Myth busting for 'down under': stories from the life of a pelvic health physiotherapist
Maxine Howell (pictued left) is a pelvic health physiotherapist at our Trust. She is a presenter at our popular staff menopause events, run by our Occupational Health and Wellbeing team. Millions of women worldwide are affected by pelvic health issues. Here, Maxine debunks commonly-told phrases and explains the difference between what is common and what is normal when it comes to pelvic health:
“Of course, as you get older you can expect to leak.”
“You’ve had a baby, it’s normal to leak.”
“I have been told I am overweight that’s why I have this problem.”
“I have had four children, that is why I have this problem.”
“My mother had the same thing so it can be expected.”
These are commonly heard phrases between friends, generations of women, work mates, women at the next table in the café (not that anyone eavesdrops!), after having a baby, between older women, younger women and, sadly, staff at our hospitals. I ask you: please stop saying these things to women!
Not one of the above is normal. Common, yes, but that doesn’t necessarily make them normal.
So, what is normal bladder function?
No leakage of urine is normal, or to put it another way, dryness is normal. A frequency of passing urine four to six times a day is normal. A fluid intake of 1500mls to two litres (in old money that is two and a half pints to three and a half pints) of a mix of fluids (it doesn’t need to be all water) is normal. By lunchtime, if your urine is the colour of champagne or diluted apple juice, you’re on the right track - that’s normal.
The feeling of increasing pressure and, as time passes, discomfort in the low abdomen indicates the bladder needs emptying. So guess what - empty it! That is what the bladder is telling you. We learn this as children and then as adults we try to ignore it because it is inconvenient. However, we may be buying trouble, resulting in urgency and leakage when we finally decide to go.
Having to rush to the toilet and leaking on the way isn’t normal. It may mean you’re holding on for too long, or your bladder has become overactive and it wants emptying more frequently.
There are a lot of reasons for this to happen but don’t assume it’s irreversible. The first thing to do is drink normally. A bladder problem cannot be cured by restricting fluids - it doesn’t work! Nor is getting up at night cured by stopping fluids at, for example, 6pm. I understand how it could be reasoned to be effective but, be honest, does it work?
Tea and coffee are frequently apportioned blame for urinary urgency. Sometimes that is so, but the experience of the Pelvic Health Physiotherapy team indicates this is usually not the case. However, it is worth experimenting with by cutting down on tea and coffee to see if it makes any significant difference. The same goes for carbonated drinks - the colas, lemonades, etc.
Do you lie to your children by saying “Mummy’s too tired or busy so I can't get on the trampoline with you”? How sad is that when a programme of regular and correctly done pelvic floor exercises will in all likelihood fix it? The same goes for avoiding exercise generally. I wonder, is the primary reason many women stop a regular exercise programme for fear of urinary leakage but instead they blame tiredness and being too busy as the reason. Come on ladies! You can do this! Here are some links for pelvic floor exercises:
And the other thing which is common, but not normal: “I’ve always been constipated, that’s normal for me.”
It costs the NHS a whopping £81m a year in hospital admissions for constipation.
What can we do? We can drink more fluid, eat more fibre and eat more fruit. In our department we call them the 3 ‘f’s’ -fibre, fruit and fluid. And eat less bread, a lot less bread. And have regular meals. And exercise. It sounds so simple, and generally it is. I accept there can be other reasons for constipation that need medical investigation and intervention, however the fact remains for most people what is put in the mouth determines the type of bowel motion we have and how easy and frequently it is to have that bowel motion.
Why is constipation of so much interest to a pelvic health physiotherapist? Because it is a major cause of vaginal wall prolapse and also seems to increase the likelihood of bladder dysfunction. The mere fact that so many of our patients report constipation as an issue makes is difficult to ignore.
Fix the bowels and the bladder is happier. Fix the bowels and the patient is happier. Fix the bowels and the physiotherapist is ecstatic."