An urgent (bladder) matter
Do you have a problem with your bladder and feel you need to speak to someone about it? To talk about bladder issues is a big deal for many people because it feels very private. But, did you know that 1 in 3 women in Australia have a bladder control problem? Yes, it really is THAT common. This month’s blog aims to release the fear of speaking out about a condition known as bladder urgency, and to show you that help is at hand.
What is bladder urgency?
Bladder urgency is a sudden, desperate and uncomfortable need to empty your bladder. Imagine walking down the street doing your weekly window shopping and instantly feeling like you have to wee. At this point it’s a frantic scramble to try and find the nearest toilet to avoid having an accident there and then. The feeling can be described as a “busting need to go to the toilet”. This can occur several times a day, and if it does, this need to urinate over and over is known as frequency.
Types of bladder urgency
There are two types of bladder urgency:
- Dry urgency: You have the sudden urge to urinate and are able to reach the toilet without leaking any urine
- Wet urgency: You have the sudden urge to urinate and leak urine on the way to, or as you reach the toilet
Dry urgency will commonly go undiagnosed because women who experience it think it is their normal bladder habit, and do not seek the help of a professional. It is those women who have accidents before reaching the toilet (a distressing and often embarrassing experience) who tend to speak up and ask for help.
Causes of bladder urgency
There are many causes of bladder urgency, including:
- An overactive bladder that contracts when it should not
- Overactive, weak, or damaged pelvic floor muscles
- An overly sensitive nervous system (triggered by stress, anxiety, poor sleep and even winter chills)
- Low oestrogen levels (commonly associated with breast feeding and menopause)
- Poor toileting habits
- Trained family habits extending through generations
A common picture we see in clinic is that of someone experiencing urgency due to an over-sensitive nervous system. A normal bladder can store anywhere between 500-700mls of urine before the brain tells you to go for a wee. In a normal setting, this occurs without the sudden, urgent feeling. With an over-sensitive nervous system, only small amounts of urine collected stimulate nerve endings in the bladder wall, sending messages to the brain to tell the woman to find a toilet… and quick. The bladder (said to be overactive) is unable to fill to its normal levels, and many people will start to develop a pattern of lots of toilet visits, combined with only eliminating small amounts of wee each time. Unfortunately for many women, this can run through the day and night, leading to disturbed sleep patterns, which increases stress and anxiety levels.
Now throw COVID-19 into the equation. The current pandemic is creating a lot of added stress and anxiety for many of us. Here at Physiotherapy for Women, our therapists have noticed a marked increase in cases of bladder urgency presenting to the clinic over the last four months. The pandemic has forced many of us to work from home, providing the convenience of a comfortable toilet nearby whenever needed, leading to poor bladder habits. As you can see, there are many factors at play here with lots to consider for the therapist and patient when implementing treatment.
Assessment and treatment of every woman’s bladder issue requires a Physiotherapist who has completed the required post-graduate training in women’s health. The aim is to help each woman develop her own skills in reducing the bladder urge, frequency of urination, and any leakage she may experience. Everyone’s circumstances are different and requires a unique approach for the individual. We have treated many women with bladder control conditions, meaning we know how to work with you to find out what works for you.
Treatment techniques may include:
- Release of overactive pelvic floor muscles
- Strengthening and re-training of weak or damaged pelvic floor muscles
- Stress management
- Advice on training your bladder habits
Do not let your bladder be the boss of your life. We encourage you to speak up now and side-step the negativity surrounding bladder problems. Call us on 08 8443 3355 to get help from our experienced, highly trained Physiotherapists.
Staying sane during isolation
Hello readers! We hope everyone is staying safe at this very crazy and uncertain time. We realise for a lot of our clients that life has changed drastically over the past weeks and months since COVID-19 has made its entrance to the world. Here at Physio For Women we have also been adjusting to some changes that have been instilled upon us in the healthcare world. We want you to know that we are still here and continue to work hard every day to ensure we uphold our high standard of care for all our patients.
This month we thought a focus on self-help advice during isolation was warranted. Trying to juggle working from home whilst looking after children and adjusting to being around partners and other family members 24/7 is a big task for anyone. We’ve highlighted a few key areas that are worth considering to keep on top of your health (and sanity) during isolation.
Home office set-up
If you are used to working in an airy and spacious office or other workplace, then being plunged into the world of working from home can come as quite a shock. Many of you won’t necessarily have the space or equipment at home to match your workplace, so taking some time to set up a space that works for you is worth it, to reduce the impact on your body. We suggest the following:
- If you can make it work, set yourself up in a separate room like a study and designate the space for work only. If this is not possible, choose a corner of any room and make it your own. This will allow you the best chance to concentrate on work when you are there.
