We All Need to Have a Wee Chat!

I am not a doctor, I am not a PT, not a GP and not an incontinence nurse. But I am a mum of three and a Feldenkrais® practitioner, and the nature of my work and interest in mothers’ health brought me to learn a lot about incontinence and pelvic health.

When we just started running Pelvic Floor workshops at Feldenkrais® Waikato two years ago, I was disheartened to find out that up to 70% of women suffer from urinary incontinence at some point of their lives. Statistic data vary, usually they say about 30% on average and up to 70% in sports and high impact activities; knowing that it’s based on self-reporting and not every woman would speak about those issues openly makes me rather believe it’s more than 30% average.

Moreover, about 13% of high school girls experience incontinence while practicing sports, without having ever been pregnant or given birth (and 6% of them have to use some kind of pads). In the big sport, this figure can reach up to 60% too.

If there is one thing teenage girls and women need to hear today, it’s this:

Incontinence has to be addressed.
Any. Leak. Is. Not. Normal. Period.
Not after having three kids. Not when running or jumping on the trampoline. Not while sneezing.

Where can I get help?

This is the World Continence Awareness week and we need to normalise this conversation, for our own health and for the health of our teenage girls.

Continence NZ (and other similar organizations around the globe) runs a Continence Awareness Week every year in June. This year I decided to join this initiative too.

Here is what you can do:

Educate yourself, read and watch. Continence NZ put together a good number of materials to make navigating this topic easier, check out their page: they cover men’s health and potty training too, along with links to pelvic floor safe workouts (keep reading to learn why it’s important).
Reach out to Continence NZ via their Helpline (0800 650 659) to get a conversation with a continence nurse or educator.
See your GP in order to get a referral for seeing a Pelvic Health Physio. Don’t accept their standard recommendation of doing “Kegels”: you need to know how to make these exercises correctly, and when they are suitable (see below).
You can see a Pelvic Health (or Women's Health) Physio privately too. Bev Hampton is one physio I could recommend in Hamilton, Waikato.
And I can offer you a more integrative approach, as well creating more awareness around your pelvic floor habits: it is usually not only your “down under” that requires attention; most probably you need to create better postural habits, examine your breathing choices, and enhance mobility of your pelvis and your general movement ease - everything that the Feldenkrais Method®️ is working so powerfully with.

But wait, what about “kegels”?!

Not everyone benefits from these exercises, and you need to knwo how to do them properly. Let’s dig a bit into the history.

Do you know that when Dr Arnold Kegel (yes it’s a doctor’s name!) first understood the relationship between incontinence and tone of pelvic floor muscles, and then started explaining to many women how to do the toning exercises, became very frustrated as his verbal instructions did not work and his female patients didn't achieve too much improvement?

Women were readily engaging other muscles, but hardly their pelvic floor.

It is not until he designed his "Perineometer" (US patented in 1951) - a pressure gauge that would be inserted in the vagina and actually measure the power of vaginal contraction and show that measure, - that he was able to get improvement in about 80% of his patients. That was the first biofeedback device for training pelvic floor muscles.

So, if the "kegels" don't work for you or other women you know - they neither did for Dr. Kegel himself! Luckily we didn't stop there and as of today (nearly 70 years later!) there is some good knowledge developed by specialized Physical Therapists about what exercise program can be efficient.

Moreover, we need to look beyond “kegels” and realize that pelvic floor is a part of a system: we need to use more global approaches, like including breathing into the picture and reconsidering our esthetic requirements (aka flat bellies). We need to integrate pelvic floor into our functional movement, awaken it and get more awareness around our daily habits.

Is there a workout that is Pelvic Floor safe?

Coming back to teenage girls and sports: do those incontinence figures mean we don't want them to do sports and exercising? Not true. But we might need a smarter way. For example, there are many ways to create extra pressure on your pelvic floor while exercising abdominals, which can actually be detrimental to your pelvic health. Yet in the same time healthy and coordinated abdominal muscles contribute to and support pelvic health.

A while ago I saw a group of teenage girls doing quite vigorous crunches. Do they know how to make it safe?.. I asked myself. Do their coaches know? Do their parents know? Because you want to know how to help them avoid incontinence and prolapses, right?

Please educate yourself. Ask your child's coach whether they are aware of healthy pelvic floor practices. Find a personal trainer or a pelvic health physio who knows their stuff. Check out Continence NZ pelvic floor safe workout program: Beginners and Intermediate.

Daily habits – what’s in the bathroom?

If we talk about continence and pelvic health, we need to get serious about wees and poos.

Potty training behind, have you ever enquired about the best practices for bladder and bowel movement? And if you say Yes – the chance is big it’s because you had issues to solve.

However, I prefer prevention and taking steps before problems like incontinence and prolapse occur.

And there is a lot you can do in the convenience of your bathroom. Beginning today, start paying attention to your habits:

Are you rushing and pushing?
Do you take time and do you go on time? (for bowel movement, your biggest call is most likely to happen in the morning, and taking time to answer this call can make things so much easier!)
Do you have to hold your breath or you can breathe freely?
Do you sit comfortably and in such a way that the biomechanics of elimination are supported?

Please don’t hesitate to address any bladder or bowel issues with your doctor or pelvic health physiotherapist.

Whatever is the approach or provider your chose, you'll benefit from their program more fully if you develop your inner awareness and integrate your pelvic floor into your most mundane daily actions ...
Remember, we need to look beyond incontinence management and look for treatment and healing. No matter age, size, number and size of children.