Let’s talk about pee
Bladder leakage is such a taboo subject that many women suffer the consequences for an average of seven years before seeking help, but urinary incontinence shouldn’t be the new normal. In fact, none of us should be leaking at all, says Pilates instructor Holly Spence, so what can we do about it?
“One of the most important things we can do is talk about it. So many women don’t recognise they have a problem or know how to seek help.” Yet one in three women over the age of 18 experiences bladder leaks every day – so even if you’ve not had a baby or hit the menopause, you can still pee a little (or a lot) when you run, jump, cough or sneeze.
Why does your bladder leak?
Bladder leakage happens when your pelvic floor is weak. This is a layer of muscles that spans the bottom of your pelvis and supports your uterus, bladder, small intestine and rectum. These muscles also connect to your core and help you to keep good posture.
Anything from pregnancy to running, weightlifting or weight gain puts extra pressure on your pelvic floor, and this can eventually weaken the muscles. Loss of bladder control also increases with age as estrogen levels drop—this is the hormone responsible for keeping the pelvic floor strong. Pelvic weakness therefore varies from woman to woman and could be the result of anything you routinely do that creates a downward pressure on pelvic muscles.
Pilates instructors pee too
Holly suffered a stage two bladder prolapse after childbirth. “I had a straightforward homebirth with no complications, but after a couple of months I still didn’t feel right.” Her GP confirmed she had a slight bulge in her bladder but told her this was normal following pregnancy. Holly wasn’t convinced so sought a second opinion from a pelvic floor specialist.
“When I found out about the prolapse, I knew I needed a serious rehabilitation programme.” Holly therefore combined physiotherapy with Kegels, Elvie Trainer, and hypopressive breathing – which helps to counter downward pressure on the pelvic floor. “None of these would have worked for me in isolation. This kind of global approach is often necessary as it looks at the biomechanics of the body to see how it’s overcompensating for pelvic weakness in other areas.”
Incontinence in every woman
A study predicts that 80 percent of women over the age of 18 will have a pelvic floor dysfunction by 2050 – and the vast majority of those women will experience stress incontinence. This happens as your bladder fills up and bears down on the urethra – anything that increases the pressure (like running) can therefore cause leaks.
Hollie Grant believes that women often leave it too late to care for their pelvic floors. “We need to make our Kegels as important as brushing our teeth,” she says, and she speaks from experience. Hollie experienced stress incontinence during pregnancy. “It was a shock to not have complete control over my pelvic floor.” Yet stress incontinence can happen outside of pregnancy too, so how can you reverse it?
Keep your Kegels effective
“Your pelvic floor acts as a hammock that’s attached to your coccyx, pubic bone and sit bones – so it can be visualized as a diamond,” explains Hollie. “As you do your Kegels, think about pulling up the hammock rather than squeezing inwards. If that visual doesn’t work for you then imagine you’re sucking a smoothie up a straw! You’ll want to vary your exercises too, switching between fast pulses and slow holds to work the different muscle fibers.”
Hollie advises against doing Kegels while you pee since this can be counterintuitive. “Stopping the urine mid flow is a good way to find your muscles but repeating this too often can cause a urinary tract infection. And try not to leave it too late to go to the loo either, as this puts unnecessary pressure on the bladder.” That said, don’t be afraid to put some pressure on your muscles if you want to go for a run. “Avoidance isn’t the answer. A bit of impact is no bad thing since we need to know how much control we have.”
Proper pelvic rehab
Kegels combined with Elvie Trainer is a winning approach, but Holly Spence says work with a pelvic floor specialist too. “The trainer gives you great bio-feedback, but you also need to look at the rest of your body to find the root cause of the weakness.”
Pilates helps but be careful with “core work” she warns. “Curl ups create the kind of abdominal pressure you want to avoid. Squats retrain the pelvic muscles but take care with the way you breathe. Belly breathing actually increases pressure on the muscles so try diaphragmatic breathing by pulling air into your lungs and letting your ribs expand instead.”
Most of all, “move in a way that feels good,” says Holly. “Focus on the way you want your body to function and give it time.” Take whatever approach you need so we can make pelvic floor recovery the new normal.