Struggling with Incontinence?

Stop unwanted leakage with the Kegel exercise and more

by Naomi Wolfman, GNC(C), NCA, BScN

Originally Published in  Health Action Magazine Spring 2014 edition

Sheila goes in for a yearly physical exam and expects the health care professional to approach the subject of incontinence. When that doesn’t happen, she goes home without having her bladder or bowel symptoms addressed. The cycle continues.

When dining out, Ken makes sure he knows the layout of the restaurant for quick access to the washroom. Otherwise, he says no to social invitations.

Nancy worries about losing her job because she has to punch out each time she leaves the assembly line. She uses pads, which cost much of what she makes but cannot disclose to anyone.

The stories of Sheila, Ken and Nancy illustrate their secret suffering. Through- out the world women and men suffer with incontinence, urgency, frequency, hesitancy, dribbling or nocturia at a ratio of four to one. In Canada alone 10 percent of the population reportedly experiences bother- some urinary symptoms. Bowel symptoms are less reported, but so far five percent of Canadians suffer with frustrating and embarrassing occurrences. Incontinence is any leakage that one does not intend to let escape. Incontinence can be divided by type of symptoms, namely stress, urge, mixed, overflow or functional incontinence.

 Causes of incontinence

There are many causes of incontinence, including loss of structural support, sphincter deficiency, detrusor (bladder muscle) instability, pelvic surgeries, and certain medications or lifestyle habits that aggravate existing symptoms.

The pelvic floor—comprised of muscles below your pelvis—cradles internal organs and gives you control when

urinating. Conversely, having a weak pelvic floor impacts most of our daily routine and often leads to incontinence.

The Kegel exercise is a practical mea- sure for everyone to strengthen their pelvic floor. Dr. Kegel developed the exercises in the late 40s and a select few women practised and greatly benefitted from them. The rest of us, men included, did our bladder training when we were around three years old and believed that it should have been good enough for a lifetime.

What causes a weak pelvic floor? For one, an expanding waistline places weight on the bladder while imposing onto the pelvic floor to support the extra weight.

Immobility also creates complications. The muscles of a person who is chronically immobile do not get as well nourished by blood flow as those of an active person. By the same token, immobility of the pelvic floor can make the muscles tense up, shorten and weak- en, leaving them vulnerable to unwanted leakage. Studies show that with consistent daily pelvic floor exercises, one can strengthen the muscles supporting our internal organs with desirable results in around three months.

Smoking negatively impacts the lower urinary tract by decreasing blood flow while the nicotine and tar irritate the fragile tissues. Over time, the blood vessels may be overwhelmed and have more and more difficulty nourishing the susceptible tissues. When a tissue is gradually starved, its function decreases and nerves suffer, rendering the organ less pliable as well as leaving the host less sensitive to bodily cues. Heeding the urge to urinate or eliminate at the right time is important to avoid worsening symptoms such as constipation or overflow incontinence. The ingredients in cigarettes are not the only irritants for bladder or bowel. Sugars, caffeine, tomato sauces, spicy foods, fizzy drinks, to name a few, adversely impact the elimination organs by creating spasms.

Years after childbirth, some women discover they have pelvic organ pro- lapse (falling out of place), resulting in incontinent symptoms. Pelvic descent can be assessed and the woman’s symptoms alleviated by fitting her with a pessary (a medical device) to address areas of pelvic organ prolapse and/or incontinence.

Pregnancy can also weaken the pelvic floor—just try carrying that extra weight for nine months! Strengthening the muscles by doing the Kegel exercises as a daily routine is an important aspect of preparing for labour and delivery. Perineal massages and sitz baths are also very soothing for moms to be. At delivery time, the perineum sometimes suffers micro tears or needs an episiotomy. When ready and free from pain, postpartum moms can resume the Kegel exercises as a daily practice to bring nourishment to the tissues, strengthen sphincters and completely heal the area.

Menopausal symptoms play an important role in addressing the lower urinary tract. There are many estrogen

receptors within the woman’s pelvic floor. Declining estrogen leaves the tissue thin, fragile, vulnerable to tears and less elastic, as in vaginal atrophy. Deficient estrogen gives irritating symptoms such as redness, tingling, inflammation. It also decreases the number of vaginal lactobacilli, leading to an increase in the vaginal pH and a predisposition to urinary infections—studies show that cranberry juice and vaginal probiotics help in this case.

Men with benign prostatic hypertrophy (BPH) are at risk for weak muscles as well. The prostate itself has muscles and when it increases in size it compresses the prostatic urethra, narrowing or even partially obstructing the passage. Having a surgery such as trans urethral resection of the prostate (TURP) can sometimes inadvertently nick the inner sphincter at the bladder base and/or scar tissue can form there, causing incontinent symptoms or ineffective stream starting or emptying. Again, practising Kegel exercises before the surgery and then after the removal of the drainage catheter has shown to be effective in regaining continence status ear- lier than without the exercises. By the same token, during radical prostatectomy (RP, an operation to remove the prostate gland), the external urinary sphincter will need to learn to perform the function of containing urine on its own. In this case the Kegel exercises are again a good conservative measure one can do any time, any place.

As we age, many of us will experience decreased bladder capacity. This is attributed to changes inside the bladder such as trabeculations (thickens bladder wall, hindering flow) and tissue elasticity. This also means that the urge to void will come at a lesser volume. By decreasing irritants, increasing fluid intake and work- ing on a daily routine, the bladder or bow- el can be trained. Again, Kegel exercises are useful as they strengthen the pelvic floor muscles.

As you can see there are numerous ways to tackle incontinence. It requires a dedication to the exercises and a willingness to be an active participant in self-care.

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