Tuesday, June 15, 2010

Do you leak? 5 exercises to build your pelvic floor muscles

I went to the doctor yesterday and he asked me if I leaked when I coughed.  Well maybe on occasion when I sneezed really hard, but since I lost 17lbs from last year my 'leaking' has been less frequent. Have you ever laughed or sneezed so hard that you peed? It may be a sign of incontinence.

Not being able to manage your bladder issues is embarrassing and uncomfortable... not to mention relatively common. Incontinence affects 10%-30% of women 64 and younger, says the National Women’s Health Resource Center.

Even if your bladder is behaving now, it may betray you later. About 25% of women will experience involuntary urinary leakage at some point in their lives.

Luckily, those little leaks when you cough, sneeze, laugh or exercise – called stress urinary incontinence (SUI) – are problems you can manage.

It’s an Anatomy Thing
Urine leaks occur when bladder pressure exceeds what the urethral sphincter can hold back, says Colleen Kennedy, M.D., assistant professor of obstetrics/gynecology at the University of Iowa.

Declining estrogen levels during menopause increase your SUI risk because the urethral tissue becomes thinner and less elastic, leading to reduced sphincter control, she says.

Women who have had multiple vaginal deliveries or difficult labors are particularly prone to leakage because pressure on the internal organs can permanently weaken the urethral sphincter.

Gail Stein can relate. After a breach delivery with her first-born, the stress incontinence – and frequent urge to go that started in her teens - worsened.

“I would be in the bathroom 20-30 times a night,” says Stein, co-author of Mind Over Bladder… I Never Met a Bathroom I Didn’t Like (IUniverse). “My pants were down more than they were up.”

A public school teacher, Stein learned to “pee at the bell,” avoid fluids after 7 p.m. and always scope out the nearest bathroom.

"As women lose control over their body, daily activities and even sex life, depression can set in,” says Jill Maura Rabin, M.D., co-author of Mind Over Bladder and head of urogynecology at Long Island Jewish Medical Center. “Getting a diagnosis and treatment is so key.”

Managing AccidentsAnything that puts pressure on the pelvic organs can open the floodgates. Here’s how to minimize accidents:

1. Monitor your fluids.Too much water overloads the kidneys, making you have to pee all the time, Rabin says. Take your ideal body weight and cut it in half. This number represents the total ounces of fluids you should drink throughout a day.

2. Take a leak – beforehand.If you’re leaking during exercise or sex, empty your bladder before you begin either activity. You may even want to insert a tampon to support the urethra before strenuous exercise.

3. Plan bathroom breaks.“Timed voiding” can help women who have a constant urge to pee, Rabin says. If you normally hit the restroom every 15 minutes, aim instead for 20-minute intervals.

Stretch the time by five minutes each week. In 6-8 months, you’ll be able to wait 2-3 hours between bathroom breaks.

4. Lose weight.A study in The New England Journal of Medicine found that women who lost just 3 pounds reduced accidents by 28%; those who lost 17 pounds cut accidents by half.

5. Avoid constipation.Eat a fresh pear and spinach with extra virgin olive oil each day to keep things moving, says Janet A. Hulme, a physical therapist at Phoenix Core Solutions and author of Beyond Kegels: Fabulous Four Exercises & More to Prevent & Treat Incontinence (Phoenix Publishing).

6. Keep a food diary.Recording what you eat will show you patterns that trigger an urge to pee. Rabin recommends limiting these bladder-irritating foods:

  • Artificial sweeteners
  • Apples, citrus fruits, peaches, cantaloupe, grapes, guavas, pineapples, plums and strawberries
  • Alcohol
  • Caffeine
  • Carbonated beverages
  • Corn syrup
  • Honey
  • Milk and milk products
  • Spicy foods
  • Sugar
  • Tomatoes and tomato-based products
  • Vinegar
  • Vitamin B complex and vitamin C

7. Wear pads.These aren't a solution, but they can help manage leaks while you’re working with a doctor for diagnosis and treatment.

Skip menstrual pads and go for those made for incontinence, which are designed to absorb urine and prevent skin irritation, Kennedy says. With options ranging from light protection pads to heavy absorption disposable underwear, wear what's comfortable and meets your needs.

Kegels to the RescueOften used as a way to boost sexual satisfaction, Kegels can also help manage incontinence.

Judy Florendo, a Chicago physical therapist specializing in pelvic floor dysfunction, helps women properly isolate the muscles.

“A woman has to prepare and go slowly; otherwise she can do damage,” she says.

Try these at-home tips to find the right muscles:

1. Insert a finger into the vagina and squeeze around it. You should feel tightness and a lift around finger. The buttocks, abdomen and thighs should all be relaxed. You shouldn’t be able to tell you’re doing a thing from the outside.

Or try it with a tampon. Insert, pull the string taut and do the same squeezing motion.

2. You also can locate the right muscles by stopping the flow of urine. Don’t do this repeatedly because it can damage the urethra and break down complex communication between the bladder and brain during urination.

