The first time I wet my pants was right after my son was born. Those ten pounds of bouncing baby boy passing through my tiny lady parts left me joyful, exhausted, and occasionally incontinent of urine. (You can find my son’s birth story here.)
Fortunately, I was young and healthy, and I healed.
As I traveled through my 30s and early 40s my urinary incontinence wasn’t too bad. As long as I didn’t let my bladder get overfull, laugh too hard, or sneeze too suddenly, over ever, ever ever jump up and down or run, I was mostly okay. But as I neared 50 I noticed I was losing it, literally, more and more often. I began wondering if adult diapers were going to become a necessary accessory.
Urinary Incontinence is NOT Sexy
I don’t care what their ads say, no pair of jeans looks good over a big, bulky pair of Depends®.
Fashion considerations aside, urinary incontinence is emotionally distressing. Who wants to be felt-up by their lover while wearing adult diapers? Not this girl. Not to mention that it is very inconvenient when your life revolves around peeing. Every outing spent constantly worrying about when you’ll have to pee next, where you’ll be able to pee, and how to keep from peeing on yourself in between finding the next place to pee.
If you are a woman who suffers from any or all of the above, take heart.
YOU ARE NOT ALONE
Tons of us ladies have urinary incontinence problems. So much so, that the care and treatment of female urinary incontinence is a billion dollar industry in the US. Here’s a good article that your tax dollars have paid for: Urinary Incontinence Fact Sheet
What You Need to Know About Female Urinary Incontinence
There are several types of incontinence, but the two primary types of incontinence that I’m talking about today are:
1. Stress incontinence — leakage happens with coughing, sneezing, exercising, laughing, lifting heavy things, and other movements that put pressure on the bladder. It is the most common type of incontinence.
2. Urge incontinence — this is sometimes called “overactive bladder.” Leakage usually happens after a strong, sudden urge to urinate. The sudden urge may occur when you don’t expect it, such as during sleep, after drinking water, or when you hear or touch running water.
If you are really unlucky, you get some combination of both called,
3. Mixed incontinence — two or more types of incontinence together, most often stress and urge incontinence.
When I first addressed urinary incontinence on my blog in 2009, I was suffering from stress incontinence, but I could feel the cold clammy hand of urge incontinence pressing down on my bladder. This really was bothering me and I’d already seen two doctors to discuss the possibility of surgery. Fortunately, our trip to Rome intervened. Rome is a magnificent city. The Italians really know how to live. Everything is better there; the food, the view, the architecture, everything. Everything that is,
EXCEPT THE BATHROOMS
Rome doesn’t have free public restrooms like the US (it costs a Euro or two to use a public bathroom), and modern bathrooms are an afterthought–so what restrooms they do have are not easily located.
Also, there is apparently a serious shortage of toilet seats in Rome, but that’s a separate problem. First you have to find the bathroom before you can decide if you can afford the luxury of turning your nose up at it.
Our daily walking tours in Rome became centered around me finding a bathroom. Once I would locate a relatively clean one, I would try to keep myself oriented towards the location of that bathroom like a female urinary incontinence compass needle always pointing towards a toilet.
This didn’t always work very well considering we were walking 5-10 miles a day and kept getting lost.
I did two things to cope, one good and one bad.
The bad thing: I didn’t drink much water. I felt dehydrated much of the time, and I was very fortunate that I didn’t pay the ultimate price by getting a urinary tract infection abroad.
But the good thing? I kegeled.
And I kegeled.
Due to necessity and vanity (who wants to walk around Europe peeing their pants or wearing incontinence pads?), I was forced into day-long kegeling marathons while we were traipsing around Rome. And guess what? I started to see an improvement. After a week of walking 5+ miles every day, all while kegeling my little vagina out, I wasn’t having any leaking at all, and I was able to hold it a lot longer.
But before you kegel you need to know:
Not all kegels are equal.
Nearly a third of women kegel with the wrong muscles.
Done incorrectly, you can actually make your incontinence worse. We don’t want that! Isolating the correct muscle, called the perineal muscle, and then doing the exercise correctly is the key to getting the best results.
Learning to Kegel
The best way to find the muscle is to put your finger in your vagina and squeeze your finger. Try to keep all your other muscles relaxed. Do not bear down, and do not squeeze your thighs. Focus on squeezing your finger with just your vagina like a Chinese finger puzzle.
Now that you’ve found your perineal muscle, how should you strengthen it?
Once you’ve isolated the correct muscle, the best self-exercise for strengthening it is called The Elevator.
In this exercise, you imagine your vaginal vault like an elevator. When the vagina is totally relaxed it is at ” The Ground Floor”, and squeezed as tight as you can is “The Penthouse”. When I started doing this exercise, the movement for me was more like a spasmodic fluttering than a controlled, sustained, upward movement, but with practice, this muscle, like any other, will get stronger and stronger and eventually I was able to contract it with intention and control, and hold it at the top for sustained periods of time.
The Elevator Kegel
Start the exercise either in either a sitting or lying down position.
With the muscle completely relaxed, start squeezing slowly for a count of 5-10 as you raise the elevator to The Penthouse. (There are rapid-fire muscle cells in the vagina, but we’re trying to improve the over-all tone which means we’re going to focus on slow, sustained movements here.)
Once you’ve reached the Penthouse: Do not just let go at this point! Hold it there for the count of 5-10. This will take time and practice.
Then try to slowly bring the elevator back down to ground floor over another 5-10 counts.
The Elevator takes time and practice to do well, but the slower you do the exercise and the more control you exert, the stronger the muscle will get. I try do 3 sets of 10 two or three times a day. As I said, I had to work up to this over several weeks before I could do it well with control.
To make kegeling a habit, I put kegeling triggers in my day. You can use traffic lights, commercials, brushing and flossing your teeth, washing dishes, opening the refrigerator, anything. Just find something you do regularly every day and kegel during that time.
What about Surgery?
Vaginal repair surgery is one of the most common medical procedures done today. But how effective is it?
Choosing surgery is a serious decision with potential serious lifelong consequences. Several studies show mixed results with many women reporting excellent results and other women finding that not only is their incontinence not cured, but they have additional sexual function problems. And many women find they need to have the surgery repeated 10 years or so all over again as the organs continue to prolapse due to gravity.
And realize this: Surgery can repair damaged tissues, but surgery will NOT restore weak and lax muscle tone. Therefore, if you are considering any vaginal repair surgeries I strongly suggest that you seek out a Physical Therapist who specializes in Pelvic Floor Rehabilitation.
Physical Therapy? Really?
Yes, there really is such a thing as pelvic floor physical therapy. I did it for a year before I ultimately decided to have surgery. I am so glad I did. Your doctor should be able to give you a referral to a physical therapist trained in the treatment of pelvic floor dysfunction (PFD).
Choosing a Surgeon for your Vaginal Vault Repair
I cannot say this often enough:
DO NOT HAVE JUST ANYONE PERFORM VAGINAL REPAIR SURGERY ON YOU!!!
The lovely guy or gal who delivered your baby is NOT the person you want performing your vaginal/bladder repair surgery. The specialist you need to perform your vaginal vault repair or bladder surgery is called a Urogynecologist. A Urogynecologist is an OB/GYN with an additional three year Fellowship in Female Pelvic Medicine and Reconstructive Surgery. These surgeons are the experts. Your vagina and you deserve less than the best.
If you have any private questions you’d like to ask me about this important issue for yourself or a loved one, feel free to email me at chloe@chloejeffreys dot com.