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A podcast from the Continence Service in the Northern Trust, providing listeners with a greater understanding of bladder and bowel dysfunction and education of what may be contributing to the problem and supportive measures which could be implemented to improve bladder and bowel difficulties. The series will give an introduction to the Continence Service and discuss common types of bladder and bowel incontinence difficulties, such as overactive bladder, stress urinary incontinence and functional incontinence. It will also look at how good bowel management can help with incontinence overall. The series will also feature service user stories and learn about the lived experience of someone with a bladder and/or bowel dysfunction.
Continence Challenge Podcast - Ep2
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Hello, welcome back to the Continence Challenge podcast, helping you regain control. Brought to you by the Continence Advisory Service staff of the Northern Health and Social Care Trust. My name is Deirdre O'Brien. I am the Continence Nurse Coordinator for Adult Services. In today's episode, we are going to talk about stress urinary incontinence, what this is, how it presents, who might be affected by this, and what coping strategies we could give you or advice that we could give you to implement into your lifestyle to try and make a difference before you see us at clinic.
Joining me today on this episode is is two of my Continence Advisors, Noeleen Henry and Bernadette Vicente. So first of all, I'm going to introduce Noeleen to speak with you, and Noeleen's going to describe what stress incontinence is and how it presents. Stress urinary incontinence is literally a leakage of urine from your bladder, especially when you're coughing, laughing, sneezing, or exercising.
It can happen because of an increase in abdominal pressure. Can you explain why that happens? Literally it is the bladder neck isn't closed over. This can possibly be due to increased pressure. And the urine literally just leaks through the bladder neck. Your weakened bladder neck or hypermobile urethra External sphincter weakens this and can be improved by a pelvic floor muscle regime.
And who would be more at risk? Um, ladies, possibly with the increased weight on their tummies during pregnancy. Both men and women who are overweight. Possible multiple sclerosis. People that have chest problems, COPD, back problems. Asthma. People that have chronic coughs. This happens both men and women.
Although it would be mostly women that we would see. With regards to pregnancy. Because in men the external sphincter is more powerful. We talk about there, about the weakened in the pelvic floor muscle, um, playing its part in stress incontinence with that increased abdominal pressure. And as Noeleen rightly said, um, women are more at risk than men.
And generally that is because men, that external sphincter is, is more powerful and it doesn't tend to change with age. But in women, um, The majority of women will have children and come through childbirth and that can distort where the bladder and urethra is sitting and can sometimes, with a bit of pelvic organ prolapse, can make them more susceptible to stress urinary incontinence.
I also have noticed that, you know, there's a lot of younger patients coming to clinic Noeleen as well that would have stress urinary incontinence, particularly maybe when they're going to the gym. Can you think about certain exercises that they might be doing that sometimes can exacerbate that?
Unfortunately, we have noticed a lot of younger ladies coming through. They would be doing a lot of heavy squats or deadlifts. Obviously, the extra pressure on their pelvic floors, they um, notice they're having ongoing issues with stress urinary incontinence then. And burpees, that's another one I, I find them, sometimes these mums post delivery want to get rid of the.
the pregnancy excess weight and they're going to the gym and they're sometimes they're engaging in exercises that are maybe just too high impact when their core muscles are not strong. And sometimes I think maybe advising them to do the likes of yoga, Pilates or things like that to strengthen their core muscles and lower impact exercises can help.
So I'll introduce you now Bernadette. Um, Noeleen had mentioned there that Stress urinary incontinence is more prevalent in women, but it does happen in men too. Can you describe to us times whenever we would see it, when it presents more in men? So most of the men we would see that has stress urinary incontinence would be men post posterior surgery.
And although this can be a big issue for them, sort of straight after surgery, with doing pelvic floor exercises routinely, sort of three times a day. Can see a big improvement in this over, over the first few months following their surgery. Of clients too that we see, Bernadette, that would be, um, particularly a risk, and that would be, like, women, perimenopause or menopause, can you describe why that would be?
So women, sort of perimenopause, menopausal. Can sometimes gain a bit of tummy weight and that can put down an increase on abdominal pressure on the pelvic floor and as well the muscle mass in ladies sort of over a certain age decreases and the muscles around the pelvic floor and that then weakens as well and as well as the lack of hormones or the decrease in hormones as well.
especially oestrogen, and then that can sort of just cause a weakness around, around the bladder and around the pelvic floor. Noeleen, do you want to give us some advice for, for these patients that are experiencing that leakage whenever they cough and sneeze and that stress urinary incontinence? What they can do between now and whenever they see us at clinic?
