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Exercising safely

    April 2008   

When laughing or sneezing is fraught with danger, the idea of exercising is totally unthinkable.  But you don't have to put up with incontinence.  Here's how to get your body ready for an active and enjoyable life.

As embarrassing conditions go, leaking urine has to be among the most blush-making – and sadly there are a lot of us with red faces. Nappies are all very well in the first months of life and incontinence pads may be forgiven in elderly residents of nursing homes.  But one in five women over 40 suffer from stress incontinence; involuntary leaking whenever there’s pressure on the bladder.  It’s disabling as well as embarrassing:  sufferers learn by experience to melt into the background at the merest suggestion of physical activity.

When even laughing or sneezing is fraught with danger, the idea of taking part in a fun run or a strenuous work out at the gym becomes unthinkable – which is a shame as exercise is exactly where deliverance is likely to be at hand.

The cause of stress incontinence is a weak pelvic floor, usually follows childbirth – though the problem may only become seriously disruptive in your late 40s and 50s.   The pelvic floor is the name given to  sling-shaped muscles that hold the bladder in place in both men and women - and which you can recognise because they stop the passage of both water and wind, provided they are sufficiently toned and strong to be tightened quickly and effectively.

The problem of involuntary leaking occurs in both men and women. But it is as common as hay fever in women and, fortunately, there are now effective methods of prevention and therapy to help sufferers live life to the max.

‘Ten years ago, stress incontinence was a taboo subject that was widely neglected by health professionals,’ says Ian Holland of the educational charity, the Continence Foundation.  ‘Today, antenatal class teachers make sure women understand the importance of regular pelvic floor exercise both to prepare for childbirth and prevent problems afterwards.’

What’s more, he says, fitness trainers are now fully informed of the importance of toning women’s muscles inside as well as outside the body: whether they’re teaching Pilates, yoga or exercise classes at the gym.

‘Women today have everything to gain by owning up to stress incontinence and finding ways to live an unrestricted life’, says confidence coach, Dawn Breslin.  ‘Of course it’s embarrassing but the problem is so common that there’s no need for it to be taboo subject any longer.  Mention it to your friends and they are likely to be relieved to hear they’re not alone.’

Once confronted, the next step is to start the right exercise regime.  That’s not always straightforward as weakness in the pelvic floor also affects sensation so that you can’t always feel what’s happening. It’s the muscles around the back passage and the vagina (not the tummy, thighs or buttocks) that need to be worked on - you’ll know you’re doing it right if you insert a finger in your vagina and feel a gentle squeeze when contracting the muscles inwards and upwards.

There’s a strong evidence base to show that pelvic floor training is the most effective treatment for stress incontinence: it’s also free, can be done at any time, sitting, standing or lying down - and what’s more, your vaginal muscles will also become stronger and better toned, making sex more enjoyable. 

But pelvic floor training does require the same kind of commitment and repetition as exercising any other muscle group.  The Chartered Society of Physiotherapists recommends one set of slow contractions (to strengthen the pelvic floor) and one set of fast contractions (to help cope sudden pressure) six times a day. Don’t expect much change for between eight to 15 weeks and be prepared to carry on exercising for a lifetime. 

If you want help getting started, contact a physiotherapist specializing in women’s health (go to www.csp.org.uk or call 020 7306 6666) or check in at an NHS continence clinic to see a specialist nurse who can give one-to-one advice.

There are also 300 continence clinics in the UK, ‘one of the health service’s best kept secrets’, says Holland, ‘and you don’t need to get a referral letter from your GP’ (details from the Continence Foundation, helpline 0845 345 0165 or www.continence-foundation.org.uk).   Specialist nurses use biofeedback training and may recommend vaginal cones or electrical stimulation therapy. 

You can also order a free Pelvicore Technique DVD, featuring Professor Kari Bo, a Norwegian exercise scientist and physiotherapist and a world leader in pelvic floor training (from www.corewellness.co.uk)

In the meantime, use an ultra-thin pad designed for stress incontinence such as Envive by Always (£2.49 for a pack of 18 pads) or Tena lady Mini Magic (£3.23 for a pack of 34 pads). 

Surgery is effective as an alternative to pelvic floor exercises. The most common is TVT (tension-free vaginal tape), an operation normally performed with a local anaesthetic – where a surgical mesh to placed under the urethra to support it at time of stress.  It is preceded by a ‘uro-dynamic’ test to assess the size of the bladder where small tubes are threaded through the back and front passage and then slowly filled with fluid.  After the operation, patients are recommended to avoid driving or sports for a few weeks.

 If pelvic floor exercises are not working but you don’t want surgery, Zuidex gel is a new minimally invasive treatment that has been shown to prevent urine leakage in more than two out of three women in a major study. Email zuidexinfouk@q-med.com or call 0800 068 3299 and they can find out details of their nearest NHS or private practitioner and receive a patient information pack.  

 


   

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