Incontinence

[TofuTuesday]

I’m menopausal, vaginal oestrogen for a year and HRT for several years.
around the time of needing vaginal oestrogen I started pelvic floor therapy, and also an exercise class.
i then noticed about five months in that I was leaking urine.
i feel really pushed into an over active bladder diagnosis by urology and urogynaecology. This is based on hearing ‘leaking’ and not listening to anything else.
I’ve noticed it’s after a wee, tmi, and I seem to end up with damp knickers shortly after. Occasionally during Pilates I might worry about leaking.
its making my life unbearable. I don’t know if kegels caused it, I’ve stopped them, I’ve also changed exercise class. It’s almost daily, and I am not taking medication for OAB because none of the symptoms fit.

I know this isn’t what you’re asking but I have interstitial cystitis and I’ve had it since I was 14, it got much worse around 37 which is when I went into early menopause due to autoimmune issues. I’m 45 now and I have a lot of incontinence. If I cough / do too much physically etc I will completely wet myself. I’m under urology and everything physically is okay, it’s just my bladder doesn’t behave itself. But anyway what I wanted to say is get some good incontinence pads - always discreet or Tena normal ones I really find work well- I order in bulk from Amazon. It doesn’t stop me living my life as long as I use pads.

What hrt are you using? It took daily vagifem to stop my leakage. Had to argue with my gp (it was originally prescribed elsewhere) to get it but its worked and I won't be stopping it.

How much caffeine are you drinking? Cutting it down really helped for me

I started to feel sudden urgency last year so upped pelvic floor exercises. It didn't get better, but worse! I knew I was doing them correctly, so I was perplexed. In desperation, I found an online pelvic floor coaching and signed up to an online course which blew my mind: although I was using my PC muscles effectively for squeezing and tightening, I wasn't relaxing properly in between and afterwards, thus walking around with a chronically over-tight pelvic floor. I started to pay attention to PC relaxation, and no word of a lie, within a fortnight the symptoms of urgency and heaviness all but disappeared, and no leaking with even the most unexpected sneeze. I would absolutely look into the possibility of the chronically exhausted, unresponsive pelvic floor as a result of habitual over-tightening. There, saved you $30!

@DorcasLanesOneWeakness which course was it, if you can remember? My therapist has said weak and tight for my pelvic floor. I stopped going because I was just confusing myself with online information about kegels being bad.
I’m on daily vagifem and randomly use the cream (estriol). I do have some pads but psychologically I can’t cope with using them, like I’m giving up.
I don’t have any caffeine, fizz, citrus, etc even dropped B12 vitamins.
ive read that your urethra can atrophy causing post wee dribble and stress incontinence but I would have thought a year of vaginal oestrogen would help.

Have you been examined by a gynaecologist? You say you've seen a urogynae- did they examine you for prolapse?

Exercise with a women's qualified physio can help but the exercises have to be religiously for months. You could try a device at home called 'Perifit' which is a probe inserted and it takes you through a series of exercises to strengthen the pelvic floor.

Pilates can make prolapse worse unless the exercises are modified.

TBH the 'dribbling' after you've had a wee sounds like a bladder or urethral prolapse where it's not shutting fast enough. There is surgery for this to put things back in place.

Vaginal estrogen won't cure a prolapse but it will help strengthen the tissues a bit.

It's worth getting a 2nd opinion if you're not happy with the first .

Yes two urogynaecologists , not the same one each appointment. Neither said prolapse although one checked and said potentially but almost negligible. His suggestion was that lack of oestrogen causes atrophy affecting the urethra.
I think Pilates made things worse.
i just feel not listened to tbh, and medicine for OAB keeps getting suggested even though none of my symptoms align. It’s like middle aged woman with leakage - OAB. I can’t express how much it doesn’t align.

You can always see someone else. It might be worth paying for a private appt with someone else if that's an option.
You need examining properly. Did they make you 'bear down' for example?

I'd not dismiss using drugs for OAB for a few weeks- you've nothing to lose.

OR see a private women's physio and they also do a physical assessment and see what they say.

Doing kegels won't make you any worse but you can over tighten the PF so you should only do 3 sets of 10 a day (30 ) and make sure you're doing them correctly. Did the physio you saw supervise that?

