Ah, the joys of aging. Since there are so many, we’ll focus on just one: the post-menopausal leaky bladder.
It’s one issue affecting lots of women, most of whom would rather just tend to the leak with panty liners or absorbent underwear instead of dealing with the source of the problem, namely weakened pelvic muscles.
Are they embarrassed to seek out medical help? Probably. Do they even consider a leaky bladder an important health issue? Many don’t, studies show.
So let’s strengthen those pelvic muscles. But before you say, “I did Kegels and they didn’t work,” read on to learn how to do them right.
Urinary incontinence explained
Urinary incontinence occurs is as an involuntary reaction to, for the most part, involuntary bodily events — laughing, sneezing or coughing. In some instances, the urge to urinate can be strong enough to go on the spot before reaching a toilet. More women than men experience this issue.
The National Institute On Aging says there are mainly two kinds: stress incontinence and urge incontinence. The former happens with excessive drinking, be it alcohol or carbonated liquids, or eating sugary and spicy foods. These are temporary causes. The latter, urge incontinence, comes with pregnancy, menopause, prostate cancer and neurological disorders such as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis as well as strokes.
Another reason women commonly have uncontrolled bladders stem from pregnancy and childbirth. On giving birth, the bladder, uterus and rectum can be pushed out of place and can jut into the vagina causing incontinence.
Tell the doctor? What for?
According to the 2018 National Poll on Healthy Aging , 46% of women aged 50 to 80 reported having loss of bladder control. Of them, 41% described this condition as problematic and 31% said their bladder leaked nearly every day. Despite this type of frequency, two-thirds of the 1,000 women surveyed had not brought it up with doctors, since they did not think it was a major health concern.
The reason these surveyed women reported such high incidences of urinary incontinence is not just because it’s a natural consequence of aging, but because of menopause, At this point in a woman’s life her estrogen production has dropped. And estrogen is needed to ensure the tissue linings of the bladder remain in good condition.
Women whose leaking issues were due to childbirth weren’t inclined to speak with their doctor, either. A recent study in the Journal of Women’s Health said that 44% of women had urinary incontinence in the postpartum period, but only 25% approached doctors.
Enter the discussion about Kegel exercises. More than half of the women over 50 years old surveyed in the national aging poll did not take this easy way out and instead used absorbent garments and pads. Only 38% exercised their pelvic muscles.
Let’s do them right this time
Kegel exercises, done properly, strengthen the pelvic floor muscles located below the bladder, says the Mayo Clinic.
With Kegels, a simple exercise of tightening and releasing the bladder muscles, you can do them by yourself or with other women. A new 2020 study of 362 women who were older than 60 years and diagnosed with stress incontinence compared how women fared in both exercise settings. They found that women who did them in a group environment reduced leakage by a few points – 74% vs 70% – than those who exercised individually. The authors said the results show that Kegel exercises work for women, period.
If they do them long enough. Women with newborns, according to the Journal of Women’s Health report, said those who were prescribed Kegels weren’t consistent in doing them and therefore did not reap the benefits.
An expert speaks
Sarah J. Haag, MS, is a Chicago-based board-certified specialist in women’s health physical therapy. She focuses on improving the function of pelvic floor muscles. She said not many people are aware that a physiotherapist can help.
“In many countries, people experiencing urinary incontinence can seek out the assistance of a physiotherapist without a referral from a physician. However, many people don’t know that pelvic floor physiotherapists exist, so it is a referral from a physician that makes them aware of this option for treatment,” Ms. Haag told Medical Daily via email.
On whether group settings make a difference, Ms. Haag said it does not matter as long as it is “getting women moving, and using their pelvic floors.” What matters is that women meet their goals and stay motivated. “However, if nothing is changing, and the woman feels like she needs guidance, or if things are getting worse, then meeting with a pelvic physiotherapist could be very beneficial.”
A step-by-step guide
Ms. Haag, who can be found at Entropy Physical Therapy and Wellness, said Kegels can be done in any position. Patients can do this in any position, she said, but sitting can be a great place to start.
Step 1: Sit up tall
Step 2: Contract your pelvic floor. You can find the floor by trying to stop the flow of urine or lifting a tiny object off the chair, hands free. You should feel the muscles move when they touch the chair.
Step 3: Once the muscles are contracted, breathe in or breathe out. Next, relax the pelvic floor. You should feel the muscles return to where they started.
Step 4: Do 5 to 10 in a row.
Ms. Haag said no one should see you contracting if you do these exercises while sitting.
As for avoiding a deluge during a sneeze or cough, Ms. Haag recommended that you “squeeze before you sneeze.”
Seema Prasad is a freelance health reporter based in Bengaluru, India. She tweets @SeemaPrasad_me