YOUR BLADDER PROBLEMS SOLVED

By Sarah Lawrence 

Introduction

As its title suggests, this is about a subject that few people - male or female - feel comfortable discussing. Yet, there can be a few of us who, if we are perfectly honest, have not, at some time in our lives, experienced a situation in which they have involuntarily lost control of their bladder.

Urination is a natural biological function. Moreover, it is a necessary - indeed vital - part of the process that sustains the health and life of every living creature. Sadly, it is only in the human world that we have learned to feel shame about our normal, healthy bodily functions. For, while on one level it is perfectly understandable that we should be taught not to burden others with talk of certain private matters that society has decreed as taboo, on an altogether different level it becomes quite nonsensical - if not unacceptable - that we should deny ourselves the opportunity to live a normal, healthy life, purely on the grounds that we are too embarrassed to seek help when any intimate part of our body begins to dysfunction.

As everyone who has ever suffered from urinary problems knows, incontinence - the involuntary leakage of urine - is a deeply humiliating experience. The sheer indignity of appearing not to be fully in control of our own bladder is distressing enough, even when no one else is aware of our problem, but when such an incident occurs in a social situation, the mortification we feel is likely to have a profound effect on our confidence and self-esteem.

The very first - and most important - thing you should understand is that you are not alone. For studies show that incontinence is a problem that is far more widespread than most people believe. While it is estimated that women constitute by far the largest group of sufferers - with as many as 54 per cent of women having admitted to experiencing some degree of leakage at some time in their adult lives - this problem can and does afflict many otherwise healthy people of all ages and both genders.

The second thing you should know is that the majority of bladder control problems can be cured, or at the very least, significantly improved.

There are several types of incontinence, and several reasons why it occurs, all of which will be described in greater detail a little further on. Provided there is no underlying medical condition that is causing you to lose control over your bladder's function, you can learn to regain a level of control that will effectively eliminate your problems, restore your confidence and enable you once again to lead a full and happy social life. 

This book provides you with all the information you need to know about both the likely cause of your problem as well as advice on how to cure it. For ease of use, it has been divided into three separate sections.

Section One contains a detailed description of the different types of incontinence problems to help you identify which category you fall into.

Section Two provides important information about the urinary system; detailing how it works and what can cause it to dysfunction. Some of you may wish to skip this section and move straight on to the exercises themselves. While this is perfectly understandable and permissible, I would suggest that anyone who opts for this approach should, nevertheless, read through this section at some point. Understanding how the urinary system works, and the location of the specific muscles that help control bladder function is an invaluable part of the programme. Knowing which muscles affect which process, and where those muscles are situated will help you to determine whether or not you are performing the exercises correctly.

Section Three consists of two parts: Part One is devoted to exercises designed specifically to strengthen the pelvic floor muscles, and the muscles which govern bladder control, while Part Two contains advice, information and exercises that will help re-train your bladder, thus enabling it to hold more urine for a greater length of time. 

The corrective exercises outlined in this book have been designed by leading experts in the medical/urology field. Moreover, in the decades since they were first introduced, they have benefited literally millions of men and women throughout the world whose lives had previously been blighted by their individual urinary ailments.

While the programme itself is designed to be a 12-week course, provided you commit yourself to it wholeheartedly, and undertake the exercises properly, regularly and intelligently, results should start to be apparent within as little as three to four weeks.

It is important to remember that each stage of the exercise programme must be completed in the way it is printed. Tempting as it may be, do no rush through the exercises, or proceed to a more advanced stage until you have not only completely mastered each exercise in turn but also noted that definite progress has been made. Of course (though it goes without saying) cheating is definitely not recommended. If, however, you should be tempted to cheat by rushing through an exercise, or doing fewer exercises than recommended, it might help you to remember that, in the long term, the only person you will be cheating is yourself.

Whenever your confidence or willpower flags do bear in mind that numerous survey results show that, apart from being perfectly safe - even during pregnancy - these exercises have proven to have an astonishingly high success rate. If as many as 70 per cent of previous sufferers can report having achieved a satisfactory increase in their level of bladder control, there is every chance that they will help you too.

A NOTE TO MEN: While it may appear that much of the information contained herein seems to be written for the benefit of women, it is important to not let this deter you from undertaking the programme on your own behalf. The fact is, the majority of exercises outlined in this book are - and have been proven to be - equally effective in helping to restore bladder control in men.

