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Leaking urine is never a pleasant experience. However, as with most things in life, you can fix it, or at least, improve the situation.

ONE of the most difficult topics for my patients to bring up is incontinence. It is natural to feel a little embarrassed talking about it – after all, it’s bad enough having to worry whether your next laugh, sneeze or cough will send you running to the bathroom. However, you’ll be surprised to learn that if you suffer from incontinence, you are not alone! And it does not have to be tolerated stoically. There are ways to manage incontinence so that your leaky bladder does not rule your life!

What is incontinence?

Urinary incontinence is when you urinate beyond your control, such as when your abdomen is under stress from laughing, exercising or straining (stress incontinence), or when you often have the feeling of not being able to reach the toilet in time (urge incontinence). Stress incontinence is most often caused by weak pelvic muscles. Your pelvic floor muscles are located at the bottom of your pelvis (see illustration). They consist of several layers of muscle that stretch between the legs and attach to the front, back and sides of the pelvic bones. These muscles support your urethra, bladder, uterus and rectum.

When you reach the toilet, you relax your pelvic floor muscles and your brain gives permission for the bladder muscle to contract, squeezing the urine out through the urethra (the tube from the bladder to the outside). When the bladder muscle contracts, the sphincter muscle that holds the urethra shut during storage relaxes to allow the urine to pass through. Incontinence affects women seven to eight times more often than men. Childbirth is one of the main reasons for this. Pushing a baby through the birth canal stretches the pelvic organs a fair bit and can weaken or damage the pelvic floor muscles.

The damage of childbirth can be worsened by such things as long-term coughing or sneezing, constipation and increased body weight. In addition, menopause, with its decreasing oestrogen levels, can also contribute to incontinence as oestrogen helps keep urinary sphincter muscles strong.

Staying dry

In 1948, a gynaecologist called Dr Arnold Kegel developed a method of treating urinary incontinence in women after childbirth – using exercises that naturally came to be known as Kegel exercises. The basic idea of Kegel exercises is to strengthen the pelvic floor muscles by contracting and relaxing the muscles. These exercises can also be done by men who experience urinary incontinence after undergoing prostate surgery, or by men and women who have faecal incontinence (involuntary release of stool).

Today, Kegel exercises are commonly taught to women before, during and after pregnancy. Besides strengthening the pelvic muscles and improving continence, the exercises may also help during the delivery of the baby and speed healing after childbirth. Kegel exercises are also useful for older women who suffer incontinence due to the onset of menopause.

Doing the Kegel

The Kegel exercises involve a series of simple contraction and relaxation techniques. For the exercises to be effective, you must get the technique right and do it regularly. Talk to your gynaecologist if you are not sure whether you are doing it right.

1. Find your pelvic floor muscle These are the muscles that you would contract when you want to stop urinating. Remember, you are not supposed to contract your buttocks, abdomen or thigh muscles. Another way to find your pelvic floor muscles is to insert a finger into your vagina and contract the muscles, using the sensations on your finger to guide you. When you have found the correct muscles, contract it repeatedly until you become familiar with the sensation.

2. Now, to begin the exercise Contract the pelvic floor muscles for 10 seconds. This is easier said than done! Remember not to contract any other muscles. If you cannot hold it for 10 seconds, just try to contract for as long as you can.

3. Relax the muscles for 10 second Good relaxation is as important as good contraction.

4. Repeat the exercise eight to 12 times, three times a day (morning, afternoon and evening). You should do this three to four days a week, for at least 15 to 20 wee.

5.  You can do these exercises anywhere, such as while lying or sitting dow

Don’t think that you can do the exercises 30 times in one day and stop the next day! If you do too many repetitions or too frequently, you may cause muscle fatigue and worsen the incontinence. If you have pain or discomfort in your abdomen or back while exercising, you may not be doing it right. Ask your doctor for advice. However, if you are doing it right, you will probably see improvement in your bladder performance after four to six weeks. It could take up to three months for some people – don’t be impatient as this is not meant to be a quick cure.

Biofeedback is sometimes used to train patients to perform the Kegel correctly. Biofeedback uses signals from the body during therapy, and in this case, measures the patient’s muscle contraction strength. Another technique is to insert weighted cones (eg Femtone) into the vagina, whereby the patient has to contract the pelvic muscles to prevent the cones from dropping out. FemTone vaginal weights are a set of five reusable, tampon-like, sterile cones of identical size and shape, but of increasing weight.

FemTone weights when used during Kegel exercises have been found to strengthen the pelvic floor and may improve urinary continence. Many women who utilise vaginal weights see marked results in trying to overcome incontinence. Electrical stimulation can also be used to stimulate the pelvic muscles.

The Kegel exercises are a simple and cheap (practically free!) method of improving a potentially embarrassing condition. There’s an additional benefit too: the exercises also strengthen the vaginal muscles, so it may improve sexual satisfaction. Now, go off and “Kegel” your way to dryness!

The Star Newspaper,  Sunday February 24, 2008

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