Aging Well: stronger pelvic floor can help women with urinary incontinence
HONOLULU - An estimated 25 percent of all women may have incontinence at some time in their life. That's often caused by a weak pelvic floor. Experts say it often happens to women in their 50s and older.
"It may happen after childbirth. It may happen after menopause," says Kapi'olani Women's Center physical therapist Nicole Tramontano. She teaches patients how to stop the leak.
"This is your bladder here. And you have your pelvic floor like a bowl or hammock," Tramontano says, pointing to an anatomical female pelvic model as she teaches a patient how to tighten her pelvic floor.
The 78-year-old patient, who wants to remain anonymous, says she had an accident when she couldn't hold it long enough to get to the bathroom. "Actually, it hit the floor when I got up, and I was not a happy camper. I got my clothes wet and it's like, What am I, three-years-old?" recalls the frustrated woman. "It's so limiting. It's embarrassing."
Tramontano says a weak pelvic floor is the problem. "You relax your pelvic floor and you're allowed to do your business. But a lot of people have trouble holding the pelvic floor when it's weak, and that's when you get incontinence," she explains.
It doesn't always have to be as drastic an example as the 78-year-old patient's. Sometimes, a woman can leak a little when she coughs, sneezes, or laughs.
There is something women can do to prevent or even reverse incontinence. Those are called Kegels, which tighten up all the muscles at the bottom of the pelvic floor. Here's how to do one:
"Imagine you're sitting on a horse. You're targeting all those muscles you're sitting on. You're going to breathe in through your nose and exhale. I want you to squeeze like you're shutting off urine," Tramontano coaches the patient. "Do you feel your muscles drawing in? Squeeze like your drawing those muscles in, and relax.
There are even weights you can train with. Tramontano produces a box of six colorful, silicone-covered, egg-shaped weights than range from zero to 4.4 ounces. "You put this in the vagina and hold. Leave it in there. It helps train the body to let this not fall," she describes. There are even vaginal trainers with a computer chip that can be synchronized to an app, so you can measure your strength.
If you have incontinence and your doctor has ruled out other medical causes, Tramontano also advises you to keep drinking water, even if that seems counterintuitive. If you drink less water, your urine becomes acidic, which actually makes the bladder want to relieve itself more often. It also leads to a host of other problems like dehydration and urinary tract infections.
Tramontano says women of all ages should do Kegels three times a day. Here's her recommended Kegel workout program:
To activate the fast-twitch muscles, exhale then squeeze for two seconds and relax for four seconds. Repeat ten times.
To activate the slow-twitch muscles, exhale then squeeze for ten seconds and relax for ten seconds. Repeat ten times.
This is one complete set. Do this morning, noon, and night.
Men can also strengthen their pelvic floors. Tramontano says men have fewer issues than women, whose pelvic floors are stretched by childbirth and whose anatomy makes them more prone to pelvic floor weakness. She says it's usually men with prostate cancer or enlarged prostates who may have overactive bladders.
More on Kapi'olani Women’s Center at https://www.hawaiipacifichealth.org/kapiolani/services/womens-services/.