• The Fit Midwife

To pee or not to pee

Yep, I am writing about pee. It’s that post. It is relevant to women everywhere. Those who have had babies, those who haven’t. So I actually wondered if it was a funny issue for me to discuss being childless myself…. My friends with kids always tell me about laughing too hard, sneezing, playing on a trampoline with the kids usually results in a little bit of pee escaping.

However, last week when a workout with so much skipping came up in the Crossfit Open my instagram was inundated with pictures of women of all levels of fitness, with kids, without, all ages who had pee'd their pants during the workout. I have to admit, that many double unders (skips) and I was running to the toilet post workout too!! It does beg the question, how can so many of us be of a decent fitness level, training all our muscles, strengthening them to the best of our ability, yet we cannot strengthen the ones that prevent this?

Firstly, I need to say I love that women are talking about it! Why be embarrassed? It’s just pee. It has kind of always been a taboo subject. But not so much anymore. The more open we are about things that we find embarrassing the less embarrassing they become. So I think the best way to normalise this further, is to maybe learn a little bit about it……

So incontinence, is the unintentional loss of urine. The type I will cover here, stress incontinence is the most common form; affecting over 45% of all women. Basically, when pressure is applied to the bladder, pee leaks out! This is known as intra-abdominal pressure. There are many causes of the increase in pressure and the weakening of a pelvic floor, such as:

  • Coughing

  • Sneezing

  • Exercise (jumping, skipping, lifting heavy weights)

  • Pregnancy

  • Vaginal delivery

  • Laughing (I’m pretty sure we’ve all laughed so hard you pee’d in your pants and if you haven’t then you’ve never laughed hard enough)

  • Menopause

  • Nerve damage

  • Pelvic surgery

So here is a picture, because, well it’s just easier to explain with a picture.

So when the pelvic floor muscles are weak, or become weak (i.e. pregnancy) they cannot adequately support the bladder and the urethra properly. So when pressure is applied, the urethra cannot close properly and pee leaks out.

How can I stop this happening?

Well, I tell all my women, pregnant, not pregnant to DO YOUR PELVIC FLOOR (KEGEL) EXERCISES! I don't say it just to be annoying, they genuinely increase the muscle tone of the pelvic floor, which aids delivery of your baby, encourages healing after delivery, stops you peeing your pants, and you'll for sure have better sex...... So tell me again why you aren't doing them?

I'll hold my hands up, I am rubbish at remembering to do them as frequently as I should. I'm doing them now. I usually do them at work when someone is pushing (don't ask me why, maybe that particular action just drives home the point of how important they are). But seriously, these exercises are the first step to correcting stress incontinence. They can be done easily and frequently and are non invasive! So this is where we start.....

Ok but how do I do them?

Firstly, you need to know what your pelvic floor muscles are and where they are. If you are not going to do them properly then there really is no point doing them at all.

So these are the pelvic floor muscles, they go around the urethra, bladder, vagina, uterus and rectum. So they are pretty much everywhere, why would you neglect them? Showing you where they are is all well and good but you have to know how to engage these muscles. The easiest way to do this, is when you are sat on the toilet, try and stop the flow of wee mid stream by squeezing the muscles together, these muscles, that stop the flow, they are your pelvic floor muscles. Imagine having a tampon in, the muscles you would squeeze to move the tampon higher up.... these are the muscles. If you still can't identify them, use your finger, try and squeeze it (if you are regularly peeing without wanting to and you want to rectify it, i'd really advise not to be squeamish about this suggestion!!! Some people are horrified when I tell them to do this!).

Once you have identified these muscles, you can begin to do pelvic floor exercises. They can be done lying down, sitting or standing:

1. Start by squeezing the pelvic floor muscles (as identified) upwards and inwards, as if towards the centre of the body. This includes the front and back, everything should feel squeezed in and up.

2. Squeeze for 4 seconds (squeeze, 2, 3, 4.....)

3. Relax for 4 seconds (relax, 2, 3, 4.....)

4. If the count of 4 is difficult start with whatever is good for you. You will slowly begin to build on this.

These should be done for 5 minutes, two to three times a day. I usually tell my women to do it at breakfast, lunch and dinner, they are easy times to remember. I had one lady who would do them for the time it took the kettle to boil overtime she made a brew! Find what works for you, for your lifestyle. If you have a new baby, finding the time can be hard (you could do them whilst breastfeeding).

When you feel confident doing these, check out my post on piston breathing...... this is tying in working the transverse abdominals and the pelvic floor! You can't go wrong!

If you maintain this routine, for 6-12 weeks you will notice an improvement. You will also be surprised just how easily it becomes a habit!

If after this time, you notice no improvement then I would advise that you seek advice from your OBGYN or GP. Contrary to popular belief it doesn't have to be 'one of those things'. Or #mumprobs....

So get started today... go forth and skip, jump on a trampoline, laugh till you cry (not till you pee) and have better sex!

Nikki xx

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