 

PART ONE - DIFFERENT TYPES OF INCONTINENCE

The word ‘incontinence' conjures up a number of images ranging from the bedwetting syndrome of small children to the total incapacity to control all bladder function more commonly associated with the elderly and infirm. Somewhere in-between, however, lie a whole range of urinary problems that affect all kinds of otherwise healthy individuals at different stages of their life, and while undertaking different activities. The fact is there are several types of incontinence and several reasons why it occurs. Discovering the medically recognised term for your particular problem is useful for two reasons. Firstly, it will help you recognise which category your problem falls into. Secondly, it will help you select the self-help treatment best suited to your specific urinary ailment.

The two most common types of incontinence, and the two that are the most easy to cure, are Stress Incontinence and Urge Incontinence.

 

STRESS INCONTINENCE

Stress Incontinence describes a condition that is characterised by small involuntary leakages of urine which largely occur in response to certain activities such as coughing, sneezing, laughing or indulging in some form of heavy exercise such as jogging, running or aerobics. In more severe cases, simple movements such as rising from a bed or chair, or even merely strolling down the road, are sufficient to cause a small amount of urine leakage, even when the bladder is nowhere near full.

The most common cause of Stress Incontinence is ‘sphincter incontinence', or weak bladder muscle control. It is very common for women to experience some temporary weakening of the bladder muscles following childbirth or gynaecological surgery. In many cases, this often disappears quite naturally once the woman is back on her feet taking gentle exercise.

Pelvic Floor exercises have proved to be invaluable in helping to restore strength and elasticity to the muscles controlling the bladder, hence the medical profession's insistence that all pregnant women should be encouraged to commence practising these immediately after childbirth.

 

URGE INCONTINENCE

Urge Incontinence is somewhat different from Stress Incontinence insofar as the former is characterised by the experience of sudden and often frequent urges to rush to the toilet to pass water. Although this largely tends to occur in later life, it can affect younger women whose muscles have been weakened by multiple pregnancies or surgery.

In older women the cause is often due to a combination of factors resulting from the reduction in oestrogen levels brought on by the menopause. As oestrogen levels drop a certain amount of shrinkage occurs in the vagina, uterus and cervix. This in turn may affect both the bladder and the urethra (the tiny pipe through which urine is transported from the bladder to outside the body). Reduced hormone levels may also create a certain laxity in the pelvic floor muscles through which the urethra passes. When this occurs, the external sphincter muscle becomes weaker and less efficient at controlling the flow of urine.

As Urge Incontinence is likely to become worse with age, exercises are vital, not only because they can prevent any further deterioration in muscle control, but also because they can and often do produce, if not a cure, then at the very least a significant improvement.

 

FREQUENCY AND NOCTURIA

In most cases Frequency and Nocturia are closely related. People who suffer from Frequency can rarely go for more than 2 ½ hours (e.g. amounting to seven or more times a day) without needing to urinate. Nocturia, as the name suggests, means urinating during the night, but does not include bedwetting. Getting up to go to the toilet once during the night is a fairly common occurrence in older people. True Nocturia rarely occurs on its own. When it happens in younger people, or becomes a regular nightly (or even several times nightly) experience, then it is fairly safe to say that the sufferer also probably suffers from Frequency during the day.

 

GIGGLE INCONTINENCE

Giggle Incontinence is the name given to a condition which generally occurs in response to extreme bouts of uncontrollable or hysterical hilarity. This type of incontinence is fairly common in otherwise healthy adolescent girls, and while it can be uncomfortable and embarrassing, an isolated incident or two should not necessarily be construed as a true incontinence problem.

 

AFTER-DRIBBLE

This condition is defined by a small amount of urine leakage several seconds after urination has taken place and usually when you have already replaced your clothes. After-Dribble, while embarrassing, invariably has no medical significance (especially when this is youronly symptom).

In men, the cause is likely to be due to a small quantity of urine pooling in the u-bend of the urethra. This can be easily dealt with by encouraging the passage of the remaining drops along the urethra into the penis. Simply apply a firm pressure to the perineum (which is situated a centimetre or two in front of the anus) and draw the fingers towards the scrotum.

The most likely cause in women is due to urine pooling in the vagina. Standing up while remaining over the toilet should be all the movement that is required to allow the trapped urine to escape. As an added precaution, a few sheets of toilet tissue will catch the last remaining drops.