- If you don’t have a desktop set-up and are working on a laptop, ensure it is on a table and avoid working on your lap. A table with a supportive chair is best, and try to break it up with periods of standing at the breakfast bar or kitchen work top. Boom… You have your very own sit-to-stand desk!
For a desktop set-up, follow these pointers to reduce stress on your body whilst working:
- Ensure the top of your computer screen is level with your eyes, or just under
- Sit upright with feet planted on the floor, arms relaxed by your side, and elbows bent at 90 degrees
- Avoid cocking your wrists back during and between typing. Keep them relaxed.
This is a must if you have children and other family members at home who you will be interacting with more than usual. Have some set times during the day when you try to focus on work. We realise this is not always possible with children, but have the routine in place and use it loosely. Children need attention and interaction (now we realise how much they get at school!), so set your expectations low and be fluid. Have the colouring pencils, craft box, toys and games at the ready and set the kids some tasks for when you are working. And if you really need to get some work done and it’s just not happening, it is OK to allow the kids to watch TV or a movie for a few hours. Unusual circumstances may mean unusual routines for a while. Children are resilient and will bounce back from these changes… Everything in moderation.
Ensure you give yourself regular breaks from screen time to have a stretch, move the body, and give the brain a rest. We recommend getting up from your workstation every 30 minutes.
You might be finding it tough being around the family 24/7. This is natural and don’t feel bad about it. It’s a good idea to set out some ground rules, particularly if you have to work on a daily basis. Everyone has a role to play to make sure the household cogs keep moving smoothly. One family member can do the washing, another can stack the dishwasher, etc… On top of this, allow time to get out and exercise and make sure you have alone time as well. Being around family can be challenging, especially when you are used to being at work for eight hours a day normally.
Seek out physio when needed
This is an important one. We realise it has not been as simple with booking appointments and getting that face-to-face time with us. But if you have any aches or pains that are not responding to exercise, stretching and other self-help remedies, then please get in touch. We are still open but are working to limited hours. We also have strict screening and hygiene protocols in place, and this is to ensure the safety of both you and us. Call us today on 08 8443 3355.
We wish all our clients the very best during this difficult time. Please practice social distancing, good coughing and sneezing etiquette, and wash your hands regularly with soap or alcohol hand sanitiser. These are still the best measures in preventing the spread of COVID-19.
We will get through this!
How important are you to yourself?
Hello readers! We trust everyone had a superb festive season. Now that the fun and frolics are over for another year, it’s back to the routine of everyday life… This may mean many of life’s stresses that disappeared temporarily during the Christmas carnage will rear their head again. This can be a bit of a shock to the system and before you know it, you’re immersed in work, family, keeping your home clean and slaving over the hob. But what about you? Where do YOU fit in to all of this? It’s easy to get caught up in life and forget about number one. Here at Physiotherapy for Women, we always ask the question ‘How important are you to yourself?’. Let’s discuss why this is important and what you can do to ensure you make 2020 more about you.
Self-care is a vital part of life. We know it’s a bit of a cliché, but if you don’t look after yourself first, how can you look after others, or work, or do anything? You’d be surprised how little time many of our patients spend looking after themselves. It often takes being in pain for someone to realise that something has to give, and change is needed. It’s also regularly the case that someone is stressed, exhausted and moving poorly (and not enough too!), which all play a role in why they have pain. And this is where we ask the questions about self-awareness and attitudes towards themselves.
Let’s give you an example… A working mum comes to us for help with neck and shoulder pain. She has two children, one at school, one at daycare, and her and her partner work a job each. The week is full of running around organising the kid’s drop-offs and pick-ups, working, cooking, cleaning and washing. Weekends are full of kids sports and visiting relatives. Sound familiar? Where is the time for anything else? For many it’s a source of stress in itself. Being time poor is a huge factor in why people fail to look after themselves and end up in pain (and stay there). For this working mum, her pain is now affecting her ability to ‘do’ life. The really hard thing is, something has to give if the cycle is to be broken and for her pain to become a thing of the past. She needs to prioritise self-care and learn that it is OK to spend time on herself. It is pivotal that she does, so she can get back on track ‘doing’ life.
