I overheard two women discussing urinary incontinence in the ladies room. One complained that coughing caused her to pee her pants. The other was upset because she leaks a little urine when she exercises. Unable to keep myself from responding to what I consider a woman’s health emergency, I said, “I’m a gynecologist. And in order to prevent this kind of urinary problem, you have to develop strong buttocks muscles and get in touch with your pelvic floor. I recommend peeing in the shower.” They were a little offended by my brash advice.
About one in four women suffers from urinary incontinence, the involuntary loss of urine when sneezing, coughing, or laughing. And even more have what’s called “urgency incontinence” when the urge to urinate is so strong that you fear you won’t get to the bathroom in time. Urinary problems in women are epidemic. In fact, the number one reason why older women have to go to nursing homes is…drum roll…urinary incontinence!
Did you know that the average woman suffers in silence for an average of seven years before she finally brings it up with her healthcare practitioner? When she does, usually she is told one of two things: take a drug or do Kegel exercises.
The drugs stop “urge incontinence” by blocking some of the nerve endings on the bladder’s main emptying muscle (the detrusor). When the muscle is less irritated, it’s less likely to contract involuntarily—and cause you to lose urine at an inconvenient time. These drugs have bothersome side effects, though, like dry mouth. And besides, like so much of modern medicine, they don’t really cure anything. They just mask the symptoms.
The Kegels strengthen the PC (pubococcygeous) muscle, which closes the sphincters of the pelvic floor and stops the flow of urine. Kegels are a step in the right direction. But they don’t address the function of the entire pelvic floor—they strengthen only one muscle. A strong, rigid muscle isn’t necessarily a functional, strong, flexible muscle. That’s where the squats in the shower come in.
When you squat to urinate as opposed to sitting up straight on the toilet, you automatically engage your butt muscles. And your pelvic floor naturally stretches and tones. Moreover, because your urethra is now pointed straight down all you have to do is relax for urine to flow out easily—as opposed to sitting up straight and having to strain to empty your bladder. The same thing is true with moving your bowels.
Before going on, I want to bust a popular myth that childbirth results in urinary incontinence. This is not true. Many teenage girls have incontinence. And so do nuns who have never had children. Yes, childbirth—especially when conducted without knowing how to push correctly—may weaken the pelvic floor for a time. But that is reversible.
So what do I recommend if you have urinary incontinence or are worried about it?
- See a women’s health physical therapist who specializes in the pelvic floor. This relatively new specialty uses Pilates and other exercises to assist you in reclaiming a healthy and functional pelvic floor. The pelvic floor is all the muscles and tissue between your pubic bone and tailbone, and it holds in your bowels, bladder, and genital organs. When this part of your body isn’t strong or toned, your organs tend to fall out! That’s known as a prolapse. Prolapses can often be treated well with physical therapy alone. You don’t always need surgery.
- When you sit on the toilet, put your elbows on your knees so that you are in a squatting position. Notice how much easier it is to empty your bladder or bowels. Better yet, get a stool and put it under your feet so that your body is comfortably seated in a squatting position. (Check out the squatty potty video to see what the proper position is.)
- Strengthen your core. I have done Pilates for 15 years and can attest to its ability to strengthen one’s pelvic floor.
- Read The Bathroom Key: Put an End to Incontinenceby Kathryn Kassai and Kim Perelli or go to www.thebathroomkey.com for more resources and to locate a physical therapist in your area.