Pilates- many positions are not good for the PF. They create far too much downward pressure. if you do Pilates the teacher should adapt the exercises to suit your PF issues.

You can find examples online of the exercises NOT to do in pilates.

So Pilates / I told her several times and nothing changed so I stopped going.
urogynae - private x 1 then my gp referred me to them and I saw a different one
urology - total waste of time , waited 6 months and saw them for five mins
private physio really lovely and knowledgeable but because leaking started after seeing them several times and doing kegels I just got so confused and disheartened I gave up

I’m waiting to go in for bladder Botox. Im also using medication until then.

Have you done a uro-dynamics test as it was only when I did one a few weeks ago that we really did understand just how many issues I was having. Suddenly everything made sense as to why I found standard questions difficult to answer.

one of my issues is an overactive bladder/urge incontinence - not that I ever thought so. But it turns out my bladder can only hold 70mls of fluid before I have to wee and cramping was detected in my bladder when I got to 50mls of wee which is less than half of what I should have been able to hold before I had to go to the loo. Aldo, like you I’d do more dribbling kind of wee than anything else - but I then started doing pelvic tilts on the loo till I could get more of a flow going on.

ETA - kennels never did anything for my bladder issues. And just to say I also had a rectocele repair recently.

I hope you can get sorted soon.

It can take 6 months for Kegels to really work and it's also advisable to do exercises for the abdomen and core too. BUT the right ones that won't make things worse.
Lots of online videos on these if you want to look.

@Jellybelly80 that’s brilliant if you are getting sorted, you must feel so relieved.
im waiting for a urodynamic study? I think that’s the same?

Thanks for the encouragement on kegels maybe I need to try again. I’ve looked up urethral prolapse and I don’t have those symptoms (I used to get awful urethral pain but it’s cleared with a diet change and is intermittent now).
I’m going to ask about a bladder prolapse.

i am literally so grateful to people for replying with ideas and suggestions, i have felt in such a black hole at 51 to be feeling like this.

@TofuTuesday Look up Elaine Miller on youtube. (aka Gussy Grips)

She's a women's physio / comedian (yes!) and gives talks etc around the country. Her videos of PFE are very helpful showing how to do them and timescales. She's lovely and very funny.

good recommendation @JinglingSpringbells, thank you

A 'tight' pelvic floor can cause this - a little bit of wee in your knickers after going to the toilet.

It happens with a tight pelvic floor because of 'incomplete evacuation' because you're not letting your pelvic floor relax all the way. We all tend to 'put down' our pelvic floor after standing up from the toilet, then you get a little dribble.

If it started after you started kegels then I'd think this would seem pretty likely... is it possible your pf function might just be a bit disordered? I think sometimes when you overthink an exercise it can get a bit uncoordinated, and if you already had a tight pelvic floor I can see that causing an issue.

A fully working pelvic floor is one which you should be able to contract fully and relax fully, tight pelvic floors often can't relax all the way.

An in-person 1:1 appointment with a pelvic floor physio who can tell you if you're contracting and relaxing fully would help.

You could try yourself doing as stronger contraction as possible when you sit down for a wee, then release and focus on fully relaxing all the way with a long slow exhale. If that helped, it would give an idea of whether or not it's a pelvic floor problem ?

Hi OP. I'd try to see a private uro-gynae where you will be fully listened to. I have a wonderful one in the southeast if you need a recommendation.

I really sympathise. I'm now in a position where I can't go for a walk later in the day or I simply leak. Coughing is fine, sneezing is fine - I do a tight pf squeeze then. But walking, my bladder just goes. It means my lunchtime walk needs a period pants and even when I am not actually leaking I get a warm feeling like I'm leaking.

However I DO have prolapse. I have a failed posterior repair and an almost non existent perineum as a result and this is I suspect making the anterior prolapse worse.

When I go for a big wee it feels like my bladder is unfolding. Very odd indeed.

I hate PFE and I can't use the stim/perifit. You might have more luck op.

Anyway I'm going to watch this thread. Good luck OP.

I have a similar problem. I find half standing after I think I have finished and then sitting back on the toilet allows me to empty the final bit!

