090716 The Unspoken Gym Secret

Incontinence affects over 25 million men and women, young and old, in our country alone. 85 percent of which are women. Imagine what these figures are world wide. About one in four women over 39 has had at least one episode of incontinence during their life time.

You may be wondering why this is even being talked about in this format. The simple answer is because it is affecting more of your trainees than you may realize, so the more you know about the subject the better equipped you are to deal with the problem. Recall the one in four who are trying to manage this condition; you can bet they are working out in your gym. Do you just stand by or offer a potential solution to these people? They may be unwilling to discuss this ongoing condition with you-especially if you are a male and they are a female, unless you have built up a close trusting rapport.

Many who suffer from this condition are too embarrassed to discuss it with their health care provider. They view this as an inevitable consequence of aging and wear protective pads or under garments to control the results. If this is left untreated then rashes, infections, emotional stresses, and a lower self image may be encountered by the individual.

Incontinence may be an off shoot of a still unidentified disease such as diabetes, an unrecognized stroke, nerve disease or multiple sclerosis. A urinary tract infection, vaginal infection or irritation and constipation can also cause incontinence to occur. However there are other causes.

Just as likely are weak muscles in the pelvic floor or an overactive bladder muscle. These can be trained to hold the urine for longer periods. Urinary sphincters control the actions of the bladder. These sphincters close off the bladder outlet to prevent the escape of fluids. As the bladder fills there is an increasing urge to empty it.

Once the nerves sense the bladder is full a signal is sent to the brain. It is now becomes a choice of whether to go or hold. Often times this is neither a choice nor a controllable function, and incontinence results.

If your trainee is leaking urine when they laugh, cough, sneeze, lift heavy or do any sort of jumping exercise then perhaps stress incontinence exists. On the other hand and complicating the treatment options somewhat are stretched pelvic floor muscles that commonly result from having a child or bring inactive.

What the person can do on their own
See your doctor and get an examination to make certain the diagnosis of incontinence is correct. Give them some background information by keeping a diary of all the food and drink you consume, list the times of day and the activity you were doing when the flow started.

When you do go the bathroom make certain to completely empty your bladder. Do this by finishing once then standing up, moving and shifting around and waiting minute or more and then going again. This method is called double voiding and is a way to help eliminate the residual urine in the bladder from causing an incomplete void.

Even though each of the following exercises have been effective in many women there is still no scientifically established or proven regimen that will prevent urinary incontinence. One of the most efficient ways to ward off incontinence is maintaining a good healthy lifestyle, staying within your ideal weight, not smoking and continuing with a combination of aerobic and anaerobic exercises.

Some have found that staying well hydrated and not waiting too long to urinate helps keep the bladder under control. Most people empty their bladder four to eight times within a twenty four hour time span. Cutting back on caffeine and alcohol can also improve the body’s ability to retain urine. Each of these substances causes a reduction in a hormone that concentrates and decreases the volume of urine by increasing the uptake of fluid back into the kidneys.

Not only are certain beverages thought to cause bladder problems but also different foods can irritate the bladder and should be avoided if they seem to increase or produce the symptoms of incontinence. Among those that are suggested to be eliminated or reduced in your diet are the following:

Pops or other liquids containing carbonation
Coffees and teas both caffeinated and decaffeinated
Milk or products made from milk
Citrus fruits and their juices
Tomatoes and the products made from tomatoes
A surprise on the list is sugar in all forms
Artificial sweeteners and corn syrup which is found in many products so look at the labels carefully
Chocolate products
Spicy foods

Notice I did not say completely give these foods and drinks up, instead I am suggesting that you just moderate ingesting them and see what happens with your bladder control. However, it may be reasonable on your part to actually stop taking some of them if an adjustment makes a difference.

The ability to control the bladder release is a treatable condition. A few of the options include:

Behavioral techniques

• Pelvic floor muscle exercises
  Medication
  Medical devices that prevent or capture the escaping urine
  Surgery that repairs or lifts the urethra or bladder neck up and provides support

Since I am not a doctor the medication, devices and surgery will not be discussed in this document. I will provide viable options for your trainee to try as you urge them to contact their primary health care provider for further information regarding various other courses of action in regards to this condition.

Behavior techniques are usually the first to be considered as they fit well with other protocols of treatment and can still be continued throughout other treatment choices. These behavioral options have no side affects and can be done at home any time you want and, more importantly, are non-invasive.

