Incontinence doesn’t mean that you have to stop doing the things you enjoy like exercising. With the right advice, you can not only minimize the issue but also cure it. Our experts explain what incontinence is, why people have it, and what they can do about it so they can continue to live active lives.
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What is incontinence?
Julia Hlaing, senior musculoskeletal physiotherapist and women’s health physio at PB Physio, explains incontinence as “the involuntary loss of control of urine from the bladder (urinary incontinence) or feces or wind from the bowel (fecal or bowel incontinence).” There are three types—stress, urge, and mixed. “Stress is when you leak during physical exertion— cough, sneeze, jump, etc. Urge incontinence is leaking urine while having a strong desire to urinate and it can happen after emptying your bladder, too,” says Erica Azzaretto Michitsch, PT DPT WCS, board-certified women’s health clinical specialist and lead pelvic floor physical therapist at 5 Point Physical Therapy. Mixed is, well, mixed.
Your pelvic floor muscles control your continence. While it has different roles, one of its main functions is to control your bowel and bladder movements. If you have a weak pelvic floor, then you have a higher chance of incontinence. This is why menopausal and pre and post-natal women are more at risk for experiencing it. However, this doesn’t mean that men can’t have it too. Obese people and those suffering from a chronic cough or chronic constipation are among those who also have an increased risk of incontinence.
What exercises should you avoid?
If you have weak pelvic floor muscles, then there are certain exercises that you should skip. Azzaretto explains, “When exercises increase the pressure in our abdomen, it places too much strain and stress on the pelvic floor. As a result, leakage can occur or worsen.” With this being said, she recommends avoiding exercises that increase this intra-abdominal pressure. Hlaing also adds these are the movements that “cause feelings of bearing down and heaviness within the pelvis.” Some examples include weightlifting or heavy lifting, high impact exercises like plyometric jumps, abdominal crunches and sit-ups.
What exercises can improve incontinence?
“Exercises that focus on transverse abdominal muscle strength will help stabilize the trunk and can affect the control of leakage,” says Azzaretto, so these are the ones you want to focus on.
She recommends giving yoga and pilates a go. “Yoga and pilates can focus on these muscle groups and increase strength in the core and pelvic floor with proper coordination. They also focus on postural alignment, which allows forces to flow evenly through your pelvic floor, avoiding the chance of leakage.” Some of these movements include “…plank variations, abdominal hollowing isolation, and bird dog with focus on abdominals when on all fours (quadruped position).”
Hlaing suggests practicing contracting and lifting the pelvic floor. When doing so, “imagine [that] you’re stopping from passing wind then stopping the flow of your urine and lifting up. Ensure [that] you’re not drawing your stomach in, holding your breath, or squeezing your bottom.” Once you’ve felt this movement, release and let go. She uses visualization cues for her clients to better understand the feeling. “Inhale from the nose into the belly and imagine a flower blossoming and opening up the petals from your vagina. Exhale slowly from your mouth and imagine drawing the petals and the entire flower back up and inside you.”
Other pelvic floor exercises are hypopressives. Azzaretto describes these as “low-pressure fitness exercises…that decreases the pressure in your abdominal cavity while using your diaphragm muscle effectively. This allows the pelvic floor to function appropriately and become stronger.”
What about kegels?
Kegels are the typical go-to exercises for pelvic floor training. While they can help, you have to be careful not to overdo it. “A kegel is basically a pelvic floor muscle contraction. It’s the motion you perform to ‘stop a stream of urine.’ When too many kegels are performed on a daily basis, it can actually fatigue the muscle and make the incontinence even worse,” says Azzaretto.
What should you do in the meantime?
Just like any other type of workout, you need to train your pelvic floor muscles regularly and consistently. Hlaing explains that strengthening your pelvic floor can take three to five months so ensure that you keep up the work to see results. However, there are steps that you can take, alongside your pelvic floor training, to help minimize the issue in the meantime.
Both Hlaing and Azzaretto prioritize healthy bladder and bowel habits. This means only going to the toilet when you actually have to and making sure that you’re not going too much or too little. As a guideline to track your bladder habits, Azzaretto says, “normal urination occurs every two to four hours.” In addition, Hlaing highlights the importance of good posture when on the toilet, as well. “Elevate your feet and lean forward slightly. Make sure you refrain from straining when doing a poo”.
They also recommend staying hydrated. Drink consistently throughout the day and avoid bladder irritants, such as carbonated drinks, caffeine, alcohol, and artificial sweeteners. Drinking more water “allows for less concentrated urine. When it’s too concentrated and you are dehydrated, the bladder becomes more sensitive and it’s easier to leak urine,” says Azzaretto.
Make sure you eat enough fiber, exercise regularly, and have good pelvic floor awareness. Hlaing describes this as being “able to feel the lift and contraction, but also able to relax and lengthen.”
Seek professional advice.
Hlaing points out that incontinence doesn’t automatically mean that you have weak pelvic floor muscles. In fact, the problem may be that you have overactive (tight) pelvic floor muscles. In this case, “you need to learn how to relax the pelvic floor muscles and let go first.”
So, if you’re experiencing incontinence, then see a qualified pelvic floor physiotherapist. Your physio will be able to give you pelvic floor training specific to your needs. As Hlaing also says, your training is “dependent on the symptoms and goals of the individual. For example, is the person experiencing leakage during a cough or sneeze (muscular strength and speed)? Or is the person finding it hard to hold for a long period of time (muscular endurance)?” Consulting a professional can help find solutions to your specific needs.
Incontinence is an issue that not only affects people physically but can cause emotional and mental strain. “Instead of ignoring this topic, let’s support and educate each other to talk openly about it,” says Hlaing. Don’t be embarrassed about it. It happens to more people than you think. “In many cases, incontinence can be minimized, prevented, and even cured,” she adds.
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