As her physiotherapist, our primary goal is to get her out of pain. Our second goal is to keep her out of pain. And this is where advice on lifestyle, exercise and moving well (and often) comes into play. One of the hardest jobs we have as a physio is educating people on how to change their lives, so they can work towards preventing injury rather than waiting for it to happen and then seeking help. In the case of the working mum, it involves helping her change her attitude towards self-care to ensure she is running at 100%, so she can give everything she needs to her family and work. Some of the topics we might discuss with her and suggest changes to may include:
- Exercise — a must for all humans. Our important bodily functions rely on us moving regularly. Try taking a walk in the evening once the kids are in bed (get your partner/family member/friend to watch over them). It will allow you to unwind from the days’ events whilst giving your body some valuable movement. Alternatively, reserve one evening in the week or weekend to attend a yoga or pilates class. Or think about what you can do at home (incidental exercise while doing mundane tasks, or a nightly 20 minutes of exercise in the lounge room or on the deck!)
- Diet — a sticking point for time-poor people, but eating a diet rich in fruits, vegetables and other nutritious foods will keep your energy levels pumping and ready for everything. Diets high in fast or nutrient poor food will leave you sluggish and tired. Try packing your own healthy lunch and snacks, when you pack your child’s lunchbox!
- Meditation or mindfulness — a great way to have you time. It only requires 10-15 minutes a day and is a fantastic way to unwind and clear the mind. It takes practice but can be very beneficial to easing stress. We can advise on where to get started.
- Keep a gratitude diary — every morning when you wake up, immediately write down 5 things you are grateful for. While you can pop it in the ‘notes’ section on your phone, try opting for a pad and paper on your bedside table. It helps give you focus on what’s important to you. This is great motivation for keeping yourself healthy, happy and grateful.
There are many other areas we may discuss with you. We won’t pretend it’s easy to make these changes, but we are here to help guide you through all of it one bit at a time. Our main message here is that whilst we appreciate you have many responsibilities and important things in your life, we would like you to make YOU a high priority. Yes, this is us telling you to read that book, take that bath and take up that hobby you’ve always wanted to! Be important to yourself and make 2020 a year for self-care.
Think Santa this Christmas!
Let’s spell it out loud and clear: SANTA (Straighten up, Active, Neck long, Take breaks, Action)
Take the S for Straighten up:
Good posture decreases our susceptibility to back pain.
Call on the A for Active:
Eating so much over the festive period requires us to be more active. Get outdoors, go for a walk, take a beach or park run with family and friends.
Sound out the N for Neck long:
Constantly looking down at our phones puts enormous strain on our necks and spines. Create ‘no phone’ policy during the festive period, allowing festive gatherings to be true social occasions. When using your phone bring it to eye level, so your neck is long.
Sing out T for Take breaks:
Christmas is always a busy time putting up decorations, wrapping presents and cooking up Christmas feasts. Our spine often feels the constant strain that we place on our bodies. Ask for help so that you are not doing all the tasks at once or on your own. Allow yourself to take frequent breaks.
Finally move the A into place for Action:
Do some simple movements outside of your repetitive movement zone as demonstrated by Santa. The action of arms out or arms up and a knee lift to the bent elbow is so easy.
Thank you, SANTA
Back pain in new mums
Mother’s Day is just around the corner, so we wanted to dedicate this blog to all the mum’s out there. Being a mum is a tough job for anyone. Juggling work, keeping a home, family and friends, and of course caring for your little ones, can be draining both emotionally and physically. This is especially the case if you are a new mum, when life with your new addition is in its settling in period. Your body has been through a major change over the last 10 months, and it’s still changing now. Having a baby is a big deal, and you now have a recovery period ahead of you. But of course, you have a child to care for constantly, so there’s no time to worry about yourself, right? Wrong… it’s a difficult balance for sure, but looking after yourself means you’ll be able to look after your new recruit to the very best of your abilities.
My back STILL hurts 🙁
Pain is a common symptom experienced by new mums, with approximately 10% of women still experiencing pain two months post-delivery. Imagine being in pain all that time AND having a baby to look after – it doesn’t sound fun does it? Now, whether you’ve been through a natural birth or c-section, your body is vulnerable and weaker than pre-pregnant you, so it’s important to look after yourself to ensure you recover quickly and nip that pain in the bud!
The back is one of the most common areas of the body affected during and after pregnancy. Other areas include the pelvis and the wrists. The main reasons your back will complain in those early days boils down to the fact your posture won’t have a clue what has just hit it. Firstly, during pregnancy, ligaments become lax, muscles stretch or separate, which can produce imbalances or weakness. Even your breathing might change, depending on where bub is sitting in your uterus. Then of course your body is frantically trying to realign your centre of gravity to deal with your growing bump. Your body is working like crazy simply to keep you upright!