 

UNSTABLE BLADDER

An unstable bladder is often associated with, and may sometimes be the cause of, such conditions as Stress and Urge Incontinence. The condition is characterised by leakages of small or large amounts of urine which occur for no apparent reason, at inconvenient time, and often in response to something as simple as the sound of running water, a cough or a sudden movement. The only sure way of knowing that you suffer from true Bladder Instability is by asking your doctor to refer you to the urology department of your local hospital for a diagnostic test, which will involve placing a pressure-measuring device in both the bladder and the vagina or rectum.

 

DRIBBLE INCONTINENCE

Dribble Incontinence can be a potentially more serious condition than those outlined above. This condition is characterised by a constant or intermittent leakage of urine which occurs without obvious stress or provocation. The cause may be due to severely damaged or weakened muscles or fistula (an abnormal hole) resulting from a previous injury. Alternatively, it may indicate that there is something amiss with the bladder's emptying mechanism. Either way, it would be wise to discuss your condition with your GP who will then arrange for any medical examinations that may be required.

 

Other conditions requiring medical consultation and possible treatment are:

HAEMATURIA - The presence of blood in your urine. While it often transpires that the underlying cause is less alarming than the sight, blood in the urine can sometimes be indicative of a more serious condition. This it is always wise to inform your doctor and, if necessary, allow him to test your urine.

TERMINAL DRIBBLE - This condition, which is characterised by prolonged dribbling after urination, or urine that leaves the urethra in a stop-start-stop-start motion as opposed to a steady stream with a definite finish, is more common in middle-aged men and is often due to an enlarged prostate gland.

HESITANCY AND SLOW STREAM - Difficulty in commencing urination, or an unduly slow and meagre stream once started, are often associated with an enlarged prostate gland. Men who experience either of these symptoms are advised to consult their GP.

 

There are many factors that can aggravate and/or contribute to bladder problems. Take, for example, something as seemingly unrelated as your weight. Even a marginal weight gain can create an unnecessary burden on the pelvic floor. If the pelvic floor is already weakened, any added pressure will not only exacerbate your existing problem, it will also cause the muscles to stretch even further. Other factors which can have a potentially adverse effect upon your bladder include anxiety, bladder infections, constipation, certain drugs, an overall unhealthy lifestyle and even something as relatively simple as body posture. Self-help measures for dealing with these contributory factors are listed below.

 

OVERWEIGHT

For a healthy person to be overweight by a few pounds is generally not harmful. For a person afflicted with bladder problems, however, shedding those few extra pounds could be crucial to the success or failure of your programme. If you are serious about improving your bladder control, then you must commit yourself to a weight-loss programme. Here are some tips to help you on your way to success.

SELF-HELP MEASURES

  • First, choose a diet that you know will be relatively easy to stick to. There's no point in starving yourself, or experimenting with faddy diets requiring you to limit yourself to only a few restrictive foods. You'll soon become so hungry, or so bored, that you won't be able to resist the urge to eat.

 

  • Set yourself a sensible target, and check your weight onlyonce a week.

 

  • If you fail to see a slow, but steady, reduction, start keeping a note of everything you eat. It's very easy to ‘forget' the odd biscuit or sweet. Recording everything you eat will highlight any slips and keep your mind focused on what you are trying to achieve.

 

  • Try changing your eating habits, e.g. instead of three large meals a day, break these up into six smaller portions. Little and often is a good rule to follow, as the action of eating switches on the metabolism.

 

  • Always sit down at the table to eat, no matter how little the portion. Taking time to savour your food, and chewing it properly will help you feel more satisfied.

 

  • Drinking a glass or two of water half an hour before a meal will help take the edge off your appetite.

 

  • Cutting out alcohol, fatty foods, pastries and ‘sweet' sugary foods will help reduce your intake of empty calories.

 

  • Never skip breakfast - it's the most important meal of the day. Try to include more grains and high-fibre foods in your diet.

 

  • Make sure that you never visit a supermarket when you are hungry. Shopping on a full stomach will help you avoid the temptation to buy unnecessary or fattening extras. Make a list of what you need before you leave the house, and don't buy anything that isn't on it.
  • Substituting fruit and low-calorie yoghurts for puddings will help reduce your calorie intake and your ‘sweet tooth'.

 

  • Make a point of exercising whenever you can - even a brisk ten-minute walk to the end of your road and back is better than nothing. Try leaving the car at home, or parking it a block or two away from your normal parking space.

 

  • Tell yourself that you're not dieting - you're merely eating more healthily. Don't tell anyone else that you're on a diet, either. Well-meaning that they might be, friends and family are notorious for sabotaging a dieter's efforts. If they ask why you're avoiding all your favourite foods - lie! In this it's perfectly permissible. Tell them you've ‘gone off' chocolate/alcohol/pastry/whatever. If they know you too well for that, say you think you have an allergy and your GP has suggested eliminating these from your diet for a few months. Few people will argue with that.

