Peeing with exercise, the new norm of women who have had children. The common joke at Crossfit, everyone lines up for the bathroom if they know double-unders or box jumps are on the board for the day. Same at the local boxing gym, when women know jumping jacks are coming, they run to the bathroom before the class starts.
Yoga and pilates, we don't need to worry as much, but if you're running the South Shore Half, mark the porta potties on the route, or make sure you know where your friends live, so you can time your bathroom stops appropriately.
Any of this sound familiar? At six years postpartum, 45 % of women have some type of incontinence.1
Why is this? Why do we as moms assume that peeing when exercising is our new normal since having kids? It is part of our culture now. The joke when groups of women are laughing: "I laughed so hard I peed my pants". We're not afraid to talk about it anymore, Hello Poise commercials, but we're still afraid to do anything about it. Women are willing to live with wet pants. It's why black yoga pants are the standard mom uniform.
But, we don't accept other injuries or dysfunctions to our body as normal. If my knee kept buckling, while I was walking causing me to fall every day, would I just say, "well hey that's part of being a mom, I guess that's my life now". No, I would go to one of my local orthopedic colleagues, like Kellie Bedoni at www.kbedonipt.com/and say, "Hey Kellie, my quads keep giving out can you help me out here?".As that is not a normal finding! Same with leaking urine, it is not normal to leak urine, really at any point in your life. It means you have a pelvic floor muscle dysfunction. And it is unlikely to go away without some type of intervention.2
Good news for anyone who has read this far, there is treatment for urinary incontinence: pelvic floor physical therapy. It is known to be very effective at treating incontinence, it's conservative, no drugs or surgery necessary.3 Sounds good, right? With such a success rate for treating this condition, it's a wonder more moms aren't seeking it out. A marketing failure of our profession, perhaps. Maybe there is too strong of a cultural belief that moms are meant to leak, and its made even stronger by social media. There's also many advertising dollars at work, Poise and Depends anyone? These ads perpetuate the belief that it is common to have incontinence. Who knows? But I'm here to let women know that pelvic floor PT is 70% effective at treating incontinence.3 You won't need to wear your black yoga pants all the time anymore. Call a pelvic floor PT today!
1. Wilson PD, Herbison P, Glazener C, McGee M, MacArthur C, 2002, Obstetric Practice and Urinary Incontinence 5-7 years After Delivery, ICS Proceedings Neurourology and Urodynamics: 21(4):284.
2. Herschorn S, Corcos J, Gajewski J, Schulz J , Ciu E, 2003, Canadian Urinary Bladder Survey: Population-based Study of Symptoms and Incontinence. Neurourology and Urodynamics, 22 (pt5)
3. Price N, Dawood R, Jackson SR, 2010, Pelvic Floor Exercise For Urinary Incontinence: A Systematic Literature Review. Maturitas, 67 (4): 309-315.
It's World Continence Week!
Yea! Let’s celebrate!
I’m not quite sure what we are celebrating....................the ability to maintain continence I guess ????
but I’ll take any excuse to party. It’s summer today, the spring craziness is finally dying down around here, and I’m ready to relax at the beach. I mean at least for 5 min, until I have to build a sandcastle with one of the kids.
Turns out the ability to maintain continence is more difficult than one might expect.
Around 50% of women have incontinence at some point in their life, so it does not just affect elderly women like many people may expect.1 It can affects teenagers (10%), young adults (20%), 30-40 somethings (50-70%), and high-level female athletes (28-80%). 1,2
Yes, it is much more common than people think, affecting a variety of different age brackets of women. And yes, men are also affected, to a lesser extent. Just another example of #genderinequality, but I digress. (It's more related to anatomical differences).
Anywho, There are a few types of incontinence: stress, urge, and mixed (a little bit of both).
Stress urinary incontinence: peeing when the body is “stressed”, during sneezing, laughing, coughing, jumping, or running.
Urge incontinence: needing to pee NOW! And maybe leaking a little bit on the way to the toilet.
Mixed: Both of the above, Fun!
So why does this affect so many women? There can be many factors: weak pelvic floor muscles, overactive pelvic floor muscles, increase in intra abdominal pressure (during exercise or maybe due to constipation), overactive bladder, and also other medical comorbidities. This is why incontinence products is a billion dollar industry.
Ok, so you’re probably thinking, I pee a little bit sometimes too, but I’m a mom, so I thought that was expected after childbirth.
WRONG! It is common after childbirth, but not normal. #commonnotnormal
So what do I do now?
