We are into day two of Women’s Health week! An initiative founded by the fantastic not-for-profit organisation, Jean Hailes, in Melbourne in 2013. Over the course of the week, Jean Hailes provides health information and free resources to support women across Australia. Each day has a theme and today’s day two theme is “bathroom boss”. Our musculoskeletal and Women’s Health Physiotherapist, Dr Lauren Earles, shares Part 1 of our Women’s Health Week/pelvic pain physiotherapy. This blog about bladder and bowel health.
The bladder is one of the three pelvic organs (the other two are the uterus and rectum) that sit in the female pelvic cavity. It is a hollow, muscular organ that’s job is to store urine until there is a convenient time to void (pass urine). The bladder does not have a fixed structure, instead it grows and shrinks depending on the amount of urine entering and exiting it. It is the role of the detrusor muscle of the bladder to contract or expand when urine enters or exits the bladder. For some people, this muscle may be overactive and contract at times it shouldn’t. This condition is known as overactive bladder and can be treated by a Women’s Health Physiotherapist- treatment may include bladder retraining (eg. retraining your brain and how it communicates with the detrusor muscle of the bladder), taking a bladder diary and dietary modification.
1 in 3 women who have had a baby, and 10% of women who haven’t, experience urinary (bladder) incontinence. There are two types of urinary incontinence that can occur- urge urinary incontinence and stress urinary incontinence. These two conditions occur for different reasons and at different times. Urge urinary incontinence is when a woman will get the urge to pass urine and they are unable to hold, resulting in leakage of urine (incontinence). Stress urinary incontinence is when the pelvic floor muscles undergo a stress or load (eg. coughing, sneezing, lifting) and they are unable to hold against the load, resulting in incontinence. Pelvic floor physiotherapy is highly effective at reducing and ceasing both urge and stress incontinence.
Pelvic floor muscle training, guided by a Women’s Health Physiotherapist, can involve a combination of long, slow holds. Which is effective for urge incontinence. While quick pulses is good for stress incontinence. It is very important to have a thorough assessment (both internal and external) by a Women’s Health or Pelvic Floor Physiotherapist before beginning a pelvic floor exercise program. This is because every woman performs pelvic floor contractions differently. You may think you are ‘squeezing’ your pelvic floor the right way but you may not be and this may result in further issues.
Bowel health is talked about less often than bladder health but is equally important. Chronic constipation can occur due to a number of causes including metabolic, neurological, psychological and endocrine (hormone) factors. The body and the brain will always do what it’s always done. We are creatures of habit. If you avoided opening your bowels in public due to fear of embarrassment (for example), your brain remembers this behaviour and will continue it unless we disrupt the neural (nerve) pathways.
There are ‘subtypes’ of constipation including slow transit and outlet obstruction. The food and drink we eat pass through our entire digestive system before we defecate. This includes the mouth, oesophagus, stomach, small intestine, large intestine/colon and rectum. The longer it takes for ingested substances to move through the colon, the more time there is for water to be absorbed out (eg. the harder the resultant stool will have become). This is known as slow transit. It can be caused from dietary factors including a lack of fibre and a lack of water in the woman’s diet.
Within the outlet obstruction subtype is something called ‘dyssynergic defecation’. This is when one of the pelvic floor muscles (the puborectalis muscle) either contracts or fails to relax during straining. The puborectalis muscle is meant to relax to allow the bowel motion to move through the anal canal. However in this case it does the opposite. This pattern may have been developed over years of straining as well as poor toilet posture. To allow the puborectalis muscle to relax, the knees must be higher than the hips and the stomach relaxed forward (yes, the Chinese have had it right all along!). Modern toilets are high and result in the knees being lower than the hips. A way to get around this is to use a toilet stool! Toilet stools allow you to elevate your feet and thus relax the puborectalis muscle. To find out more, head to www.toiletstool.com.au.
Stay tuned for Part 2 of our Women’s Health Week blog which will be about pelvic floor overactivity!
Women’s health. Powerful stuff.