Then baby comes along. Of course, there’s the trauma you may experience with a vaginal or cesarean birth. Then, straight away, you will be feeding, changing, bathing and dressing/un-dressing your bubba multiple times a day. All these activities require you to have your baby lying down in front of you, with you bent over them, keeping them fed, warm, and happy. This continuous motion, combined with broken sleep, tiredness, and a recovering body, can lead you to over-work those back muscles. It’s also important to remember that your core muscles will have taken a big hit during pregnancy, so you won’t be as stable in the trunk as you were pre-pregnancy. Eventually your body will let you know things are not right by sending a few signals to the brain – hello pain!
What can I do to help?
Now you know why you may experience back pain, we want to let you know some of the things you can do from the very first day you bring your newborn home, to care for your back (and the rest of you of course), and reduce the risk of injury and pain. That way, you can dedicate 95% of your time to looking after your son or daughter. “Only 95%” we hear you ask – don’t worry, we’ll get to that!
To reduce the impact of feeding on your back, consider the following tips:
- Get a comfortable and supportive feeding chair: Avoid chairs that allow you to sink into them, such as a low arm chair or sofa. You will struggle to get yourself up from a slouched position, whilst holding your baby, without risking strain on your back and shoulders.
- Move regularly: Enjoy the one on one time, it’s magical! But, when you sit for long periods, your back and neck muscles will eventually feel it. Try some light neck stretches, and gentle spinal movements like rotating side to side and extending to open out the chest.
- Try a feeding pillow: As your baby grows, they will get heavier and heavier. A feeding pillow will take the weight of your baby so your arms, shoulders and back don’t have to bear the brunt of it all.
- Get your partner involved: If you’re a bottle feeder, then spread the load and ask your partner (or another family member) to feed when possible to give you a break. If you are breast feeding, they can still help by taking the baby from you when you have finished so you can get yourself up off your chair, minus the weight of your baby.
Oh so many nappies! “I didn’t sign up for this!” Ahem, sorry, yes you did! Just embrace the poo… It gets easier ;). The following tips also apply for dressing your baby:
- Get a change table: Whether it’s a nappy change or outfit change, do it at a height where you can stand comfortably and not be bent over for long periods.
- Following on from the above point… Avoid changing your baby on the floor. It’s not only your back that might complain, but your neck, shoulders and knees also!
There is no easy solution to this one. Most baths are low to the ground and require you to kneel and lean right over to get to where you need to be. However, we have found that baby baths can be useful as they are small, mobile, and can be placed at a height that suits your back better. Some change tables even double up as baby baths. Obviously be careful about carrying a heavy bath of water though – as long as it’s safe, try to bath your baby near a sink where you don’t have to carry the bath to fill and empty it.
So, you mentioned 95%?
You’re right, we did! And this is very important. Your baby is going to need lots of attention. But you also need attention. So, the remaining 5% is just for you. The following tips are aimed to address other areas of your life that often get neglected when being a new mum:
- Sleep when the opportunity arises: Whether this is when your baby is sleeping, or when your partner or family member are looking after your baby, getting sleep is very important. You need time to restore energy levels and allow the body to repair and recover. Who cares if the housework gets left for an extra day or two – it will still be there when you are ready to do it. Better still, get a family member to help. Team work!
- Eat well, stay hydrated: Don’t forget about the importance of a good diet. Eat lots of fresh, nutrient rich food, such as fruits and vegetables. And keep a bottle of water on the go constantly. It’s easy to forget and become dehydrated. If you are breast-feeding, remember where the water in the breast milk comes from… YOU!
- Have a bath: Of course, this doesn’t have to end at bathing. Read a book, do a crossword, go and sit in the garden with a cuppa… Our point is, make time for yourself regularly. These little breaks will keep you sane during a chaotic time of life. If help is at hand, use it. It is OK to have a break from it all. We cannot stress this point enough.
These last points can also help in the fight against back pain. Sleeping, eating and relaxation will help to reduce the risk of fatigue. Fatigue will compromise your ability to hold your posture in standing, sitting, and other positions such as bending. So, you can see why the 5% is so important.
At some point, you will need to address the physical changes that have occurred as a result of pregnancy and giving birth. These may include abdominal and pelvic floor muscle dysfunction, as well as spinal and other joint restrictions and dysfunctions. Every woman that has given birth needs to rehabilitate and strengthen their core again. Unfortunately, many don’t get around to it or it isn’t high on their priority list. However, (see points above) it needs to be! And of course, if you’re reading this and are pregnant, or thinking about having a child, there is so much you can do pre-birth to aid your recovery after having your baby, so come and see us!
