right combination for your needs may take some time and you will need to work with your Healthcare Professional to determine a treatment that works best for you. Sometimes surgery may be necessary; for instance, the bladder or urethra may have moved out of its normal position following childbirth.
What can I do to lessen my symptoms?
Some women find success by restricting certain liquids, such as coffee, tea, and alcohol. Severe constipation can worsen symptoms so try to keep your bowel movements regular. While absorbent undergarments such as adult diapers make the problem less visible, it’s important to use appropriate skincare products at the same time to avoid skin irritation and sores.
Three out of 10 people experience incontinence
Three out of 10 people experience some form of incontinence, but you don’t hear much about it.
Many people need to urinate more frequently as they age and there isn’t a formula for determining when urinary symptoms merit treatment, the rule of thumb is that when they interfere with a person’s quality of life, it’s time to seek help.
As women age, they lose estrogen while muscles in the bladder and urethra weaken, however chronic conditions like diabetes, congestive heart failure, Parkinson’s disease and stroke also can affect bladder. Calcium deposits in the kidneys or bladder also can prevent it from emptying completely, leading to sudden urges to urinate or leakage.
Incontinence isn’t just a problem for older people and those who have other health problems, though. Serious runners may experience some leakage because the rhythmic pounding of exercise takes a toll on their pelvic floor muscles. Some young women also develop incontinence during and after pregnancy. The uterus sits above the bladder and the weight of the baby presses on the bladder, so that between one-third and one-half of pregnant women experience some incontinence, the symptoms don’t always go away after the birth, because the weight of a baby strains the muscles of the pelvic floor, she said.
Incontinence can also run in families, different ethnic groups tend to have different problems.
Despite the fact that incontinence is common, many women are embarrassed to talk about it or assume it’s a normal part of aging. Many doctors either don’t think to ask about it or don’t have the time to work with patients on what’s causing the problem.
Most people can improve their symptoms, though. About 50% of people with incontinence improve after behaviour modification and 46 to 78% may be helped by taking medication without behavioural changes. When the two tactics are combined, 93% of people improve, surgery and nerve stimulation remain as as alternatives if these don’t prove effective.
One of the first steps is for people to keep a “bladder diary” of what is eaten and drank, when they urinate normally and any leaks. With that information, people can be helped to modify their habits and train their bladder to urinate at the right time.
Caffeine and alcohol are diuretics and can worsen bladder control problems. Spicy food, citrus fruits, excessive consumption of milk or calcium supplements and artificial sweeteners also can irritate the bladder.
The idea is to help people improve their quality of life, instead of giving them rules they may not follow. For example, instead instead of drinking several cups of coffee in a morning, rather than give up coffee altogether it’s easier to reduce the amount of coffee drank, switch to decaffeinated coffee, alternate between coffee and water throughout the day or sip the coffee, so that it doesn’t flood the bladder.
Some people also benefit from pelvic floor exercises that strengthen the muscles around their bladder. Many women develop incontinence during menopause, but these exercises can help women recovering from childbirth and importantly prevent incontinence for those who want to have children in the future.
Pelvic Floor Exercises App
We’re always talking about the benefits of Pelvic Floor Exercises for managing Incontinence and Bladder problems. Well it seems that the folks at Tena are just as strong believers as Allanda. They’ve just launched their new Pelvic Floor Exercises “App” which reminds you when and how to do Pelvic Floor Exercises, you can download it at www.lightsbytena.co.uk/mypffapp.
Those who want a refresher on Pelvic Floor Exercises can watch our video.
Botox injections said to have cured incontinence
The Daily Mail covers incontinence relatively frequently within it’s Health Section and last week it features the story of Emma Henderson who received Botox treatment to help with her continence problem.
Botoxt has been used to treat everything from wrinkles to depression, and excessive sweating to strokes. And now, following clinical trials, Botox is being offered on the NHS for people suffering from urinary incontinence.
Previously the treatment was available only to those suffering neurological conditions such as multiple sclerosis or Parkinson’s disease, which may also affect continence.
But the injectable toxin, which works by blocking nerve transmissions within muscles, is being prescribed for general overactive bladder syndrome (OAB), this condition is thought to affect one in six Britons. Most sufferers are aged over 40 and women are twice as likely as men to develop the condition.
Sufferers suddenly feel an overwhelming urge to pass urine and cannot hold it. If you need to pass urine more than seven times a day, you could be suffering from the condition.
OAB can be caused by diabetes, an infection, bladder stones and spinal injury. In men, prostate problems can lead to an overactive bladder, but for many people the cause is never determined.
Treatment includes pelvic-floor exercises and medication, as well as a fibre-rich diet, because the pressure caused by constipation can make the condition worse.
Botox is thought to work on the sensory nerves in the bladder. The procedure is carried out under local anaesthetic and lasts about 30 minutes. A tube is inserted directly into the urethra – the opening of the bladder – with a needle and a camera on the end called a cystoscope.
When surgeons reach the bladder, the Botox is injected directly into the muscles surrounding it. About 30 jabs are administered to ensure the muscles relax sufficiently, and each procedure alleviates the condition for six to eight months.
One person to benefit is Emma Henderson, who was just seven when her troubles began.
Emma, 22, from Bristol, says: ‘It affected me psychologically. I couldn’t be in a supermarket or anywhere crowded in case I lost control. And I couldn’t drink wine as the diuretic effect of the alcohol worsened my condition for a week afterwards.’
In April 2009, Emma was referred to a urologist, who diagnosed her with OAB, and in February 2010 she underwent the Botox procedure at the Worcester Royal Hospital.
‘It was life-changing,’ she says. ‘Suddenly I didn’t need to go to the loo all the time. I could go out again, drink wine at parties, have fun dancing, or enjoy a film at the cinema without the fear of wetting myself.’
Since then she has experienced very few problems, with symptoms returning only towards the end of the eight-month period.
‘I get a bit anxious around that time but I do my best to lead a normal life,’ says Emma.
‘It feels so good that I no longer have to know where the nearest lavatory is. It’s great being able to enjoy a long walk in the countryside with my new boyfriend.’
Read the full story at: http://www.dailymail.co.uk/health/article-2136679/Botox-injections-cured-embarrassing-bladder-problem.html#ixzz1tbQKhYcC