Wear black all the time?
Pee right before exercising?
Pee every hour so I don’t leak?
Don’t drink as much water so I won’t leak?
Buy stock in Depends?
Wrong! (Except maybe wearing black, that's always in)
Physical therapy is perhaps the most effective conservative treatment for urinary incontinence.3 You no longer need to suffer in silence……...or wetness.
See a women’s health PT that can teach you many strategies to effectively manage all types of incontinence.
1. Nitti, V. THe Prevalence of Urinary Incontinence, Reviews in Urology. 2001; 3(1) S2-S6)
2. Heath A, Folan S, Ripa B. et. Al. Stress Urinary Incontinence in Female Athletes. Journal of Women’s Health Physical Therapy. 2014;38(3):109.
3. Berghmans L, Hendricks H, Bo K, Hay-Smith E, De Bie R, Van Waalwijk van Doorn E. Conservative treatment of stress urinary incontinence in women: A systematic review of randomized controlled trials. British Journal of Urology. 1998; 82, 181-191.
A question I am often asked by many women. First let’s define what a kegel is. Basically, a kegel is a contraction of the pelvic floor muscle group. Just like a bicep curl is a contraction of the biceps muscle group. It is called a kegel, because back in 1948, Dr. Arnold Kegel coined the term and it stuck. It’s also easier to say “perform a kegel”, then “contract your pelvic floor muscles”. In a time-crunched society we love our abbreviations.
You often see those memes, e-cards, or even articles in fitness magazines, toting: Do your kegels often and regularly to prevent a variety of women’s health issues, such as urinary incontinence, prolapse, or even bad sex. If you follow the general advice, it basically amounts to doing kegels every day, at every spare moment of the day. Do your kegels at every commercial, every red light, when you’re peeing, etc. Basically, there is never a time not to be doing your kegels. It leads women to believe if they are not performing kegels at this high frequency, their vagina will fall out of their body or they will have a lackluster sex life.
This message is inaccurate, and an unnecessary scare tactic for women desperate for any advice to help with these private and personal issues.
The pelvic floor is never at rest, which is why we don’t need to be constantly training it. You would never train any other muscle group that way.
Marathoners don’t run every day.
Cross-fitters don’t dead-lift every day.
These athletes know the risk of overuse injuries when they over train a group of muscles.
So what happens when you over-train the pelvic floor? It can become overactive, and it will develop muscle failure due to fatigue of constantly contracting. As a result, when it is tasked to perform at a high level, like when you sneeze, you will have failure of the pelvic floor to do its job, i.e. maintain continence.
You can have a perfectly strong pelvic floor, but because it is now overactive it functions as if it’s a weak pelvic floor. This is why the recommendation from mainstream media to “just do your kegels” does not help everyone, and can actually make a problem worse. Pelvic rehab is not a one-size-fits all approach.
The pelvic floor can be either weak or overactive, and it is important to identify how it is functioning in each individual person.
Kegels do have their proper time and their place in pelvic floor rehab, but the key is to know when, where, and how often to perform them. A women’s health therapist can give you that answer and help you to design a pelvic floor exercise program that is specific to you and your needs, your individual issues and your long-term goals.
And it likely will not start with kegeling every time a commercial comes on..........
Can we stop calling it mommy tummy?
1. I hate the phrase, kind of like I hate the word moist.
2. It is not just moms that are affected by it.
We don't call an ACL injury, football knee because it mainly affects football players. The technical term is diastasis rectus abdominus or DRA for short.
Ok, so what is it anyways?
Well, DRA is when the abdominals separate in the middle, more specifically when rectus abdominis muscle (6-pack muscle) separates along the linea alba. It is typically diagnosed when the distance is 2 cm. or greater. It DOES typically occurs in pregnancy, but like previously mentioned men can get it too. Some research supports the notion that it happens in 100% of women in pregnancy, but that is not necessarily a bad thing.1 The women's growing uterus needs a place to expand. However, it can become a problem when it doesn't resolve after pregnancy. Women with DRA can develop low back pain, pelvic pain, prolapse or even incontinence. It is not just a cosmetic issue. It is important to identify this condition as it improper exercise can actually increase the size of the DRA.
Many women will ask their trainers, fitness instructors or even ob/gyns......"What can I do to prevent this from happening during pregnancy?" Unfortunately, any advice given is not supported by any current research.
Wait, What ?!?!?! So there's nothing I can do to prevent this from happening to me?
