The other day I had a leaflet through the door of the clinic from Always for the incontinence pads and I had a look at it out of interest, thinking maybe they've put some information there about how you can manage your symptoms.

Funny enough, there was nothing about managing symptoms. It just said many women suffer from incontinence, use these pads and get on with your life. Don't let the incontinence stop you.

But yet it didn't say anywhere that actually incontinence is something that can be improved or resolved.

So this is what we're going to talk about today, and I will try and keep the episode short because I could probably talk for hours about incontinence because it's one of the things that I treat day in, day out and I'm very passionate about.

Incontinence can happen at any age. It is often common after having babies, particularly vaginal deliveries. It can be common in pregnancy as well, just from the weight of baby down onto the bladder.

But postnatally, sometimes that gets better. Then we get the problem again when we hit perimenopause.

So why?

Why is it common at perimenopause?

Now again, this comes down to our oestrogen, as most things do during menopause.

Our oestrogen acts as a scaffolding that supports the vagina.

Also, our urethra, which comes from our bladder to outside, so it's where we empty our urine, is when we are younger and we've got enough oestrogen, like a soft tube that closes on itself.

When we don't have that oestrogen, we don't have all the support of everything and the tube actually is more than like a hose and it stays more open.

We do have some sphincters at the top and our pelvic floor helps to control everything.

But if we don't have the support from the vagina, our walls are a little bit laxer so we can get prolapses, or at least laxity of the walls.

We also have this tube that's open, so it's more likely to leak because we don't have that closure on itself.

But also our pelvic floor is muscle, and muscles of the body often lose some of their strength or become stiffer, tighter, so they don't function correctly when we don't have the oestrogen that we need.

Everything becomes stiffer and weaker.

So we are more likely to get leakage because we've got this tube that's more open, our muscles are slightly weaker.

Often we put on maybe a bit of weight as well, so there's a bit of pressure down onto the bladder.

We also may have weaker muscles elsewhere.

So for our pelvic floor to function properly, we need to have good core strength. We need to have good glute strength. We need other muscles not to be tight.

So there's lots of things that go into causing incontinence.

The pH changes as well and what we drink we can become more sensitive to, and our bladder can become more irritated.

So there's lots of things that can cause us to be more likely to have incontinence.

But there are a couple of different types of incontinence.

One type is the one that you get if you went on a trampoline. I think most ladies that have had babies would be reluctant to go on a trampoline in case they leaked.

But also if we cough or sneeze, anything which increases the pressure down onto the bladder, and that's called stress incontinence.

Extra stress down means that the pelvic floor and the sphincters and everything else can't control the urine and stop it from being emptied.

So you might get a couple of drops leakage. You might get the whole lot leakage.

So incontinence will vary.

It might be just occasionally. It might be every day or several times a day.

The other type is what we call urge incontinence.

So this is where the bladder, which is a big muscle, actually tightens and goes into a bit of a spasm.

As our bladder fills up, it's like a big balloon. It fills up to a certain point, then it sends a signal to the brain to say, "Empty me, I need to be emptied."

Then that's when we're like, "Okay, I will go to the toilet and empty the bladder."

Often we can delay that if we need to, for however long we need to do so.

But people with an overactive bladder, their bladder does that contraction to say that we need to empty even if there's only maybe a tiny bit in there.

Or if it is fuller, then it contracts, but the pelvic floor isn't strong enough and everything else isn't working the right way to hold it and delay it.

So therefore we have to rush to get to the toilet and we may not always get it.

So you might have an overactive bladder with urge incontinence, or it may not be overactive. It might just be that we can't withstand it as soon as the bladder wants to empty.

This is often called latch-key incontinence.

So when people have been out and they put the key in the door and the brain's like, "Oh, the toilet is near."

Then they suddenly are absolutely desperate and need to run to the toilet.

It might be that you can make it or it might be that you leak before you get there.

Again, it could be a few drops. It could be completely.

You can have one or the other of those, or you can have both together.

There are things that you can get like overflow. If we're struggling to empty the bladder, then if it's so full we can get leakage because it's so full.

But the main two that we look at are stress incontinence, urge incontinence, or both.

Along with that, you can get frequency. So you're having to rush to the toilet or go to the toilet quite often.

This is really common in pregnancy because you've got a baby sat down on your bladder and you tend to go often, but you may or may not have leakage with that.

So we need to work out what's causing the leakage.

Is it what you're drinking that's irritating the bladder?

Anything that's fizzy, acidic or caffeinated will cause irritation to the bladder and that makes that bladder contract more.

Is it because your pelvic floor is too weak?

Is it because the pelvic floor is overactive?