 

  • Finally, when you start to see results from your efforts, do avoid the temptation to give yourself a little edible reward. One biscuit, chocolate or whisky soon leads to three. Fall into this trap, and before you know it, you'll be back where you started. Non-edible treats, on the other hand, are not only permissible, they're advisable.

 

CONSTIPATION

Our increasing sedentary way of life has led to an increase in the numbers of people suffering from constipation. While a full bowel will exert some pressure on the bladder, most of the real damage to it is sustained during straining to evacuate. Straining not only places enormous pressure on the pelvic floor muscles but, because it stretches and weakens the muscles, it can also undo all the good work achieved by pelvic floor exercises.

SELF-HELP MEASURES

  • First and foremost, change your diet. Eat more fruit. Fruit is an excellent source of roughage and fibre. Apples and oranges are filled with vitamin C. Apart from being a good, necessary vitamin; ‘C' also has a mild laxative effect on the bowel.

 

  • Eat more high-fibre breads and cereals. Sprinkling bran on to your food will also help. Because it's full of indigestible fibre, bran cannot be absorbed by the body. Once in the intestines it adds bulk to the faeces, soaking up water and making them softer and easier to pass. As a natural laxative, bran is unsurpassed. Moreover, it helps reduce the incidence of glass stones and diverticular disease. Start by adding one teaspoonful of bran to soups, stews and gravies, or sprinkling it onto yogurt, fruit and cereal. If your motions are not softer and bulkier within a few days, gradually increase your intake of bran until you reach a stage where you do not have to strain to pass your motions. But be careful not to overdo it - too much bran in your diet can cause wind, abdominal bloating, pain and diarrhoea.

 

  • Avoid laxatives and purgatives unless absolutely necessary, and even then, you should only take them on advice of your doctor and for limited periods only.

 

  • Remember, it is not necessary to have the bowels opened every day, so do not strive for this unless it was normal for you to ‘go' every day before you became constipated.

 

  • Increase your fluid intake. Try to drink at least one litre of natural mineral or filtered water each day. If you are worried about the effect this might have on your bladder - reduce your intake of coffee, tea and other caffeine-rich drinks (such as cola) accordingly.

 

  • If blood occurs in your faeces, see your GP immediately.

 

  • Finally, do not strain. By all means, visit the toilet regularly, but set aside time when you can do so without rushing the process, as this will only increase your anxiety.

 

DRUGS AND MEDICINES

Certain drugs and prescription medicines are known to have an effect on the bladder, thereby reducing the strength and efficacy of the pelvic floor and sphincter muscles, while others can cause constipation. For example, certain drugs prescribed to help control high blood pressure conditions have been known to cause incontinence, while diuretics designed to combat fluid retention can aggravate the condition by creating an increased urge to pass water. On the other side of the fence, many of the drugs prescribed to control arthritic pain cause constipation. This is not to suggest, however, that anyone taking such medication should cease to do so without first consulting their GP to ascertain the risks involved. However, if you haven't already informed him or her of your bladder or bowel problems, you would be well advised to do so immediately, as they cannot recommend suitable alternatives unless and until they are in full possession of all the factors affecting your health.

 

DIABETES

Although fairly rare, Diabetes mellitus has been known to have an adverse effect on the vital nerve supply to the urethra and bladder. Diabetics also tend to suffer an increased tendency to contracting urinary infections. That aside, and provided that your GP is happy for you to do so, there is no reason why you shouldn't receive the same benefits from this programme as non-diabetics.

 

URINARY INFECTIONS

Cystitis and other inflammatory conditions involving the bladder and urethra can also affect bladder control. Symptoms of infection include an increased urge to pass water, which may or may not be accompanied by pain, or a stinging, burning sensation on passing urine. In some cases, the urine may be cloudy, blood-stained or have a strong ‘fishy' smell. If you suspect you have a urinary infection, see your GP immediately as they may need to take a urine sample and will probably want to start you on a course of antibiotics immediately.

Although more common in women (especially young women), cystitis can affect men, too. Trigger factors include the following:

Men - An infection of the prostate gland, or an infection spread by sexual contact.

Women - The cause may be due to allergy; an infection spread by sexual contact, or by bacteria from the yeast (or fungus) organism that causes thrush.

