Can’t Hold It? Tips for a Better Bladder

Do you “sneeze pee,” or leak when you cough, laugh or jog? A pelvic floor disorder may be to blame. Expert Katy Bowman explains how building up your butt can help – and give you a great booty at the same time… Urinary incontinence isn’t only for grannies. Just look at your grocer’s diaper aisle; once devoted to wetness protection for the very young and old, it now showcases pads for all ages. It’s a symptom of pelvic floor disorder (PFD), when your pelvic floor muscles don’t open and close properly. Symptoms range from urine leaks, pain and burning to pelvic organ prolapses, when the vagina and surrounding organs drop down. We’re all at risk, from couch potatoes to athletes, and the number of women who get it is growing. More than 28 million women in the U.S. already have PFD, and that number is expected to rise to nearly 44 million over the next four decades. Plus, the number of women with urinary continence alone will go from over 18-28 million during that time, according to a 2009 study by researchers from Duke University. Why? Because we’re sitting more, says Katy Bowman, a biomechanical scientist who specializes in mechanics of the human body. “It’s really an affluent disease – people living in post-industrialized countries sitting in chairs too much and using toilets to go to the bathroom,” Bowman says. As director of the Restorative Exercise Institute in Ventura, Calif., and through a series of DVDs (including “Down There,” which includes an exercise program devoted in part to preventing and treating pelvic floor disorders), Bowman wants to change the way women look at their health problems, like UI. It’s not the same old doc advice. Most women don’t use their bodies properly, says Bowman, and even blames Kegel exercises – the traditional therapy to prevent urine leaks – for the rise in pelvic floor problems. In this interview, Bowman explains why we get urinary incontinence and how to tackle it. How can you tell if you have urinary problems? If you drink and then feel like you have to go to the bathroom within 10 minutes, you might have a [problem]. When your urinary frequency seems to be interrupting your quality of life, then it’s an issue. What’s urinary incontinence? There are different types. When people use the term “incontinence,” they’re usually unable to operate the machinery that keeps things closed when they want it closed, and open when they want it opened. What causes it? If you ask an ob-gyn, the general answer would be damage during childbirth. Age is another one, the general weakening of the whole body. But actually, it’s not muscle weakness; it’s a musculo skeletal problem. The real cause is lack of butt strength. Butt muscle is equal to the quantity and quality of movement. It’s not the sitting; it’s the way we’re sitting. Are women more likely to be incontinent? Slightly. In general, we think of it as a women’s issue, but only because they talk about it more. A weakening of the pelvic floor tends to be a structural issue, [and] we have more surface area then men. They have more structural integrity [in that area]. Is it more likely to hit certain women? The women suffering from pelvic floor disorder are not your grandmother; they’re a thirtysomething tri-athlete. These are fit women who’ve had one or two kids. It’s not my mother, who had 10. This whole age-related thing is absolutely not true. The women buying my DVD are under 40 and peeing their pants already. When are you more likely to leak? It happens most often when you create a quick bearing-down movement, like laughing, sneezing, coughing or sitting up from a lying down position. These are all things that cause a sudden increase in internal pressure on the pelvic floor. If you don’t have the muscle strength, it squirts out. Why is there a rise in pelvic floor disorders? Western society has puritanical roots – we tuck our tailbones in – we were taught to do it. You inherited muscle movement the way you inherited your pattern of speaking – through observation. If you tuck your tailbone under because you’re told to, your gait pattern actually creates no glute muscle. You’re falling forward instead of pushing back off the earth. Having no butt is a risk factor for pelvic floor disorder. Urinary incontinence is a hot issue. Why? Because it’s so sensitive [a topic], and our perception of who it happens to and why is so different from actual experience. If you’re doing what you’re supposed to – Kegels, taking good care of yourself, eating right – and your organs are falling out, there’s a huge missing piece, and it’s frustrating. People are asking more questions and wanting [answers]. For generations, women have been told to do Kegel exercises to strengthen their pelvic floor. First, what is a Kegel? You have three areas you can Kegel independently: There’s the urinary area you use when you pee, the vaginal sensation when you squeeze a tampon, and the anal Kegel. We’ve taught women to tense, tense, tense and hold up all the time. The Kegel is like flexing the bicep up and not setting it back down again. You need to bring the weight back down to stretch the muscle out. Women are doing half of a curl with their pelvic floor, and that's what’s making it weaker and weaker. Why doesn’t it work? The Kegel will work in the short term. It’ll give you a little strength and some muscle action to push your organs back up or keep muscles closed. But it ends up pushing the sacrum [a triangular bone at the base of your spine] back into your bottom. The Kegel doesn’t work in the long run because it continues to tug on the sacrum bone. What are long-term solutions to ease, or prevent, pelvic floor disorders? You want to stop doing the thing that allows pelvic floor muscles to become weak in the first place, which is a lack of gluteal strength. We need a new pelvic floor exercise – the combination of a pelvic floor contraction and a deep squat – so the pelvic floor muscles can be strengthened at the same time. The most appropriate Kegel is done when glutes are contracted. If you’re in a full squat, that’s when you should do your Kegel. It’s that easy? People say, “I can’t believe it’s that simple,” but it really is. That’s why PFD isn’t prevalent around the world. If you squat, you know that 100% of the time you’re using your muscles in the right position. In research and literature, there are correlations between squatting cultures and easier deliveries – the amount of birthing trauma to the mother and baby is much better in squatting cultures. How often should we do squats? Sit down into a full squat three times a day. Put it into a daily routine. You can do it when you’re brushing your teeth, and that will give you deep hip and gluteal strength. It would allow you to do your Kegels in a way that you get more bang for your buck. It’s both prevention and treatment. What are other tips for urinary incontinence? Minimize caffeine. If you’re already struggling to keep your bladder shut, as soon as caffeine hits, it causes it to open. Don’t reduce water intake. Minimize intra-abdominal pressure exercises. Instead of crunches, do planks. You want abdominal tone. Stretching the backs of your legs by getting out of a chair regularly if you have to sit for a long time. If you wear high heels, the higher your heel, the more you tuck your tailbone under. Here are 5 exercises Bowman recommends for building your pelvic floor. How hard is it to overcome pelvic floor disorder? It depends on your level of commitment to changing the length of your muscles. It’s a daily practice. If you were supposed to be squatting three times a day since birth and you’re 50 years old, you’re going to have to give yourself time to undo habits. You would have to say, “How am I sitting?” and decrease your sitting time. You also have to look at your shoes to see what’s making the back of your legs tight. It depends on a lifestyle makeover. I’ve seen people with prolapsing organs get them back up with nothing more than diligence. Read a description of how to do a proper pelvic squat, complete with pictures, on Bowman’s blog, Katy Says. Consult your doctor if you think you’re experiencing urinary incontinence. For more complete information, visit our OAB Health Center. Are You Having Bladder Problems? Leak when you laugh? Have a constant urge to pee? Incontinence is a problem that can be managed. Knowing the causes and common triggers can help you stay dry and out of the bathroom.