Strengthening the pelvic floor musculature

The most common of the recommended exercises are the Kegel’s named after Dr. Arnold Kegel back in 1948. He described these for women following childbirth who were experiencing difficulty in controlling their bladder releases. The exercise was designed to increase the tonus of the muscle in the pelvic floor.

Pelvic floor muscle specific exercises

There are two types of contractions that have to be done in order to make the muscles work as intended. One is described as a fast contraction and is meant to stop the flow quickly. The second is a more prolonged effort and is designed to build up the muscles endurance and their ability to support the over head organs that rest on them.

The fast contraction exercise may be done by first getting into a comfortable position such as in a chair or on the bed with your legs either bent or outstretched and close together for the first few times. Realistically these can be done anywhere but if you are just starting out then the fastest way to learning how to do them is if you are comfortable to begin with and can easily find the target muscles.

Beginning fast contraction exercises.

Relax by taking a few deep breaths and relaxing all of your muscles. During this stage it is important to actually exercise the pelvic floor muscles and this is not done by tightening up the abdominal, buttocks or leg muscles. Instead these have to be kept loose. For instance if you put your hand on your abdominal area, i.e. your belly, you should not feel it move at all as you tighten up the pelvic floor muscles.

To find the right ones try stopping the flow of urine the next time you are voluntarily voiding your bladder. Once you are able to do this then you have located the right muscles and now need to keep at it on a consistent basis.

After you are able to squeeze the right ones do so quickly for a second or so and then let off just as fast. Release the contraction for a second and then hit it again. Do as many as you can to begin with. Your goal is to build up to least one set of five repetitions of these several times a day to start out. After you are able to do these five times in a row it’s time to add more sets and reps. You will have to be the guide on this one.

Beginning long contractions

Once you have the short contractions mastered it is time to move onto the long hold contractions. These exercises will help build up the pelvic floor muscle endurance which then helps to hold the organs above in place so there is not the unrelenting pressure on the bladder. In this instance the squeeze is done much more slowly, deliberate, and steady, for longer periods with each repetition. Remember to contract only the pelvic floor and not the abdominal’s, back, buttocks or legs.

Work on tightening these muscles for up to ten seconds at a stretch. In between each rep, rest for an equal amount of time. In this case, ten seconds before beginning a subsequent repetition. Work up to a total of twenty repetitions several times a day.

Variations and combinations of the short and long contractions

Work on combining the fast and long contracting exercises by quickly squeezing then releasing, followed immediately by a slow contraction that is built up in stages of tightness during the way to full contraction in other words several isometric stages of the long hold contraction. In each of the foregoing exercises it is important that you do not hold your breath as you do them.

Training the pelvic floor muscles is like any other muscle training program, it takes persistence and regularity to see results. Do them throughout the day and just before taking part in activities that cause the problem in the first place. This has improved control in 40-75% of the women doing them according to the American College of Obstetricians and Gynecologists. The keys are consistency in sticking to the program and accuracy in identification of and then exercising the correct muscles while doing these exercises.

These non invasive exercises are not a panacea for this condition, but they have been shown to be 50-80% effective in improving urinary control over a three week to six month period.

Practicing bladder control

There are two common ways of approaching this training; timed voiding and controlled voiding.

In the first instance a schedule is set up that establishes the time of urination intervals. Begin by going every thirty minutes whether you feel the urge or not. Gradually extend this time out into two to four hour stretches before going again.

In between the preset timed intervals, if you feel the need to go practice relaxation techniques. These can be something as simple as breathing in and out slowly. As you are thinking of the breathing tempo the urge in many cases will go away. Another way to control the urge is to do Kegel’s-if this helps you to control the bladder.

After the urge to urinate passes wait another five minutes or so and then go to the bathroom even if the need to go has passed. By waiting longer you may not be able to control the flow. After a five minute wait is no longer difficult begin to increase the time to ten minutes and upward. The training of your bladder may take from three weeks up to three months of steady consistent practice at the skill.

Studies have shown that bladder training behavioral therapy has been successful in curing twelve percent of the women and in seventy five percent there was an improvement in control.

Summary
There is help for those with incontinence issues and this may come from exercising the muscles that make up the pelvic floor. Diligent and accurate training may make incontinence a thing of the past or at the very least reduce its effects.