How to improve your bladder control

More than 70% of women have trouble with urinary incontinence and many are too embarrassed to seek help. Here’s advice on how to improve your bladder control

YOU sneeze or cough and feel the quick, uncontrollable rush between your legs. For some women it’s not a big problem, but it can be an embarrassing one all the same. For others, the urge to urinate comes on so suddenly they’re never sure they’ll make it to the toilet in time.

Urinary incontinence – the loss of bladder control – is a common problem for women and the severity ranges from occasionally leaking urine to having the urge to urinate come on so suddenly and intensely that it’s followed by involuntary urination.

There are various types of incontinence (see box on opposite page) but whatever the cause these tips from pelvic floor physiotherapists Sue Croft and Fiona Rogers should help you get to grips with your bladder control.

Every birthday, keep a bladder diary for 24 to 48 hours Make a note of what time you go, measure how much you produce, if you had any leakage, possible triggers, the degree of urge and how much and what you drank.

Someone with a healthy pelvic floor and no urge incontinence issues should urinate around eight times a day, no more than once at night and produce around 350ml to 500ml each time with no leakage.

Urine should look like a glass of chardonnay, not a glass of beer Concentrated urine irritates the bladder so not drinking enough water will make you feel the need to urinate more.

If your urine looks like water, you’ve got far too much fluid on board. You need around 1,5 to two litres of water a day depending on your size, activity level and how much you sweat.

Your bladder is actually intelligent It’s an intelligent organ that can be trained – it’s how we all got out of nappies as toddlers. So be careful what cues you give your bladder.

If you’re in the habit of letting go when you shower your bladder will develop an association between the sound of running water and urinating, which means you might have problems every time you go near a fountain or turn on a tap!

Similarly, if the first thing you do when you get home is go to the toilet, the sound of a key in the door could trigger the urge. Retrain your bladder so there’s no association between a specific event and going to the toilet.

Curling your toes can help you hold on Focusing your attention on curling your toes can help you hold on for longer. Squeezing your buttocks and sitting on the edge of a bed or on a rolled-up towel also help. Use these little exercises regularly to help retrain your bladder to hold on. These techniques also work if you’re trying to improve bladder capacity. Women who are in the habit of going to the toilet “just in case” can find that their bladder loses its stretch.

A distended colon irritates the bladder and straining puts stress on the pelvic floor

Caffeine can be a bladder irritant It’s possible for some people to reduce or even end incontinence by cutting down on coffee, tea, hot chocolate or cola drinks. If incontinence is a problem for you, it’s worth a try. Alcohol, fizzy drinks and citrus can also irritate some bladders.

Urinating a lot at night can be a sign of sleep apnoea Little nerve endings in your heart detect pressure changes within the chest. Sleep apnoea can cause a temporary increase

in that pressure, which results in those nerve endings getting the signal that blood pressure is rising.

They then respond by sending a message to the kidneys to offload fluid to get your blood pressure down.

So if you’re a snorer and you find you’re getting up to go to the loo a lot at night, see your GP about whether you have sleep apnoea.

Constipation is not the bladder’s friend A distended colon irritates the bladder and straining puts stress on the pelvic floor, so ensure your diet includes plenty of soluble fibre in the form of vegetables and fruit.

Also, make a point of sitting correctly on the toilet when you have a bowel movement – with your knees slightly up and your feet resting on a low stool or a stack of magazines about the height of an upturned toilet roll. Relax your tummy and widen your waist.

Ask your doctor to check for a prolapse When you have your next Pap smear, ask your gynaecologist or GP to check for prolapse. A prolapse happens when the pelvic floor muscles are so weak the organs above “fall” out of their normal positions and lean into the top of the vagina.

About 50% of women over 50 have a prolapse but most don’t realise it until they feel a bulge lower down towards the entrance to the vagina.

This can be really uncomfortable and it can alter the position of the urethra, causing incontinence.

Prolapse might also make it difficult to empty your bladder or bowels completely. Pelvic floor exercises, pessaries and hormone creams can help manage prolapse.

Pelvic floor strength suddenly gone? Get help fast! If you’ve noticed a sudden and dramatic weakening in your pelvic floor strength, seek professional help straight away from a pelvic floor specialist or urogynaecologist. It could be due to a condition called levator avulsion, which is when the pelvic floor muscle tears off the pubic bone. It’s particularly common among women who’ve given birth after the age of 35, particularly if they’ve had a forceps delivery.

It’s important to get help to train the muscles that are still attached, learn to brace using intra-abdominal pressure, sit properly on the toilet and do special pelvic-floor exercises.

A pessary device can be fitted if there are subsequent problems with prolapse. Surgery is possible but the success rate is low.

Relaxing your pelvic floor is as important as strengthening it Some women experience pelvic pain because they have a hypertonic (constantly contracted) pelvic floor.

This could be because they do lots of crunches, leg lifts or pelvic floor exercises. Endometriosis can be a problem too, as pain can cause involuntary tightening of muscles.

Having an overactive bladder, which means you’re holding on all the time, can also cause a hypertonic pelvic floor.

A pelvic floor specialist can show you how to use a vaginal dilator to help relax the muscles.

You’re never too old to improve your pelvic strength A Canadian study found that even elderly women living in a residential home had lasting benefits from pelvic floor physiotherapy.

Oestrogen pessaries and creams can also help by supporting the vaginal tissues, helping the urethra close better, and preventing the bladder from becoming irritated and overactive.