Diary with a Capital Pee: Keeping a Bladder Diary

When trying to improve any area of your life you will only know if you have done so by recording the figures and measuring the change. This is the reason I ask my patients who come to me for pelvic floor rehabilitation to keep a diary. In the diary I ask them to jot down the following activities:

• Date / time of day
• Type and amount of fluid intake
• Type and amount of food eaten
• Amount of urine excreted (small, medium, large)
• Amount of leakage (small, medium, large)
• Activity engaged in when leakage occurred
• Was an urge present? (Yes or No)
• Change of pad required?

It is very important for all women to be doing their pelvic floor exercises every day. The reason being that we have so many factors against us that we need to be one step ahead of the game. Pelvic floor muscles get weakened with every pregnancy. 65% of pregnancies come with incontinence. Although lots of women then have no incontinence problems once the baby is out, it is important to remember that the muscles have been weakened so exercise is still crucial.

If you are lucky enough not to fall in the above 65% you are still not home free because the actual delivery can also cause weakness. 60% of women who have had 4 or more babies complain of incontinence.

I am very pro breastfeeding, it has many advantages and I do it myself, but unfortunately it is also a contributing factor, due to hormones. As mentioned in previous blogs, relaxin weakens joints and ligaments, and it takes 3 months for this hormone to leave our bodies after birth - but while we are breastfeeding, this hormone is mimicked. It is more important for breastfeeding mums to do their exercises and they often see little improvement for there efforts – but it would be far worse if they don't.

Another contributing factor is the neurological one. It is important to remember your pelvic floor contracts reflexively before we cough or sneeze. Reflex inhibition is the brain’s way of protecting a part of the body that is damaged. Unless these reflexes are re-established, chronic injury can be a result. You are probably more familiar with ankle sprain, and probably know that if the ankle is sprained badly there is a tendency for that ankle to twist and give way again. When treating sports injuries the physio concentrates on retraining the protective reflex action of the muscles around the ankle. There is no point in treating the joint without re training the reflex. So to it is the same with pelvic floor after childbirth. The protective reflex contraction of the pelvic floor when you cough or sneeze is lost, but this protective reflex can be re-learnt. You can teach yourself to actively squeeze and lift before each cough or sneeze.

Even if you do not suffer incontinence post-birth, the muscles have gone through a real beating and exercise to regain strength should start no later than 24 hours post delivery.

The pelvic floor muscles fatigue like all other muscles do. It is important to realise that fatigue is also a contributing factor to the fall of the pelvic floor. Therefore rest is also important, especially just after giving birth.

Quite often if you have recurrent cystitis/urine infections it can lead to bladder instability. It is the inflammation in these cases that is the cause of your incontinence.

Now let's mention menopause. Many women sail through life blissfully unaware of the time bomb ticking away between their legs. Quite often they are totally unaware of the stresses and strains that have weakened their pelvic floor until they reach menopause and this is the final straw. During menopause the oestrogen level drops. Oestrogen factor is also responsible for the thinning effect that can occur within the vagina and urethra. Meaning the pelvic floor needs to be stronger.

Ageing can also take a toll on your pelvic floor like it does with all your muscles, so too with constipation, chronic cough and being overweight.

As you can see the odds are against us women, but the dairy helps monitor all aspects of the bladder routine and can hopefully help show the effects of exercise and work out what needs to be changed.

If you are suffering from incontinence and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.