Wine & Lady Bits Pelvic Workshop Series No. 1 of 4

Have you ever laughed so hard tears ran down your leg?

Pelvic Floor & Orthopaedic Manual Physiotherapy
Angela Growse 
PT, FCAMPT, B.Sc., B.Ed, M.ScPT 

We just completed our first of 4 Workshops on the pelvic floor with Physiotherapist Angela Growse and I am happy to report that incontinence is NOT something you have to live with! Can I get a YipPEE! Angela’s knowledge and talent to communicate her knowledge in a humorous and comprehensive way was much appreciated by the attendees last night. This information was too good not to share. Angela’s message can be broken down into 5 key questions:  

1. How much positive (hydrating) fluid (water) are you taking in?

2. How much comes out when you go?

3. What bad habits have you developed over the years?

4. How is the communication between your bladder and your brain?

5. To Kegel or Not to Kegel, that is THE question!

Now this is obviously the Coles notes version of last nights talk, just an overview. Angela would ask a few more questions when treating you. For the purpose of an easy at home solution, I’ve simplified it a bit.

I’ve always thought that incontinence was inevitable. It will happen to all of us one day, some sooner than others. So start investing in Depends now so that you can still dance the cha cha in your 70’s. Or in my case wiggle my tooshie! So let’s breakdown these 5 key questions.

1. Fill ‘er Up!

How much positive fluid are you taking in? Water is really the only positive fluid. Other fluids have negative components such as citrus, sugar, caffeine, carbonation, or alcohol. These liquids will contribute to dehydration or can irritate the bladder. When we dehydrate ourselves our urine becomes chemically concentrated, darker and irritates our bladders. Irritated bladders do not work functionally. This will often show up as an intense urge to pee, often coming on quickly, and then you don’t pee that much when you get to the toilet (if you get there in time!). So really it comes down to math. Each irritating liquid you drink puts you in a negative, so you would have to consume 2x more in the same amount of water to keep hydrated. Angela has her patients keep a journal. When you add up all of your liquids at the end of the day you should be at around +7 cups (250ml/8oz per cup) of water.  So for most of us, a glass of wine or a couple of cups of coffee aren’t then end of the world as long as there are 8-10 cups of water in the day too.

2. 1 MississipPEE, 2 MississipPEE, 3 MississipPEE …

How much comes out when you go does matter. The bladder is dysfunctional when voiding your bladder takes just a few seconds. This usually means the bladder was not full and you could have held off longer before going. Doing this several time throughout the day leads the brain to register this low quantity to be a full bladder. This can lead to that sense of urgency, or distrust in being able to hold “it”. You should be able to count to 8-10 Mississippi’s. This is a good exercise to try at night. Those of us under age 65 should all be able to sleep through the night with out getting up to pee. So next time you wake up try counting, 11 Mississippi’s is a legitimate reason to leave your cozy, comfy bed for a bathroom break. If it’s less, then maybe you are getting up out of habit. To break it, try relaxed breathing for a few minutes and see if the urge goes away or if you can go back to sleep. If you do get up because you are convinced your bladder is full and it turns out to be a 3-5 count pee, tell your bladder that was a false alarm and try the techniques again the next night.

3. The Pee Police

Once we figure out this potty training thing, we start to build bad habits. In fear of having an accident Mom & Dad ask obsessively; have you peed? Do you have to pee? When did you pee last? Before any car ride your parents strongly request or force a trip to the bathroom before you leave. I don’t know about you, but that is the last thing I do before I leave the house, a quick pee before I leave. A “Just In Case” pee. Or as in the above example, waking up every night around the same time to go to the bathroom. The good news is, you can break these habits, but it will take some work. A bit of mind over matter but the big rule is no “Just in Case” peeing! 

4. Fake News

There is a consistent component to each of the above questions; the communication between the brain and the bladder. Angela called the bladder a ‘social’ organ. The brain is hard wired to operate our organs functionally, however in the case of the bladder the communication can become jumbled by habit and socialization. A dehydrated bladder gets irritated and tells the brain it’s full when it really isn’t. Bad habits convincing the brain that you gotta go when you don’t really – you are just nervous about a meeting, or you always go before leaving the house, so your brain sends off a “bladder full” signal as you get ready to leave, even if you just went 20 minutes ago. Or even repeatedly holding it in will tell the brain you don’t have to go when you really should, and this can lead to dysfunction. How many of you out there are guilty of being too busy to pee? Peeing when we don’t need to, holding it longer than we should, all of this changing how the bladder functions and communicates with your brain.

5. To Kegel or Not to Kegel, that is the question

And what about Kegels? Aren’t they the answer here? Well, sometimes yes, but often no!  A weak pelvic floor certainly can mean you don’t have the strength to hold back the flow, but it’s not as common as people think. Often the pelvic floor is too tight, or the timing of it is off.  We can’t really know where we fall on this spectrum unless someone (a pelvic floor Physiotherapist) does an internal exam. For some of us – doing Kegels could be making our incontinence worse! 

A physiotherapist specializing in the pelvic health can help navigate this process. We have just skimmed the top of the issues that contribute to incontinence. Some conditions do require medication or even surgery. To find a Physiotherapist that specializes in the Pelvic Floor and Incontinence visit the College of Physiotherapists website in your Province. Ontario’s College is:

Angela Growse is currently on Mat-leave until September. Her colleague and friend Jaclyn Seebach is available at Rebirth. To make an appointment call 226-663-3243.

Our next workshop will be Thursday August 10 at 7:30pm. Angela will be covering the issue of Diastasis Recti and Prolapse. This information is so important for all women. Don’t wait until there is a problem, educate yourself now to prevent health issues later on.