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.

No worries. I really can't tell if that is the problem, I can only say what was the case for me.

I did see both NHS and private urogynaes and both sent me to women's health physios. It's like first line treatment.

One (particularly annoying) urogynae did actually say the phrase "I'm not the expert in pelvic floors, I'll leave that to the pelvic health physio".

There is quite a lot of information available online, but if you've got a bit uncoordinated and in a muddle with it all, you might do better just starting with someone to help you make sure you're doing it correctly.

One thing you 100% cannot go wrong with is diaphragmatic breathing. Loads of videos about how to do it on YouTube, you don't need to think about what you should or shouldn't be doing with your pelvic floor, just get the breathing right. It's like the foundation of everything. You add in pelvic floor movement with it after you've nailed breathing, then core alongside pelvic floor after that.

I do have a habit of holding tension in my pelvic floor. To stop doing this (I have pain with tension) I don't actively "put it down", I focus on diaphragmatic breathing which gets it to relax. I'm not very good at recognising when I'm holding it, but I can feel that the pain recedes with the breathing, which means I'm relaxing the muscles in the right way, I can feel the tension release after that, even though I didn't feel it was tense before, just painful. It would be a good technique for ensuring you're completely emptying your bladder I think.

I do now do conventional kegels, but I had to work on relaxing before I could strengthen, it just made everything worse when I wasn't fully relaxing - you can't fully contract a muscle you can't fully relax, it needs to be able turn all the way off and on.

Hope it's helpful info, but I am really not sure it's the right answer for you. Women's health physio would be a sound next step, whether you need to do more kegels or less.

I had the same from a urogynaecologist- both have said they don’t know about pelvic floor. Interestingly one said my low thyroid needed to be kept under control as thyroid can cause issues.

I think I need to decide what to do next. I’ve seen two urogynaes, one urologist, a pelvic floor therapist and my GP. I also saw a private GP before the incontinence when I ‘just’ felt like I needed a wee most of the time.
I’m hoping the urodynamic test will help.

That's very disappointing as a urogynae should absolutely know about the pelvic floor! If they are doing surgery on women they need to know the muscles and structure/ support of the PF.

The wee that you're finding dribbling at the end is usually caused by your bladder outlet not closing quickly enough- where the urethra joins the bladder. This can be due to a lax pelvic floor or can also be because of the positioning of the bladder outlet /prolapse.

One type of treatment now is using gel to restore the correct position.
Has anyone you've seen mentioned this or diagnosed a minor prolapse?

@TofuTuesday This might help?

nafc.org/bhealth-blog/dribbling-after-urinating-why-it-happens-and-what-to-do-about-it/

Possibly a minor prolapse. You know when you feel like you are going mad?
I feel like I’ve tried to explain what’s happened but real life moves faster than appointments, so for example it started with burning and constant uti pain which, by the time I saw someone had resolved largely through extreme dietary changes, but leaking had begun. The OAB has never been explained as in why anyone suggested that, with urology it felt like being fobbed off, discharge, re refer if the pills don’t work in the next six months (NHS). No tests except seeing my bladder via scan and no actual consultation beyond this is what it is, based on a referral from six months before.

Thank you, I’ve never seen this

Update - my appointment for a urodynamic flow is at the end of the month, which I’m kind of nervous about (pain) but also pleased. In the interim I’ve seen some tiny success with using cream externally as well as pessaries. Not sure if it’s linked. I’m considering going back to kegels - my pelvic floor must be getting some exercise as I’m doing yoga a couple of times a week.

Hi Op, regarding your urodynamic test - if it helps you, mine was pain free. There was nothing about it that hurt at all.

Oh that’s good to know, I’m a bit stressed about the catheter side of it.

Tofu, the catheter was very fine.