Health Mummy Mayhem

Do You Pee A Little When You Giggle? By Anita Selby, B.Physio (Hons) of Ultimate Physio NQ.

3 November, 2013
Anita Selby Physiotherapist Townsville

Do you pee a little when you giggle?

Do you ever go from feeling “oh, I have to go to the toilet soon”, to being absolutely busting to go to the toilet, that you’re doing a little cross-legged dance on the way whilst you got four bags of groceries and are trying to get the keys in the door?

Do you ever leak urine when you run or go to the gym or aerobics classes? Do you leak urine when you laugh, cough or sneeze? Does your urges to go to the toilet increase with certain triggers, such as trying to get the keys in the door lock, running water, or the petrol bowser?

As cliché as this sounds, you’re not alone.

Urinary incontinence affects one in three women who have ever had a baby, one in ten men, and 40% of people aged over 75. It is usually not talked about in society and just accepted as part of getting older or as a consequence of childbirth. It’s thought of as a taboo subject, women giggle nervously about it (whilst keeping their legs crossed to avoid any accidents!), and just live with it. The interesting thing is that exercises and other treatment for the pelvic floor has a quite strong evidence base as being effective at reducing continence issues, in fact, it’s one of the areas of physiotherapy with the strongest evidence base!

My name is Anita and I am a physiotherapist. I dabble in a bit of all areas of physiotherapy – sports, musculoskeletal, orthopaedics, neuro, lymphoedema, and the good old women’s health.

It shits me to tears when ads come on the television about Poise liners for LBL (light bladder leakage). LBL is a load of crap, it’s not a medical term. The proper terms are stress incontinence and urge incontinence, urgency and frequency. And don’t even get me started on the Reebok Crossfit advertisement on “do you pee when you workout?” (A recent campaign by Reebok creating the impression that leaking with working out, peeing when you do ‘double unders’ (a Crossfit term for a skipping technique where the jump rope passes under you twice on one jump) is perfectly normal, and in fact, actually an achievement to show you are working hard.

THIS IS WRONG. It is NOT OK to pee when you work out. Whilst you are loading muscles of your legs, you must consider that the core muscles including the pelvic floor, are alot smaller, and with that exertion increasing your intra-abdominal pressure, it puts more load on the pelvic floor.

So if it’s not light bladder leakage, what are the correct terms to use? Stress incontinence is the leakage of urine with effort or exertion – anything that is going to increase stress on the pelvic floor – coughing, laughing, sneezing, running and physical activity.

Urgency is the sudden strong desire that you would feel you would not be able to delay it any longer, going from “Oh, I have to go to the toilet… OH I HAVE TO GO TO THE TOILET NOW… GET OUT OF MY WAY!!”

Urge incontinence is the leakage associated with urgency.

Frequency is the frequent need to visit the toilet throughout the day, often without the bladder filling to an adequate level. So sometimes it’s actually the bladder contributing to the problem, to put it in a very simplified way, it’s like the bladder muscle (the detrusor) is cracking a tantrum and spasming, and that creates the sudden urge feeling. If you are going more frequently than 4-6 times during the day and 0-1 times at night as a guide, than that could be a sign of increased frequency.

A normal bladder should:

* Need to empty 4-6 times per day, and 0-1 times at night

* Pass 1-2 cups of urine (250ml-500ml) at each visit to the toilet

* Be able to hold it until convenient

* Empty in a steady continuous stream and not require straining to empty , leaking, or post-void dribble

* Should not leak between visits to the toilet

A normal bowel should:

* Empty anywhere from 3 times per day to 3 times per week (this varies for every individual, but on average is daily).

* Should not require straining to empty

* Should pass motions easily as a continuous sausage-shaped form

* Should be able to hold off until convenient

* Should be able to hold back wind until an appropriate time

A physiotherapist trained in the pelvic floor will be able to determine which type of incontinence that you have, and provide you with ways to retrain the pelvic floor and the bladder to improve your symptoms. As with all exercises, having someone tell you exactly how to do them and with the right technique is pretty important! And trust me, there are alot of important bits down there!!! There is so much evidence-based literature supporting complying with a pelvic floor exercise program post-partum (after childbirth).

Additionally, women who are supervised by physios who work in these areas do much better than just handouts alone, or looking at Doctor Google. The reason is there are many factors that may affect the pelvic floor, including bowel habits, occupation, lifestyle, respiratory conditions, diet, health, and overall fitness, which can be picked up by someone trained in these areas.

So to wind up, please, don’t think that you have to live with it, and nervously giggle when people bring up the subject. Please don’t shy away from the life you want to live for the embarrassment of not knowing if there will be a toilet when you go out or if you might have an accident. Please don’t give up exercise and accept it just because “I’ve had four kids” or “It’s just part of getting old”.

For one, there are people who can help. Secondly, there are many in the same boat. The more we ladies (and men) talk about our pelvic floors, the more awareness we raise, and hopefully we can reduce the incidence rate of incontience and improve quality of life. Women’s health Physiotherapists see this. Lots! Get back to doing what you want to be able to do, and don’t let incontinence run your life!

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