Is it because your core muscles aren't strong enough?

Your glutes are overactive or too tight or too weak?

We've got tightness elsewhere that's causing the pelvic floor to be too tight and then not relax fully so therefore we don't get full contraction?

Is it because you are holding on for too long so your bladder's overstretched?

Is it because you go just in case and your bladder's got used to having a tiny amount in it before it needs to empty?

Is it because you're getting constipation?

Is it because your bowels are not functioning as they should do and you've got IBS and that's causing the pelvic floor to be overactive?

So there's so many things.

I would be here all day if we went through every single one, but there are so many things that could be causing a problem.

Many women think that if they just do pelvic floor exercises that will address it.

Then when it doesn't work, they think, "I just have to put up with it."

That isn't the case.

Yes, pelvic floor is an element of what you need to do in order to improve, but it's one part of it.

There are so many other things that we need to look at and address rather than just doing pelvic floor squeezes.

The majority of people that come to see me, their pelvic floor is probably overactive.

So we need to address that side of it before we start doing pelvic floor exercises.

The really important thing would be to see a women's health physio, whether that is myself or whether that is somebody else nearby.

I would highly recommend getting an assessment and working with someone directly because then they can be telling you the main things to be doing in the right way.

But at home, if you're just thinking about it yourself, there are a few things that you could do.

Working out what you're drinking first of all.

Is that having an effect?

If you're drinking lots of caffeine, I would try and cut it down, swap to decaf, cut it down as much as you can.

Reduce fizzy drinks.

Reduce anything that's acidic.

Alcohol is also another one.

That's not great for menopause anyway, but it's also not great for your bladder.

So it's worth changing what you're drinking.

That often has the biggest effect straight away without doing anything else.

Also make sure you're drinking enough because if we're not drinking enough, ideally water, if we're not drinking enough, so you want about one and a half to two litres, then the urine becomes more concentrated and irritates the bladder more.

Make sure you're drinking plenty, which often seems to contradict the fact that you are leaking, so drink more.

But trust me, we do need to make sure that we're having enough fluid.

Other things that you can do is do some bladder retraining.

Make sure that you aren't going to the toilet just in case because then we get bad habits of emptying the bladder more often than we need to.

Then when we do have a fuller bladder, it can't withstand it and then it will leak because there's too much in there.

So gradually trying to delay a little bit.

Not massively if you're going to then leak, but it might be that you get to the toilet and delay for ten seconds and then gradually build on that.

Don't go unless you actually have the urge to go.

Generally working on your whole body strength.

Doing Pilates, yoga, doing strength workouts is going to help with the pelvic floor.

Obviously, if there are certain things that make your incontinence worse, such as skipping and really high impact exercise, it might be worth avoiding those or changing.

There are things that you can use, I'll talk about that in a minute, that can help.

But I wouldn't use anything without speaking to a women's health physio first.

Things that you can do yourself, if it doesn't cause leakage, crack on.

If it causes leakage, it doesn't mean you can't do it, but it might be that we need to change how you do it.

Or we work on other things.

You can do pelvic floor exercises, making sure that you are able to relax in between.

Something like the Squeezy app by the NHS is really good because that helps to remind you and it counts with you and records how often you're doing it.

If you find that you've been doing pelvic floor exercises for a long time and it's made no difference, it may be that you're not relaxing fully or you're not doing them correctly.

So again, having an assessment is really important.

I talked a minute ago about when we're running.

You could use some special absorbent pants or whatever, but there are things that you can use to insert such as a Contiform or similar that you can wear.

It's like a pessary that you insert that you can use when you're doing activity that can help reduce incontinence.

But I wouldn't recommend using anything unless you have had an assessment first because some of the devices aren't suitable if you do have a prolapse and it might not be suitable for you anyway.

It might be that you need to be doing other things.

But there are things that can help.

Even if you've done all the pelvic floor stuff, there are things that can help.

There are other things if you've got an overactive bladder.

There are medications that you can take.

There are other interventions that can help if the bladder is overactive.

There are tests that you can have to see exactly what's going on.

So it can be worth seeing the GP or seeing a uro-gynae consultant if we're thinking you need more intervention.

But I would always start with a women's health physio because about 80% of people improve with physio and those that don't, we can advise on where to go.

So if you've got a leaflet through the door from Always telling you that you should wear pads and get on with it, temporarily that might be the case, but don't think that it is normal.

Don't think you have to put up with it.

Common does not mean normal.

So if in doubt, seek out some help from a professional.

Check out my website if you are local or if you want to do online appointments and get in touch if you need more support.

Until next time, take care.

Bye bye.