Pilates and Women's Pelvic Health Part 2: Urinary Incontinence - How Pilates can help?

 In the previous first part of this series, we discussed how Pilates teachers can play a vital role in helping Women with their Pelvic health, providing expert exercise therapy and a comfortable environment to address the issue openly.  

In this second and subsequent third parts, we will detail the individual dysfunctions and explore why Pilates is such an ideal form of exercise for the Pelvic Floor.  Starting with Stress Urinary Incontinence:

What is STRESS URINARY INCONTINENCE (SUI) ?: 

As a generalisation, Urinary incontinence is simply the involuntary leakage of urine.

Stress Urinary Incontinence (SUI) occurs during everyday sudden physical exertion or movement such as laughing, coughing, sneezing, running, lifting, or having sex. These activities put pressure on your bladder, causing the accidental release of urine.  Stress incontinence is much more common in women than in men and this article specifically addresses women.

If you suffer from stress incontinence, you may feel embarrassed, isolate yourself, or limit your work and social life. You may also avoid physical and leisure activities. However, with treatment, you'll likely be able to manage stress incontinence and improve your overall well-being.  

Exercising is a proven, effective, self-help therapy for the treatment of SUI. There are some other invasive and surgical therapies to treat the condition but this article focuses on the benefits of exercise and in particular Pilates, to avoid these if possible.

Why do Women get SUI?

Stress Urinary incontinence occurs due to the weakening of the Pelvic floor muscles (Urethra) and the muscles that control the release of urine, known as the urinary sphincter.

Causes and contributory factors for Stress Urinary Incontinence sufferers:

Pregnancy:  The indirect effect on the Pelvic floor through the stretching of soft tissue and the responses of the pelvis to pregnancy.

Childbirth: In women, tissue or nerve damage during the delivery of a child can weaken the pelvic floor muscles or the sphincter. Stress incontinence from this damage may begin soon after delivery or occur years later.

Obesity:  People who are overweight or obese have a higher risk of stress incontinence. Excess weight increases pressure on the abdominal and pelvic organs.

Surgeries:  Hysterectomy in women can weaken the muscles that support the bladder and urethra, increasing the risk of stress incontinence.

Other Pelvic Health conditions:  For example Pelvic Organ Prolapse

Lifestyle –Work/Hobbies/Exercise: High-impact activities, such as running and jumping, over many years.

Other health conditions: Illnesses that cause chronic coughing/Vomiting/Constipation or Neurological disease.

Menopause/aging processes: Physical changes that occur as you age, such as the weakening of muscles, may make you more likely to develop stress incontinence. However, occasional stress incontinence can occur at any age.

Pelvic floor weakness or overactivity

Poor management of intra-abdominal pressure

What is URGE URINARY INCONTINENCE (UUI) ?

It is defined as: “The complaint of involuntary leakage accompanied by or immediately preceded by urgency” [Abrams et al 2003]

• Urgency: A sudden urge to pass urine, which is difficult to defer
• It may occur on its own or in combination with SUI [Mixed UI]
• Often occurs with high frequency [passing urine >7 times a day]
• Often associated with Nocturia [passing urine at night]
• May also be referred to as ‘Overactive Bladder’

Why do Women get UUI - Causes and Contributors?

Urge Urinary Incontinence can be caused by everyday habits, underlying medical conditions, or physical problems.

Urinary Tract Infection (UTI) –May occur recurrently [more than 3 times in a 12-month period]

Surgeries

Neurological conditions [MS, Cauda Equina, GuillanBarre, nerve injury]

Obstruction – May report flow issues when passing urine or incomplete emptying

Bladder pathology –Inflammation/cancer/BPS/stones

Medications

Pelvic Floor Dysfunction

Catheters

Trauma [Physical/Sexual/Emotional]

Menopause - Age-related changes/

Anxiety/Depression

Obesity

Drinking habits - The amount and types of fluid consumed (particularly caffeinated, alcoholic and carbonated)

Psychological – Patterns/behaviour/visual cues/triggers

Smoking - Use of tobacco may increase your risk of Urinary incontinence

Incorrect control of the Pelvic floor and ‘Core’ muscles is intrinsically linked to bladder dysfunction

The pelvic floor muscles are a part of a group of muscles commonly called the ‘core’.  These lower muscles work together with the deep abdominal, back muscles and the diaphragm (breathing) to both support the spine and control the pressure inside the abdomen.

