Not only can incontinence cause embarrassment, shame and even depression, in 2010 the cost of incontinence to Australia’s economy was approximately $46.9 billion – or $9,014 per patient (Deloitte Access Economics 2011).
Whilst it is much more likely for women to suffer from incontinence – around 80% of sufferers according to DeLoitte, – men can be incontinent too. Due to the perceived stigma of incontinence being a woman’s illness, men are perhaps less likely to seek help until their symptoms are moderate to severe and can no longer be ignored.
So strong is the taboo that incontinence can be a key cause of social exclusion. Patients suffering from incontinence have been reported to be less likely to have high self-esteem or be in employment (Cromwell et al. 2004). Yet 60% of people with bladder or bowel problems don’t seek help from a health professional (Continence Foundation of Australia 2017).
The pelvic floor is a sheet of muscles that extend from the coccyx (tail bone) to the pubic bone at the front of the body. This forms a platform between the legs and, as the name suggests, provides a floor to support the bladder and bowel.
The pelvic floor muscles also help to control the urethra and anus – allowing for the passage of urine and faeces out of the body. Female pelvic floor muscles also support the womb.
If the muscles are weakened, the supported structures may lower into the vagina. Not only is this extremely uncomfortable, it can also cause urinary or faecal incontinence.
Whilst pregnancy and childbirth are the common causes of pelvic floor weakening, it’s less well known that prostate surgery can also be a key cause.
When the pelvic floor muscles weaken, a range of symptoms can be experienced, such as:
Strengthening the pelvic floor muscles can also improve sexual function.
Some pelvic floor muscles help to achieve erection and may prevent premature ejaculation (Guys’ and St Thomas’ NHS Foundation Trust 2014).
For women, pelvic floor muscle strength is directly related to increased sensation.
The thought of exercise and physical therapy can be difficult for patients to understand and incorporate into their lifestyle. Though pelvic floor exercises can feel strange, no one can tell they’re being done – so they really can be done at any time or place.
By exercising the pelvic floor muscles, the structures can be supported again. Not only does this improve bowel and bladder control, but will also improve or stop leakage.
Given the symptoms and consequences of incontinence for patients, it’s perhaps quite staggering that simple and quick pelvic floor exercises can be so effective at preventing incontinence and reducing the impact.
One of the reasons why we might not exercise our pelvic floor muscles is the difficulty in locating exactly where they are. Being at the core of the body, they can be difficult to find, with confusion over whether it’s the ‘right place’ or not.
Once the pelvic floor muscles have been located, the exercise is straightforward.
Squeezing and drawing in the muscles around the anus (and vagina for women), lifting them up and holding for a count of eight, then letting go. The length of the hold can be gradually built up from three to eight, or even higher, but it is vital that no other muscles are used.
It’s perhaps easier for women to exercise their pelvic floor, with the sheer amount of accessories and equipment that can be found from a quick online search.
From ben wa balls, to kegel devices, they are widely available and intensively marketed to women of a certain age. No wonder there is such a persistent stigma surrounding men suffering from pelvic floor weakness and incontinence issues.
Unfortunately, as these devices exercise the muscles from inside the vagina it’s impossible for men to benefit, and no viable alternative either.
With persistent exercise, the pelvic floor can be strengthened to reverse the weakening of the muscles, although full reversal may not be possible with all patients.
In such cases, there are other options available – including surgery. What is important, is that everyone exercises their pelvic floor – even without symptoms and from a young age, as it is much easier to retrain previously strong muscles.
All efforts should be made to remove the stigma surrounding the ‘taboo’ topic of incontinence, and encouragement of free and open discussion. So, maybe when we’re checking for blood pressure and heart rate, we should also be having a conversation about pelvic floor exercises with our patients – regardless of their age or gender.