Incontinence

Hi Kiki :)

Stress urinary incontinence (coughing, sneezing, etc) is complicated only because it seems to occur (and this is supported by the gynecologic literature) in between two stages of prolapse.

Almost all of us have been told at one time or another that we have a "tipped" uterus. After years of pulling our stomachs in, as nice ladies do, the uterus moves from horizontal to slightly vertical, and the cervix begins to be pounded further down into the vaginal canal. The vaginal walls become lax and the urethra and bladder neck less supported. The normally sharp angle between bladder and urethra straightens somewhat and this is when SUI becomes problematic.

In time, as the base of the bladder falls further back, the urethra is kinked off in the opposite direction. Incontinence improves, but now women have to deal with a symptomatic bulge. SUI often resolves entirely, but urinary retention becomes more of a problem.

It is of interest to note that studies now show older women with a history of vaginal birth suffer less incontinence than their childless sisters.

I believe both vaginal birth and our native posture help us maintain a lifetime of continence and vaginal health. The anatomical model of a healthy, mature vagina is slightly bulgy, yet toned from being pulled up and into its natural axis. Prolapse symptoms should be expected to be mild for most women who adopt natural posture and lifestyle, and incontinence virtually nil.

Time will tell.

Christine

Kiki, that was probably me who said Kegels can help with mild incontinence, but not with POP. Muscles work best when they can act through their whole range of movement. If, after being distended through pregnancy, they cannot get themselves contracting again with normal movement, I think that Kegels can re-establish normal movement in them. If there is a nerve response problem I think some electrical stimulation therapy has a role. This is from my own experience, and they were moving properly again after just a couple of electrical stimulation sessions. Once I could do Kegels by myself I had steady progress. However, I would temper that by saying that I was a great tummy and butt tucker, and proud of it, at the time. Had I gotten myself into Wholewoman posture postpartum my pelvic floor muscles may have woken up by themselves? My distended pelvic floor was as a result of hyperstimulation of my ovaries during fertilisation, implantation and early pregnancy, (football sized ovarian cysts on each ovary at conception, which blew me up like a balloon for about a month in early pregnancy, to a point where I could barely breathe, eat or drink, because there was no room left in my abdominal or pelvic cavities., Yes, I was hospitalised for about a week). My pelvic floor never recovered right through the pregnancy. So mine was an exceptional situation, but women do experience weird things and this was the solution to mine. I wouldn't recommend starting a pregnancy like this!!!!!

I was tired last night when I wrote my reply. I meant to say that most older women have a slightly bulgy vagina and little or no incontinence.

Well, Kiki, the data we have is that young, post-partum mothers with incontinence are able to reverse their symptoms over the post-partum year. Women like Saddleup are also able to improve incontinence - often trading it for a worsening cystocele. I don't think it's that cut and dried - that this is a fixed structure that bends one way to worsen and the other way to improve. I'm not sure older women (35+) with significant cystocele are actually able to improve their bulge 100%. I know Alemama has done it - but will that be true for the next several years? I think some women with bladder neck instability (wobbliness) and no significant prolapse improve by moving everything forward. I don't believe kegels should be the focal point here, but rather natural posture where the pelvic floor is pulled into its full dimensions, therefore better supporting the urethra.

Normal anatomy has the urethra, vaginal walls and rectum vertical. Btw, I've been meaning to mention this for awhile... Isn't it amazing that general medical illustrations portray the rectum as vertical, while gynecology portrays it as horizontal??? More on the gynecologic "field of view".

The organs bend 90 degrees to rest against the abdominal wall. Therefore, this is the anatomy we should be trying to re-create through posture and exercise. Prolapse and incontinence both have their causes in altered anatomy. The pelvic floor enters into the equation - but only in that it should be exercised all the time as we move through our lives in our natural shape.

Hope this helps. It is the WW point of view. Surgeons admit that the highly complex female urinary system is still not yet fully understood. It has not been to our advantage that the surgical field has been adopted as the anatomical perspective, rather than the macro-scopic big picture, i.e. outer structure and posture.

Christine

Kiki, I don't know, and occasionally I find myself on my way to the toilet, thinking the same thing.

For me, it usually happens after I have been sitting, and change to standing, or else I am sitting and suddenly realise that my bladder is full, and I only just make it.

I think it is to do with the intraabdominal pressure generated as I stand up. I think it compresses my bladder and stretches the top of my urethra into a cone shape, rather than a neat round hole. Or else it pushes my bladder back and down so part of my bladder is below the deep PF muscles, or something. This makes it harder to stop a sudden big pee. . Another possibility is bowel contents moving around, which might rest on the bladder and suddenly increase bladder pressure.

I can sometimes stop the sudden urge by tilting my pelvis back, which seems to kink the urethra again. I can also bend deeply from the hips and take the gravity pressure off my urethra. This will stop the big flood, but I can still feel urine in my urethra, and might get a little leak. That's OK by me on an occasional basis. It is usually only when I have a really full bladder.

For me, stress incontinence has gone, but urge incontinence is occasionally there. I used to get this urge incontinence as a child.

Louise

I believe bringing our bodies back to the point of being able to jump and skip should be the goal of each of us. This sort of impact in strong WW posture brings with it the possibility of correcting the bladder/urethra angle as much as any other outcome. I jump and skip all the time around the room, with hip turnout and pointed toes. Interestingly, skipping rope is more challenging for me, as my body doesn’t feel as well supported. So I don’t do it.

The huge blind spot in our cultural response to female exercise and body fitness is the importance of external hip rotation *while keeping* a strong lumbar lordosis (curve). This is the story I am addressing with Whole Woman Yoga.

Urge incontinence is extremely common as we age and may not have a specific cure. It is a nervous system disorder, exemplified by losing it just as you’re running for the loo. If you ran in the opposite direction, you’d probably be able to hold it. There is a psychological component, which remains a mystery. The bladder “trigone”, or nerve complex, seems to become more sensitive and less meticulous with age.

Great info in this thread!
I think as of today I am the young-ish woman (30) with the urethra wobbliness and no significant prolapse. I'll tell you my experiences:

Sometimes I experience some stress incontinence . Usually around ovulation and right before my period. A year ago I still had the bulge, but no SUI whatsoever, not even a drop.

When my bladder is full, it never bulges into my vagina anymore, not even if I slouch. Weird, huh? BUT...I guess my bladder neck is straighter now so I experience some SUI here and there. Is this the casse?

Liv

You know that tight gearbox feeling that you get with a brand new car? By the time it has done 20000km the sharp edges have been knocked off the gear changes and it is much more comfortable and easy.

We are dying from the moment we are born. Nothing ever stays the same.

Your reasoning sounds good. Just cos we are a little looser doesn't mean we are headed for the scrap yard. 'Worn in' is more like it than 'worn out'!