This from any one of a number of patients who come to see me in my clinical practice. Kegels or Pelvic Floor Muscle Exercises are touted as the "cure all" for leakage of urine. But are they?
After leaking urine for an average of 7 years, you've probably decided to speak to your doctor about leaking urine with cough, sneeze or exercise. Or maybe you know where every bathroom is in your daily travels.
Your doctor stares blankly and either says, "Can you put up with it?" Of course you think. I am woman. I delivered a 12 lb baby......naturally. I've breastfed so many babies, I can hang by my nipples from any suspension bridge using nothing more than a clothespin. Or, "I've raised teenage sons." I am invincible.
Can I handle it? PFFFT!!!
So you get an "atta girl," Now men typically see the doctor sooner for urinary incontinence. "Hey doc, I leaked one drop."
Regardless, if you're one of the lucky ones, you get a referral to a pelvic floor physiotherapist. And so begins your journey down Leaky Lane. You expect a cure. You go. You Kegel. You Breathe. You Kegel Some More. You even out your chest. You Kegel more. Your pelvic floor is tight. You loosen it. You Kegel more.
YOU STILL LEAK URINE.
Many men and women are frustrated after 10-20 visits or more to a pelvic floor physiotherapist with no change in their bladder leakage.
In my experience with my patients over the last 26 years, I have found that Kegels do NOT work for Stress Urinary Incontinence which is when you leak with cough, sneeze, exercise, orgasm or jumping on a trampoline.
Kegels do work better for urge suppression or bladder retraining. In other words, if you have urgency, stop what you are doing, remain calm and squeeze your rectal muscle 10-15 times quickly. This will calm your bladder down increasing the time between voids and functional capacity.
Normal voiding is approx 6-8 times in a 24 hour period or about every 3-4 hours. The bladder can hold 400-600cc's.
The truth is that Kegels or Pelvic Floor Muscle Exercises don't work for everyone all the time. And if you have not seen any change in your leakage after 2-3 visits to your pelvic floor physiotherapist, it's time to seek alternative solutions (this from a physiotherapist colleague of mine).
What is little known is that there are a number of treatment options available. But first a few facts:
- Leakage of urine is never normal. Never. I mean never.
- Diagnose is Key. Is your leakage the result of leakage or a urinary tract infection? Are you post menopausal? It may be GSM.
- There are many health care professionals that treat leakage of urine from Nurse Continence Advisors to Obstetrician/Gynaecologists to Uro-Gynaecologists and Physiotherapists.
Here are a number of treatment options available to you that may work in conjunction with Kegels or better than Kegels. That said, it begins with good bladder health.
- A Bladder Diary has a 30% placebo effect.
- Reduce bladder irritants (coffee, tea, citrus, spicy foods, alcohol, chocolate)
- If you have urge or Overactive Bladder or OAB (urgency, frequency and nocturia);
- Drink enough water based fluids so your urine is clear 90% of the time.
- Distribute fluids evenly throughout the day.
- Don't drink after 7 pm.
- Sit with your feet elevated above the level of your heart for 30 minutes 2 hours before bed. This increases peripheral vascular return and you will void a larger amount before bed.
- Urge Suppression or Bladder Retraining.
- Treat your constipation (water, psyillium fibre, fruits, veggies and a squatty potty)
- Low dose localized estrogen helps many women especially post-menopausal women who leaking while coughing or with urge. GSM is a condition common at the menopause that involves leakage of urine and vaginal dryness and estrogen is the hormone regulator of the urogenital tract.
- Impressa is an OTC product that may help some women with leaking during cough, sneeze and/or exercise.
- A Pessary is a medical grade silicone device that a woman is fitted for and is inserted into the vagina and either remains in place or is used during exercise. And most of them can be worn during sex. Because guess what, a fair number of women leak at orgasm. Yes. Yes. Yes. O-dear.
- The BTL Emsella (aka Kegel Throne) delivers 11,200 Kegels in 28 minutes. 6 treatments are required. You sit on the throne (finally, ladies, where we belong) fully clothed. It's rather dignified.
- There's also minimally invasive procedures from injections beneath the mid urethra to taping.
- A Viveve or Radio Frequency (RF) treatment may help some women but the science is scarce. Some doctors who are more interested in your money than bladder management might tell you you need a Viveve prior to the surgery to ensure healthy tissues. There is no evidence for this. Don't be fooled.
- For OAB, medication may be warranted but the side effects are pretty severe (dry mouth, constipation & short term memory loss) so my recommendation would be to work on conservative management
The point is pelvic floor physiotherapy is one treatment worthy of a try. But it won't take long to learn if it works or not. Moveon.com
Maureen McGrath RN is a Nurse Continence Advisor and Sexual Health Educator in private practice. She is Chair of the BC Chapter of Nurse Continence Advisors. She is in private practice in North Vancouver, Vancouver at Arbutus Laser Centre and at Amari Medical in Surrey, BC where she treats patients conservatively with bladder, bowel, sexual and vaginal health concerns.
She also hosts the Sunday Night Health Show on Corus Radio Network in Western Canada & available on iTunes: https ://podcasts.apple.com/us/podcast/sunday-night-health-show/id1179064116