It is important to develop a strategy to help you manage your incontinence.  This may include special clothing or the use of devices that will allow you to continue with normal activities as well as any recreational activities you choose to participate in.  We will review four strategies that can help you to manage your incontinence.

The first management strategy is use of a pessary device.  A pessary is a small latex or silicone device, similar to a diaphragm, that you insert into your vaginal canal to give better support to your bladder and urethra.  The goal is to hold your bladder and urethra in its appropriate position.  This takes pressure off of your pelvic floor muscles, allowing these muscles to squeeze tight on the urethra, preventing urine leakage.  Your healthcare provider can help fit you for a pessary device that is the right size and shape for optimal performance and comfort.     

The second management strategy is use of a urethral plug.  These plugs again can be rubber or silicone plugs that are designed to be inserted in and removed directly from your urethral opening.  The goal of the many different types, sizes, and shapes of urethral plugs is the same:  to temporarily block urine flow out of the urethra between bathroom breaks. You can talk to your healthcare provider to discuss different options available to you if this is a strategy you may want to use.

The third management strategy is the one most commonly used and that is absorbency products.  The newest absorbency products, including absorbency pads and protective undergarments have essentially replaced the adult diaper.  The newer products are more discreet because they are lower profile and are treated to control odor and minimize skin irritation.  This allows more comfort for the user and greater confidence in continuing with an active lifestyle.

A fourth management strategy is wearing compression shorts, which I have mentioned in a prior blog entry.  This strategy uses a common physical therapy rehabilitation principle called “proprioception.”    Shorts that provide compression and support to our pelvic floor will enhance the proprioception of our pelvic floor muscles, which improves the efficiency with which the muscles will fire.  Triathalon shorts are one example of compression shorts and the light biking pad in these shorts gives comfortable compression directly to the pelvic floor.  These shorts can also hold an absorbency pad in place if extra protection is needed.  Compression of your pelvic floor may be just what you need to get back on the hiking trail, the walking path, or back to whatever activity you love.

I recommend that you contact your healthcare provider or search the internet on “incontinence devices” for more information.

Published by Tasha

7 Comments

  1. I am 14 weeks post partum, have been doing pelvic floor exercises since allowed to (last 6 weeks) with as yet no real result, and have been diagnosed with severe stress incontinence following a traumatic long 2nd stage of labour. I leak smallish volumes on walking, even around just my home, and always leak on any exertion. I can’t influence my urinary stream at all yet with my pelvic floor muscles. I was very unfit by the end of a high risk pregnancy, but have regained some core strength with the walking, and gentle abdo work outs plus pelvic floor exercises in the last few weeks. After 10 days of walking daily though I notice the leakage on exertional walking is increasing, as well as some more leakage at home though in much smaller quantities.

    I am only walking fast, not doing anything else more strenuous, however since taking on this regime, aiming to do 10,000 steps a day, I sometimes fill a pad with 100 mls or more during my ‘workouts’ (something I never did before), and sometimes leakage the rest of the day is increased too though in much smaller amounts than the exertional leakage.

    I am desperate to continue my walking, but also very frightened of ‘straining’ my pelvic floor any more. Very frustrated. What do you advise?

    Reply
  2. I would recommend that you take a break from the walking until you get your pelvic floor firing appropriately. It sounds as though your pelvic floor muscles have not established or returned to their normal firing pattern and you may need some help getting them back on track. This is quite common when a muscle has been traumatized and quite often it requires outside assistance through electric stimulation. There are some home e-stim units available, but getting in to see a women’s health physical therapist is your best bet as they will be able to identify specific muscles within your pelvic floor that are not firing appropriately and give you feedback that will help you activate those muscles.

    Once you re-establish an efficient neuromuscular connection, then working through a strength and endurance program for your pelvic floor and supporting muscles will allow you to return to your walking program. You can find 4 thorough exercise programs on the Hab It Pelvic Floor dvd that I would recommend you work through for 4-6 weeks before resuming your walking.

    I know you want to continue with your walking program, but appropriate strengthening is so important for long term health of your pelvic floor and more. A 4-6 week break is a short time when you look at the big picture.

    Keep us informed of your progress and let me know as other questions arise.

