Women’s Health Physiotherapy Information and advice for women Women’s Health Physiotherapy This booklet is designed to help you better understand some of your gynaecological problems and symptoms. It contains advice and exercises which will form the basis of your physiotherapy treatment. As part of your assessment your physiotherapist may complete a vaginal examination. This will be fully discussed with you at your appointment. If you would like any further information after reading it, please contact: Women’s Health Physiotherapy Ground Floor, Lift Bank C Chelsea and Westminster Hospital 369 Fulham Road London SW10 9NH T: 020 3315 8404 Notes 2 3 How common is urinary incontinence? Estimates vary—about 10–30% of all women have some incontinence but only a quarter of these women seek help. Types of incontinence • Stress leakage with effort/exertion (lifting, running, jumping) or with sneezing/coughing • Urge leakage with or immediately preceded by urgency (often you can’t make it to the loo in time) • Mixed leakage associated with urgency and with exertion/effort/ sneezing/coughing Other urinary problems • Frequency—complaint of urinating too often in the daytime (more than 8 times/24 hours) • Urgency—sudden, compelling desire to urinate which is hard to put off • Nocturia—getting up at night one or more times to urinate • Combination of all three problems Facts and figures Normal bladder size/volume 400–600mls Recommended fluid intake 1.5–2 litres/24 hours 3–4 pints/24 hours Average n° of times to pass urine 4–8 times/24 hours Average n° of times to open bowels From 3 times/24 hours to 3 times/week Food and drink that may irritate the bladder and increase your urgency to urinate • Coffee/tea(caffeine) • Carbonated(zzy)drinks,especially those with caffeine • Alcohol • Citrusjuice(egorange/grapefruit) • Lowuidintake(concentratedurine) • Somespicyfoods • Nicotine Drinks that do not irritate the bladder • Water • Squashesinwater • Fruitteas • Herbaltea • Decaffeinatedcoffee/tea • Non-citrusfruitjuices(egapple) Advice for patients with urgency and/or urge incontinence 1. Try to reduce alcohol, fizzy drinks (especiallyCoca-Cola)andcaffeine intake (or drink decaffeinated tea/ coffee). 2.Aimtodrinkthreepintsor1–2litres ofuidseachday,waterisbest. 3. Try to avoid going to pass urine ‘just in case’—only go if you need to. 4.Whenyougettheurgetourinate,try to ‘hang on’—here are some tips: a) Keep calm—don’t panic b)Standstillorsitdown c)Crossyourlegs 3 d)Stronglysqueezeyourpelvicoor muscles e)Waituntiltheurgencypasses (10–20 seconds), then carry on with your activity 5. Try to delay going to the toilet, gradually extending the time between voids, up to three hours. 6. If you get up in the night to empty your bladder, don’t drink after 8:30pm. 7. You will have good days and bad days to start with but don’t give up. Pelvic organ prolapse If you have been diagnosed with a prolapse please read the following information. Aprolapse occurswhenone or a combination of the pelvic organs—uterus, bladder or bowel—lose their normal support and move out of position. Normal Uterine prolapse Rectocele (uterus) (bowel) Cystocele Enterocele (bladder) (small bowel) Causes of prolapse include: • Pregnancyandchildbirth • Ageingandmenopause • Weakpelvicoormuscles • Constipation • Heavylifting • Obesity • Largebroids Symptoms include: • Sensationofa‘lump’or‘something coming down’ •Pressure,heavinessorpaininthe vagina • Backache • Difcultyemptyingthebladder/bowel • Repeatedurineinfections • Discomfortduringsexualintercourse Managing a prolapse: • Practicepelvicoormuscleexercises regularly •Brace(squeeze)yourpelvicfloor prior to coughing, sneezing, straining, running, jumping or lifting • Avoidheavypushing/pulling/lifting/ heavy housework 4 Uterus Peritoneum Bladder Smallbowel Largebowel Urethra Vagina •Avoid high-impact exercise (ie jogging, aerobics etc) or exercise that increases the pressure in the abdomen(sit-upsorrowing) • Trytoavoidlongperiodsofstanding without a break • Avoidstrainingtoemptyyourbowels, eat a balanced diet and drink enough uidstopreventconstipation • Avoidsmokingandchestinfections—if you get a chest infection, seek prompt treatment to minimise coughing • Loseweightifyouneedtobecause this will reduce the pressure on your pelvicoormuscles •Sexualintercoursewillnotmake your prolapse worse but may be uncomfortable—try using a vaginal lubricant or varying positions Opening your bowels The following position and techniques to open your bowels should stop you