Putting a stop to incontinence

Putting a stop to incontinence

Do you leak when you laugh? Its time to raise awareness for the 5 million+ Australians who experience bladder or bowel incontinence. Yes, it really is THAT common! This can be a very debilitating condition, but unfortunately, a lot of people suffer in silence through fear of speaking out, due to the embarrassing nature of the problem.

What you may not realise is that the majority of incontinence cases can be treated, and a lot of the time, stopped completely. So, to try and help break the silence surrounding incontinence, we are going to give you a little run down on what it is, who it affects, and some tips on what you can do to help.

WHAT IS INCONTINENCE?

Incontinence is the term used to describe the uncontrollable loss of urine from the bladder or faeces from the bowel. It ranges in severity from losing only a very small amount of urine, to a complete void of the bladder or bowel. If you’ve never experienced this, you can only imagine how distressing this must be. There are different types of urinary incontinence, including:

  • STRESS INCONTINENCE, where small amounts of urine leak due to small increases in pressure on the bladder during physical activity, or from coughing, sneezing or laughing.
  • URGE INCONTINENCE, where you get an unexpected, strong urge to urinate with little to no warning. This is usually as a result of an overactive bladder muscle.
  • INCONTINENCE ASSOCIATED WITH CHRONIC RETENTION, where your bladder cannot empty fully, and you get regular leakage of small amounts of urine. There are many causes for this, including an enlarged prostate in men, or prolapsed pelvic organs in women, as well as medications and certain conditions, such as diabetes and kidney disease.
  • FUNCTIONAL INCONTINENCE, where you are unable to get to the toilet, possibly due to immobility, or wearing clothes that are not easy to get off in time.

Faecal incontinence is when you have a lack of control of bowel movements and you may accidentally pass a bowel movement, or even pass wind without meaning to. This may be due to weak muscles surrounding the back passage (Unfortunately ladies, this is common following pregnancy and childbirth), or if you have severe diarrhoea.

TAKING THE STRESS OUT OF INCONTINENCE

For all those suffering in silence, it is time to speak out.  There is no need to be embarrassed, it is surprisingly common – and like we have already mentioned, help is out there! You may not need to look very far. Being your local Osteopath, we may be able to help.

The most common type of incontinence that we see and treat is stress incontinence. Although seen across both sexes, women are three times more likely to experience it than men. It is very common in women following pregnancy and childbirth (when the pelvic floor muscles get over-stretched, and sometimes even damaged), during menopause (due to hormonal changes) and in the elderly. It commonly affects men who have had prostate surgery.

The pelvic floor muscles sit at the bottom of the pelvic bowl, spanning from the pubic bone to the tailbone (front to back) and from one sitting bone to the other (side to side). Imagine a tarpaulin stretched out with a person holding each corner and you kind of get the gist. When these muscles are strong, they help to support our internal pelvic organs (i.e. the bladder, bowel and the uterus in women) and wrap around the openings of the front and back passages, allowing us to control when we decide to do a number one or two. Following pregnancy for example, they may become weak and dysfunctional, and we can lose that ability to control voiding. It only takes something as small as a cough, or an activity like jumping or running (things many of us take for granted) that may cause a person to lose a small amount of urine.

WHAT WE CAN DO TO HELP

The most important thing to point out is that not all types of incontinence will improve or resolve with just strengthening of weak pelvic floor muscles. So, it is very important to get an accurate diagnosis, because there will likely be other factors that need addressing too. For instance, losing weight, stopping smoking, and making other lifestyle changes are just as important in the management of these conditions, if relevant to the person of course. Some people may also require release of tight and over-active muscles.

Once you have your diagnosis, then strengthening may well be a part of your therapy. In order to strengthen, you need to know where the muscles are, and how to activate them. Below is a little step by step guide to getting a grip on those pelvic floor muscles (we don’t mean literally!):

  1. Get in a comfortable position – try sitting or lying on your back and take a few breaths to relax.
  2. Imagine you are trying to stop yourself from urinating mid-stream by squeezing for about a second. If this is not easy to feel, next time you are on the toilet emptying your bladder, have a go at stopping mid-stream and then relaxing again to finish emptying (don’t hold it for too long please – just enough to feel which muscles you need to use).
  3. Do the same as step two for the back passage – this time imagine you are trying to stop yourself from passing wind by squeezing.
  4. Do these quick squeezes 3 x 20 reps a day. Once you’re comfortable, you can do it sitting or standing. Make it routine… Do it when you’re brushing your teeth, eating lunch, or in the ad breaks of your favourite TV show.