    Tasha

    Reply
  3. Thanks Tasha, I thought as much. I really appreciate your reply as have been very frightened since the birth and on becoming incontinent, about what exercise to do, what not to do, and whether recovery is indeed possible? I have ordered the DVD and am awaiting it, I have also just started using a Kegal 8 machine as a supplement to my pelvic floor workouts.

    I had stopped the walking just before seeing your reply after having an episode where I leaked over 200mls, flooding completely through a pad with a virtually continuous leakage, and when returning home found my bladder was completely empty on attempting to void. Very scary. Total leakage. I had been ‘pushing’ it, but was only walking! I also now suspect that my mild prolapse (not sure if it is bladder, urethra, or both) has worsened. That stopped me dead in my tracks and I felt devastated at doing too much. Now trying to just tone tone tone.

    I am still exclusively breast feeding which I believe makes recovery slower? I had 2nd degree left lateral vaginal wall tear ( and can feel a difference using e-stim on this side), episiotomy, and forceps delivery, after a very prolonged and chemically assisted ‘pushing’ stage. I knew even then that I was wrecking my pelvic floor because straining like that in a squat position for hours goes against everything you were ever taught NOT to do normally.. and I KNOW my pelvic floor is really really weak now because even with bracing, on coughing, blowing my nose etc, it still bows downwards. Very frightening, but I just live in hope of a good recovery – I am prepared to put the work in. Birth can be very traumatic when it all goes wrong : (

    Thanks again for your help. This is an excellent resource, I have trawled the web and have not found better.

    Reply
  4. Phillipa, there is no doubt that your hormone levels while breastfeeding will increase your symptoms. That is absolutely no reason to stop, but just be aware of the effect that it has.

    I am very interested in your response and feel for the Kegel 8 machine. Please stay in touch with your thoughts on your progress with that “at home” electric stim unit. Your timeline for use of the estim and the upcoming use of our dvd is perfect. Visualize the estim as putting oil in an engine. you are waking up and forcing neuromuscular communication of all the fibers of your pelvic floor, then once you get the dvd, you will actively contract these fibers on your own, which is an important step in full recovery of your pelvic floor.

    The dvd will also increase your awareness of your posture, the position of your tail bone and the other muscles of your pelvic basket that are so very important to optimal pelvic floor function.

    Look ahead and be very optimistic. you will regain control. You are taking all the right steps!

    Tasha

    Reply
  5. Hi Tasha,

    I had my beautiful baby boy on May 3, 2012 (7 months ago). I started leaking at 5 months pregnant, and have continued to do so since then (almost a year!) I leak small amounts all day long, no matter sitting, standing, bending, etc. At this point I use a pantyliner, but fear
    1: Having another baby, and 2: My quality of life when all I can think about is the leaking. I did Kegals throughout my entire pregnancy and after…clearly didn’t help.

    I went to a PT, who recommended I go to a urologist for a proper diagnosis. They said I have a hypermobile urethra and I got one round of the bulking agent procedure (didn’t work). Their solution is surgery after I’m done having kids, but there is no way I am doing that, given the complications, and low rate of success.

    I recently ordered your DVD, and after reading the reviews on Amazon, I am really excited to start. I am fit and active, typically hitting the gym 3-5 days a week (5-7 before and during pregnancy), for yoga, pilates, strength training and cardio including walking, elliptical, arc trainer and recumbent bike.

    I guess I’m writing to see if you have any other tips or ideas, and for that vote of confidence that consistency with your exercises can get my body back to the way it was before baby. Thanks so much!

    Reply
  6. Allison,
    It will take consistency and attention to detail, but by your description of your comittment to workouts, you will be fine! A couple of recommendations for you is to read through my blogs. They will help your understanding of why your body may not be responding and introduce some new concepts to you that you haven’t thought of before. One thing that jumped out at me in your description of your activity level above, is your cardio choices. I see alot of “Flexion” activities that need to be balanced out with a good amount of extension! Also, be aware of your posture from this day forward and always know where your tailbone is, when sitting, when standing, when walking, etc. Finally, as you begin to work your way back to the “old you”, feel free to ask questions throughout my blogs or on our “Ask Tasha” section.

    Tasha

    Reply
  7. Thanks for responding…

    So even though I have a hypermobile urethra, I will be able to regain control and stop leaking?

    What are some examples of extension activities? I saw the blog about swimming, biking, cross country and walking…is that what you’re referring to?

    Reply

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