The symptoms of cystitis are the same as those described above e.g. a burning pain on passing urine and a desire to urinate more frequently, but very often this provides little or no relief at all as there is often an accompanying feeling of wanting to pass urine again immediately afterwards. In severe cases there may also be a raised temperature fever and possibly an appearance of blood in the urine.

SELF-HELP AND PREVENTATIVE MEASURES

  • Increase your fluid intake by drinking at least 3 litres of water a day. This will help flush out any organisms that might be causing your infection, and also keep your urine diluted.
  • If taking antibiotics, do ensure that you finish the course, even though your symptoms may have disappeared.
  • Avoid acidic drinks and foods, such as citrus fruits and fruit juices, or anything in vinegar.
  • Make sure you keep the genital area scrupulously clean. Those who prefer showering to bathing are advised to bathe at least once a week.
  • Eat live yogurt every day, if possible. Live yogurt is an excellent natural source of friendly bacteria. Antibiotics and urinary infections can upset the balance of bacteria in the digestive system and urinary tract. Taking live bacteria in the form of yogurt or supplements helps re-populate the system and replace any friendly bacteria that may have been killed off by antibiotics or through an over-growth of bacteria from the yeast organism.
  • Women should always be careful to wipe themselves from front to back in order to avoid transferring bacteria from the anus to the urethra and vagina.
  • Acute attacks of cystitis can be eased by mixing one cup of warm water with one teaspoon of bicarbonate soda and drinking this every three hours. Those who suffer from heart problems are advised to substitute barley water for the bicarbonate and soda mixture. Alternatively, steep three teaspoons of fresh parsley (or one teaspoon of dried parsley) in a cup of hot water, leave for several minutes to infuse and drink hourly. Curling up with a hot water bottle pressed to the abdomen for short periods of time may also provide some relief from cystitis pain.
  • At times of infection, it is advisable to use condoms to prevent the spread of infection between partners.
  • If practical, women taking the Pill should consider another form of contraception to prevent depleting the body of essential vitamins that safeguard against infection.
  • The use of deodorants, antiseptics, disinfectants and soap in the vaginal area is not recommended, as these can irritate sensitive skin.

 

POSTURE

Apart from making you look older and shorter, bad posture not only leads to back and stomach problems in later life, but also places additional strain on the pelvic floor and back muscles.

Try this test: Adopting your normal standing position, take a look at yourself in the mirror. Are your shoulders hunched? Does your chest droop? Does your tummy protrude more than you would like? Now, turning sideways, take a look at your silhouette, first, while standing naturally and again while standing erect and tall. See the difference? Without even losing so much as one pound, you not only look taller, trimmer and fitter, but I'm willing to bet that you actually feel better, too.

SELF-HELP MEASURES

  • Standing or sitting, try to cultivate the habit of holding your body in a nice, straight line, keeping your shoulders back, tummy tucked in and chest raised.

 

  • Use your stomach muscles to pull in your protruding belly.

 

  • Make a habit of checking your appearance in a mirror to note how you are standing and holding yourself, and, if necessary, correct your posture - this isn't vanity, it's a sign of self-pride.

 

  • Watch your weight, take pride in your appearance and tell yourself repeatedly that good posture is essential to good health.

 

  • Exercise your muscles. You don't have to go to a gym to do this, as you can practise isometric exercises anytime - whilst standing in a bus queue, driving the car or even doing housework. Isometric exercises are simple - all you need to do is to tighten your muscles, hold them taut for several seconds and then relax them again. Every time you find yourself slouching or standing incorrectly, do ten stomach tightening exercises. If you do this several times a day, you'll soon begin to notice a difference.

 

 

PERSONAL HYGIENE

Personal hygiene is always important. But it becomes even more so for people who suffer from incontinence problems as the fear of being thought ‘smelly' is always present. While it is perfectly normal to be concerned about personal hygiene and odour, it is important to keep a sense of perspective and to not allow your fears to grow to the point of irrational phobia.

Depending on the severity of your incontinence, the degree of leakage may result either in occasional dampness, or a constant wetness resulting in chafing and irritation of the genital area. Either way, the following self-help measures will help you to avoid the build-up of bacteria which cause odour, irritation and infection.

SELF-HELP MEASURES

  • Every time you empty your bladder, make sure you rinse the area with cool water and dry it thoroughly by patting rather than harsh rubbing.

 

  • Severe incontinence sufferers and those with severe skin irritation or fungus infections should, wherever practicable, use a hair dryer set to a comfortably cool setting.

