A Leaky Gasket

Does this happen to you?  You are out for drinks with friends and a joke is told and suddenly it's not so funny because, well, because you leaked a little?  Or maybe you are like a friend of mine who said, no I don't really leak - except if I drink anything when I am running. Or like most moms, who will NEVER get on a trampoline again. Well, you are not alone.  Estimates are that one in six women over 30, and one in four women over 40 experience incontinence in one form or another.  But what you should realize, is that while leaking is common, it is NOT normal.

Now there are a lot of factors that go into why women experience leaking, but perhaps the most common is that the muscles of the pelvic floor and core are not working well together. Consider this study in 2007 by Smith et al, that found between three groups - continent, mildly incontinent and severely incontinent - the incontinent groups actually had stronger pelvic floor and abdominal muscles than the continent group.  However, the issue was the balance between these muscles:  the incontinent group's abdominal muscles where overpowering their pelvic floor muscles, whereas the continent group demonstrated a "balanced, efficient and task appropriate system" (J. Wiebe, PT). We should also consider how alignment fits into the picture as well. Alignment can change the availability of a muscle; in a study by Sapsford et al in 2006, it was demonstrated that there was greater activation of the pelvic floor muscles as alignment improved.  In a later study those same researchers also found that continent women had a better lumbar curve, whereas those with incontinence were more likely to have a kyphosis.

 All interesting stuff, but how does that all fit together for someone who can't cough without peeing a little?  Well, when we take all of that into consideration, what happens when we improve alignment, re-establish muscle balance and connect both of those to functional tasks?  We see that we have set the core up for success.  We see less breath holding, less unwanted low back and pelvic movement and best of all less leaking during activity. My interest in retraining breathing patterns has naturally progressed into how the diaphragm works with the pelvic floor and core muscles to create efficient, functional movement strategies.  I see often people with breathing difficulties who struggle with coordinating tasks of movement with breathing (that is, they hold their breath). By restoring not only breathing patterns, but also the interaction of the diaphragm with the pelvic floor and core, we see an improvement in functional movement as well as symptoms of breathlessness.  And this is now taking me onto a new and exciting area of women's health. Connecting the breath, the core and pelvic floor can improve quality of life and allow women with pelvic floor issues to return to the activities they love.

Jessica DeMars is a physical therapist with a special interest in dysfunctional in breathing at LIVACTIV. She recently was the recipient of The Pinnacle Award of Distinction which recognizes one physiotherapist who significantly contributes to Alberta's physiotherapy profession.