• mphelstrip

To pee or not to pee - how to avoid those embarrassing leaks


TV adverts for panty pads - designed to absorb those unintended little leaks that can happen when you cough, laugh or sneeze - seem to be on the increase.


Urinary incontinence affects 1 in 3 older women and can be a source of major discomfort for young Mums.


But do we really need to just put up with it?


To answer the question, let’s first look at the physical process of having a pee (urination).



The Urination Process


Our pee (urine) is stored in the bladder and emptied via a tube called the urethra. Normally when we are ready for a pee, the muscles of the bladder wall contract, forcing urine from the bladder into the urethra. At this point the muscles surrounding the urethra (the urethral sphincter muscles) relax, allowing urine to release from the body. That’s a natural pee.


Sometimes things don’t go as smoothly. The bladder muscles may suddenly contract without giving us the normal warning signals. Or it may be that the sphincter muscles are not strong enough to hold the urine until we are ready to pee. That’s urinary incontinence.



Some Causes of Urinary Incontinence


  • Childbirth – the bladder may move downward, preventing sphincter muscles from squeezing tightly


  • Hysterectomy – the operation may create structural changes in the pelvic floor muscles that control urine flow


  • Weight gain – excess weight around your midsection can increase your risk of incontinence, as extra pressure on your bladder can weaken or damage your pelvic floor and urethral structures


  • Ageing – lower estrogen levels following menopause can decrease sphincter pressure


  • Medicines – some medications prescribed for conditions such as high blood pressure can impact bladder control temporarily


  • Medical conditions – urinary tract infections (UTIs) may cause temporary incontinence that often resolves itself once the infection has been treated


  • Anxiety – being anxious about ‘having an accident’ can sometimes have the unfortunate effect of making it more likely


  • Certain fluids – fluids such as alcohol and caffeine-containing drinks can exacerbate the issue



Treatment


Incontinence should always be highlighted to your GP, as you may have an infection that needs to be treated. Don’t be embarrassed – this is a common problem, so common in fact that you can buy UTI tests in Boots!


Once an infection, or any external factors such as medication, has been addressed, there are ways in which you can help yourself to re-train your internal muscles to become more efficient. The NHS has a useful guide (see link), including video, showing how to perform pelvic floor exercises.



A healthy, active set of pelvic floor muscles can:


  • prevent or reduce incontinence


  • increase core stability


  • enhance sexual activity


  • ease the process of giving birth



Yoga and your Pelvic Floor


Dru Yoga has a very definite focus on ‘core stability’ – switching on your core muscles to enable effective and efficient movement. The pelvic floor muscles form an integral part of the core, and every Dru Yoga movement that you do involves both conscious and unconscious engagement of the core muscles.


In addition, there is a 3 stage pelvic floor exercise that allows the yoga student to experience and understand how to isolate movement for engagement of the locks (bhandas) that enhance our yoga practice but are also extremely useful for preventing incontinence!*



3 Stage Pelvic Floor Exercise:


Starting position – lying on your back, knees bent and feet on the floor hip-width apart. Keep your facial muscles relaxed. Always finish the exercises by completely relaxing all of the muscles that you have been working with.


1. Anal squeeze, as if you were trying not to poo (ashwini mudra)


Keep your buttocks relaxed during the whole process.

Take a Breath in (inhale/inhalation).

Breathe out (exhale/exhalation), taking your breath and your mental awareness down to the base of your spine.

As you inhale, squeeze the ring of muscle around your anus.

As you exhale, release the squeeze.

Don’t hold your breath. Don’t hold the squeeze.

Continue to squeeze on the inhalation and release on the exhalation.

Repeat five times, following the natural rhythm of your breath.


2. Clitoral tickle, as if you were trying not to pee (sahajori mudra)


Take a Breath in (inhale/inhalation).

Breathe out (exhale/exhalation), taking your breath and your mental awareness down to the base of your spine.

Now move your focus forward to your pubic bone.

As you inhale, squeeze the muscles right at the front until you feel a ticklish sensation around your clitoris. It feels as if the clitoris is being gently moved or wiggled by these muscles.

Exhale and release these muscles completely.

Don’t hold your breath. Don’t hold the squeeze.

Continue to squeeze on the inhalation and release on the exhalation.

Repeat five times, following the natural rhythm of your breath.



3. Perineal lift, the space running between anus and genitals (mula bhanda)


Take a Breath in (inhale/inhalation).

Breathe out (exhale/exhalation), taking your breath and your mental awareness down to the base of your spine.

Move your focus to the middle, right inbetween the two extremes (front and back) of the previous exercises. Take that focus deeper inside.

As you inhale, lift the muscles inside the vagina right up high – it feels more like a lift than a squeeze.

As you exhale, release the lift.

Don’t hold your breath. Don’t hold the lift.

Continue to raise on the inhalation and lower on the exhalation.

Repeat five times, following the natural rhythm of your breath.


NOTE:

Pelvic floor exercises are equally valuable for both women and men. Men can follow the above instructions by substituting urethra for clitoris/vagina, or follow the link given below to Guy’s and St Thomas’ hospital guide ‘Pelvic floor exercises for men’.



Conclusion


We don’t have to just ‘put up with it’. Incontinence is not a definite consequence of getting older or having a hysterectomy. Having a baby and laughing does not automatically have to lead to a leak. Get checked by your GP, then get down to these pelvic floor exercises. Join a Dru Yoga class to improve your core muscles – see you on the mat!




Namaste


Michelle

Michelle Helstrip

Founder

DRUVA Yoga Therapy & Wellbeing

www.druva.co.uk




Sources & Further Information


‘Urinary incontinence in older women’ – includes useful diagram of internal organs relating to passing of urine

https://jamanetwork.com/journals/jama/fullarticle/185997


‘Will I suffer from a leaky bladder after a hysterectomy?’

https://www.news24.com/health24/medical/incontinence/incontinence-in-women/will-i-suffer-from-a-leaky-bladder-after-a-hysterectomy-20190408


NHS video demonstrating how to perform pelvic floor exercises https://healthandcarevideos.uk/bladder?videoId=1595


NHS urinary incontinence advice

https://www.nhs.uk/conditions/urinary-incontinence/


*Pelvic Floor Exercise - my thanks go to Uma Dinsmore-Tuli for introducing me to this more nuanced approach to pelvic floor work

Uma Dinsmore-Tuli, author of ‘Yoga for Pregnancy & Birth’

https://www.waterstones.com/book/yoga-for-pregnancy-and-birth-teach-yourself/uma-dinsmore-tuli/9781444100976


Jennilee Toner of Eckhart Yoga

https://www.ekhartyoga.com/articles/anatomy/mula-bandha-root-lock


Pelvic Floor Exercises for Men https://www.guysandstthomas.nhs.uk/resources/patient-information/elderly-care/pelvic-floor-exercises-for-men.pdf