Stress Incontinence

Stress incontinence Do you suffer from Stress Incontinence?

*Do you leak when you cough, sneeze, exercise or laugh?
*Do you have to hurry to the toilet and don't always make it in time?
*Do you have to pass urine more often than you used to?
*Do you leak urine in your sleep?
*Does your bladder wake you up more than twice a night?
*Do you feel that you can't empty your bladder completely?
*Does your urine stream stop and start, and is the flow slower than it used to be?
*Do you have trouble controlling your bowels?
**For men, see also Prostrate

Stress Incontinence is more common than you think
Stress incontinence is the most common form of urinary incontinence and it’s estimated that approximately 3 million people in the UK are regularly incontinent, this is a about 4 in every 100 adult’s, over half of these are due to stress incontinence.

Stress incontinence becomes more common in older women and its thought as many as 1 in 5 women over the age of 40 have some degree of stress incontinence.
What is stress incontinence?

Stress incontinence comes about because of a sudden extra pressure or stress on your bladder. Urine then leaks because your pelvic floor muscles and urethra cannot withstand the extra pressure. Stress incontinence develops because the pelvic floor muscles are weakened and small amounts of urine may leak, occasionally it may be quite a lot and causes embarrassment. This may happen when you cough, laugh, or when you exercise.
What are the causes of stress incontinence?

The most common reason for the pelvic floor muscles to become weak is pregnancy and childbirth. Stress incontinence is more common in women who have had several children. Age is also a major factor as the muscles become weaker. Women who are obese are more likely to suffer from stress incontinence.
What are the treatments for stress incontinence?
The first step to consider is to strengthen the muscles, by improving your pelvic floor muscles. Approximately 6 out of 10 cases can be cured or much improved with this treatment. Surgery may be advised by your GP if the problem continues.

Pelvic Floor

Why do I leak when I jump on the trampoline?
It may not be the trampoline it could be just when you sneeze or laugh, a cough or you notice when you have to do a sudden moment like running or jumping for exercise. The truth is that it’s estimated that 1 in 5 women suffer from stress incontinence, and these are the ones that have asked for help. There are many more women who haven’t asked for help because they are embarrassed, and lets face it no-one wants to admit to ‘weeing’ a little when they laugh, it’s just not funny.
Many women suffer from stress incontinence at sometime in their life, either during or after pregnancy or late on in their late 50’s when lack of muscle tone and exercise cause the pelvic floor to collapse. Many women who are overweight are beginning to suffer because they don’t exercise and because the weight is putting so much pressure on their pelvic floor area.
Occasionally some women have health problems and find that Stress Incontinence is a side effect of surgery, illness or medications, in these instances your GP or Consultant should always be able to offer help and advice or refer you on to a Continence Nurse or specialist.
There is help out there and it’s not uncommon as you might think.
So Ok I leak a little why?
In most cases as said before the Pelvic Floor muscles have become weakened, and like all muscles they need to be exercised and worked to be effective, most women don’t know where to find these muscles (see exercise) or how they are important so the following diagram should help.
As you can see it’s a group of muscles that lie horizontal underneath the bladder, rectum and uterus, often for women the additional weight of baby and fluids puts additional strain on the Pelvic Floor Muscle and causes them to become weak and less effective, women who are active often exercise this muscle without realising it and of course in older women muscle tone in general become weaker.

I have Stress Incontinence now what?
There are a great many products on the market and they are very helpful in the initial stages prior to getting pelvic floor fit, and often its just a few months of exercise that can make a huge difference to your life, once you have mastered them it’s easy to fit them into your daily routine almost without thinking.
However if you are unsure then do consult your GP or Practice Nurse for advice, there are many types of incontinence but Stress Incontinence is the most common one. Urge Incontinence the second most common and is a condition where you feel the need to go suddenly and may not make it in time, this is due to an over active bladder.
As said before there are a large number of products available to help in the initial stages of getting fit, these are generally in the form or disposable pads much like Sanitary ones however they are specially designed to contain urine flow and may have odour inhibitors for that extra sense of security, rather than a menstrual many women will find that Sanitary Towels simply don’t work. Another product is specially designed underwear, totally normal looking but with a built in pad to help contain urine, and manufacturers are realising that Stress Incontinence is a condition that affects many young women not older ladies requiring ‘big pants’, the advantage of washable pants is the overall cost, whilst initially they might be expensive compared to using pads several times a day over a period of time they could work out cheaper, they also have the advantage of peace of mind after you have got Pelvic fit!
I can see on the picture where the Pelvic Floor is but I can’t feel it!
Like all muscles you need to physically know where it is then you know if you are exercising the right ones, there is no point in trying till you locate it first!
Finding the right muscles to exercise

1. Sit in a chair such as a kitchen or office chair with your feet flat on the floor and your knees slightly apart. Imagine you are trying to stop wind escaping from your back passage, you will need to squeeze the muscle that is just above your bottom, you should feel the muscle tighten but do not move your bottom or legs.