 

  • Wear loose pure cotton-gusseted (or natural silk) underwear. Tight fitting underwear and man-made fibres are not advisable, as these tend to promote sweating, hold dampness and prevent the free circulation of air.

 

  • If you must wear tights, choose ones with a cotton gusset and switch to stockings in summer, or go without.

 

  • Avoid the use of elasticised garments such as corsets, roll-ons and stretchy ‘bodies'.

 

  • Change underwear and protective pads regularly.

 

  • If necessary, use a non-perfumed talc or dusting powder, but do be careful to avoid any scented products - baby powder is ideal.

 

  • Increasing your fluid intake will help keep your urine diluted. Not only does this help reduce the risk of ‘smell', it also helps prevent ‘burning' and ‘stinging'.

 

  • Ulcers, irritations and chafing can frequently be soothed and healed by the application of a 0.5% Bocacic acid cream.

 

  • See your GP immediately if you experience any of the following:

 

-Offensive, smelly urine,

-Pain, stinging or burning sensation on passing water,

-Vaginal discharge,

-Bloody discharge between periods, and/or

-Blood in the urine.

 

PART TWO - THE URINARY SYSTEM AND HOW IT WORKS

There is little point in exercising certain muscle groups if you don't know where theses muscles are, and what their function is. Understanding the urinary system and how it works, therefore, is a vital part of this programme. Apart from helping you to understand what each specific exercise is designed to do, you will also find that this knowledge will help you perform the exercises more effectively. The more adept you become at performing these exercises, and the more assiduously you apply yourself to performing them, the more quickly you are likely to see results.

 

THE URINARY SYSTEM

Urine is produced by the kidneys which act as the body's purification centre. The kidneys act as a filter, separating water, dissolved salts and other substances from the blood as it passes through their filter systems. Water and waste products are then eliminated from the body in the urine.

Healthy adults produce about three pints of urine a day, but this can vary a great deal depending upon the amount of fluid you ingest and the amount your body loses through evaporation. Fluid is evaporated from the body via the breath, skin, faeces, urine and, of course, through perspiration.

Once it leaves the kidneys, urine travels down into the bladder via two supple muscular tubes, called ureters. The ureters have a special valve at the end of them to prevent the urine from flowing back up into the kidneys. Urine is stored in the bladder at a low pressure (and without any effort from ourselves) until such a time as we are ready to expel it. A normal bladder holds between 400-500ml (20-25fl oz) of urine and empties, on average, between four and six times each day. The urethra is encircled by bands of muscle. These sphincter muscles exert pressure on the urethra to keep it closed.

When the sphincter muscles are weakened, through childbirth, surgery, lack of exercise, hormonal changes due to the menopause or illness, their ability to compress the urethra diminishes, thus, when the pressure inside the bladder rises to a point where it is greater than the pressure exerted by the sphincter muscles on the urethra, leakage tends to occur.

The pelvic floor muscles can be likened to a hollow hammock. Slung between the bony walls of the pelvis, they act rather like a girdle, encircling and supporting the entire contents of the abdomen, including the bladder, uterus and rectum.

The sphincter muscles control several functions:

  • When resting, they exert a constant pressure on the urethra, keeping it closed without any effort form ourselves.

 

  • Under mechanical stress - e.g. changing posture, coughing, sneezing, lifting, jumping, running or laughing - an automatic reflex action occurs which increases their ‘resting tone' and reinforces the urethra closure pressure to keep the bladder outlet closed.

 

  • On emptying our bladder, the sphincter muscles automatically relax to allow urine to pass through the urethra and out of the body.

 

  • Both the pelvic floor and sphincter muscles can be contracted at will to interrupt the urination process and prevent the passage of urine. In other words, the same reflex action that prevents us leaking urine when our bladder is full, but no toilet facilities are available can also be utilised deliberately and consciously to stop our urine in mid-flow when necessary.

 

 

Thanks to the pioneering work of several eminent physicians - not the least of whom was an American doctor named Arnold Kegel - millions of people who previously suffered from incontinence have now learned that it is possible to re-train both the pelvic floor and sphincter muscles with a simple yet remarkably effective set of exercise, thereby enabling them to regain full bladder control.

 

PART THREE - PELVIC FLOOR EXERCISES

EXERCISE ONE:

First, locate and identify the anal sphincter muscle. This is the muscle that we all use when we are trying to prevent ourselves from passing wind. You can do this by simply imagining that you feel a need to pass wind, and contracting the muscle around the anus that prevents you from doing so. Can you feel the muscle move? If you do this correctly, you should not feel any movement in your bottom or thighs; rather you should be aware of your anus lifting slightly off the seat of your chair, as if being drawn upwards into your stomach.

