Urinary Stress Incontinence

Stress incontinence is the most common form of urinary incontinence, exercises are generally given to "strengthen" the pelvis floor (PF) and in extreme cases surgery may be necessary.

Urine & The Bladder

Our kidneys are making urine all the time - it trickles constantly down the ureters (tubes from the kidneys to the bladder) how much urine you make depends on your diet, how much fluid you take in and how much you sweat.

The bladder stores the urine, expanding like a balloon as it fills up. The Urethra, the outlet for urine is normally kept closed, assisted by the muscles that run underneath - the pelvic floor muscles (PF).

When you feel the sensation that your bladder is full you will pass urine - the bladder contracts whilst the pelvic floor and urethra muscles relax.

I have explained this very simply - the reality is a complex connection of nerve messages between the brain, bladder and pelvic floor muscles that tells them when to contract or relax as needed.

What is stress incontinence?

This occurs when urine leaks because there is sudden extra pressure on the bladder and the support muscles of the pelvic floor and urethra cannot withstand it. Stress incontinence happens when the pelvic floor muscles become weak. It can be a small amount, but it can also develop into an embarrassing situation.

People complain it happens when the cough or sneeze, run or jump. This is due to extra abdominal pressure on the bladder.

What can cause weak PF Muscles

Probably the most common reasons are child birth, menopause and high impact exercises. Being overweight, long distance lorry driving (yes) and a desk bound job may also be part of the reason. What is sometimes forgotten is that incorrect technique when performing abdominal exercises has significance too.

Pilates exercises and the PF

The PF is an interwoven hammock of muscles from the tailbone to the back of the Pubic bone. They support the bladder and bowel.

There are 3 main reasons these muscles become weak:

• Fascia becomes stretched - muscles become too short or too long
• Delayed, Absent or Asymmetrical contractions
• Lack of strength and or endurance of the muscles

When our clients are performing exercises during their Pilates sessions with us, we need to ensure they understand the importance of not holding their breath. This is not only a bad idea for their blood pressure, but it also creates abdominal pressure that may push their pelvic organs and bladder downwards. Continued practice like this may eventually effect the structure of the PF muscles to stretch them or cause them to easily fatigue.

Mind & body connection

Teaching our clients how to stabilise their low back and pelvis at the same time improving mobility as well as stability through the low back pelvis and hips will help them become aware of their deep abdominal and pelvic muscles as they move. This will also help them transfer load through the pelvis correctly.

Correct alignment between and within the Lumber spine, Pelvis and Hips together with improved posture and good movement habits are all factors when considering PF exercises.

Stability and mobility are basic Pilates practice when performing exercises, by default regular Pilates practice should help those suffering with continence problems and avoid it for others.

However, the big thing is only perfect practice makes perfect.

Just "doing" Pilates will not affect the problem if there is one or avoid one either. Robotic performance of the moves is not enough.

Back to Basics

As part of your regular teaching practice its a good idea to revisit the basics from time to time. This doesn't mean you have to take your advanced and more skilled classes back to a full hour of basic practice. What I am suggesting is that you take the time either at the start of your session in the preparation phase or as a cool down to remind your clients how to engage their PF.

As we know we cannot see if our clients are working correctly but we can give them the information they need and encourage them to notice how they are feeling.

When instructing a client to draw up their PF - there should be no outward sign of muscle contraction. Glutes, Adductors or Rectus abdominis should not contract.

It is often easier to do this specific practice sitting down - so maybe a warm up of cool down on a stability ball is an idea. The contraction starts in the Sphincter muscles or Rectum and then the Vagina in women followed by the Urethra, the three areas of the PF gently contract and a sensation of drawing up, ideally for around 10 seconds before slowly releasing is a guide.

For male clients drawing their testicles into their body is the cue. You may have a less clinical description such as walking into the sea as a visual.

Some clients may say they cannot contract for 10 seconds at a time - this is ok let them start where they can and work on that. Allow a short rest in between contractions.

Time to refer

The PF is a complex structure. Should a client of yours be suffering with stress incontinence to the degree she talks with you about it showing concern. I suggest you refer her to her medical practitioner. An ultra sound scan will inform her exactly what her situation is and how best to address it.

As exercise teachers we are not in a position to diagnose conditions, in this area in particular care needs to be taken.

Merely suggesting Kegel style exercises for your client may not be enough to help, medical advice is the best solution if a client has a problem that effects her daily activities.

However, we can rest assured that our method of gentle contraction of the deep abdominals, together with the layering on of muscles as a movement progresses is both effective and useful in fighting the possibility of stress incontinence.

Reminding our clients of the need to:

• Not hold their breath
• Soften knees as they perform a roll up exercise
• Pre-contract their support muscles before movement

is essential for perfect practice.

Finally

Your comments and input regarding this article are always welcome.

Nuala

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