A great strategy to protect a leaky bladder!

by Tus Jierasak, women’s health physiotherapist

If you leak urine when you cough, sneeze, skip or run, you might be experiencing what is known as stress urinary incontinence.  To understand why this happens, it is first important to know a bit about why.

Why does leaking happen?

Now the ‘stress’ in stress urinary incontinence is not referring to the stress that we all experience (work and commitments, bills, and the general cost of living in Sydney!).  It actually refers to the downward pressure in your abdominal cavity onto your pelvic floor. With activities like coughing, sneezing and laughing, there is downward pressure from your abdominal cavity onto your pelvic floor, and it is often sudden.

Behind your urethra sits a wall of connective tissue (fascia). Every time you contract your pelvic floor, this tightens that wall of connective tissue.  Most of the time to counteract downward abdominal pressure, your pelvic floor will automatically contract, and tighten the fascia behind your urethra so the urethra closes, and ta-da! No leaking.

But… you might have had a cold or cough for a few weeks which has put a lot of downward load down on your pelvic floor, and weakened it so it now cannot provide enough support up against the downward pressure. And now you might have new symptoms of leaking with a cough or sneeze, when you previously never leaked. Or maybe your pelvic floor contraction is a bit slower and can’t quite lift in time to counteract the downward pressure. There can be a lot of factors that contribute.

So what should I do to stop the leaks?

If you leak (or fear that you might) during activities such as sneezing, coughing or laughing, you should try “The Knack”. This is a pre-emptive, fast and maximal pelvic floor contraction that you do right before coughing, sneezing, or laughing. So let’s take a cough for example. Before you cough, you consciously engage in a fast, 100% pelvic floor contraction, and try to hold this throughout your cough. Have a go right now and test one. It might be a bit harder to hold during multiple coughs or sneezes, or sometimes one might catch you off hand, but the more you practice, the easier it will get, and the more automatic it will become.

But what about when you can’t hold your pelvic floor lifted throughout, like running?

Our pelvic floor is designed to pre-emptively contract during the instant of cough, sneeze or laugh. However, it is not designed to lift and support constantly throughout an activity such as running or skipping where there is intermittent downward pressures on your pelvic floor. This is where us women’s health physios come in, and might suggest something like a pessary for use during your exercise.  A pessary is a little silicone device that comes different shapes, sizes and fits, and sit within the vagina (if fitted correctly, you shouldn’t feel anything), and can do many wonderful things such as providing support for your pelvic organs. For stress urinary incontinence, we use special ones often with a knob that sits can sit against the back of your urethra and provides that firm backstop to prevent leaking.

If you do experience any leaking, come and have a chat with any of our women’s health physios to find out more about what you can do, and for a personalised pelvic floor assessment to see exactly what is going on.  Please know that leaking with activities is common but not normal, and not something you should have to put up with. Don’t feel embarrassed- contact us!

Draft ‘summer school’ for January 2020. Timetable is subject to change.

These classes will run for 3 WEEKS in our Sydney CBD and Broadway clinics. Classes will **run over the weeks of Monday 6th, 13th and 20th January 2020 .
**

Classes are recommended and scheduled for:

• Intermediate/advanced  mixed level Pilates for challenging and functional postural control. These classes are suitable for our existing Pilates clientele currently attending our clinical rehab, intermediate or advanced classes in 2019.
• Pregnancy specific Pilates. These classes are suitable for our existing pregnancy Pilates clientele currently attending our classes, or have been assessed to be ready for these classes.
• Mums&bubs Pilates. Safe pelvic floor, belly and postural awareness exercises with bub in tow!

Chatting about menopause for October 18 and World Menopause Day!

by Aline Filipe Nunes, women’s health physiotherapist

Menopause is the name we give to the last time a woman had her menstrual period. Having a latin origin, the word comes from meno- pausis, meaning the stop or pause of the monthly flow. Although the prospects of not having the period may sound good for some, others dread at the thought of it.