These two contractions together form the basis of what you need to be able to do to begin your pelvic floor muscle training. If you struggle to feel this, then ask for help from your therapist. They will be able to help you perfect the activation of the correct muscles.

We hope you have found this blog interesting and helpful. If you, or someone you know is looking for answers to questions and advice on the management of these conditions, then please get in touch. We are ready to offer advice and/or treatment. 

References

  1. Continence Foundation of Australia. 2019. World Continence Week. [Online]. [Accessed 07 May 2019]. Available from: https://www.continence.org.au/events_calendar.php/482/world-continence-week
  2. Continence Foundation of Australia. 2019. Laugh Without Leaking. [Online]. [Accessed 07 May 2019]. Available from: http://www.laughwithoutleaking.com.au
  3. Continence Foundation of Australia. 2019. Key Statistics. [Online]. [Accessed 08 May 2019]. Available from: https://www.continence.org.au/pages/key-statistics.html
  4. Milsom, I. and Gyhagen, M. 2018. The Prevalence of Urinary Incontinence. Climacteric. 22(3). 217-222. DOI: 10.1080/13697137.2018.1543263
  5. Continence Foundation of Australia. 2019. Pelvic Floor Muscles in Women. [Online]. [Accessed 08 May 2019]. Available from: https://www.continence.org.au/pages/pelvic-floor-women.html

Attention new Mum!

Attention new Mum!

Being a parent can be very challenging at the best of times. And especially if you’re a new mum. It doesn’t matter whether it’s your first, second, or fifth child, being a new mum comes with a whole host of daily challenges. Your new little human requires all your attention – feeding constantly, changing eight nappies a day, bathing… Throw in another child, other family members, work, groceries (and the list continues) into the equation and it’s easy to see how life can be taxing on you and your body.

The good news is, we’ve devised a little self-help guide for new mums! Below we give you tips on how to be kind to your body and not put yourself at risk of injury, so you can give your little munchkin the attention they need.

FEEDING

As a new mum, you’re going to be doing a lot of this. Your new recruit requires constant nourishment to ensure they grow strong and stay healthy. And it doesn’t matter whether you breast or bottle feed, it’s likely you are going to be seated for long periods, looking down at your baby. This all leads to extra strain through your neck, back and shoulders. So, try some of these little gems of advice to help keep this process pain free:

  1. Get a comfortable, supportive chair – pick a chair that is going to feel good to sit in, but one you can easily get up and down from. If it’s too low, allowing you to slouch right back into, you’ll struggle to move yourself and your baby around without compromising your back.
  2. Keep your neck moving – feeding is a great time to bond with your baby. Eye contact is important but try not to spend the whole time looking down at a funny angle. Once your baby is comfortable feeding, it’s OK to break that eye contact every now and then to move your neck. Doing some light stretches will ensure you don’t end up with sore, overworked muscles.
  3. Consider a feeding pillow – these are great for taking the weight of your baby, so your shoulders and arms don’t have to. And they still allow you to have that important close contact.
  4. If you have a partner who can help feed, allow them to help regularly to give you a break. This tip is more for the bottle feeders of course, but it can make a huge difference.

CHANGING

It’s going to be nappies galore! This can mean a lot of bending over, so it’s important as a new mum that you look after your posture so your lower back doesn’t take all the strain. Try to avoid changing your baby on the floor in these early days. Ideally, get yourself a changing table. It means you can place your baby down on the table and change them at a height where you don’t have to bend forward and hold an awkward position. And of course, the same advice can be followed when changing your baby’s clothes. Look after that back, you’re going to need it!