Florendo recommends 2 strengthening exercises:

  • If cough- or sneeze-induced leaks are a problem: Squeeze and release in one-second intervals, gradually working your way up to three sets of 10.
  • If you feel fine in the morning, but can’t hold your urine as well later in the day: Squeeze for 10 seconds and release for 10 seconds, gradually building to three sets of 10. 
Beyond KegelsHulme’s simple “Roll for Control” exercise rebalances the pelvic rotator cuff to manage leakage:

1. Lie on your back on a high-density foam wedge that raises your hips 6-8 inches above your shoulders. Place feet up against a wall with legs straight. (Wedges are available online or ask an upholstery store to cut one to size.)

2. Take 4 or 5 breaths (using your diaphram), allowing your stomach to soften and move in and out.

3. Pivoting on your heels, roll knees and toes out hip-width while inhaling.

4. Pivoting on your heels, rolls knees and toes back to neutral while exhaling.

Long-Term OptionsIf you’re still having accidents, other treatments are available.

Surgery is one option that yields great results, Kennedy says. The procedures restore support to the urethra.

If surgery's not an option, other treatments include:

  • Herbal remedies: Corn silk, saw palmetto, pumpkin seed and magnesium supplements have shown promise in reducing bladder leakage.
  • Duloxetine (brand name: Cymbalta): Several studies have found that this antidepressant can help manage incontinence.
  • Vaginal pessaries: A pessary is a device designed to be inserted into the vagina to support it. Women need to be properly fitted for one.
  • Collagen injections near the urethra: The injections help narrow the urethra and improve bladder issues. Results typically last 2-4 months.

  • If the condition persists, then prescription medication may be needed, says Lifescript Chief Medical Officer Edward Geehr, M.D.

    The most common medications prescribed are anticholinergic agents, such as Detrol and Ditropan, which block the chemical messenger that triggers bladder spasms.

    The information contained on www.lifescript.com (the "Site") is provided for informational purposes only and is not meant to substitute for advice from your doctor or healthcare professional. This information should not be used for diagnosing or treating a health problem or disease, or prescribing any medication. Always seek the advice of a qualified healthcare professional regarding any medical condition. Information and statements provided by the site about dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. Lifescript does not recommend or endorse any specific tests, physicians, third-party products, procedures, opinions, or other information mentioned on the Site. Reliance on any information provided by Lifescript is solely at your own risk.
5 Exercises to Build Your Pelvic Floor

Exercise can help you stay dry all day.

Double Calf Stretch

Do you sit all day? Wear heels? Stand without sticking your butt out because it’s "proper"? Then your pelvis is probably tucked under. Try this stretch for better pelvic posture.

Step 1: Place your hands on the seat of a chair and step your toes and balls of the feet up onto a thick, rolled towel.

Step 2: Line up the outside edges of your feet and straighten your knees. Your weight should be in your heels, and you should be able to lift your toes.

Step 3: Lift your tailbone toward the ceiling without bending your knees.

If you can’t, keep doing this exercise a few times a day, holding up to a minute, until you’re able to.

Repeat at least 3 times.


Seated "Number 4" Stretch

This is a great stretch for your piriformis
(a hip muscle partly within the pelvis), and you can do it while sitting.
Step 1: Cross your right ankle over your left knee.

Step 2: Lower the right knee to the same height as the right ankle.
Step 3: Keeping your bottom on the chair seat, stick out your bottom, which untucks your tailbone and pelvis (pictured left). This will open the pelvic muscles.

Hold for a minute and alternate legs for at least 3 times each.

Watch out:
If you’ve had a hip replacement, stretch only the leg on the side that wasn’t replaced.

Prone Inner Thigh Stretch

When the pelvis is habitually tucked under, groin muscles can become tight. Start with this stretch before moving on to the more advanced "Legs on the Wall" stretch shown later.
Step 1: Lie with your belly flat on the floor, resting your forehead on your hands.

Step 2: Slide one leg out to the side without bending your knees.

Step 3: Try to bring your leg up to a 90-degree angle. Hold for at least a minute and repeat at least 3 times.

Watch out:
If you’ve had a hip replacement, stretch only the leg on the side that wasn’t replaced. 

Inner Thigh Opening

This exercise strengthens your adductors, fan-shaped muscles in the upper thigh.

Step 1: Lying on the floor, place the soles of your feet together and let knees drop to the sides. (The height of the legs above the floor indicates the tension in your groin and hips.)

Step 2: Hold the stretch for a minute. If it gets uncomfortable, rest, then try again when you're ready. Repeat at least 3 times.

Watch out:
Don’t do this exercise if you have an artificial hip.

Legs on the Wall

This advanced move also works adductor muscles.
Step 1: Place your legs straight up against a wall, keeping your entire pelvis on the ground but leave some space under your waistband.

Step 2: Open legs to the sides. If tension in the back of the leg makes your knees bend, scoot away from the wall.

Step 3: Hold for up to a minute and rest when you need to. Repeat 3 times.

Watch out:
Don’t do this exercise if you have an artificial hip.

resource: http://www.lifescript.com/