Is yours cyclical? I find I have a run of good days for most of the first half of my cycle, then around mid cycle I get a bad day when just normal walking can make me dribble a bit. I can usually tell when it’s going to be the bad day after I get up in the morning and go for my first wee of the day and I have to squeeze to get the pee out which I don’t usually. Then later on that day the leakage problems will start so I’m forewarned and forearmed with Tena pads.
I’m a similar age to you and have had this for several years but now that my cycles are becoming less predictable, so the leakage is too. I now wear a panty liner (hate that word) every day just in case.

@Dahliasrulei do try that but there’s so much conflicting advice on line about ‘double voiding’ etc I’m really struggling to see sense about any of it.
I tried a posters suggestion of a pelvic floor squeeze just before a wee and I feel like that might have done something, like the focus on relaxing.
its so depressing I’m sorry for those of you in similar situations.
ive seen a private urogynae but open to suggestions if people have had success?
I dont get urgency to run to the loo, or wee before I get there.
interesting about the going for a walk, how bloody awful though. not cyclical, periods long gone.
really really appreciate the suggestions, I’m going to ask about a prolapse, and try to be really clear about what’s happening.

i do think Pilates made it worse, since stopping I don’t have so much stress incontinence, I used to panic I would wet myself in the classes.

Hello, that was me who suggested the squeeze before a wee.

If it is a tight pelvic floor then you're not really supposed to do conventional kegels (because they do make it worse) you're supposed to do 'reverse kegels', which is focusing on the lengthening, or fully letting go part of a kegel, not the squeeze.

Sometimes they suggest doing a quick squeeze before you focus on releasing (which is why i suggested it), but only so that you can learn what to do the opposite of - because it's hard to work out what muscles you need to 'put down'.

If you Google 'overactive pelvic floor' or 'pelvic floor dysfunction', the NHS has lots of resources. There are stretches, breathing techniques and reverse kegels (sometimes called 'pelvic floor relaxation' or 'put down'). But you can also ask your GP for a referral to a Women's Health Physio. In some places you can self refer.

Pilates also made it worse for me because it is very focussed on using your core - which is linked to your pelvic floor. You can't engage your core properly without also engaging your pelvic floor muscles, so pilates focusses on teaching you to engage them at the same time. Which is great, unless you have a tight pelvic floor. It's like pilates is the end point you want to be aiming for, but you need to sort out the tightness first so you can coordinate it all to work properly and fully relax. Fully relaxing is part of a kegel, not just squeezing.

If that is the problem anyway... it was for me but may not be for you!

@101treesthank you this is really helpful. I am going to have a think about what to tackle. I had thought the private urogynae would be the answer but it was more a starting point (and at that time I was really struggling with painful bladder as well) for yet more questions!

Have you had a look at the Elaine Miller (Gussie Grips) videos? They are very helpful.

My own view is that when you found your symptoms increased when doing PFE it was a) a coincidence and something that was going to happen anyway or b) you were doing them wrongly and perhaps creating tightness in the wrong places - but more likely just not doing them for long enough.

It can take up to 6 months of 3 x 10 a day- AND the right abdominal exercises to make your core more supportive - to make real changes.

If you have an overactive PF can you feel it? Like if you think about it can you tell it’s not relaxed?

Incontinence isn’t my problem but I do have trouble fully emptying my bladder and I suspect overactive pelvic floor.

I’ve been doing Pilates for over 10yrs but the instructor puts emphasis on relaxing PF in order to then engage it.

If I think about it I can feel that I’m clenched and I make an effort to relax the muscles but it’s an ongoing thing or bad habit or something. This thread has been very helpful, will have a look at some of the resources mentioned here.

@TofuTuesday one thing I was advised to do was get up off the loo after I thought I’d finished weeing and walk around the bathroom then sit down again and wee. It did help a bit. And I’m like you - even when I think my bladder is empty is not. We saw this recently on ultrasound when I went for a wee just before it and there was still some in my bladder just minutes later.

This is really helpful chat, thank you.

yes definitely I will realise I’m holding my bum/stomach/PF and then actively try to unclench - driving, lying down reading, at the gym etc. I try to look out for it.
its interesting to think maybe it isn’t related - I wonder about going back to physio now I don’t have Pilates as a side issue.