A problem with the waterworks
This personal experience of pelvic floor problems is a really good starting point for the subsequent articles about the pelvic floor weakness.
Having PGP is one thing but starting to leak is quite another and, to begin with, I had absolutely no problems! I managed to jig vigorously up and down with a full bladder before and after both my deliveries with no leakage problem, despite being on crutches because of my PGP symptoms. I smugly put it down to inheriting a cast-iron pelvic floor and doing a few squeezes now and again.
I remember practising the squeezes in my antenatal classes before I got PGP. Remember the ones? “Now, ladies, when you go the toilet, try stopping in mid-flow. Remember it’s very bad to stop yourself half-way through going to the toilet but it is OK to do it once, just to find the right place. Those are the muscles you need to use. Squeeze, release; squeeze, release; squeeze, release. Very good! Not only will it help you not to leak in later life, but your partners will all be very pleased too.” Snigger, snigger. (What? Who cares if he’s pleased or not? After those pregnancies and those deliveries, those inflated, lumpy breasts, those sore nipples, PGP and a crying baby, he’s fulfilled his purpose and doesn’t deserve ever to be pleased again…)
So I was quite surprised, when my PGP was finally resolved after numerous manual therapy sessions, to find that going to the gym and doing some harmless skipping caused a leak. It wasn’t a vast amount but it felt like I had started to slide down a slippery slope. I started to avoid drinking any water before I went but I quickly felt odd from becoming dehydrated and realised that wasn’t going to help.
Those of us who leak are not alone; we just don’t talk about it! One day I forgot the pad and had to go and get changed into different shorts half way through the class. Oh dear. It was beginning to get irritating. Then I was talking to a slightly older friend who has three children. I was very pleased that she did open up and talk about this problem or I may have been none the wiser about the fact that I am not alone and this is actually a very common problem for women and particularly those of us who have had children. My friend casually related a tale which chilled my blood, or rather, made me clench my buttocks. She had been late for a bus and decided to run to catch it. Breathlessly she legged it down the road and managed to get on the bus. She gasped her thanks to the driver and didn’t notice a thing until she sat down and found that her trousers were soaking…and the seat wasn’t even plastic. Apart from making me sit down a tad more gingerly on the Park and Ride upholstery, this tale also made me realise I was at the top of the slippery slope. I took this as a big warning: today, a mild leaking which you could stop if you weren’t silly enough to go the circuit classes; tomorrow, pints of fluid escape and you don’t even notice until you sit in it. The time had come to act so I went to see my GP and explained the problem to her and she referred me to the Incontinence Clinic (great title, eh?) within my local hospital.
When I got there I immediately engaged an elderly lady in hearty conversation for the entire time I was waiting so that everyone would think I was only there to support her. She didn’t even seem to mind when I called her Mum. But then, senility and incontinence do go hand in hand, don’t they?
Anyway I saw the Incontinence Nurse who briefly examined me. This meant she put her finger in my vagina and told me to squeeze. Then she frowned, withdrew her finger and said I seemed to have a prolapse (i.e. the vaginal wall was collapsing and part of the bladder was poking through). She gave my squeeze a rating of one out of ten and referred me to Simon Jackson, the consultant for this kind of thing. She chatted to me about pelvic floor exercises and I described the squeeze, release business and was reassured that this was exactly the right thing to be doing.
I staggered home with my knees together and visions of internal organs falling out unnoticed whilst I skipped manically round the gym. Not to mention visions of my husband skipping off with a younger, tighter, model… the trauma of the pregnancies and births had faded by now and he was turning out to be quite a good husband and father so I didn’t really want him to suffer too much anymore. Surely one out of ten was too low a rating for a satisfactory marriage to be maintained?
So I went to see Mr Jackson, who was very nice and very reassuring. Just the sort of bedside manner you’d like if it had to be a man you were seeing. Although I was reading recently that we’re all putting far too much emphasis on a good bedside manner when what we should be worrying about is how good they are at wielding the scalpel, I still appreciated seeing ‘a nice man’. Maybe I’ll write about my breast lump next time and you can compare and contrast consultants… but I digress.
Mr Jackson gave my squeeze a rating of four out of five (thank goodness, I’d had enough of being nice to my husband) and said I didn’t have a prolapse, I just had a slight weakening of the vaginal wall and wouldn’t need an operation, just pelvic floor exercises. Pelvic floor exercises? I’ve been performing them religiously for years, I protested. So he referred me to Georgina Evans for physiotherapy.
This is the woman we should all see (annoying that she has recently retired). She is friendly, patient and completely professional with the perfect bedside manner for the job she does. Somehow we both got through the following procedures with far less embarrassment than I’ve felt being measured for a bra or trying on a dress in a shop.
I had to lie down and once again watch while the health professional squeezed out the clear jelly and put on the latex gloves. Are there any procedures for which men have to watch that preparation? Probably prostate examinations and that kind of thing, but nothing that happens regularly every three years…. but I digress again.
We then proceeded to have a long discussion, all with her fingers inside my vagina, as if it were the most natural thing in the world. And I wasn’t even at all embarrassed! Anyway, the upshot of it all, and the reason I am writing this article, is it turns out that I was doing my pelvic floor exercises wrong. I bet most of you don’t know this, but you can’t just do any old squeezing and hope for the best, you have to squeeze properly. You’ve got muscles at the front and at the back (i.e. towards your anus and towards your bladder) and you have to squeeze all of them. I was only using the ones at the back. It took me quite a few goes but I finally found the front ones and found I could squeeze them a little bit, but not very well.
So Ms Evans sent me away to practise, which I did religiously five times a day, and I gradually got better and better until I could squeeze hard for a much longer time. It also turned out that I’d been doing sit-ups incorrectly and that had weakened my pelvic floor, maybe even causing the problem in the first place.
Unfortunately I can’t say for definite whether I am fully cured, because I had a car accident (ironically on the way home from the physiotherapy) which meant I’ve had to stop going to the gym for the moment. However, experimental jumping up and down with a full bladder seems to indicate that I no longer need to buy shares in TENA Lady and I feel very optimistic about the whole thing.
I can’t really think of a way to find the correct muscles without having an expert physiotherapist to help you. The best way I can think of to describe it is to squeeze your vagina and anus as tightly as you can and then try to squeeze above the entrance to your vagina as well. But this is what I had to do; maybe if you are incontinent, there’s something else you need to be doing. As with PGP, I recommend asking for professional help and if the first person you see isn’t helpful, keep asking until you feel confident you’ve got a competent practitioner. Then you, too, can have a husband with a permanent smile on his face. (Good job this is anonymous, eh?)
This upbeat and amusing article also demonstrates that incontinence in women is quite common particularly during exercise but is not a subject that is often aired even amongst close friends.