MYTH 1: I have a weak bladder
The weak bladder fallacy is interesting and one I suspect finds its roots in our vernacular language – just as the term “slipped disc” is common lay terminology although anatomically incorrect. The “weak bladder” has similar familiarity: we know what Sally means when she says “Oh I have such a weak bladder” but it is anatomically and physiologically incorrect. What Sally actually has is either a poorly functioning or damaged urethral sphincter ( the tap washer that keeps your bladder neck closed) or dysfunction of her pelvic floor fascia and muscles which work to help the sphincter stay closed under pressure such as coughing, sneezing, lifting, laughing.
You probably have a very strong bladder (known as the detrusor muscle) and it is overcoming your weaker pelvic floor and making you leak which makes you THiNK you have a weak bladder when in fact you have a strong bladder and weak pelvic floor.
Note I say dysfunction of the pelvic floor muscles. It is not necessarily a problem purely of weakness. This often goes hand in hand with poor co-ordination of the pelvic floor complex, but often we also see the opposite – a pelvic floor so tight and highly strung that it won’t allow the bladder to function properly.
Which leads us to myth number two:
MYTH 2 : Everyone should do pelvic floor exercises
We regularly hear the call to action: strengthen your pelvic floor, do your exercises every day, squeeze, squeeze and squeeze again ………but there is a significant group of people who should not strengthen their pelvic floor yes, I said should not.
This is the group of women (and men) whose pelvic floor is so tight and over-tensed that doing pelvic exercises will get them nowhere and in fact will make matters worse. Tight pelvic floor muscles are just as problematic as weak ones.
Some signs of a possible over-tight pelvic floor are :
- difficulty initiating or starting flow of urine
- thin pencil -like bowel motions
- pain during or after using bladder or bowel
- bladder urgency
- feeling like you haven’t emptied properly
- painful penetrative sex
- difficulty getting or maintaining an erection, pain with intercourse
- combined with some of these symptoms you are unable to effectively tighten or squeeze your pelvic floor
MYTH 3 : Red light specials and 100 a day
Hmm – here is another good one. Would you spend every spare moment lifting a weight to strengthen or tone your biceps? No, you would do your reps at the gym. You don't carry a weight around with you and pump out a few bicep curls every chance you get. So why do we hear that we should do this for the pelvic floor? They are skeletal muscles as well, so train them the way you train your other muscles.
Sitting at the lights you should be focused on the road, not your nether regions. Seated posture in the car tends to be with pelvis tilted backwards (posterior tilt for the purists) which is not ideal for optimal pelvic floor activation. When the pelvis is tilted backwards, or tail tucked under, the pelvic floor is already a bit shortened as it attaches to your 'tail'.
Correct technique for pelvic floor exercises, or kegels, is just as important as for any other exercise. Quality sets once a day is the answer. Poor technique pumped out here and there will only reinforce poor technique – which won’t help you under pressure like coughing or running. Down the track you need to focus on integrating function- getting your pelvic floor to work against increasing loads, whilst doing activities that require it to work and again, that won't happen at the stop lights.
* Pelvic floor muscle training and adjunctive therapies for the treatment of stress urinary incontinence in women: a systematic review. Patricia B Neumann, Karen A Grimmer, Yamini Deenadayalan BMC Women's Health20066:11
** Urinary incontinence among group fitness instructors including yoga and pilates teachers.
Bo,K etal Neurourol Urodyn 2011 Mar:30(3):370-3
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