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Urinary Incontinence PT - Part ...

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Adventures in the Sand Box -part deux

Okay, I saw Ann again last week, and she was thrilled that my little voice is harnessing my bladder and honored that I had immortalized her in an essay.  She wants a copy.

Notice:  This is a very frank and graphic discussion of the mechanics of assessing the strength of our most intimate muscles.  Please do not read if this if it would embarrass or offend you.

The next phase in the Bladder Retraining is strengthening the pelvic floor.  This is the classic Kegel Exercises.  Before I get into the nutshells and bolts of the visit I want to explain why having a strong pelvic floor is important and what the pelvic floor actually is.

I don't intend to get technical here nor is this planned to be humorous.  My little voice got all out of control and began making gross comments while I was planning this, so I sent her and Dr. Kegel out to make whoopie.  I can hear them giggling as I type.

Think of the pelvic floor as those muscles that keep our undercarriage in place.  They are the muscles that squeeze together and both voluntarily and involuntarily.  They nip off the flow of urine, tighten the vagina, and tighten the anus.  You can picture them as making a double figure-8 around the urethra, the vagina and the anus.

One way to identify them is to tighten up down there as though you are tring to keep from peeing or to tighten your rectum.  When you sneeze, laugh or cough, the pelvic floor muscles tighten reflexively (involuntarily).   As we age several things can happen to weaken the pelvic floor.  Childbirth is one of those things, but a study of nuns showed that older nuns have as much problem with weak floors as do women that have given birth.  Obesity, gynecological surgery are among other things that can weaken the floor.

Why do we care if the pelvic floor is weak?  Well, it keeps our stuff from falling out, that's one reason.  A strong pelvic floor allows us to keep our urine from spilling out so we can stop investing in nutshells. When the floor is weak it causes Stress Incontinence.   It also aids in satisfying sex and helps us from losing stool at inopportune times.

We tend to squeeze all of the the muscles of the pelvic floor together, but we can squeeze the rectum apart from the muscle in front.

Weakened pelvic floor muscles are one of the primary culprits in "Stress Incontinence."  When we laugh, jostle, sneeze, cough, and bounce, if the floor does not tighten up, the increase in abdominal pressure pushes the urine out.

I also learned that the pelvic floor plays a role in helping to retrain our bladders not to be so spazzy in Urge Incontinence.  It turns out that when you feel the urge to urinate, but it is not the "right place," if you tighten the muscles of the pelvic floor it causes a reflex "relaxation" of the detrusor muscle in the bladder.  So this was the next step in learning to not be led around by the nose by my bladder - part of the "Hush" technique.  I let my inner voice hush the bladder into submission, but I also am learning to tighten the pelvic floor to add more signals to the bladder to help it relax.

My second visit to the Continence Physical Therapist was more than just talking.  After having me sign a consent, she examined me much like a gynecologist would.  I was prepared for this and I understand why she needed to, but I could imagine that some women would be taken aback.  She assessed the strength of my perineal muscles, by seeing if I could tell where she was pressing and also by how hard I could squeeze and by how long I could hold the squeeze.

I pretty much got an "F" on this test.  On a scale of 0 to 5 with "0" being no movement at all and "5" being able to crack nutshells, I rated a "1."  A "2" is a definite squeeze, but no lifting or tightening of the perimeum.  A three is a definite squeeze with visible lifting of the perimeum or pelvic floor.  4" is a firm squeeze and a "5" is ready for the Nutcracker Suite. 
On being able to squeeze I could hold the first for 6 seconds, but then progressively fatigued until by the 5th try I couldn't squeeze at all.  I wasn't too surprised by this.  I noticed about the time of my first MS symptoms that I have very little feeling in my undercarriage and had lost the ability to squeeze.

So, my homework for this week was to do squeezing exercises with reps and sets.  I am to squeeze and try to hold for 5 seconds and do 5 reps and 2 sets.  I'm supposed to do this three times a day and I am trying.  Sheesh!  I hardly remember to take my pills.  I have post-its all over saying to squeeze, but half the time I read them and can't remember what they refer to.  But I am trying and I think I'm making good progress.  The sensation is becoming more definite.  My inner voice is convinced we are training to enter the Ms. Pelvic Floor Universe competition is is really jazzed.

Any of you can look up the Kegel Exercises online and get the basics on what to do.  Even though I know I have some neurologic deficit "down there,"  it is clear that I can strengthen something and help myself with my incontinence.   When you do the Kegel exercises, it is important that you do NOT squeeze your thighs together and you do NOT tighten your abdominal muscles.

I have to report that I have had NO episodes of urge incontinence in the last week.  My life is soo much different.  For one thing I can throw away all my nutshells.   I had no idea before all of this that there was so much I could do to help the problem.  I'm a little ashamed that I could have done all of this earlier, but I was so convinced that it was neurological.  And thank you to all the people that have told me (us) that they are trying the exercises and seeing some improvement.  Even a little improvement is wonderful when it comes to incontinence.

Well, I have to go retrieve my little, inner voice.  She likes to comment on things I write and is going to be p!ssed - so to speak - when she finds that I wrote all of this without her snide observations.  I think Dr. Kegel left her once he got his.

So, that is the latest in my efforts to better myself.  Not only are "urine control," but I am, too. 

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