Last week, a conversation on twitter grabbed my attention. Sandy Hilton, owner of Entropy Physiotherapy and Wellness in Chicago, IL, had a lot to say about bladder leakage. Since she specializes in pelvic rehabilitation, I tracked down her website and asked for an interview. I had questions. She had answers. Before we started with the LBL conversation, I asked, “What exactly is physiotherapy?” “What we call physical therapy in the U.S. the rest of the world calls physiotherapy,” she said. As Sandy has traveled extensively learning about pelvic health, it’s no wonder she uses the term most common around the globe.
Three Things Women Worry About
When women go to see a physical therapist for help with LBL, they tend to have similar questions weighing heavy on their minds. I asked Sandy to provide answers to her patients’ three most common concerns.
1) How can I tell if I'm doing Kegel exercises right? It takes a bit of practice to do Kegels correctly. It’s more than just a squeeze and release. To explain, Sandy asked me to snap my fingers. To get that loud snap sound, it takes a bit of timing and coordination. Sandy teaches women to develop body awareness in their pelvic floor so they can do Kegels correctly every time. “Squeezing like you are trying not to pee isn't a great cue,” Sandy said, “There is a normal lift 'up and in' of the pelvic floor muscles. This can be hard to feel for many women, and that is exactly what a trained pelvic health Physical Therapist can teach you.” PT’s like Sandy make sure you can easily do the proper squeeze and release of a Kegel exercise to strengthen your pelvic floor muscles. “We do an internal pelvic floor evaluation and help you find the right movement and learn the sensation so that you will be confident that you can do it on your own, accurately,” Sandy added, “If you’ve done Kegels and it didn’t help, see a PT.” One of Sandy’s patients was pregnant when she started leaking. She thought she was doing her Kegel exercises correctly, but she was actually doing it backwards, squeezing out instead of lifting up and inward. “I got a mirror, and showed her how to do it in the opposite direction.” Sandy said, “She could see it in the mirror. I only had to see her three times. That was it. The leaks stopped.”
2) What will happen during the evaluation? And will it hurt? Sandy does a private evaluation in a quiet room. “We check things like spinal mobility, pelvis, tummy, leg strength and breathing patterns. Plus, we do a visual inspection of your pelvic floor area externally, and an internal assessment of all the pelvic muscles,” Sandy said, “We check for strength, mobility, coordination and make sure you learn how to use these muscles correctly, with ease.” For some women the reason for their bladder leakage isn't pelvic floor muscle weakness, it's actually that the muscles are held and lifted tightly, like a muscle cramp or spasm. “While pain is not normal to have during a pelvic evaluation, if you are in pain we will address what might be causing it,” Sandy said, “You do not have to hurt any more than you have to leak.”
When to Stop Kegel Exercise
When pelvic muscles are painful to touch or held tightly, Kegel exercise is exactly the wrong thing to do at that time. Just as if you were making a tight fist with your hand, you would not want to practice squeezing harder. You’d need to learn how to let your hand relax so that it opens and closes easily. You want that same comfort and strength in your pelvic muscles—and it should not trigger pain.
Breathing Right Helps To create a bladder friendly environment in your body, Sandy also suggests breathing deep into the diaphragm the way small kids and animals do. It lets the pelvic floor relax. As women, we’ve grown up being told to hold in our stomachs, which causes shallow chest breathing. “When you breathe correctly your ribs expand and the diaphragm descends into your gut. The bladder is supposed to squish and move. That’s normal mechanics,” she said, “If you take deep breaths, it normalizes intra-abdominal pressure making the environment of the bladder friendlier, so the pelvic floor doesn’t have to work so hard.”
3) How long will it take to see results? Every woman’s body is different. Though, it’s common to start seeing results by the third visit. Between visits women are asked to do exercises daily, based on their particular needs. Sandy typically sees women 6 to 12 times weekly and many reach their goal of getting up to use the bathroom at most one time at night, with no LBL episodes at all, even when running or exercising. Sandy wants you to know that LBL isn't a forever condition for most people. If what you’re trying isn’t working, go see a physical therapist. There is hope and there is help. Find a PT near you: http://www.womenshealthapta.org
Have you ever visited a PT for LBL? What’s an LBL-related question would you like answered?