During exercise, the internal pressure in the abdomen changes.  On exertion the pressure tends to increase, returning to normal when relaxed again.  The regulation of pressure within the abdomen happens automatically when all the muscles of the ‘core’ work together correctly in synergy.

However, if any of the muscles of the ‘core’, including the pelvic floor, are weakened or damaged this may cause susceptibility to SUI.  Conversely if a particular muscle within the core has been inadvertently overexercised over time, it may become less flexible and be excessively tight and stiff.  Pelvic floor muscles need to be flexible to work as part of the ‘core’, which means that they need to be able to relax as well as lift and hold. So impaired ability to relax may also result in bladder control abnormalities.

So how can exercise, and in particular Pilates help?

Unfortunately, all too often the embarrassment of the condition and the greater likelihood of occurrence during exercise makes many women reticent of pursuing exercise or discussing their incontinence issues openly.  This is counterproductive because physical therapy by regularly exercising in the correct way can be highly beneficial to strengthening the pelvic floor and reducing, managing, or even curing these conditions.

For women with either or both of these conditions, being open about it, and practicing beneficial exercises correctly, such as Pilates, is highly desirable.  Expert, knowledgeable, and sympathetic Pilates instructors, as supportive mentors, can be of great benefit in promoting Pilates as a self-help therapy.

Why is Pilates a highly appropriate form of exercise for Urinary Incontinence?:

Pilates is a highly appropriate form of exercise as therapy for SUI and UUI sufferers because it is renowned for working and strengthening the core as detailed above, it integrates correct breathing to control the diaphragm and delivers targeted strengthening of specific muscles.

·        It promotes co-contraction of the Pelvic Floor (Kegel) together with the abdominal muscles which can help with preventing leakage. [Sapsford 2004]

·        It provides focus, not only on strengthening muscles but also on relaxation, with a goal of restoring a full range of muscle contraction rather than sub-optimal contraction in an over-strengthened muscle.

·        Controlled strengthening of the Pelvic Floor muscles helps to avoid over-tightening, resulting in poor function of sphincter muscles and the Pelvic Floor as a whole unit. Submaximal contractions of the pelvic floor – endurance, functional, motor control.

·        Pilates may be incorporated into exercise programs along with Abdominal Muscles and Pelvic Floor coordination, correction of posture combined with effective breathing optimises control of internal pressures between the diaphragm, core, and Pelvic Floor.

·        Pilates Incorporates the whole core system, not just isolated muscles. A balanced approach to optimising global muscles of the Core and Pelvic Floor rather than focusing on specific muscles only.

•  Pilates is a functional and enjoyable exercise therapy, therefore women are much more likely to adhere to a beneficial and focused Pilates exercise regime in a comfortable social setting, with an empathetic instructor and class companions.

·       General health benefits Overall holistic approach to total body exercise where the healthy pelvic floor is one part of a complete body health focus.

For information about Mbodies Training Academy visit: https://www.mbodiesacademy.com/

For Online Pilates Teacher Training and to enrol visit:  https://mbodies.thinkific.com/

Author:  Chris Onslow - Pilates Consultant

Chris Onslow, has run Pilates focussed businesses since 1998.  He and his team specialise in supporting Pilates entrepreneurs and business owners.  With a rich history of owning and running successful Pilates studios in the UK, and supporting others in Europe and the Middle East, Chris has broad expertise in maximising profitability and optimising operational efficiency.  His agency provides top-tier advice on selecting new, pre-owned, and hireable Pilates equipment from renowned brands such as Align-Pilates, Balanced Body or Stott-Pilates/Merrithew.  As the founder of Mbodies Training Academy, Chris continues to revolutionise Pilates education, offering premier online and hybrid CPD and qualification courses for Pilates apparatus instruction and special population CPD.  Discover more about how Chris can support your Pilates Business or home exercise choices at www.pilates-consultant.co.uk