Why is menopause seen as a bad thing?

In Australia, menopause occurs in average around 51 years old however, the common period is situated between 45 and 55. If earlier than this it is said that there was an early or premature menopause.

The peri menopausal period (this means ‘around menopause’) is often associated with many symptoms such as:

• Hot flushes
• Night sweats
• Weight gain
• Aches and pains
• Fatigue or irritability
• Mood swings
• Depression
• Premenstrual such as sore breasts
• Bloating and gastrointestinal complaints
• Decreased cognition and brain fog
• Dry skin
• Decreased vaginal lubrication and decreased libido
• Pain during sex
• Urinary frequency
• Sleeping problems and insomnia

These symptoms can last from 5 to 10 years after menopause so, no wonder many women do not look forward this time. However, it is important to mention that not every woman feels these symptoms. About 20% of women will not feel any symptoms at all and 60% of them only feel them mildly. However, the remaining 20% of women will feel these symptoms more severely.

So why do these symptoms happen?

During the peri-menopausal period hormonal changes start to occur with a permanent drop of the production of oestrogen until a new lower level is found. Oestrogen is a sexual hormone that is linked to serotonin, a chemical that regulates mood, emotions and sleep.

After menopause, this new lower oestrogen level has an effect on our sex drive, musculo-skeletal system and sleep.  There is often a  reduced libido, vaginal dryness and pain that can occur during intercourse. Skeletal muscle mass, strength, and regenerative muscle capacity can explain the fatigue, aches and pains associated with this period. The lack of oestrogen associated with sleep deprivation seems to be a major contributor to mood swings, anxiety, irritability and brain fog.

A cool fact!

Research has shown that peri-menopausal symptoms don’t seem to be linked to only hormones alone. Did you know that the way we perceive menopause seems to have a direct impact on the severity of symptoms.  Cultures where being old is seen as something negative, report more severe symptoms. So, considering that women currently live about one third of their lives after menopause, it is crucial to spread the word that there is treatment and there is a lot you can do to improve your life and decrease your symptoms. Start with a different outlook for this period of your life.

Here’s a plan to tackle menopause head-on!

• Exercise. Exercise appears to improve many menopause related symptoms, in addition to being a great way to improve weight, body strength and bone health.  Exercise also helps with cognition and mood swings as well as improves self esteem, libido and stress levels. Exercise is also linked top reduced changes to develop cancer and other diseases. What a great way to improve or maintain your quality of life during menopause!
• Eat well. Eat your vegetables and fruits, whole grains, lean meats and legumes to help your gut, improve digestion and, as a consequence, improve your energy levels and mood.
• Sleep! Stress ( due partly to lack of sleep) is a major hormonal disruptor and has a direct impact in your whole body. Stress can worsen your gut, impact your sleep further and worsen your mood symptoms.
• Pelvic floor physiotherapy (contact us!). If you have any pain during intercourse, vaginal dryness or urinary related symptoms (such as incontinence, urgency, increased frequency to empty bladder or bowel), a women’s health physio is an expert therapist at helping you with these issues ‘down below!’
• Counselling or psychology. Finding yourself a good counsellor can help you transition through this period. Some of us may feel that menopause is a period that transitions a woman from a fertile to infertile period. Some women need to go through the mourning of what their body was and what it is now. Having someone to debrief this is often crucial so women can embrace their new life period in full.

Be kind to yourself.

The period around menopause is a symbolic period of change and often women use it to define new goals and set new commitments. Having some time off and time to restore energy is crucial in order to embrace this new beginning and assess your lifestyle and overall health and relationships.

It is crucial to mention that, if you believe that you are going through early menopause, finding a good team is crucial. A woman that goes through menopause around her 40s has a higher chance to develop osteoporosis and other health problems hence, menopause hormonal therapy, being low risk, can be recommended. If you have concerns regarding this, ask your doctor.

https://jeanhailes.org.au/health-a-z/menopause/menopause-management