Maybe, maybe not. The point is we don't necessarily know why it happens in some women and not others. It's not due to excess weight gain, it's not due to having multiples, and it's not due to large babies.2 There's not enough research out there on DRA yet to make specific recommendations of what to avoid during pregnancy. Most advice is based on theories or opinions.
So please ladies, don't blame yourself. We got enough that we need to avoid during pregnancy, we don't need to add any more things to our "AVOID list in Pregnancy". We already miss our wine and sushi!
The postpartum period almost needs to be treated like any other injury or trauma to the body. We aren't just magically healed at 6 weeks postpartum. We need to take the time to take care of ourselves.
DRA is treatable condition, even large DRA have been showed to be treated effectively with conservative treatment like physical therapy.3 However, correcting DRA is not a one size fits all approach, so if you tried an online program and it didn't work for you, there's likely a reason for it. One possible explanation is that you are only training the abdominals and not evaluating the function of the pelvic floor. It's like trying to fix a crack in the wall, and not addressing the the huge crack in the foundation of the house. The wall will just develop another crack until the foundation issues are corrected. Same with DRA. If only the abdominal separation is treated, and the pelvic floor is not addressed, it's likely that issues will continue to happen. DRA treatment is most effective when the entire person is evaluated and their treatment is personalized to their own impairments and functional limitations.
How can you do that? The best way is to seek out help from a pelvic health physical therapist.
1. Gilleard, WL & Brown, JL. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postpartum period. Physical Therapy. 1996; 76 (7): 750-762.
2.Mota, PG, Pascoal AG, Carita AI, and Bo, K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbopelvic pain. Manual Therapy. 2015; 20 (1): 200-5.
3. Litos, K. Progressive Therapeutic Exercise Program for Successful Treatment of a Postpartum Woman With a Severe Diastasis Recti Abdominis. Journal of Women's Health Physical Therapy. 2014; 38 (2): 58-73.
This is the question I've been asked most frequently upon starting my business. What is women's health (or pelvic health) physical therapy? Depending on my audience, I will give differing responses.
Say, it's one of my husband's male coworkers.....
"Women's health is a physical therapy specialty treating mainly conditions that occur in women, such as pregnancy-related pain, postpartum pain......." eyes glaze over before I even finish my sentence and then I usually get some mansplaination, such as "Oh yeah, I had to have physical therapy once, when I sprained my ankle playing softball. Had to get back for the team, playoffs". Priorities right?
Or maybe it's an older female relative of mine...
"What do you do again honey?"
"I actually just started my own women's health physical therapy business".
"That's wonderful! Now, what is that again?"
"Well, Aunt Doris, I am specialize in treating women who have conditions related to pregnancy or childbirth, such as incontinence, diastasis recti, pelvic organ prolapse, or pelvic pain."
"Isn't that what Depends are for?"
"No, Aunt Doris, physical therapy can actually cure incontinence, so you wouldn't need adult diapers anymore".
"Oh really?, But did you see the new patterns they came out with?
And therein lies the issue, there is not a whole lot of understanding of what women's health physical therapy is, from men or women. Most people understand orthopedic physical therapy, pediatric physical therapy, or even geriatric physical therapy without a huge long explanation of what they do or who they treat. We as a specialty need to get the word out there to the general public. The problem is that there is a stigma associated with many of these conditions. Who likes to talk about incontinence with their friends over dinner and drinks?
Luckily, incontinence has been gaining traction in the media, as Crossfit has been publicizing urine leakage in their female athletes as a badge of honor. While this does serve to destigmatize incontinence, it is also normalizing it as a common condition among female athletes. Just because its common does not make it normal, but that's another post for another day.
When I talk to fellow mom, I usually try to give more specific details so that they know that there is help out there, whether it is from me or another physical therapist.
And the conversation usually goes like this...
"Aaargh, I hate doing these (burpees). I'm just going to run to the bathroom."
"You know that physical therapy can help with that?"
"Really, with peeing my pants?!?"
"Yes, of course, just like any other muscle group the pelvic floor can be rehabbed to perform like it did before childbirth."
"My ob/gyn said it's just a factor of having two kids."
"It is certainly common after two kids, but it does not need to last for the rest of your life. The pelvic floor can be strengthened like any other muscle group."
"Oh, that would be life-changing! If only I had time for that".
Riiiiiight, If only you had the time. I usually have to bite my tongue at this point. As I know that they could make the time if it was important to them, they just have not made it a priority in their life...............................yet. The time will come.
Pelvic health physical therapist, wife, mother, yogi, foodie.