As part of my job, I listen to stories of my clients as it helps me understand the bigger picture of their pelvic floor dysfunction. Many women just don’t realise that there are plenty of other life style factors that can influence their incontinence, help minimise their risk of prolapse and give them avenues to go and explore to get the right diagnosis and professional help.
Let me share such a story.
Let’s call her Linda.
Linda is in her early 60’s and has had a prolapse since her mid 50’s when she was going through menopause. Linda has an active role in her community and she also loves looking after grandchildren several times per week.
Linda’s issue is that her life is dictated by where the toilet is. Linda has incontinence, but more than that, she has anxiety about her incontinence. Linda’s biggest fear is not making the toilet in time and disgracing herself in public.
This means that going out is carefully planned around where the toilets are located. Linda knows every public toilet at her local shopping mall. In fact, she knows every public toilet as part of all her routines. However, experiencing new places and doing new things is a secret source of worry and instead of admitting the truth to her friends and family, Linda is more likely to make excuses and stay at home. Or stay at the picnic table, rather than go for an ambling walk with the family. Her incontinence is making her inactive. Her inactivity is causing weight gain, which in turn is putting more stress on her prolapse.
Let me share another story.
Let’s call her Mary.
Mary is in her early 30’s and has come to see me as a fairly newly postnatal client. Mary felt herself prolapse quite early after the birth of her second child when she was straining on the toilet. Mary had been suffering from constipation and was eager to finish her poo to attend to her crying baby in the next room.
In shock Mary searched on Google and found mishfit, rang me and I encouraged her to see one of our Women’s Health Physiotherapists who confirmed that she had prolapsed.
At our initial consultation I asked her about her toileting habits. She told me that she had suffered from Light Bladder Leakage (her words not mine. I just call it incontinence) after the birth of her first child. Mary had taken to being very careful about emptying her bladder before she left the house, whenever a public toilet presented itself and most certainly before she exercised.
This gave her confidence that she was minimizing her risk factors of leaking a little wee. When I got her to count up the number of times she went to the toilet, she thought it was at least 12 times in a 24 hour period and had never really given it much thought. But Mary did admit, that she did not wee very much each time. Mary also said that she often forgot to drink water and her urine was often dark in colour.
Mary was going to the toilet just in case.
I explained to Mary that a normal range of having a wee was between 4 – 8 times and our bladders can hold up to 400-600 ml of urine ( with the sensation of needing to empty starts at around 200-300ml’s). Mary definitely knew that she was nowhere near normal.
I told Mary about Linda’s story and how she was going to the toilet just in case. Hers had also started after having early postnatal incontinence . I told her that Linda did not wake up one day and find that her life outside her house was dictated by the proximity of a toilet. This had just crept up over time.
In fact Linda, just like Mary had really not given in much thought at all.
Mary looked at me and she said that Linda reminded her of the same behaviours of her Aunty, who was a similiar age to Linda.
Our bladder, if not allowed to experience fullness, will shrink in size. Keeping your bladder in healthy proportions means that we need to monitor our toileting and ensure that we are not emptying it until it is full (or near to it). The bladder system, complete with valve, works best when it is in the right position (so hence can be misplaced with a bladder prolapse) and when it is allowed to be full and emptied. With little urine in the bladder, it may become very acidic and can further irritate and cause further issues and pain.
Many people from a young age are taught to go to the toilet just in case. And perhaps you are even teaching these same habits to your children.
Mary has an opportunity to change the direction of her life for the better. However, it is never too late to change habits and Linda went on to have and enjoy a much anticipated European trip with her sewing girlfriends!
A technique that I teach my clients to enable them to have a little more time, is when they feel like they want to go to the toilet, is to ask themselves: Do I really need to? Or is it because there is a toilet there? If after a quick calculation of fluid in and time between visits, it may be that you can last for awhile longer. A series of quick pelvic floor squeezes can trick the brain to enable you to last a little longer.
Monitoring your self talk at this time is essential. If you are repeating the mantra “I’m going to wet myself”… then chances are you will!
To measure your progress, use a measuring cup or count the seconds of your stream. Start with counting how long it takes for you and look at extending it (once you have measured exactly how much you generally expel). This will be gradual and over time. Counting your stream, can also bring a mindfulness to the process. Do you ever think you are finished, rush to stand up only to find an extra wee drizzle down your leg? This strategy will certainly help you.
Being mindful of experiencing a full bladder and how many times you empty your bladder can go a long way in ensuring that at the stage of your life when you have freedom from children and work, that you can have new adventures and new experiences, that this not dictated nor hampered by where a public toilet is located!
If you are concerned about your toileting habits or your incontinence… or just think that you are ready to learn some other skills that will help keep you continent for the long term, why not get in touch and make an appointment with me. Often this only needs to be a single session (of 1.5 hours) to get you on your way via my Pelvic Floor Movement and Recovery Program.
Check out this infographic to understand more about how I can work with you!
To get in touch, feel free to call on 0418 592 539 or email me here!
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