What can they do in their lifestyle to make things maybe a bit better? First of all, there's a few lifestyle changes. Very, very basic. Try and lose weight if you are carrying a wee bit excess weight. Do pelvic floor exercises. Again, very, very simple to do, but very easy to forget to do. Pelvic floor exercises can be done sitting, lying, standing.
Um, literally, you pull your bottom in. As if you're holding in wind. And try and really tense that muscle up. And then pull your front up along with that. Pretend it's a zip and just zip up the front. And keep that tense hold for about 10 seconds, if you can. And then relax. You're repeating that exercise 10 times.
And then there's another set of exercises that's exactly the same, except there's no hold. So again, pull your bottom in, pull your front up, and just relax. So we're doing ten of the exercises with the hold, ten of the ones without the hold. Repeat it roughly about three times a day. Morning. Afternoon. And that's great.
That's, that's how you actually do the exercise as Noeleen described. To hold for 10 seconds, you may not find that you, at the beginning, that you can do that. And as you tense that muscle in, you know, when you're thinking about that feeling of needing to pass wind, trying to pull those muscles in and bring it forward, bring the tension right round to the front.
If you find that you can only hold that for maybe two or three seconds initially. That's fine. Work with that. This is an exercise program and everybody's individual. So, you start from your starting point and you keep working at that until you can reach where you can hold it for ten seconds. And that may take you a number of weeks to reach there.
So, as Noeleen described, you want to do the slow exercises and those are the endurance exercises that help your pelvic floor muscle become stronger. Hold on when you really need to go. The other ones, again, the quick exercises, that helps your body react quickly whenever you have to cough or sneeze.
There's another type of pelvic floor hold that we call the knack, and that is really where you, um, pull that pelvic floor muscle in, but this time, rather than pulling it into the intensity that you, your maximum intensity, this time you're pulling it in to sort of half intensity. And if you do that regularly before you, um, cough, cough, or sneeze, or even whenever you have that sudden urge to get to the toilet, you'll find that you'll be able to hold a bit better.
So that's called the knack, sort of preparing yourself for that. Maybe if you're going to lift a heavy box or if you're going to, um, cough or sneeze, um, that you do that exercise. The other thing too, is that these exercises could be new to you. You may not have done them before. And You may google them or read online how to do them.
And they'll tell you that you have to just isolate that muscle alone. And that you shouldn't be holding your breath whenever you do it. At the beginning you might find that you are using other muscles and that you do tend to hold your breath. Don't panic about that. Just keep practicing. And with practice you'll get better.
The more you, the more you engage that muscle, the easier it's going to become to pull it in and for it to react for you. It does take time though. It takes, it takes roughly a good six weeks of doing this before you may notice those changes within your incontinence. But do persevere and keep going. It really is worth the effort.
I'm going to ask Bernadette to speak now about, sometimes there's patients that we would see at clinic where we might not ask them to do pelvic floor. Muscle exercises, even though they're having stress urinary incontinence. And that would be for specific reasons. So, Bernadette, do you want to explain how some patients doing initial pelvic floor exercises might not make things a bit better?
So, there's, there's some ladies that would already have tense pelvic floor muscles and these would generally be be ladies who maybe are, are tense in life anyway and they would hold themselves close. Maybe hold in their tummy muscles. Um, so ladies who do that all the time then can be putting pressure on their pelvic floor quite a bit and then their muscles aren't relaxing in between doing their pelvic floor exercises.
So at this stage we would say not to be doing as many exercises because it can be putting in extra strain. on their pelvic floor muscles. And in situations like that, we would probably onward refer that client, Bernadette. But there's other things, if maybe this, for this person listening today, if they know that they maybe do suffer a lot of tension around the pelvic area, or maybe a pain or discomfort around the pelvic area, they might be at risk.
Maybe something like taking warm baths or meditation things, they could maybe help them. And then we could onward refer them to pelvic health physio as well and they could give them relaxation exercises to, to help and the likes of meditation as well can, can sometimes help these ladies to try and relax their muscles and generally relax as well.
I think there's another thing too, I, um, would have found sometimes in clinics, talking to particularly younger women, um, that suffer from stress urinary incontinence, and a lot of them wouldn't necessarily sit on a toilet, they sort of, um, hover over a toilet seat when they're out to go to the toilet, because they don't want to sit on the toilet seat, and just to make you aware that doing that.
Well, I'm not saying you have to sit in every toilet seat, um, but you know, if you can, give it a wipe and sit down because once you're actually emptying your bladder by hovering, your pelvic floor muscles are not really relaxing properly and you can actually make problems worse for yourself because the bladder itself is maybe not fully emptying because of the muscles being held tight while you're trying to empty the bladder.