If you’re a new mum or have had a child in the last few years, we can’t recommend enough to come and see one of our women’s health focused physios. We’ll assess you, and advise you on the best course of treatment and exercise to get you ‘back’ (excuse the pun) fighting fit and who knows… Another baby anyone?!
Stress urinary incontinence – what causes it, how to treat it and how to prevent it
Running, sneezing, jumping, laughing – they should be normal activities, but for some women they bring embarrassment or anxiety. Bladder weakness, incontinence and urinary leaking are common problems, especially in women after giving birth or going through menopause. There are many causes of bladder weakness, but today, we’re focusing on one of the most common: Stress urinary incontinence (SUI).
What is stress urinary incontinence?
SUI is where the bladder leaks a small amount of urine during activities that put pressure on the abdomen and push down on the bladder, like coughing, running or laughing.
What causes it?
Stress incontinence in women is often caused by pregnancy,
childbirth and menopause. In a quick anatomy lesson, your urethra transports urine from your bladder out of the body, via a muscular structure called the urethral sphincter. The sphincter contracts to hold urine inside your body until you’re ready to go.
During pregnancy and childbirth, your pelvic floor muscles can stretch and weaken. The muscles normally support the urethra, so when they, or the sphincter muscles, are weak, they can’t do their job properly and hold your wee in. During menopause, the female hormone, oestrogen, is produced in lower quantities. Oestrogen helps maintain the thickness of the urethra lining, so sometimes with decreased oestrogen, the lining is affected, and some women experience SUI.
It’s most common with activities such as coughing, sneezing, laughing, walking, running, lifting or playing sport. Other factors that can contribute to SUI include diabetes, obesity, constipation, and a chronic cough (often linked to asthma, smoking or bronchitis).
How to treat it?
Every single person is different, so it’s always best to see your Pelvic floor physio so we can assess you and work out the best treatment plan for you. However, some common treatments we recommend to our patients include:
- Pelvic floor exercises (see below for more information!).
- Changes in fluid consumption: This could include drinking certain amounts of fluids at certain times of the day. Or it could involve cutting down caffeine or alcohol to see if they irritate your bladder.
- Healthy lifestyle changes: Quitting smoking, losing excess weight or treating a chronic cough will decrease your risk of SUI, as well as improve your symptoms.
- Bladder training: We may recommend a schedule for toileting, depending on the type of incontinence you have. This is more so used when it’s a mix of SUI and another type of incontinence.
- Manual therapy: You may have some muscular imbalances that are inhibiting your pelvic floor from working properly or are impacting on other parts of your body. We’ll assess you, and then put together a treatment plan, which may include soft tissue massage, other musculoskeletal therapies, strengthening or stretching exercises, or more.
How do I prevent it?
Remember your physios, nurses, doctors, female relatives, mum friends (and the list goes on) telling you to do your pelvic floor exercises or Kegels when pregnant? Well, that’s one piece of advice you should listen to! In fact, it doesn’t matter whether you’re pregnant or not, you should always do your pelvic floor exercises to help strengthen those important muscles. Some basic pelvic floor exercises include:
- Draw your pelvic floor muscles in and up, like you are trying to stop urinating mid-flow. Hold for 10 secs. Relax for 5-10 secs between each tightening and repeat 10 times. (Don’t actually do your pelvic floor exercises on the toilet – trying to stop while actually urinating can cause other bladder issues)
- You can add faster pelvic floor lifts to the exercise by holding for 1-3 secs and relaxing for 1-3 secs. Repeat 10 times.
- Progressing the long holds to 20 secs and then 30 secs may be a goal to reach for.
Try and make pelvic floor exercises part of your routine. For example, do them when you brush your teeth each morning and evening, and when eating lunch. There are also many more exercises to help you, including core exercises such as Pilates.
Pelvic floor exercises should not cause any discomfort or pain. If you have a history of pain with intercourse, vaginal exam or using tampons, or if you have trouble emptying your bladder or starting a wee, you should see a Pelvic Floor Physio prior to starting pelvic floor exercises.
If you’re experiencing urinary leaking, are pregnant, have given birth (at any point in your life!), or if you want help with a preventative program, please come and see us. It is always best to see a Pelvic Floor Physio to get an individual program and to be confident on correctly tightening your pelvic floor muscles. We have helped thousands of women with stress urinary incontinence over the years and would love to help you live a happier, less-anxious life, so you can laugh all you want without having to worry about incontinence!