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Incontinence: A Taboo Subject

Urinary incontinence or loss of bladder control. It?s not at all uncommon and no one really wants to talk about it. Seeing the television commercials are a big step, yet talking about it remains something that might be whispered about behind closed doors. Chances are, your medical provider may not even talk about it. It?s been my experience that when women are asked, they are often so surprised that an answer does not appear until a few visits later.

One brave woman opened up an asked this question in a women?s forum:

Let’s talk about kegels. Or rather, incontinence. I know, it’s a very delicate subject, and I have frequently been embarrassed, ashamed, etc. about this little problem. For one thing, I didn’t think I’d even face this until into my 80s or so. I’m too young to have to wear pads every day. I do kegels, when I think about it. I’m probably 10 pounds overweight, most of it in my belly and thighs. I don’t have health insurance, so getting that little ‘tie-up surgery? is out. And besides, my little sister had that done and 6 years later, it’s no longer effective. Anyone else struggle with this?

So, let?s talk about urinary incontinence (UI) in women. To begin with, there are several types, but we?ll focus on the two main ones here.

Stress urinary incontinence (SUI) (that?s the kind that occurs when you sneeze, cough, lift something, etc) is the most common form, affecting about 50% of those who experience incontinence. It seems to be more common in younger women, though occurs in older women as well.

Urge urinary incontinence (UUI) is more common with advancing age (this is the kind that when you gotta go, you GOTTA go NOW!).
Many women will have a mixture of both.

There are various causes, but interestingly enough; studies have been inconsistent in identifying factors that regularly contribute to UI. Some contributing factors may include:

* childbirth ? the more vaginal deliveries, the greater the overall risk

* current smoking status as been associated with UI (though the results are inconsistent in former smokers)

* obesity (it does improve with weight loss)

* constipation

* hysterectomy ? Some studies show a 60% greater risk of UI following a hysterectomy.

* hormone therapy (A recent study showed that hormone therapy actually has been shown to increase the incidence of UI. JAMA. 2005;293:935-948.)

Kegels become and important part of treatment with SUI since frequently the pelvic floor muscles are weakened. Just like we need to do strength training for our overall health, we need to do pelvic muscle strength training to support our bodies.

When doing Kegels, it’s important to make sure you are doing them correctly. To identify the correct muscles, sit on the toilet and try and stop your urination. You may notice that your attempts at stopping urinary are ineffective…well those are the very muscles you need to work on. Use this as a bench mark for yourself and re-test yourself weekly.

Kegels must be done several times each day. Fortunately, they can be done anywhere and no one need know what you are doing. When they are done frequently enough, most women will be able to tell a difference. In addition to the contractions, try holding the muscle tight for a count of 8-10.

Other possible treatments include: behavioral modification therapy using biofeedback, physical therapy using weighted cones to help strengthen pelvic floor muscles, bladder training, acupuncture, medications and surgery.

Treatment often takes a multi-pronged approach beginning with an evaluation to discover the exact type of UI that is present (they have different treatment approaches). Often times, treatment will consists of a few different modalities.

For women who wish to try self treatment first, do consider doing kegels, and increase your fluid intake. While that sound counter-intuitive, concentrated urine, along with caffeine are actually bladder irritant and will make the problem worse. Keep a diary to assess how often this is a problem, what may be some contributing factors, and what you are doing to address the problem. When you do see your health care provider, take this diary with you.

If you are faced with this issue, please do see your health care provider for an exam. Left untreated, it generally does not get better on its own, but can improve with the proper treatment.



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    Kegelmaster Instructions

    Make sure you lubricate the vaginal area with a water soluble natural lubricant and lubricate the Kegelmaster at the tip. Place the Kegelmaster between your thighs, insert the unit into your vaginal opening until it is firmly in place. You will notice this when the Kegelmaster feels much smaller and locks into place.

    Grasp your Kegelmaster firmly, you are now ready for your initial adjustment!! This is done by turning the knob at the top of the Kegelmaster counterclockwise - until the knob is no longer touching the top of the Kegelmaster and until you feel a slight pressure. This should not be uncomfortable.

    NOTE: If the knob is at the top of the Kegelmaster and you don't feel any pressure from the Kegelmaster putting resistance against the vaginal muscles, then you will have to add another spring. If you have the right tension, squeeze down against the Kegelmaster. If you are easily able to clamp down with your vaginal muscles completely for thirty reps (closings), remove the unit from your vagina and change the position of the spring, moving forward one pin (see Power Spring Combinations). If you are still able to easily close down all the way, for thirty reps - after insertion, then you must move the single spring back to the rear pin (1) and add a spring to the next forward pin (2), then repeat the process.

    Power Spring Combinations:

    1,2,3,4, 1*2, 1*3, 1*4, 2*4, 3*4, 1*2*3, 1*2*4, 1*3*4, 2*3*4, 1*2*3*4

    The ideal spring tension is determined by one's ability to close the Kegelmaster at the beginning of the exercise and become unable to close it completely at the end of 30 reps. This is not hard to do and it is a lot of fun to see how many of the springs you can squeeze for 30 reps, having difficulty with the last five. The exercise sequence starts with 3 sets of 30 reps daily. With each rep you attempt complete closure of the Kegelmaster, pausing in between each set of 30 reps for 3-5 seconds. It is recommended to work up to 6 sets of 30 reps a minimum of 3 times a week. An individual may do more sets, but it is not advisable to exceed 30 reps. A final fatigue of the muscle until the last rep is performed with very little vaginal movement is your goal. When you are finished, close the device before removing! Gently close the device, tighten the knob and slowly remove the Kegelmaster.

    Ideally, use the kegel exerciser twice a day, morning and evening. For women with prolapse, it is recommended to use the Kegelmaster in the morning to start with.

    For prolapse or any other medical condition, please consult your doctor before purchasing the Kegelmaster.

    The Kegelmaster is cleared and deemed effective by the FDA as a medical device for incontinence.

    We in no way intend to diagnose, treat or make any medical claims about the Kegelmaster.

    Cleaning the Kegelmaster is simple. Use an anti-bacterial cleaner after each use. Open device, remove springs, and use a small brush to reach all areas of the Kegelmaster. Dry and store for the next use.