Because your bladder is not completely empty, you might have a greater risk of that stress urinary contents whenever you cough or sneeze. There's other advice, really, that we would give them regarding their, their fluids. So be keeping a healthy intake of fluids of one and a half to two litres of total fluids in a day.
Um, cutting back on the likes of fizzy drinks and high caffeine drinks, which includes tea and coffee. And not drinking sort of big cupfuls or big glassfuls at a time and sort of having fluids evenly throughout the day. Because if you're drinking big cupfuls at a time and then you have to cough or sneeze or it can put an increase because your bladder is in fuller, then it puts an increase on your pelvic floor whenever you're coughing or sneezing.
So if you're drinking evenly throughout the day, that helps eliminate that risk whenever you go to cough or sneeze. Noeleen also mentioned earlier that, you know, some patients that we see with stress urinary incontinence may have certain conditions, you know, maybe back problems or maybe multiple sclerosis.
These particular patients can be at a higher risk of constipation. And, you know, the patients that we see that have stress urinary incontinence, we also will inquire about their bowel, about their bowel habit, and, um, if they are at risk of constipation or if they potentially have chronic constipation, that's something where we would give advice to, to, um, to introduce lifestyle changes to try and prevent that and have a healthy bowel habit, because If the bowel, um, gets emptied easier and well, then it's not going to be putting the same impact and pressure on the bladder.
Sometimes people, um, I know the clinic don't see the relation to it, but I think, you know, we're not, we're not stone inside, we're, we're, we're soft, everything does impact against the other. So it is important. So Noeleen, do you want to give some advice about how they might look after their, their bowel?
Again, bowel habit, obviously, because your bladder and bowels are in such close proximity to each other, one will, as Deirdre says, bounce off against the other. We very much recommend that their fluids are a litre and a half to two litres, as Bernadette was saying. Because your bowel needs fluid to ensure that your faeces are soft enough to move through your bowel.
Always maintain, um, a very high fibre diet, plenty of fruit and veg in your diet. Um, fruit would, um, include prunes, pineapple, kiwi, pears. They're all very high in fibre and maintain, um, That good roughage. Yeah. I think another thing too, flaxseed and good oily fish intake, you know, like salmon or sardines and that.
That oil within the digestive tract helps make the, the bowels move much easier. Um, and as long as the patient ensures their bowels are moving at least every one to two days to prevent that pushing against the bladder. And again, um, there's a wee technique we use, splinting. Um, for patients to just. Put toilet roll round their hand and support their pelvic floor whenever their bowels are moving so that they're not putting that extra pressure onto their bowel and pushing onto their pelvic floor.
And again, a nice habit whenever your bowels are moving would be to use a wee footstool so your knees are slightly elevated off the floor. With your elbows onto your knees, and just as I say, the pressure then, you're on, you're nearly squatting more than sitting on the toilet. That their faeces moves down, um, through the anus easier.
Noeleen you described that stress urinary incontinence is that leakage from the bladder whenever we cough, laugh, sneeze or exercise. Can you describe, um, to the listener why that happens? This happens, um, because the increased abdominal pressure is either greater than the pelvic floor counter pressure. Um, there can be a possible weakness in the bladder neck or again a weakness in the external sphincter muscles.
Whilst you're waiting your appointment, a useful resource for stress urinary incontinence is the squeezy app. This is an app that was devised by a pelvic health physio therapist. It is available in the app store, and a link to it will be found on the Northern Trust website. There is a cost for this app.
I think it's about £2. 99, but it is a really useful resource and I know that I have signposted patients to it and they find it really useful in helping them remind them to do their pelvic floor exercises. So as a recap on what we've talked about today, we've given the information on who this can happen to, why it happens.
Things you can do to prevent it and your pelvic floor exercises, which for a lot of people can improve things. Um, although if these things don't help by the time we get to clinic, there is other things that we can do. So don't be disheartened by the fact that things haven't improved by the time you've seen us.
Because there is other things that we can, we can offer. So there's the likes of vaginal inserts. There's a vaginal cone. Uh, stimulation machine and some medications as well that that can help with stress incontinence and as well as a onward, referral then to pelvic health Physiotherapy. Thank you for listening, and I hope that you find this information useful.
I would encourage you to listen to this podcast regularly between now and when you receive your appointment date, to keep your motivation high, and to, um, to get the best out of all the information that we have given to you. There will be other episodes within this podcast series, and I would encourage you to listen to them too, because again, We find that patients very seldom fit into one particular box and whilst they might have symptoms of stress incontinence, sometimes they have symptoms of other types of incontinence as well.
So I would think that you would find the other episode useful too. So thank you very much for listening. Please provide feedback on our podcast, which can be found on the podcast summary or the Northern Trust website. Thank you.