OTHER USEFUL TIPS

The following tips are by no means any less important, so try to take these on where possible:

  1. Sleep when your baby sleeps: Getting those extra hours in when your baby is taking a nap is important to conserve your energy and reduce the risk of fatigue.
  2. Eat and drink well: It’s easy for the focus to turn to your baby, and rightly so, they are little and dependent on you. Remember though, you can’t look after your baby if you aren’t well. Eat for the health of you and your baby – lots of water and good nutritious food such as fruit and vegetables!
  3. Stretch: Especially your shoulders, neck and chest. Once baby comes along, our arms are always in front of us. Whether it’s holding, feeding, changing or playing, we’re usually a little slumped in our shoulders. Build stretching into your routine (like every time after baby feeds for example). We want to reverse the ‘slump’ position, so take your arms out wide, open up your chest and hold for 30 seconds (and repeat). Aim to do this three times a day (or whenever you get the chance!). Gentle shoulder shrugs and neck stretches can also help.
  4. Take time to relax: When the opportunity arises, get your partner, grandparent or friend to look after your newborn while you take a bath, read a book, or close your eyes for a little while. You deserve it, and it helps keep you sane and grounded during a very busy period in your life.

We hope you’ve found our list of tips interesting and helpful. If you are ever unsure, have a niggle or need some further advice on breastfeeding, please do not hesitate to call us to discuss your needs and book to an appointment with Dr. Reena Murray who is a Lactation Consultant (IBCLC) and Advanced Paediatric Osteopath with a special interest in helping new mum’s and babies navigate the early parenting period.

References:

  1. Everymum – https://www.everymum.ie/baby/expert-advice-5-practical-posture-tips-for-new-moms/
  2. Womens Health Australia – https://www.womenshealth.com.au/prenatal-postnatal-posture

Rectus Diastasis (Abdominal Separation)

Rectus diastasis physiotherapy
What is it?

Ask any woman who’s been pregnant and she’ll tell you that the bigger the baby grows the harder even the simplest tasks become (try putting your socks on with a basketball strapped to the front of you sometime!). With foetal growth and uterine expansion there is a widening and thinning of the gap between the two sections of the rectus abdominis muscle (AKA the 6-pack muscles). This gap is called rectus diastasis. The muscles have not “torn”, simply separated. The split occurs in the mid-line collagen structures of connective tissue at the front of the abdomen.

An easy way to check if you rectus diastasis in if you have a ‘pooching’ or ‘doming’ of your stomach, especially when coming up from a lying position on your back. Women often describe looking several months pregnant, many months after the birth of their child.

Whilst rectus diastasis most commonly occurs during pregnancy, women are not the only ones to suffer it. Newborn babies can also have a diastasis. Men can also experience a diastasis as a result of yo-yo dieting, an incorrect technique of doing sit-ups or weightlifting. This is most commonly linked to poor internal abdominal pressure control and biomechanics. It means you can be fit, and still have a diastasis.

Is it common?

Yes! 2 out of 3 women will experience some degree of rectus diastasis in the first two trimesters of pregnancy and 100% of women have a diastasis during their 3rd trimester. A staggering 66% of women with a diastasis will also have some level of pelvic floor dysfunction and 75% of women will suffer from a pelvic organ prolapse. Although common, this is not normal and can be improved with correct exercise.

Signs to look out for:

• Looking pregnant even though back to pre-pregnancy weight

• Pooching or doming of your stomach

• Weak core and pelvic floor

• Lack of strength and stability in the entire pelvic region and midsection

Why is this so important to fix?

Healing the connective tissue and reducing your diastasis is important as these muscles are what protects our internal organs and back. Other areas where you can be at increased risk of if not fixed include:

• Lower back pain

• Constipation

Incontinence

• Breathing difficulties

• Hernias

• Pelvic organ prolapse

What should I avoid and what should I do to heal or prevent rectus diastasis?

Exercises to avoid include those that place a huge load on your back and excessive forces through your pelvic floor like:

  • running,
  • jumping,
  • sit-ups,
  • deep lunges and
  • some pilates movements.
  • Holding your breath when lifting heavy objects (including your toddler) should be avoided also.

The majority of cases can be greatly improved as well as prevented through specific core and breathing exercises, correct lifting technique and posture, as well as wearing a splint.

Walking, swimming and stationary cycling are all safe forms of cardiovascular exercise you can partake in with rectus diastasis.

For an assessment of your diastasis and a comprehensive exercise rehabilitation program call 02 4655 5588 or book an appointment now to see one of our Osteopaths.