A Woman’s Guide to Urinary Incontinence

As part of a series I’m writing on female urogenital problems, today I’m going to talk about the importance of pelvic floor rehabilitation exercises, i.e. kegeling.

The first time I wet my pants was right after my son was born. Ten pounds of bouncing baby boy passing through my tiny lady parts left me joyful, ecstatic, and incontinent of urine. (You can find Wolfie’s birth story here.)

Fortunately, I was young and healthy and I healed.

Mostly.

Let me reassure you: There isn’t anything groovy about peeing on yourself.

No pair of jeans looks goodover a butt wearing a big old bulky pair of Depends® underneath.

But far worse than the fashion implications, urinary incontinence is emotionally distressing.  It is very inconvenient when your life revolves around having to pee, when you’ll have to pee next, where you’ll be able to find to pee, and how to keep from peeing on yourself in between all that other peeing and looking for places 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. 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

There are several types of incontinence, but the two primary types of incontinence that we’re 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. It can be treated. 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.

My Story

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,

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EXCEPT THE BATHROOMS

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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, 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 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 as much water as a person should in 80 degree weather. 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 Depends?), 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:

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Not all kegels are equal.

Nearly a third of women kegel with the wrong muscles.

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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 correct exercise  is the key to getting the best overall effects.

So do not skip this step no matter how shy, modest or squeamish you think you are. Peeing on yourself won’t help you maintain your modesty anyway.

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 your vagina like a Chinese finger puzzle.

Now that you’ve found your perineal muscle, how should you strengthen it?

After doing  a lot of research, I’ve discovered that the best self-exercise for strengthening the perineal muscle is called The Elevator.

In this exercise, you imagine your vaginal muscles 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.

The Elevator

1. Start the exercise either in either a sitting or lying down position.

2. 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.)

3.  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.

4. 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.

Kegel Time

To make this a habit, I put kegeling triggers in my day. One of my favorites was during a recent trip I made with some girlfriends. Anytime the topic of sex came up we’d declare “KEGEL TIME!” And all of us would do 10 (well, I did mine and they said they did theirs.) You can use traffic lights, commercials, brushing and flossing your teeth, washing dishes, 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 modern procedures done today. But how effective is it?

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. Choosing surgery is a serious decision with potential serious lifelong consequences. 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.

Realize this: Surgery can repair damaged tissues, but 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.  Conditioning your vagina prior to surgery and continuing physical therapy after surgery will likely give you the best results. Also, and I cannot say this loudly 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 repair surgery. Look for a surgeon with a Fellowship in Female Pelvic Medicine and Reconstructive Surgery or Urogynecology and Pelvic Surgery.

What About You?

I have not had any episodes of urinary incontinence in 2.5 years, but I found out two days ago that I likely do need female surgery for this intermittent bleeding problem I have. Look for a post about this in the upcoming days. What about you? Do you struggle with this problem? What steps, if any, have you taken to treat this?

The next installment in my journey is here.