from straining: Position • Legsapart • Leanforward • Forearmsrestingonknees • Backstraight • Feetuponstool(kneesalittlehigher than hips) Action •Relaxyourjaw(mouthopen,teeth apart) • Bulgeyourlowertummyforwardand make your waist wide—a pear shape • Feelyourbackpassagerelax • Maintainthispositionbreathinggently as you open your bowels Tips to help with constipation If you suffer from constipation or strain to open your bowels you may be weakening your pelvic floor muscles further. • Besuretodrinkaminimumof1.5–2 litresofuidaday—trytomakewater a large percentage of this •Eatplentyoffibre(egfreshfruit and vegetables, cereals, wholemeal breads and pasta) •Eatbreakfastaftergettingupand don’t miss meals during the day • Don’tdelaygoingtoopenyourbowels after you have felt the urge—you are less likely to strain if your body is ready • Giveyourselftimetogo—do not rush •Keepactive—exerciseencourages regular bowel habits •If constipated tryusing natural products (eg prune juice, linseed plus, dried fruit) 5 Pelvic floor exercises What is the pelvic floor? The pelvic floor consists of layers of muscle and ligaments that stretch like a hammock from the pubic bone in front to the end of the backbone and from side to side (see diagram). Firm, supportivepelvicoormuscleshelpto hold the bladder, womb and bowel in place, and to close the bladder outlet and back passage. How does the pelvic floor work? Themusclesofthepelvicoorarekept rmandslightlytensetostopleakage of urine from the bladder and wind or faecesfromthebowel.Whenyoupass water or have a bowel motion the pelvic oormusclesrelax. Afterwards, they tighten again to restore control. The muscles should also squeeze when you laugh, cough or sneeze so as to help you avoid leaking. In addition, they have an important sexual function for both yourself and your partner during sexual intercourse. What weakens the pelvic floor muscles? • Pregnancy/childbirth • Repeatedstrainingwhenopeningyour bowels (constipation) • Overweight • Chroniccough • Menopause(hormonalchanges) • Highimpactexercise/heavylifting • Medicalproblems Weakmusclesgiveyoulesscontrol and you may leak urine, especially with exercise or when you laugh, cough, lift or sneeze. How can I strengthen my pelvic floor muscles? Exercising the pelvic floor muscles (at any age) can strengthen them so that they once again give support. This will improve your bladder control and improveorstopleakageofurine.Like any other muscles in the body, the more you use and exercise them, the stronger thepelvicoormuscleswillbe. How to perform pelvic floor exercises Sitcomfortablywithyourkneesslightly apart. Nowimagineyouaretryingtostop yourself passing wind from the bowel or trying to stop the stream of urine. You do the exercise by squeezing and lifting the muscles, closing and drawing up the front & back passages. 6 Bladder outlet Urethra Vagina Bladder Uterus (womb) Spine Rectum Anus Pelvicoor muscles Exercising your pelvic floor muscles should not show at all ‘on the outside’. You should not pull in your tummy exces- sively, squeeze your legs together, tighten yourbuttocks-orholdyourbreath. There are two types of exercises: • Slow (squeeze and lift)—Holdthe squeeze for as long as you can, up to 10 seconds, then release and rest for four seconds (repeat 5–10 times) • Fast—follow this with up to 10 quick strong contractions which will help your muscles react quickly when you laugh, cough, sneeze, exercise or lift Try to do these slow and fast squeezes at least 3–5 times a day. Where do I do these exercises? Youcandoyourpelvicoorexercises anywhere—lying/sitting/standing—but it is not advisable to do them on the toilet while urinating. It takes time for muscles to get stronger. You are unlikely to notice any improve- ment straight away so stick at it. You will need to exercise regularly for several months before the muscles gain their full strength. Your physiotherapist will be able to check whether you are doing these exercises correctly and progress them as appropriate for you. 7 Notes 369FulhamRoad London SW109NH Main Switchboard +44 (0) 20 8746 8000 Website www.chelwest.nhs.uk February 2011 • •Español• Lietuviškai•Polski•Português Русский•Soomaali•  020 3315 6727 . Women s Health Physiotherapy Information and advice for women Women s Health Physiotherapy This booklet is designed to help you better understand. would like any further information after reading it, please contact: Women s Health Physiotherapy Ground Floor, Lift Bank C Chelsea and Westminster Hospital 369