You’ve admitted to yourself there is an issue. You’ve summed up the courage to seek help and now you have a diagnosis. Urinary incontinence, as we discussed in the first post, A Wee Accident, is not just a one size fits all diagnosis and treatment. There are a number of different types of urinary incontinence resulting from a variety of causes, with a variety of approaches to treatment. Remember that for the vast majority of women, urinary incontinence is not only manageable, but treatable and it is treatable at all ages. But to address the issue effectively you have to (with the help of a medical professional) figure out just what is going on.
Chocolate and other Bladder Irritants
In an early visit to the urologist I received a list of foods to avoid for several weeks: tomatoes, citrus, spicy foods, chocolate, what?! Chocolate? Say it isn’t so. Actually, tomatoes and curry are a favorite in this house too, but chocolate? I’d just made the switch to dark chocolate as that at least had some reported health benefits, now I had to cut it out? The instruction was to cut the foods out and see if there was a difference and, if so, to slowly reintroduce foods after several weeks to see if UI was worsened by particular foods.
Apparently, urge incontinence is worsened for many women by chocolate as it irritates the bladder. Coffee, decaf or regular, tea, soda, and smoking are also major irritants (give up the smoking now, it’s killing you), and caffeine can also cause bladder spasms. Nothing like a bladder spasm to send you rushing for the loo. For some people acidic foods like oranges and tomatoes can also irritate the bladder. Some bladders are irritated by milk, corn syrup, sugar, honey, artificial sweeteners andeven spicy foods.
After several weeks with no dairy, no spice, no tomatoes, no chocolate and avoiding sugar I was feeling lighter, but frustrated. I missed my spicy food most of all. However, it was making a difference. The question was what particular dietary elimination was making the difference. I started adding foods back in. First on the list, a nice hot curry. I was okay with spicy food, phew. Next dairy, then tomatoes and citrus and finally chocolate (I’m not a coffee, soda or tea drinker). I’m sorry to say that it was the chocolate that seemed to make a difference. Yet another reason beyond my waistline to give up that scrumptious stuff.
Addressing bladder irritants in my diet certainly helped the UI, but it still wasn’t right. I knew there were some physical, musculature issues going on including mild prolapse following my pregnancy. Pregnancy and extra weight can do a number on pelvic floor muscles that aren’t in great shape. The urologist recommended a physical therapist who specialized in the pelvic floor, and so off I went.
Heels, Squats and Posture
I remember very clearly at the six-week follow-up after my daughter was born the obstetrician laughing at my attempt at a kegel. No suggestion at how I might improve the situation, other than do more kegels. And it sort of makes sense, if you can’t lift much on a bicep curl you keep at it until you can, surely the same is true of kegels? Apparently not, because according to the Physical Therapist, the issue was much more complex.
The inability to do a kegel was a symptom of a much bigger issue which couldn’t be simply addressed by more kegels, especially half-hearted, not well-formed kegels, no this was an issue of alignment and posture as well as strengthening. This was learning, just like any training program, good form and strengthening all the muscles that supported the pelvic organs. Off with any kind of heel on my shoes, as they were contributing to poor posture and a weakened set of pelvic floor muscles. The physical therapist focused on my posture (a desk-bound worker I sat down all day, only to come home to my toddler who I put jauntily on my left hip) when standing, when sitting, when walking. I had stickers in the car reminding me to sit in a neutral posture and stickers on my work computer reminding me to do squats and now, I have my computer so that I stand to type for much of the time. Along with more specific pelvic floor exercises (we’ll talk more about kegels in another post) the focus on posture and alignment, strengthening the pelvic floor, made a dramatic positive difference to my symptoms.
It took a while to work out, but part of the Urologist and Physical Therapist’s suggestion was to note when incidents of UI occurred. They didn’t suggest when it might be, just to note if there was a time I noticed it most. Lo and behold there was a pattern, and there was good reason. Every month, in the week before your period, your levels of estrogen decrease, and this in turn affects the musculature around the urinary tract. The goal is to increase the pelvic floor strength, and this lowering of estrogen level will be less of an issue. This was a rather unpleasant insight into what will happen after menopause and an encouragement to get strengthening the pelvic floor now.
If you’re dealing with urinary incontinence, make a date to talk with your physician. Get a referral to a urologist and ask them whether physical therapy might provide the non-surgical, non-pharmacological treatment you need. At TMC we have a comprehensive Urologic Diagnostic & Treatment Center that can provide support for many of the treatments for UI. Physical therapy and behavioral treatments are part of a wider range of possible treatments to address UI. You should talk with a medical professional (neither this information, nor the resources beneath, should be viewed as a substitute for medical expertise) about what treatment is most appropriate for you.
Next time in this series we’ll talk a little more about behavioral treatments and the infamous Kegel.
Mayo Clinic – How to do a Kegel
Aligned and Well – This was a blog recommended by a pelvic floor physical therapist