 

EXERCISE TWO:

Now, locate and identify the muscle that controls the flow of urine. You can do this quite easily, either by imaging that you are passing urine, or practicing it for real the next time you pass water. Once the flow of urine has begun, try squeezing the muscles around your bottom and vagina to see if you can stop the flow. If the muscles are weak, they will have little effect. If you are experiencing a slight lessening or cessation in the flow of urine, you will know that you have located the correct muscle.

If you cannot stop the flow at all, don't worry. These exercises are designed specifically to help you regain full control of your bladder muscles, and while it may take a little time for you to master them, I guarantee that, provided you do them regularly and correctly, you will soon see results.

WORD OF CAUTION:

Tempting as it may be to carry out frequent checks on your progress, attempting to stop your flow of urine should not be attempted more than once a day.

 

EXERCISE THREE:

Find a quiet moment when you will not be disturbed. Next, with a mirror to hand, remove your lower clothing and lie down on your bed with your legs bent and your knees held wide apart. Now, try to imagine that someone is prodding a sharp object, such as a stick or pin at your perennial area. (The perineum is located between the vagina and anus in women, and just a little forward from the anus in men). Without moving any other part of your body or holding your breath, and keeping your bottom firmly on the bed, concentrate on trying to pull your perineum up inside your body. Try it now. See the pin, and contract your pelvic floor muscles. Can you feel any movement?

If not, pick up the mirror, do it again and this time watch your reflection carefully. What you should see is a slight forward movement and wrinkling of the skin around the anus. Now do it again, only this time, place your finger on the perineum and feel how it moves when you contract your muscles.

 

EXERCISE FOUR:

Remaining in the same position, place one finger on your tailbone (the coccyx, or bony protrusion at the bottom of your spine just above the anus). With your other hand, place one finger on top of your pubic bone. Next, contracting your pelvic floor muscles hard, try to bring your two fingers nearer to each other. You should feel a slight movement of the coccyx up towards the pubic bone as you do this.

 

EXERCISE FIVE:

This is the most important exercise for women. Assuming the same position as you did for step four, lubricate the index and middle fingers of one hand and gently insert both fingers right inside the vagina. Spreading your fingers wide apart, position them so that one is placed at the front of the vagina, just beneath the pubic bone, with the other at the back, close to the coccyx. Now, contracting your pelvic floor muscles, try to squeeze your fingers together. If done properly, you should feel some movement towards the back of your vagina as the pubococcygeal and puborectal muscles contract. If you cannot feel anything at all, keep trying until you do. Weak though they may be, your muscles are there - all that's required is for you to learn how to use them again.

This exercise, which can also be done in the bath, is extremely important and, therefore, should never be skipped or omitted. As your muscle strength improves you will be able to carry out your own self checks on the progress you have made, and determine how much muscle strength you have regained.

 

EXERCISE SIX:

Next, with a tampon inserted into your vagina, tug gently on the string (as if trying to remove it) while at the same time contracting your pelvic floor muscles hard to keep it in place. If, despite your efforts, the tampon slips out quite easily, try dampening it first so that it swells slightly when inserted into the vagina.

Squeeze Technique One - Squeeze your muscles and try to hold the contraction for three seconds. Relax the muscles for one second, and then repeat this process six more times.

Squeeze Technique Two - Squeeze for one second, let go for one second and continue doing this for at least 20 ‘squeezes'. Repeat this exercise at least three times daily.

Squeeze Technique Three - This exercise is quite hard, but once you've mastered the two techniques described above, it should not take long before you can build up until you are accomplishing this with relative ease. Squeeze and hold the contraction for 10 seconds. Relax for 5 seconds and then repeat the exercise five times in quick succession.

 

You can do these exercises any time and in any place - while standing in a bus queue, at the stove while cooking, the sink while washing the dishes, or even while watching television. The important thing is to make sure that you practise each set at least ten times a day. If it helps, set yourself a series of prompts, e.g. specific times of the day or specific activities that will serve as reminders to practise your exercises. Draw up a list of numbers from 1-10 and alongside each number write one daily activity that can be easily combined with exercise. For example -

 

Set 1.     Set your alarm five or ten minutes earlier than normal rising time, and use this period to do your first set of each exercise.

Set 2.     Brushing your teeth, combing your hair or putting on your make-up.

Set 3.     Whilst taking a bath or shower, or eating breakfast.