2. Imaging now that you are weeing and want to stop, you will find that the muscle near the front tighten slightly and it’s these that you will need to strengthen. You will also find if you are sat on the toilet and attempt to stop mid stream you will find these muscles tighten, if you are unable to stop completely consider doing some pelvic muscle exercises.

3. If you still aren’t sure you are exercising the right muscles, try to put a couple of clean fingers into your vagina. You should feel a gentle squeeze when doing the exercises. You can also practice this exercise during sex, your partner will be surprised.

Found them! When to do these exercises?

Everyday, whilst doing your hair, washing up, watching TV, standing making the tea, you can do them anywhere, though its best to practice at home first as you may be pulling a few strange faces which might scare the kids or fellow passengers till you have the knack.

Do them at least once a day but preferably several times, and continue doing them for at least 3 months to obtain best results. You will know if you are getting better when you can stop mid stream when sitting on the toilet!

So what do I do?

The Slow Pull Up

Sit, stand or lie with your knees slightly apart. Slowly tighten your pelvic floor muscles under the bladder as hard as you can. Hold to the count of five then relax. Repeat at least five times.

The fast Pull Up

Then do the same exercise quickly for a second or two. Repeat at least five times. These are called fast pull-ups.

Repeat these two exercises alternating between the fast pull up and the slow pull up for five minutes. Try to do these once a day but for outstanding result at least 3 five minute sessions. Perhaps if you are about to embark on a new fitness regime you could do these as a gentle warm up or wind down.

As you get better and your muscles get stronger try to lengthen the time you hold the slow pull up, 10 seconds is doing very well.

Be sure that you are pulling the right muscles, and remember to check, if you still aren’t sure ask your GP, Practice Nurse or Physiotherapist for help.

I’ve done the exercises and its no better
All is not lost, there are many reasons why, the most common is that despite your best efforts you just aren’t finding the right ones and they aren’t easy to locate as you have discovered. It could be that you have an undiagnosed infection which can be irritating the bladder or Urethra , it could be that you need to call in your very own personal trainer in the form of your Practice Nurse or Specialist Nurse/Physiotherapist.
And what will as specialist do for me?
They can offer a range of products and methods to help you find the right muscles or to stimulate the muscles into working properly.

• Electrical stimulation. Sometimes a special electrical device is used to stimulate the pelvic floor muscles with the aim of making them contract and become stronger this isn’t at all painful and is extremely effective, sometimes you are able to use this at home for a period of time to help get Pelvic Floor fit again.

• Biofeedback. This technique will help you to locate and to make sure you are exercising the correct muscles. A physiotherapist or continence advisor may insert a small device into your vagina whilst you are doing your pelvic floor exercises. When you squeeze the right muscles, the device makes a noise or signal to the computer screen to let you know that you are squeezing all the right muscles, at this time we are unaware of a home device.

• Vaginal cones. These are a set of small plastic cones that you insert into your vagina for approx 15 minutes, twice a day. These come in a set of different weights, starting with the lightest cone first (as with all muscle building) You then use your Pelvic Muscles to keep the cone in place, this helps you locate and thus exercise them and as with all weight training you gradually build up till you can hold the heaviest one for 15mins or so twice a day. These are extremely effective and discreet enough to use at home without anyone realising. These can also be obtained from some chemists and on-line.

• Other devices. There are many other devices available all with the same basic principle of inserting them inside your vagina with the aim of helping the pelvic muscles to exercise and squeeze. Like many products its best to do some research first as there is very little research evidence to show how well they work, there are no quick fixes.

It should always be remembered that these should be used along side the general and free exercises rather than instead of.

And if all that fails?
There is the option for surgery but this is usually only offered when all else has failed to help. This kind of surgery like all others carries certain risks which would be discussed with you by your specialist. The operation’s aim is to tighten the muscles and support structure just under your bladder, and is often very successful.

There has been some reports that the drug Duloxetine used to treat depression may have some benefits towards the treatment of Stress Incontinence because of the way it helps stimulate the chemicals that affect the nerves around the muscle near the Urethra that causes it to contact more strongly however as yet we are unaware of any UK studies that prove this.

As with all conditions, you should always consult your GP and consider making changes to your lifestyle if they impact on your well being. It is considered that doing regular pelvic floor exercises from early teens and onwards may help prevent the incidences of incontinence.

For more information click here

Your Prostate

What is the prostate?
The prostate is a fleshy organ, which is wrapped around the neck of the bladder like a ring doughnut or like a thick collar open at the front. It is made of glands and muscle. When a man has an orgasm, the prostate muscle squeezes fluid from the glands into the semen where it seems to energise the sperm.
Why do men get prostate trouble?
In boys and young men the prostate is tiny but for unknown reasons it gets larger later in life. The amount of enlargement varies from man to man, as do the problems that it causes. In most men this is an entirely benign process, which is so common that it can almost be considered a normal part of getting older. In a very small number of men there maybe a cancerous growth of the prostate. Because of its position, the enlarging prostate can throttle the outlet from the bladder (like tightening a collar) until it interferes with the flow of urine through the bladder outlet (urethra).