Set 4.     Standing at the bus stop, or whilst driving to work.

Set 5.     Whilst cleaning the house, or taking a tea break.

Set 6.     During or after your lunch break.

Set 7.     Whilst having a mid-afternoon snack.

Set 8.     Preparing dinner, or watching T.V.

Set 9.     Brushing your teeth or bathing before bedtime.

Set 10.  Before going to sleep.

 

As you improve, you can add to your ten sets by making a vow to do another set every time you're caught at a set of traffic lights, say. However you choose to do your exercises is entirely up to you - just as long as you do them every single day. 

 

RE-TRAINING YOUR BLADDER

There is nothing complicated about this part of the programme. Re-training your bladder involves mastering a simple set of techniques that will allow you gradually to increase your bladder's capacity to hold more urine, whilst also increasing the interval between your visits to the toilet. Ideally, you should be aiming to decrease your visits to the toilet to between four and six times per day.

Bladder re-training is most effective for Frequency, Urgency, Unstable Bladder and related problems. It is not advisable to attempt to practise any of the following exercises in either of the following circumstances:

  • In cases where incontinence is caused by some underlying medical condition such as prostatitis, prolapse of the womb or an obstruction of the urethra.
  • When suffering from infections such as cystitis.

If you do not already have a fairly good idea of your own bladder emptying pattern, spend a few days observing this. Note how many times you visit the toilet each day, and what the circumstances are. Record the interval time between visits to the toilet, and note how much or how little urine is passed each time, e.g. judging by the amount of volume passed, was your bladder full, half-full or almost empty?

There are two basic methods of increasing the time between visits to the toilet.

Method One requires you to wait until you feel the urge to go, and then try to delay your visit by a set number of minutes. This method is designed to allow you gradually to increase the period between ‘feeling the urge to go' and actually ‘going'. With practice, it is possible to overcome the urge so completely that the feeling of needing to empty your bladder disappears altogether.

If you feel this method would be more suitable for you, start by setting yourself a two-minute delay time. When you feel the urge to pass water, contract your muscles and relax them slightly (but not fully) several times in quick succession. When the urge has abated (but not before your two minutes are up) make your way to the toilet without hurrying. If you can, try to continue squeezing as you walk. Once there, use your muscles to release the urine in a steady, controlled flow.

When this method has proven consistently successful for a minimum of two days, increase your delay time by a further one or two minutes. After a few more days, and provided that you are still successfully managing to hold back on emptying your bladder, increase your delay time to five minutes, adding a further five minutes every day thereafter until, eventually, you've managed to delay your visits by half an hour.

Record your results in a diary and, if at all practicable, measure the amount of urine passed at each visit. Within a short time you should be recording fewer daily visits with each visit producing a greater volume of urine.

Method Two involves setting yourself a fixed time between visits to the toilet, and overcoming all urges that arise in-between. For example, if your normal interval between visits is one hour, decide that you will only allow yourself to ‘go' every one and a half or two hours. When you have successfully achieved your set target everyday for a week, increase your interval time by a further half hour.

It helps to remember that on most occasions when your bladder tells you it is full, it is lying. This can be easily proved by keeping a daily record for a few days recording both your interval time and the volume of urine passed. The highest volume figure will provide you with a clue as to how much urine your bladder can hold before it will start to signal that it needs to be emptied. Of course, this figure may not be accurate, as your bladder could probably hold far more than this amount, but at the very least it provides you with a minimum bladder capacity figure to work from.

Once you know - at the very least - how much your bladder can hold, all you have to do is trick it into proving to you that it can hold even more. Every time you feel the urge to pass water, practise the following techniques until the urge passes. Initially, you may find that one technique is not sufficient. In time, however, you will soon become adept at dismissing the urge altogether and only going to the loo at your appointed time.

  • The moment you feel the urge to urinate, try sitting down and keeping very still for several seconds. Take a few deep breathes to help you relax, and try to use your mind to will the ‘urge' away. Don't think about ‘going', and don't start worrying that you might not be able to wait. Instead, try distracting your attention from the problem altogether by using one of the following techniques.

 

  • Concentrate on your breathing. Visualise the air being sucked deep into your lungs; imagine it circulating through your body; expanding your chest and abdomen, travelling down your arms and legs, and then slowly leaving your body.

 

  • Recite poetry to yourself. If you don't know any poetry, recite nursery rhymes instead.

 

 

  • Do mental arithmetic; work out how much money you've spent this week, mentally listing all the things you've bought.
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